Thrombosis , kapena kuti magazi osadziwika bwino, nthawi zambiri ndizoopsa kwambiri zomwe zimabala mitundu iwiri ya matenda.
Choyamba, thrombosis mkati mwa mitsempha imatha kuletsa kutuluka kwa magazi, kuwononga ku ziwalo zomwe zimaperekedwa ndi mitsempha yotsekedwa. Kupweteka kwa m'magulu (matenda a mtima) kawirikawiri kumaphatikizapo thrombosis mkati mwa mitsempha yamakono , ndipo kukwapula kwapwetekiti kumayambitsidwa ndi thrombosis mkati mwa mitsempha yomwe imapereka ubongo.
Chachiwiri, kupweteka komwe kumachitika mkati mwa mitsempha kapena mkati mwa mtima kukhoza kuyambitsa . Izi zikutanthauza kuti magazi amatha kuchoka ndikuyenda kupyola muyeso, ndikuwononga kulikonse kumene kumakhala. Kuphatikizika kwapopysi kumayambitsidwa ndi magazi omwe amachititsa kuti mapapu (makamaka, kuchokera mu mitsempha pamlendo). Kukwapulika kwa embolic kumayambitsidwa ndi magazi omwe amatha kupita ku ubongo, kawirikawiri amakhala ndi thrombus mkati mwa mtima, nthawi zambiri mogwirizana ndi atrial fibrillation .
Mankhwala Amene Amapewa Kapena Amachiza Zovala za Magazi
Anthu omwe ali pachiopsezo chachikulu kuti apange thrombosis yoopsa nthawi zambiri amafunika chithandizo kuti athetse vutoli kuti lisadzachitike kapena kuyesa kupasuka magazi omwe apanga kale. Pali mitundu itatu ya mankhwala omwe amagwiritsidwa ntchito popewera kapena kuchiza thrombosis - mankhwala a antiticoagulant, mankhwala osokoneza bongo komanso mankhwala osokoneza bongo.
Ngakhale kuti mankhwalawa ali ndi zotsatira zake zoipa, zotsatira zake zimakhala zowawa kwambiri.
Choncho mankhwala onsewa ayenera kugwiritsidwa ntchito mosamala.
Mankhwala Osokoneza Bongo
Mankhwala a antiticoagulant amaletsa chinthu chimodzi kapena zingapo zomwe zimachotsa . Zinthu zowonongeka ndi gulu la mapuloteni a magazi amene ali ndi udindo wopha magazi.
Mankhwala awa ndi awa:
Heparin. Heparin ndi mankhwala osokoneza bongo omwe amatha msanga (pamphindi masabata) kuti asawonongeke.
Madokotala akhoza kusintha mlingo wake nthawi zambiri, monga pakufunikira, poyang'anira nthawi ya thromboplastin (PTT) ya magazi . PTT ikuwonetsa kuchuluka kwa zinthu zomwe zowonongeka zaletsedwa. (Ndiko kuti, "kuchepa" kwa magazi.) Heparin imagwiritsidwa ntchito pokhapokha kuchipatala.
Low Molecular Weight Heparin: enoxaparin (Lovenox), dalteparin (Fragmin). Mankhwalawa ndi mankhwala oyeretsera a heparin. Zopindulitsa kwambiri pa heparin ndikuti akhoza kupatsidwa ngati jekeseni la khungu (limene pafupifupi aliyense angaphunzire kuchita maminiti pang'ono) mmalo mwa intravenously, ndipo safunikira kuyang'aniridwa mosamala ndi kuyesera magazi. Choncho, mosiyana ndi heparin, akhoza kuperekedwa ndi chitetezo chokwanira pambali mwapakati.
Zatsopano zogwiritsira ntchito mankhwala osokoneza bongo. Mankhwala ambiri a "heparin" a antiticoagulant apangidwa, kuphatikizapo argatroban, bivalirudin (Angiomax), fondaparinux (Arixtra) ndi lepirudin (Refludan). Nthawi yabwino ndi malo ogwiritsira ntchito mankhwala onsewa akupangidwa pang'onopang'ono.
Warfarin (Coumadin). Mpaka posachedwa, warfarin ndiyo yokhayo yomwe imayambitsidwa mankhwala ovomerezeka pamlomo.
Vuto lalikulu ndi warfarin lakhala pakukonza mlingo wake.
Poyamba kutengedwa, mlingo wa warfarin uyenera kukhazikika pa nthawi ya masabata ndikuyesedwa magazi nthawi zambiri (mayeso a magazi a INR). Ngakhale pambuyo pa kukhazikika kwa INR kumafunikanso kuyang'aniridwa nthawi ndi nthawi, ndipo mlingo wa warfarin nthawi zambiri umafuna kukonzanso. Choncho, kupeza ndi kusunga mlingo woyenera wa warfarin nthawi zonse kunali kovuta komanso kosasangalatsa.
"Zatsopano" Mankhwala Osokoneza Bongo Achipatala - The NOAC Mankhwala Osokoneza Bongo. Chifukwa chakuti mlingo woyenera wa warfarin ukhoza kukhala wovuta kulamulira, makampani osokoneza bongo akhala akugwira ntchito kwa zaka zambiri kuti azibwera ndi "warfarin-m'malowa" - omwe ndi mankhwala a antiticoagulant omwe angathe kutengedwa pamlomo.
Zina mwa izi zatsopano zamagetsi zolimbitsa thupi (mankhwala a NOAC) tsopano zavomerezedwa.
