Pansi pa veous thrombosis (DVT) ndi mkhalidwe umene magazi amawomba mawonekedwe a mitsempha ya mwendo. DVT ndi yofunika pa zifukwa ziwiri: DVT yokha ingayambitse zizindikiro zoopsa, ndipo nthawi zambiri DVT imayambitsa chiopsezo cha moyo wa mapulaneti .
DVT ikhoza kuchitika m'mitsempha pamwamba pa bondo (ndiko kuti, mu mitsempha yambiri ya mvula ndi ntchafu) kapena m'mitsempha pansi pa bondo (ndiko kuti, mu mitsempha ya ng'ombe).
Kuopsa kwa mitsempha ya m'mapapo ndi yotsika kwambiri pamene DVT ili kutali ndi mwana wa ng'ombe.
Ndani Amalandira DVT?
Kawirikawiri DVT imawoneka mwa anthu omwe akhala osasunthika kwa nthawi yaitali, mwachitsanzo, pakutsata opaleshoni yatsopano, kupweteka , kufooka, kapena kuchira. DVT imapezanso kawirikawiri mwa anthu omwe ali ndi matenda oopsa kapena amtima, ndipo (makamaka akazi) mu ovuta kwambiri komanso osuta. Kugwiritsira ntchito mapiritsi oletsa kubereka komanso mankhwala omwe amachititsa kuti magazi asamalowe m'malo mwake kumawonjezera chiopsezo cha DVT.
Zizindikiro za DVT
Zizindikiro zowonjezereka za DVT ndi kutupsa, kupweteka ndi kuphulika mu mwendo wathithi. Zizindikiro zimenezi zimasiyana mofatsa mpaka kulepheretsa.
Kuzindikira DVT
Pamene DVT ilipo, chithandizo mwamsanga ndi mankhwala a antiticoagulation (onani m'munsimu) chidzachepetsera zizindikilo, komanso zovuta za kukula kwa mapulaneti. Komabe, zizindikiro zomwezo zimapezeka ndi DVT zimayambanso kudwala matenda enaake, kuphatikizapo misozi, misozi yambiri, mawonekedwe a mawondo, ndi kutupa kwa mitsempha ya m'mimba - ndipo mankhwalawa ali osiyana .
Choncho, pamene DVT ikuyikiridwa, zimakhala zofunikira kupanga chitsimikizo chotsimikizira.
M'mbuyomu, kudziŵika bwino kwa DVT kunafunika njira yowonongeka yotchedwa venography, yomwe utoto umayikidwa mu mitsempha ya mimba, ndipo zithunzi za x-ray zinapangidwa, kuyang'ana zopinga zomwe zimayambitsa magazi. Mwamwayi, kufunikira kwa venography kwakhala kosasinthika m'zaka zaposachedwa ndi kupezeka kwa mayesero awiri osadziwika - impedance plethysmography ndi compression ultrasound .
Mu impedance plethysmography, cuff (yofanana ndi kapu ya magazi) imayikidwa pafupi ndi ntchafu ndipo imakhudzidwa, kuti ikwaniritse mitsempha ya mimba. Nkhungu ya mwanayo imayesedwa (pogwiritsira ntchito electrodes yomwe imayikidwa pamenepo). Chophimbacho chimachotsedwa, kulola magazi omwe "atsekereredwa" mu ng'ombe kuti atuluke kupyola mitsempha. Nyerere ya mwana wa ng'ombe imabwerezedwa mobwerezabwereza. Ngati DVT ilipo, kusiyana kwa voliyumu (ndi chifuwa chokhudzidwa ndi chifuwa deflated) chidzakhala chochepa kuposa chachibadwa - chikusonyeza kuti mitsempha imatsekedwa pang'ono ndi magazi.
