1. Ukusetshenziswa komtholampilo kwamaphrojekthi wokuxhuma kwegazi enhliziyweni nasezifo ze-cerebrovascular
Emhlabeni wonke, inani labantu abahlushwa izifo zenhliziyo nemithambo yegazi likhulu, futhi likhombisa ukukhula unyaka nonyaka.Emisebenzini yomtholampilo, iziguli ezivamile zinesikhathi esifushane sokuqala futhi zihambisana ne-cerebral hemorrhage, okuthinta kabi ukubikezela futhi kusongela ukuphepha kokuphila kweziguli.
Kunezifo eziningi zezifo zenhliziyo kanye ne-cerebrovascular, futhi izici zabo ezithonya nazo ziyinkimbinkimbi kakhulu.Ngokuqhubeka nokujula kocwaningo lwemitholampilo mayelana ne-coagulation, kutholakala ukuthi ezifweni zenhliziyo kanye ne-cerebrovascular, izici ze-coagulation zingasetshenziswa njengezici eziyingozi zalesi sifo.Ucwaningo lwezokwelapha luye lwabonisa ukuthi kokubili izindlela zangaphandle kanye ne-intrinsic coagulation yeziguli ezinjalo ziyoba nomthelela ekuxilongweni, ekuhlolweni nasekuqaguleni kwezifo ezinjalo.Ngakho-ke, ukuhlolwa okuphelele kwengozi ye-coagulation yeziguli kubaluleke kakhulu ezigulini ezinezifo zenhliziyo kanye ne-cerebrovascular.ukubaluleka.
2. Kungani iziguli ezinenhliziyo kanye nezifo ze-cerebrovascular kufanele zinake izinkomba zokuhlangana
Izifo zenhliziyo kanye ne-cerebrovascular yizifo ezibeka engcupheni impilo nempilo yabantu, ezinenani eliphezulu lokufa kanye namazinga aphezulu okukhubazeka.
Ngokuthola umsebenzi we-coagulation ezigulini ezinezifo zenhliziyo kanye ne-cerebrovascular, kungenzeka ukuhlola ukuthi isiguli sinokopha kanye nengozi ye-venous thrombosis;ohlelweni olulandelayo lwe-anticoagulation therapy, umphumela we-anticoagulation ungabuye uhlolwe futhi imithi yomtholampilo ingaqondiswa ukugwema ukopha.
1).Iziguli zohlangothi
I-Cardioembolic stroke i-ischemic stroke ebangelwa ukuchitheka kwe-cardiogenic emboli kanye nokuqinisa imithambo yobuchopho ehambisanayo, okubalelwa ku-14% kuya ku-30% wayo yonke imivimbo ye-ischemic.Phakathi kwazo, unhlangothi oluhlobene ne-atrial fibrillation landisa ngaphezu kuka-79% wayo yonke imivimbo ye-cardioembolic, kanye nokushaywa kwe-cardioembolic kuyingozi kakhulu, futhi kufanele kubonakale kusenesikhathi futhi kungenelele ngenkuthalo.Ukuhlola ubungozi be-thrombosis kanye nokwelashwa kwe-anticoagulation yeziguli, kanye nokwelashwa kwe-anticoagulation kudinga ukusebenzisa izinkomba zokuhlangana ukuze kuhlolwe umphumela we-anticoagulation kanye nemithi enembile ye-anticoagulation ukuvimbela ukopha.
Ingozi enkulu ezigulini ezine-atrial fibrillation i-arterial thrombosis, ikakhulukazi i-cerebral embolism.Izincomo ze-Anticoagulation ze-cerebral infarction yesibili kuya ku-atrial fibrillation:
1. Ukusetshenziswa ngokushesha okujwayelekile kwama-anticoagulants akunconywa ezigulini ezine-acute cerebral infarction.
2. Ezigulini ezelashwa nge-thrombolysis, ngokuvamile akunconywa ukusebenzisa ama-anticoagulant phakathi namahora angu-24.
3. Uma kungekho ukuphikisana okunjengokuthambekela ukopha, isifo esibi sesibindi nesifo sezinso, umfutho wegazi > 180/100mmHg, njll., izimo ezilandelayo zingabhekwa njengokukhetha ukusetshenziswa kwama-anticoagulant:
(1) Iziguli ezine-infarction yenhliziyo (njenge-valve yokufakelwa, i-fibrillation ye-atrial, i-myocardial infarction ene-mural thrombus, i-atrial thrombosis yesokunxele, njll.) ijwayele ukushaywa njalo.
(2) Iziguli ezine-ischemic stroke ehambisana nokushoda kwe-protein C, ukuntuleka kweprotheyini S, ukumelana ne-protein C esebenzayo nezinye iziguli ezine-thromboprone;iziguli ezine-symptomatic extracranial dissecting aneurysm;iziguli ezine-intracranial kanye ne-intracranial artery stenosis.
(3) Iziguli ezilele embhedeni ezine-cerebral infarction zingasebenzisa i-heparin yomthamo ophansi noma umthamo ohambisanayo we-LMWH ukuvimbela i-deep vein thrombosis kanye ne-pulmonary embolism.
2).Inani lokuqapha inkomba ye-coagulation lapho kusetshenziswa izidakamizwa ze-anticoagulant
• I-PT: Ukusebenza kwe-INR yaselabhorethri kuhle futhi kungasetshenziswa ukuqondisa ukulungiswa komthamo we-warfarin;hlola ingozi yokopha kwe-rivaroxaban ne-edoxaban.
• I-APTT: Ingasetshenziselwa ukuhlola ukusebenza kahle nokuphepha (imithamo emaphakathi) i-heparin engahlukanisiwe kanye nokuhlola ngokufanelekile ingozi yokopha kwe-dabigatran.
• I-TT: Izwela ku-dabigatran, esetshenziselwa ukuqinisekisa insalela ye-dabigatran egazini.
• I-D-Dimer/FDP: Ingasetshenziselwa ukuhlola umphumela wokwelapha wezidakamizwa ze-anticoagulant ezifana ne-warfarin ne-heparin;kanye nokuhlola umphumela wokwelapha wezidakamizwa ze-thrombolytic ezifana ne-urokinase, i-streptokinase, ne-alteplase.
• I-AT-III: Ingasetshenziselwa ukuqondisa imiphumela yemithi ye-heparin, i-heparin yesisindo esiphansi se-molecular, ne-fondaparinux, nokubonisa ukuthi kudingekile yini ukuguqula ama-anticoagulants ekusebenzeni komtholampilo.
3).I-Anticoagulation ngaphambi nangemva kwe-cardioversion ye-atrial fibrillation
Kukhona ingozi ye-thromboembolism ngesikhathi se-cardioversion ye-atrial fibrillation, futhi ukwelashwa okufanele kwe-anticoagulation kunganciphisa ingozi ye-thromboembolism.Ezigulini ezingazinzile ngokwe-hemodynamically ezine-atrial fibrillation edinga ukushaya kwenhliziyo okusheshayo, ukuqaliswa kwe-anticoagulation akufanele kubambezele ukukhuphuka kwenhliziyo.Uma kungekho ukuphikisana, i-heparin noma i-heparin ephansi ye-molecular weight noma i-NOAC kufanele isetshenziswe ngokushesha ngangokunokwenzeka, futhi i-cardioversion kufanele yenziwe ngesikhathi esifanayo.
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