Munthu akapezeka kuti ali ndi mapulaneti ovuta kwambiri, chithandizo choyenera chimadalira ngati mtima wawo uli wotsimanga kapena wosakhazikika.
Kwa Anthu Okhazikika
Anthu ambiri omwe amapezeka kuti ali ndi pulmonary embolus amatha kukhazikika pamtima maganizo. Izi zikutanthauza kuti iwo amadziwa komanso amakhala ocheru, ndipo kuthamanga kwa magazi sizowopsa.
Kwa anthuwa, mankhwala ndi antiticoagulant mankhwala (magazi ochepa) amayamba nthawi yomweyo. Kuchedwa kochepa kwambiri kumachepetsa mpata wawo wakufa chifukwa chokhala ndi pulmonary.
Masiku 10 Oyambirira
Kwa masiku 10 oyambirira mutatha kulumikizana kwa mapiritsi, mankhwalawa ali ndi mankhwala awa:
- Heparin yolemera maselo (LMW), monga Lovenox kapena Fragmin. Izi ndizochokera ku heparin zomwe zingaperekedwe ndi jekeseni la khungu mmalo mwa intravenously.
- Fondaparinux, inanso yosamalitsa mankhwala monga heparin.
- Heparin yosasamalidwa, heparin "wakale" yomwe imaperekedwa mwachangu.
- Rivaroxiban (Xarelto) kapena apixaban (Eliquis), awiri mwa "mankhwala atsopano a mankhwala osokoneza bongo" ( NOAC ) omwe amalowetsa m'malo mwa Coumadin . Mankhwala awiriwa a NOAC ndiwo okha omwe amavomerezedwa kuti athandizidwe ndi mankhwala a pulmonary.
Mankhwala onsewa amachititsa kuti zinthu zisawonongeke, mapuloteni m'magazi omwe amalimbikitsa chithokomiro.
Masiku ano, madotolo ambiri amagwiritsa ntchito rivaroxiban kapena apixaban pa masiku khumi oyambirira achipatala kwa anthu omwe amatha kumwa mankhwala achipatala. Apo ayi, LMW heparin imagwiritsidwa ntchito kwambiri.
Masiku 10 mpaka 3 Miyezi
Pambuyo pa masiku khumi oyambirira, mankhwala amasankhidwa kuti athandizidwe kwa nthawi yaitali. Nthaŵi zambiri, mankhwalawa kwa nthawi yaitali amapitirira kwa miyezi itatu ndipo nthawi zina kwa chaka.
Mankhwalawa nthawi zonse amakhala ndi imodzi mwa mankhwala a NOAC. Chifukwa cha mankhwalawa (kutanthauza, pambuyo pa masiku 10 oyambirira), NOAC mankhwala dabigatran (Pradaxa) ndi edoxaban (Savaysa) amavomerezedwa kuti agwiritsidwe ntchito, kuphatikizapo rivaroxiban ndi apixaban. Kuonjezerapo, Coumadin ndi mwayi wosankha mankhwalawa kwa nthawi yaitali.
Chithandizo chosadziwika
Kwa anthu ena, chithandizo chamaganizo choyenera cha nthawi yaitali chiyenera kugwiritsidwa ntchito nthawi zonse pambuyo pa mapulogalamu a pulmonary, mwinamwake kwa moyo wawo wonse. Kawirikawiri, awa ndi anthu omwe amagwera m'magulu awiri:
- Anthu omwe ali ndi mapulogalamu a pulmonary kapena thrombosis yozama kwambiri popanda chifukwa chodziwitsa.
- Anthu omwe amachititsa kuti vutoli likhale lachilendo, monga khansa yogwira ntchito, kapena kuti chibadwa chokhala ndi chibadwa chokhala ndi magazi osadziwika bwino.
Ngati Anticoagulant Mankhwala Osagwiritsidwa Ntchito
Kwa anthu ena, mankhwala osokoneza bongo sangathe. Izi zikhoza kukhala chifukwa chiopsezo chokhala ndi magazi ochulukirapo ndi chokwanira kwambiri kapena mwina iwo anali ndi mapiritsi apamtima obwerezabwereza ngakhale mankhwala oyenerera amadzimadzi.
Mu anthu awa, fyuluta ya vena cava iyenera kugwiritsidwa ntchito. Fyuluta ya vena cava ndi chipangizo chomwe chimayikidwa muzitsulo zochepa (vine cava) (mitsempha yayikulu yomwe imatenga magazi kuchokera kumunsi otsika ndikuikira pamtima) mwa njira yothandizira.
Zisudzozi ndi "misampha" yamagazi omwe aphwanyidwa ndipo amawateteza kuti asafikire mapulaneti.
Mafuta a Vena cava angakhale othandiza, koma sakufuna mankhwala osokoneza bongo chifukwa cha zoopsa zomwe amagwiritsa ntchito. Izi zimaphatikizapo thrombosis pa malo a fyuluta (yomwe ikhoza kutsogoloza kupuma kwa pulmonism), kutuluka m'magazi, kusuntha kwa fyuluta pamtima, ndi kuwonongeka kwa fyuluta.