Awa ndiwo dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), ndi edoxaban (Savaysa). Njira yabwino kwambiri ya mankhwala osokoneza bongo ndi kuti akhoza kupatsidwa mlingo woyenera tsiku lililonse, ndipo safuna kuyeza magazi kapena kusintha kwa mlingo. Komabe, monga momwe ziliri ndi mankhwala onse, pali zochepa mpaka mankhwala a NOAC .
Mankhwala a Fibrinolytic
Streptokinase, urokinase, alteplase, reteplase, tenecteplase. Mankhwala amphamvuwa amaperekedwa mwachangu ndi mwachangu kuti asungunuke magazi omwe ali mkati mwa kupanga. Kawirikawiri, ntchito yawo imakhala yokwanira kwa odwala omwe ali ochepa maola oyamba a matenda a mtima kapena kupwetekedwa mtima, ndipo amapatsidwa kuti ayese kutsegula mitsempha yotsekedwa ndi kuteteza kuwonongeka kwa minofu.
Mankhwala otchedwa fibrinolytic (omwe nthaŵi zambiri amatchedwa "busters clot"), akhoza kukhala ovuta kugwiritsa ntchito. ndipo amakhala ndi chiopsezo chachikulu chokhala ndi mavuto a magazi. Komabe, panthawi yoyenera, kugwiritsira ntchito mankhwalawa kungateteze imfa kapena kulemala ku matenda a mtima kapena kupwetekedwa. Pa mankhwala otchedwa fibrinolytic, streptokinase amagwiritsidwa ntchito kawirikawiri padziko lonse, chifukwa ndi yotchipa. Ku United States, tenecteplase pakalipano ndi mankhwala osankhidwa chifukwa akuwoneka kuti amachititsa kuti pakhale zotsatira zochepa zowononga magazi, ndipo zimakhala zosavuta kupereka kuposa mankhwala ena m'gulu lino.
Mankhwala Osokoneza Bongo
Magulu atatu a mankhwala amagwiritsidwa ntchito kuchepetsa "kukhutitsidwa" kwa mapaleleteni , zinthu zazing'ono zamagazi zomwe zimapanga maziko a magazi. Mwa kulepheretsa luso la mapuloletti kuti agwirizane palimodzi, mankhwala odana ndi aplatele amaletsa magazi kutsekemera. Mankhwalawa ndi othandiza kwambiri popewera magazi osadziwika kuti asapangidwe mitsempha ndipo sagwira bwino ntchito yoteteza thrombosis mu mitsempha.
Aspirin ndi dipyridamole (Aggrenox). Mankhwalawa ali ndi zotsatira zochepa pamapiritsi "okonzeka" koma amachititsa kuti zochepa zokhudzana ndi magazi zikhale zovuta kuposa mankhwala ena odana ndi mankhwala. Amagwiritsidwa ntchito poyesera kuchepetsa chiopsezo cha mtima kapena kupweteka kwa anthu omwe ali ndi chiopsezo.
Ticlopidine (Ticlid), clopidogrel (Plavix) ndi prasugrel (Zotsatira). Mankhwalawa ndi amphamvu kwambiri (choncho ndi oopsa) kuposa aspirin ndi dipyridamole. Amagwiritsidwa ntchito nthawi zambiri pamene chiopsezo chotsekemera chimakhala chapamwamba kwambiri. Ntchito yawo yowonjezereka ikupezeka mwa anthu omwe adalandira mankhwala amtundu wambiri . Ntchito yawo yokhudzana ndi ntchentche - makamaka, zosankha za nthawi komanso nthawi yogwiritsira ntchito - zakhala zikutsutsana .
IIb / IIIa Zizindikiro: abciximab (ReoPro), eptifibatide (Integrilin), tizilombo (Aggrastat). Mankhwala a IIb / IIIa omwe amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda. Iwo amaletsa phokoso pamwamba pa mapaleletti (omwe amatchedwa IIb / IIIa receptor) omwe ndi ofunikira kuti apangidwe. Kugwiritsa ntchito kwawo kwakukulu ndiko kupewa kutseka kwapadera pambuyo pa njira zothandizira (monga angioplasty ndi malo osungira malo), komanso odwala omwe ali ndi matenda oopsa a mitsempha . Mankhwalawa ndi okwera mtengo kwambiri ((ambiri) ayenera kuperekedwa mwachangu.
Mawu Ochokera
Mankhwala angapo ali mu ntchito zamagetsi kuti ateteze kapena asamalidwe magazi. Iwo ali ndi njira zosiyanasiyana zochitapo kanthu, zoopsa zosiyanasiyana, ndipo amagwiritsidwa ntchito pazochitika zosiyanasiyana zachipatala. Kugwiritsira ntchito mankhwalawa nthawi zonse kumakhala koopsa kuti magazi asapitirire, ndipo ayenera kugwiritsidwa ntchito pokhapokha ngati phindu lawo likhoza kupambana. Poyang'anira thrombosis, ndikofunikira kwambiri kuti dokotala asankhe mankhwala abwino, pansi pazifukwa zabwino.
> Zotsatira:
> Franchini M, Mannucci PM. Anticoagulants Chatsopano M'kati mwa Mankhwala: Chitsitsimutso. Eur J Intern Med 2010; 21: 466.
> Kearon C, Akl E, Omelas J, et al. Antithrombotic Therapy kwa VTE Matenda. CHEST Guideeline ndi Report Panel Panel. Chifuwa cha 2016; 149: 315.
> Weitz JI, Hirsh J, Samama MM, American College of Chest Physicians. Mankhwala Osokoneza Bongo: American College of Chest Physicians Malangizo Othandizira Malangizo Okhudza Zipatala (8th Edition). Chifuwa cha 2008; 133: 234S.