Embolism yopanga maulendo ndi matenda omwe amatha kukhala ndi mavuto aakulu. Chithandizo choyenerera , chotumizidwa mwamsanga, ndikofunika kukulitsa mwayi wochira. Kupereka chithandizo choyenera kumafuna kupanga matenda oyenera mwamsanga.
Koma kupanga matenda oyenera a pulmonary embolus, ndipo kuchita mofulumira, nthawi zina kungakhale kovuta.
Mayesero omveka bwino okhudza mapulmasi amatha kukhala nthawi yochuluka, okwera mtengo, ndipo akuphatikizapo zoopsa zina. Mayesero awa sayenera kugwiritsidwa ntchito mosasankhidwa.
Akatswiri asintha njira zitatu zomwe zimapangidwira mwamsanga kuti zidziwitse kapena kuti zidziwitse kupopera kwapopysi popanda kuwonetsa anthu ku kuyesa kosafunikira. Ngati dokotala akudandaula kuti mwakhala ndi pulmonary embolus, mumatha kuyembekezera kuti agwiritse ntchito njira zitatu izi.
Khwerero 1
Pang'onopang'ono mmodzi dokotala akufulumira kuwonetsa kuti mwayi wa pulmonary embolus wachitika. Adzachita izi powalingalira zizindikiro zomwe adayimilira komanso zomwe zikuchitika.
Makhalidwe angapo opangidwira adakonzedwa kuti madokotala azigwiritsa ntchito poyesa zokhudzana ndi mgwirizano wa pulmonary. Ndondomeko yamakono yomwe amagwiritsidwa ntchito nthawi zambiri ndi system ya Wells scoring system , yomwe imalingalira:
- Kaya zizindikiro zikusonyeza kuti m "mitsempha yambiri imakhalapo
- Kaya matenda ena onse omwe angatheke amawoneka ngati ochepa kusiyana ndi mapulogalamu a pulmonary
- Kaya chiŵerengero cha mtima chili ndi zoposa 100 pamphindi
- Kaya pali mbiri ya opaleshoni yatsopano kapena zovuta zina
- Kaya pali mbiri yakale ya ma pulmonary embolus kapena deep vein thrombosis
- Kaya pali hemoptysis (kukopa magazi)
- Kaya khansa ilipo
Zolemba zapadera zimaperekedwa kuzinthu izi zisanu ndi ziwiri ndipo chiwerengero chonse cha Wells chiwerengedwa. Pogwiritsa ntchito zilembo za Wells, dokotala amatha kudziwa ngati mwayi wa pulmonary embolus ndi wotsika, wamkati, kapena wapamwamba.
PERC
Ngati zikutanthauza kuti pokhapokha pali vuto lochepa la mapangidwe a pulmonary pogwiritsa ntchito kafukufuku wa chipatalachi, dokotala angagwiritsenso ntchito njira yowonjezereka: dongosolo la Pulmonary Embolus Rule-Out Criteria (PERC).
Ndondomeko ya PERC ikhoza kudziwa ngati mwayi wa pulmonary embolus ndi wochepa kotero kuti kuyesa kuyenera kuimitsidwa palimodzi. Zili ndi zifukwa zisanu ndi zitatu:
- Zaka zosakwana zaka 50
- Kuchuluka kwa mtima pansi pa 100
- Magazi a oxygen amakhala osachepera 95 peresenti
- Palibe hemoptysis
- Palibe ntchito ya estrogen
- Palibe mbiri ya mitsempha yambiri ya thrombosis kapena pulmonary embolus
- Palibe mwendo kutupa
- Palibe opaleshoni kapena chiopsezo chosowa kuchipatala pamasabata anayi apitawo
Ngati ziwerengero zisanu ndi zitatu zokha za pulogalamu ya PERC zilipo, sipangayambe kuyesedwa kwa pulmonary test chifukwa chiopsezo choyesa kupitanso patsogolo chidzapambana chiopsezo cha kusowa kwa pulmonary embolus.
Khwerero 2
Ngati mwayi wa pulmonary umakhala mu sitepe imodzi imatsimikiziridwa kukhala pakati, kapena ngati chithandizo cha matenda a pulmonary chikhale chochepa koma njira ya PERC siinakumanepo, sitepe yotsatira ndiyo kupeza D-dimer magazi.
Mayeso a D-dimer amatsimikizira kuti pakhala pali njira yodabwitsa ya ntchito yotsekemera m'magazi, monga momwe zingakhalirepo ngati munthu ali ndi mitsempha yambiri ya thrombosis kapena pulmonary embolus.
Ngati mankhwala omwe ali ndi kachilombo ka HIV ali otsika kapena apakatikati ndipo mayeso a D-dimer ndi oipa, chiwalo cha pulmonary chimalepheretsedwe ndipo dokotala adzapitirizabe kulingalira zina zomwe zingayambitse zizindikiro.