Kupanikizika kwa ultrasound ndi kusiyana kwa njira yogwiritsidwa ntchito popangidwa ndi ultrasound, yomwe mafunde amagwiritsidwa ntchito ku minofu pogwiritsa ntchito kafukufuku, ndipo chithunzi chimamangidwa ndi mafunde obwerera. Powonongeka kwa ultrasound, kafukufuku wa ultrasound amaikidwa pamwamba pa mitsempha, ndipo chithunzi cha ultrasound cha mitsempha chimapangidwa. Mitsempha imakanikizidwa (mwa kuikankhira iyo ndi kafukufuku wa ultrasound). Ngati DVT ilipo, mitsempha imakhala "yolimba" (chifukwa cha kukhalapo kwa chinsalu), ndipo kumakhala kochepetsetsa.
Ngati DVT ikukayikira, matendawa akhoza kutsimikiziridwa kapena kukanidwa pogwiritsira ntchito chimodzi mwa mayeserowa omwe sali ovunda.
Chifukwa chakuti zipatala zochepa chabe zimachita plethysmography, pamene chipatala chilichonse chamakono chimayesa mayesero ambirimbiri tsiku lililonse, kuyesa kwa ultrasound kumagwiritsidwa ntchito kwambiri kuti apeze DVT.
Kuchiza kwa DVT
Chithandizo chachikulu cha DVT ndi kugwiritsa ntchito mankhwala a antiticoagulant ("magazi ochepa thupi"), onse pofuna kuteteza magazi kuwonjezera mitsempha ya m'mimba, komanso kuchepetsa mwayi wopanga pulmonary embolus.
DVT itangotulukira, kawirikawiri limalangizidwa kuti mankhwala ayambe mwamsanga ndi imodzi mwa mankhwala ochokera ku heparin (monga Arixtra, kapena fondaparinux) omwe angaperekedwe ndi jekeseni (pansi pa khungu).
Mankhwalawa amapereka zotsatira zowonongeka.
Pamene mankhwalawa akuyamba, chithandizo chochuluka kwambiri ndi Coumadin chingayambe. Nthawi zambiri amatenga masiku angapo kwa sabata kapena kuposerapo Coumadin atayamba kugwira ntchito, ndipo mlingo wake woyenera watsimikiziridwa. Kamodzi ka Coumadin ikasinthidwa ndipo mankhwalawa akugwira ntchito bwino, chochokera ku heparin chingathe kuimitsidwa.
Ngakhale mankhwala atsopano a antiticoagulation Pradaxa ( dabigatran ) adayesedwa kwa odwala omwe ali ndi DVT ndipo amawoneka ogwira mtima, sanakwaniritsidwe ndi FDA kuti agwiritse ntchito.
Thandizo la antiticoagulation kwa DVT nthawi zambiri limapitirira kwa miyezi itatu. Ngati DVT imakhala yowonongeka, ngati chinthu chomwe chimayambitsa (monga mtima kusagwirizana ) chikadalipo, kapena ngati chimbudzi chachikulu chikuchitika, chithandizochi chimapitilira nthawi zonse.
Kuwonjezera pa kugwiritsira ntchito mankhwala, ndikofunikira kuti anthu omwe ali ndi DVT aziyenda mobwerezabwereza, komanso kupewa malo omwe angafunikire kuti akhalebe nthawi yaitali. Zosakanikirana, zomwe zimathandiza mitsempha kumbuyo kubwerera m'mtima, zimathandizanso, ndipo ziyenera kuganiziridwa mozama kwa zaka ziwiri kuchokera pamene DVT yachitika.
Ndi chithandizo chokwanira, anthu ambiri omwe ali ndi DVT akhoza kuchira kwathunthu.
Zotsatira:
Cushman M, Tsai AW, White RH, et al. Kupweteka kwapakati pa mitsempha ndi mapulaneti m'magulu awiri: kufufuza kwanthawi yaitali kotchedwa thromboembolism etiology. Am J Med 2004; 117: 19.
Zabwino S. Mu chipatala. Pansi veous thrombosis. Ann Intern Med 2008; 149: ITC3.