Mitundu yambiri yamakono ya vena cava ikhoza kutengedwa kuchokera ku thupi ndi njira yachiwiri yothandizira ngati sakufunikanso.
Kwa Anthu Osakhazikika
Kwa anthu ena, kugwiritsidwa kwa pulmonary ndi mitsempha ya mtima.
Mwa anthu awa, ziwalozo ndi zazikulu zokwanira kuti zisawonongeke kwambiri magazi kupita m'mapapo, zomwe zimayambitsa kugwa kwa mtima. Anthuwa nthawi zambiri amasonyeza tachycardia yochuluka (kuthamanga kwa mtima mwamsanga) ndi kutsika kwa magazi, kutsika khungu, ndi kusintha maganizo.
Pazochitikazi, njira yodziwiritsira ntchito yosavuta kugwiritsira ntchito-yomwe imagwira ntchito kwambiri polimbitsa mitsempha ya magazi ndi kupewa kutsekemera kwina-sikokwanira. M'malo mwake, chinachake chiyenera kuchitidwa kuti chiwonongeke zomwe zakhala zikuchitika, ndikubwezeretsanso ma circulation.
Throbolytic Therapy ("Chovala Busters")
Ndi mankhwala opatsirana pogwiritsa ntchito mankhwala, mankhwala osokoneza bongo amathandizidwa kuti asungunuke. Pogwiritsa ntchito mitsempha yambiri yamagazi, amatha kubwezeretsa kufalitsa kwa munthu.
Mankhwalawa (omwe amatchedwanso kuti fibrinolytic mankhwala chifukwa amagwira ntchito mwa kusokoneza fibrin m'magetsi) amakhala ndi chiopsezo chachikulu chokhala ndi mavuto a magazi kotero amagwiritsidwa ntchito pokhapokha ngati phokoso la pulmonary limangokhala pangozi. Mankhwala otchedwa thrombolytic omwe amagwiritsidwa ntchito nthawi zambiri pamagulu amphamvu a embolism ndi alteplase, streptokinase, ndi urokinase.
Embolectomy
Ngati chithandizo cha thrombolytic sichingagwiritsidwe ntchito chifukwa chiopsezo chokhala ndi magazi ochulukirapo chimawoneka ngati chokwera kwambiri, chiyeso chikhoza kupangidwira pamasewero. Njira yoyesera imayesayesa kupasula chophimba chachikulu mu mitsempha ya pulmonary, mwina mwa opaleshoni kapena mwa njira ya catheter.
Kusankha pakati pa catheter kapena opaleshoni ya opaleshoni kawirikawiri kumadalira kupezeka kwa madokotala omwe ali ndi zodziwika ndi zina mwa njirazi, koma kachitidwe ka kathete kamene kamasankhidwa kawiri kawiri kawiri kawiri kamatha kuchitidwa mofulumira.
Komabe, njira yosiyanitsira mtundu uliwonse imakhala ndi zoopsa zazikulu-kuphatikizapo kupasuka kwa mitsempha ya mitsempha, ndi kupweteka mtima kwa thupi ndi kuopsa kwa moyo wa mthempha (kutuluka m'magazi). Choncho, chidziwitso chimangochitika mwa anthu omwe amadziwika ngati osakhazikika kwambiri komanso omwe ali ndi chiopsezo chachikulu cha imfa popanda kuthandizidwa mwamsanga.
> Zotsatira:
> Aymard T, Kadner A, Widmer A, et al. Embolism Wamkulu Yopangitsira Zofufuzira: Njira Yopangira Opaleshoni Ndi Njira Zopangira Thrombolytic - Kodi Zizindikiro Zopangira Opaleshoni Ziyenera Kubwerezedwanso? Chithandizo; 43:90. DOI: 10.1093 / ejcts / ezs123
> Kearon C, Akl EA, Comerota AJ, et al. Matenda a Antithrombotic kwa VTE matenda: Antithrombotic Therapy ndi Prevention of Thrombosis, 9th ed: American College of Chest Physicians Malangizo Othandizira Malangizo Okhudza Zipatala. Chifuwa cha 2012; 141: e419S. DOI: 10.1378 / chifuwa.11-2301
> Kuo WT, van den Bosch MAAJ, Hofmann LV, ndi al. Kupangidwira Kwambiri kwa Catheter, Kupatukana, ndi Thrombolysis Kwa Chithandizo cha Massive Pulmonary Embolism Pambuyo Kusowa Kwambiri kwa Thrombolysis. Chifuwa cha 2008; 134: 250. DOI: 10.1378 / chest.07-2846
> Tapson VF. Chidziwitso chodziwika bwino cha Embolism. N Engl J Med 2008; 358: 1037. DOI: 10.1056 / NEJMra072753