Kuyeza kwa D-dimer kungagwiritsidwe ntchito pokhapokha kugwiritsira ntchito mapulogalamu a pulmonary, osati kuti apeze matenda. Choncho ngati mayeso a D-dimer ali othandizira (kapena ngati chithandizo cha mankhwala cha pulmonary munthu chimawoneka kuti chiri pamtunda umodzi), ndi nthawi ya sitepe itatu.
Khwerero 3
Khwerero 3 liri ndi phunziro la kuganizira za kugonana. Kawirikawiri, imodzi mwa mitundu itatu ya mayesero idzagwiritsidwa ntchito.
CT Scan
CT scan ndi njira ya kompyuta yomwe imalola dokotala kufufuza mitsempha ya pulmona kuti awone ngati pali chitetezo choyambitsa magazi. Chojambulira chosiyana chimayikidwa m'magazi panthawi ya mayesero kuti athandizire kuona mitsempha.
CT scan ndi yolondola kuposa 90 peresenti ya nthawi pozindikira mgwirizano wa pulmonary ndipo tsopano akuyesedwa kuti ndi mayeso osankha ngati chithunzi chikufunika kuti chidziwitsocho chichitike.
V / Q Scan
Kujambula kwa AV / Q (komwe kumatchedwanso mpweya wotsegula mpweya wabwino) ndi mapulogalamu a mapapu omwe amagwiritsira ntchito dyosekeni, jekeseni mu mitsempha, kuti awonetse kutuluka kwa magazi ku minofu ya mapapo. Ngati mitsempha ya pulmonary imatsekedwa pang'ono ndi chophatikizidwa, zigawo zofanana za m'mapapo zimapindula pang'ono kusiyana ndi dye ya radioactive.
Masiku ano kuyeza kwa V / Q kumagwiritsidwa ntchito kwa anthu omwe sayenera kudziwika ndi ma radiation omwe amafunika ndi CT scan, komanso omwe omwe CT amawadziwa.
Chidziwitso Chachidziwitso
Kwa zaka zambiri maphunziro a catheterization omwe amadziwika kuti pulmonary angiogram ndiyo ndondomeko ya golide yowunikira mapulogalamu a pulmonary, koma mayeserowa tsopano ayambitsidwa ndi CT.
Ndi mpweya wamakono, utoto umayikidwa kudzera mu kathete yomwe imayikidwa mu mitsempha ya pulmonary kuti magazi aliwonse amatha kuwonetsedwa pa x-ray. Mayesero ovuta awa angakhale oyenerera nthawi zina ngati kanema ka CT kapena V / Q sizingagwiritsidwe ntchito kapena zotsatira za mayeserowa sizodziwika.
Anthu Osakhazikika
Kuphatikizika kwapopysi kumayambitsa kugwa kwa mtima msanga. Ndipotu kugwiritsidwa ntchito kwapopysi nthawi zambiri kumayambitsa achinyamata omwe amafa mwadzidzidzi.
Ngati munthu ali ndi vuto la mtima losasinthasintha ndipo mawonekedwe a pulmonary akuoneka kuti ndi amene amachititsa, ndondomeko yoyendetsera kayendedwe ka katatu siingatheke. Mwa anthuwa, mankhwala amathandizidwa nthawi yomweyo, pamodzi ndi zoyesayesa zina, musanayambe kupeza chithandizo chodziwika bwino cha pulmonary embolus.
Kusiyanitsa kusiyana
Pofuna kupeza mankhwala opangidwa ndi pulmonary, ndi kofunikanso kuti dokotala adziwe mankhwala ena omwe ali ndi zizindikiro zomwe zingakhale zofanana ndi za pulmonary embolus. Zinthu zomwe ziyenera kuganiziridwa (ndiko kuti, kusiyana kwa matenda) nthawi zambiri zimaphatikizapo kuwonongeka kwa mtima , mtima wosalimba , pericarditis , katemera wa mtima , chibayo, ndi pneumothorax .
Ma electrocardiograms , chifuwa x-rays, ndi ma echocardiograms omwe amapezeka nthawi zamakono zowonongeka zamaganizo chifukwa cha vuto la mtima kapena m'mapapo akukayikitsa nthawi zambiri kuti athetse izi.
Ngakhalenso chimodzi mwazidziwitso zinazi zimapangidwa, izi sizikutanthawuza kuti mgwirizano wa mapulitsi umatulutsidwa kunja, chifukwa munthu akhoza kukhala ndi zikhalidwe ziwiri panthaŵi imodzimodzi-ndipo matenda ambiri a mtima amachulukitsa chiopsezo cha mitsempha ya pulmonary. Choncho ngati pali zifukwa zomveka zoganizira kuti mankhwala omwe amapezeka pampiritsi amatha kupangidwa, ndi bwino kutenga njira zowonjezera kuti muyese kuyezetsa magazi.
> Zotsatira:
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> Raja AS, Greenberg JO, Qaseem A, et al. Kuwunika kwa Odwala Amene Akukumana Nawo Akudzidzimutsa Kwambiri: Kugwiritsa Ntchito Malangizo Ochokera Kumakomiti Otsogolera Amakono a American College of Physicians. Ann Intern Med 2015; 163: 701. DOI: 10.7326 / M14-1772
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