1. Ts'ebeliso ea bongaka ea merero ea ho kopanya mali ho pelo le mafu a cerebrovascular
Lefatšeng ka bophara, palo ea batho ba tšoeroeng ke lefu la pelo le cerebrovascular e khōlō, ’me e bontša mokhoa o ntseng o eketseha selemo le selemo.Ts'ebetsong ea bongaka, bakuli ba tloaelehileng ba na le nako e khuts'oane ea ho qala 'me ba tsamaisana le ho tsoa mali ho tsoa bokong, e leng ho amang bokuli le ho sokela polokeho ea bophelo ba bakuli.
Ho na le mafu a mangata a lefu la pelo le cerebrovascular, 'me mabaka a bona a susumetsang a boetse a rarahane haholo.Ka ho teba ho tsoelang pele ha lipatlisiso tsa kliniki mabapi le coagulation, ho fumanoa hore mafu a pelo le a cerebrovascular, mabaka a coagulation a ka boela a sebelisoa e le mabaka a kotsi bakeng sa lefu lena.Liphuputso tsa bongaka li bontšitse hore litsela tse peli tsa ka ntle le tse ka hare tsa coagulation tsa bakuli ba joalo li tla ba le tšusumetso ho hlahlojoang, ho lekola le ho lemoha mafu a joalo.Ka hona, tlhahlobo e felletseng ea kotsi ea coagulation ea bakuli e bohlokoa haholo ho bakuli ba nang le lefu la pelo le cerebrovascular.bohlokoa.
2. Ke hobane'ng ha bakuli ba lefu la pelo le cerebrovascular ba lokela ho ela hloko matšoao a coagulation
Mafu a pelo le cerebrovascular ke mafu a behang bophelo bo botle le bophelo ba batho kotsing haholo, a nang le lefu le phahameng le litekanyetso tse phahameng tsa bokooa.
Ka ho lemoha ts'ebetso ea coagulation ho bakuli ba nang le mafu a pelo le methapo ea pelo, hoa khoneha ho hlahloba hore na mokuli o na le mali a mangata le kotsi ea venous thrombosis;ts'ebetsong ea kalafo e latelang ea anticoagulation, phello ea anticoagulation le eona e ka hlahlojoa mme meriana ea kliniki e ka tataisoa ho qoba ho tsoa mali.
1).Bakuli ba stroke
Cardioembolic stroke ke lefu la ischemic le bakoang ke ho tsoa ha cardiogenic emboli le ho kopanya methapo ea methapo ea boko, e etsang karolo ea 14 ho isa ho 30% ea lichapo tsohle tsa ischemic.Har'a tsona, stroke e amanang le atrial fibrillation e baka ho feta 79% ea lipolao tsohle tsa pelo, le lefu la pelo li mpe haholo, 'me li lokela ho tsejoa kapele le ho kenella ka mafolofolo.Ho lekola kotsi ea thrombosis le kalafo ea anticoagulation ea bakuli, le kalafo ea anticoagulation e hloka ho sebelisa matšoao a coagulation ho lekola phello ea anticoagulation le meriana e nepahetseng ea anticoagulation ho thibela mali.
Kotsi e kholo ho bakuli ba atrial fibrillation ke arterial thrombosis, haholo embolism ea boko.Litlhahiso tsa anticoagulation bakeng sa cerebral infarction ea bobeli ho ea atrial fibrillation:
1. Tšebeliso e tloaelehileng ea hang-hang ea li-anticoagulants ha e khothalletsoe ho bakuli ba nang le lefu le bohloko la cerebral infarction.
2. Ho bakuli ba tšoaroang ka thrombolysis, hangata ha ho khothalletsoe ho sebelisa li-anticoagulants nakong ea lihora tse 24.
3. Haeba ho se na li-contraindications tse kang tšekamelo ea ho tsoa mali, lefu le matla la sebete le liphio, khatello ea mali> 180/100mmHg, joalo-joalo, maemo a latelang a ka nkoa e le tšebeliso e khethehileng ea li-anticoagulants:
(1) Bakuli ba nang le lefu la pelo (joaloka valve ea maiketsetso, atrial fibrillation, myocardial infarction e nang le mural thrombus, left atrial thrombosis, joalo-joalo) ba atisa ho tšoaroa ke stroke khafetsa.
(2) Bakuli ba nang le lefu la ischemic le tsamaeang le khaello ea protheine ea C, khaello ea protheine S, ho hanyetsa protheine ea C e sebetsang le bakuli ba bang ba thromboprone;bakuli ba nang le matšoao a extracranial dissecting aneurysm;bakuli ba nang le intracranial le intracranial artery stenosis.
(3) Bakuli ba robetseng betheng ba nang le boko ba boko ba ka sebelisa heparin ea tekanyo e tlaase kapa tekanyo e lekanang ea LMWH ho thibela ho teba ha methapo e tebileng le ho embolism ea matšoafo.
2).Boleng ba tlhahlobo ea coagulation index ha ho sebelisoa litlhare tsa anticoagulant
• PT: Ts'ebetso ea INR ea laboratori e ntle 'me e ka sebelisoa ho tataisa tokiso ea lethal dose ea warfarin;lekola kotsi ea ho tsoa mali ea rivaroxaban le edoxaban.
• APTT: E ka sebelisoa ho lekola katleho le polokeho ea (litekanyetso tse itekanetseng) heparin e sa qhetsoeng le ho lekola ka boleng kotsi ea ho tsoa ha dabigatran.
• TT: E na le kutloelo-bohloko ho dabigatran, e sebelisetsoang ho netefatsa masalla a dabigatran maling.
• D-Dimer / FDP: E ka sebelisoa ho hlahloba phello ea phekolo ea lithethefatsi tsa anticoagulant tse kang warfarin le heparin;le ho hlahloba phello ea phekolo ea lithethefatsi tsa thrombolytic tse kang urokinase, streptokinase, le alteplase.
• AT-III: E ka sebelisoa ho tataisa liphello tsa meriana ea heparin, heparin ea boima ba molek'hule e tlaase, le fondaparinux, le ho bontša hore na hoa hlokahala ho fetola li-anticoagulants litloaelong tsa bongaka.
3).Anticoagulation pele le ka morao ho cardioversion ea atrial fibrillation
Ho na le kotsi ea thromboembolism nakong ea lefu la pelo ea atrial fibrillation, 'me kalafo e nepahetseng ea anticoagulation e ka fokotsa kotsi ea thromboembolism.Bakeng sa bakuli ba sa tsitsang ba hemodynamically ba nang le atrial fibrillation e hlokang ho potlaka ha pelo, ho qala ha anticoagulation ha hoa lokela ho liehisa lefu la pelo.Haeba ho se na li-contraindication, heparin kapa heparin e tlase ea boima ba molek'hule kapa NOAC e lokela ho sebelisoa kapele kamoo ho ka khonehang, 'me lefu la pelo le lokela ho etsoa ka nako e le' ngoe.
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