1. Ukusetyenziswa kweklinikhi yeeprojekthi ze-blood coagulation kwintliziyo kunye nezifo ze-cerebrovascular
Ehlabathini lonke, inani labantu abathwaxwa zizifo zentliziyo kunye ne-cerebrovascular likhulu, kwaye libonisa umkhwa okhulayo unyaka nonyaka.Kwinkqubo yeklinikhi, izigulane eziqhelekileyo zinexesha elifutshane lokuqala kwaye zihamba kunye ne-cerebral hemorrhage, echaphazela kakubi i-prognosis kwaye isongele ukhuseleko lobomi bezigulane.
Kukho izifo ezininzi ze-cardiovascular and cerebrovascular disease, kwaye izinto ezichaphazelayo nazo zinzima kakhulu.Ngokuqhubekayo ukujula kophando lweklinikhi kwi-coagulation, kufunyenwe ukuba kwi-cardiovascular and cerebrovascular disease, izinto ezidibeneyo zingasetyenziswa njengemingcipheko yesi sifo.Uphononongo lwezonyango lubonise ukuba zombini iindlela zangaphandle kunye ne-intrinsic coagulation yezigulane ezinjalo ziya kuba nefuthe ekuxilongweni, ukuvavanya kunye nokuxilongwa kwezifo ezinjalo.Ke ngoko, uvavanyo olubanzi lomngcipheko wokudityaniswa kwezigulana lubaluleke kakhulu kwizigulana ezinentliziyo kunye nezifo ze-cerebrovascular.ukubaluleka.
2. Kutheni izigulane ezinentliziyo kunye nezifo ze-cerebrovascular zihlawule ingqalelo kwizikhombisi ze-coagulation
Izifo zentliziyo kunye ne-cerebrovascular zizifo ezibeka impilo yabantu kunye nobomi emngciphekweni, ngokufa okuphezulu kunye namazinga aphezulu okukhubazeka.
Ngokufumanisa umsebenzi we-coagulation kwizigulane ezine-cardiovascular and cerebrovascular disease, kunokwenzeka ukuvavanya ukuba isigulane sinegazi kunye nomngcipheko we-venous thrombosis;kwinkqubo yonyango olulandelayo lwe-anticoagulation, umphumo we-anticoagulation unokuvavanywa kwaye unyango lweklinikhi lunokukhokelwa ukuphepha ukopha.
1).Izigulana zestroke
I-Cardioembolic stroke yi-ischemic stroke ebangelwa ukuchithwa kwe-cardiogenic emboli kunye nokufaka i-cerebral arteries ehambelanayo, i-akhawunti ye-14% ukuya kwi-30% yazo zonke izibetho ze-ischemic.Phakathi kwazo, i-atrial fibrillation-related stroke akhawunti ngaphezu kwe-79% yazo zonke izibetho ze-cardioembolic, kunye ne-cardioembolic strokes ziyingozi kakhulu, kwaye kufuneka zichongwe kwangaphambili kwaye zingenelele ngokusebenzayo.Ukuvavanya umngcipheko we-thrombosis kunye nonyango lwe-anticoagulation lwezigulane, kunye ne-anticoagulation unyango lweklinikhi kufuneka lusebenzise izikhombisi ze-coagulation ukuvavanya umphumo we-anticoagulation kunye neyeza elichanekileyo le-anticoagulation ukuthintela ukopha.
Umngcipheko omkhulu kwizigulane ezine-fibrillation ye-atrial yi-arterial thrombosis, ngakumbi i-cerebral embolism.Iingcebiso ze-Anticoagulation kwi-cerebral infarction yesibini ukuya kwi-fibrillation ye-atrial:
1. Ukusetyenziswa ngokukhawuleza ngokukhawuleza kwe-anticoagulants akukhuthazwa kwizigulane ezine-acute cerebral infarction.
2. Kwizigulane eziphathwe nge-thrombolysis, ngokuqhelekileyo akukhuthazwa ukusebenzisa i-anticoagulants kwiiyure ezingama-24.
3. Ukuba akukho zichaso ezifana nokuthambekela ukopha, isifo esibi sesibindi kunye nesifo sezintso, uxinzelelo lwegazi> 180 / 100mmHg, njl., ezi meko zilandelayo zingaqwalaselwa ukusetyenziswa okukhethiweyo kwe-anticoagulants:
(1) Izigulane ezine-cardiac infarction (ezifana ne-valve yokufakelwa, i-fibrillation ye-atrial, i-myocardial infarction ne-mural thrombus, i-thrombosis ye-atrial ekhohlo, njl.) ixhomekeke kwi-stroke ephindaphindiweyo.
(2) Izigulane ezine-stroke ye-ischemic ehamba kunye neprotheyini ye-C, i-protein S, i-protein S, i-protein C esebenzayo kunye nezinye izigulane ze-thromboprone;izigulane ezine-symptomatic extracranial dissecting aneurysm;izigulane ezine-intracranial kunye ne-intracranial artery stenosis.
(3) Izigulane ezilele ebhedini ezine-cerebral infarction zingasebenzisa i-heparin yedosi ephantsi okanye idosi ehambelanayo ye-LMWH ukuthintela i-deep vein thrombosis kunye ne-pulmonary embolism.
2).Ixabiso le-coagulation index monitoring xa kusetyenziswa amachiza e-anticoagulant
• I-PT: Ukusebenza kwe-INR yelabhoratri kulungile kwaye ingasetyenziselwa ukukhokela ukulungiswa kwethamo le-warfarin;ukuvavanya ingozi yokopha kwe-rivaroxaban kunye ne-edoxaban.
• I-APTT: Ingasetyenziselwa ukuhlola ukusebenza kunye nokhuseleko lwe (idosi eziphakathi) i-heparin engaxutywanga kunye nokuvavanya ngokomgangatho umngcipheko wokopha kwe-dabigatran.
• I-TT: Inovakalelo kwi-dabigatran, esetyenziselwa ukuqinisekisa intsalela ye-dabigatran egazini.
• I-D-Dimer / FDP: Ingasetyenziselwa ukuvavanya umphumo wonyango wezidakamizwa ze-anticoagulant ezifana ne-warfarin kunye ne-heparin;kunye nokuvavanya isiphumo sonyango lwamachiza e-thrombolytic afana ne-urokinase, i-streptokinase, kunye ne-alteplase.
• I-AT-III: Ingasetyenziselwa ukukhokela imiphumo yeyeza ye-heparin, i-heparin ephantsi ye-molecular weight, kunye ne-fondaparinux, kunye nokubonisa ukuba ngaba kuyimfuneko ukuguqula i-anticoagulants ekusebenzeni kweklinikhi.
3).I-Anticoagulation ngaphambi nangemva kwe-cardioversion ye-fibrillation ye-atrial
Kukho umngcipheko we-thromboembolism ngexesha le-cardioversion ye-fibrillation ye-atrial, kwaye unyango olufanelekileyo lwe-anticoagulation lunokunciphisa umngcipheko we-thromboembolism.Kwizigulane ezingazinzanga ze-hemodynamically ezine-fibrillation ye-atrial efuna i-cardioversion ephuthumayo, ukuqaliswa kwe-anticoagulation akufanele kulibazise i-cardioversion.Ukuba akukho kuphikisana, i-heparin okanye i-heparin ephantsi ye-molecular okanye i-NOAC kufuneka isetyenziswe ngokukhawuleza, kwaye i-cardioversion kufuneka yenziwe ngexesha elifanayo.
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