Embolism yamapulisi (PE) imayamba chifukwa cha magazi omwe amapezeka mumapiritsi , mapepala a magazi omwe amatsogolera m'mapapo, kapena nthambi zake. Kawirikawiri, kachilombo ka HIV kamapezeka pamene magazi amagawidwa m'milingo, mitsempha yambiri ya thrombosis (DVT), kutaya komanso kuyenda ku mitsempha ya m'magazi. Zisonyezero za embolism yamapapo zimaphatikizapo vuto kupuma, kupweteka pachifuwa, ndi kukakamira magazi.
Anthu ambiri amatha kuchiritsidwa, koma 30 peresenti ya anthu omwe sanatsatire PE sakhala ndi moyo. Ndi chithandizo chamankhwala, chiŵerengero cha kufa ndi pafupifupi 5 peresenti.
Zizindikiro
Mitsempha yamapiritsi imakhala ndi ntchito yovuta yonyamula magazi m'mapapu kuti akwaniritsidwe ndi mpweya, kotero kutsekedwa kwa magazi mkati mwa chotengera ichi cha magazi kumakhudza mapapo ndi mtima, ndipo zimapereka zizindikiro za mpweya wotsika thupi lonse.
Zizindikiro zowonjezereka za embolism ya pulmonary ndi:
- Mpweya wochepa, umene umayamba mwadzidzidzi, kawirikawiri mkati mwa masekondi pang'ono a PE
- Mwadzidzidzi, kupweteka kwambiri pachifuwa
- Chifuwa
- Kudula magazi
- Pleuritic kupweteka kwa chifuwa, chomwe chimapweteka pachifuwa chomwe chimakhala choipitsitsa pamene mutenga mpweya
- Kupuma
- Kuthamanga kwa magazi, kuchuluka kwa mtima, kupuma mofulumira
- Maonekedwe achikasu ndi ofiira a milomo ndi zala
- Makhalidwe a mtima (zosayenerera za mtima), monga matenda a atrial , ndi zizindikiro zowonjezera kapena zotsatira zoopsa (mwachitsanzo, kumutu, kuperewera kwa chidziwitso)
- Zizindikiro za DVT mu imodzi kapena miyendo yonse
Kulemera kwa embolism yamapulmenti kawirikawiri kumatsimikiziridwa ndi kukula kwa chovalacho. Ngati mapulogalamu a pulmonary ndi aakulu, vutoli limatchulidwa ngati lalikulu PE. Izi zingachititse kuti mitsempha ya pulmonary iwonongeke, zomwe zimayambitsa matenda aakulu a mtima, kutaya magazi, komanso kuchepa kwa mpweya wa okosijeni, kapena njala ya mpweya imene imakhudza ubongo ndi thupi lonse.
Kuphatikizana kochepa kwapopysi kumayambitsa zizindikiro zosachepera zochepa koma ndidakali vuto lachipatala lomwe lingathe kupha ngati silingatululidwe. Mitsempha yaing'ono yamagazi nthawi zambiri imatseka imodzi mwa nthambi zing'onozing'ono za mitsempha ya pulmonary ndipo ikhoza kuwonetsa kachidutswa kakang'ono ka pulmonary chotengera, potsiriza kumatsogolera ku matenda a pulmonary , imfa ya gawo la mapapo a mapapo.
Zimayambitsa
Mitsempha yamagazi, yotchedwa thromboemboli , yomwe imabweretsa PE imayambitsidwa ndi DVT mu mitsempha yakuya ya ntchafu kapena ntchafu.
DVT ndi Mapula
Akuti pafupifupi 50 peresenti ya anthu omwe ali ndi DVT osatembenuzidwa adzakhala ndi mapulogalamu a pulmonary.
Kutuluka kwa thupi kumapangidwira m'njira yomwe imapangitsa kuti DVTs ifike m'mapapo. Mitsempha miyendo, kumene DVTs imakonda kupanga, kuphatikiza pamodzi ngati magazi amabwerera kumanja kwa mtima kudzera mu mitsempha yaikulu, inferior vena cava (IVC). Kuchokera kumbali yowongoka ya mtima, magazi amatha kupita kumapapo kudzera m'mitsempha ya pulmonary kuti atsitsire mpweya wake. Monga chovala cha magazi chikuyenda kupyola mitsempha miyendo mpaka pamtima, mitsempha yonse ya magazi, kuphatikizapo ya mtima, ndi yaikulu kuposa mitsempha miyendo. Pamene magazi amalowa m'mapapu, komabe ziwiya zimakhala zochepa pang'onopang'ono, ndipo apa ndi pamene zikhomo zimagwidwa mu mitsempha ya pulmonary, yomwe imatsogolera ku PE.
Mitsempha yamagazi imeneyi imatha kulowa mu mitsempha yamagazi iliyonse m'mapapu. Mitsempha yaing'ono yamagazi imatha kukhala m'mitsuko yaing'ono yamagazi m'mapapu. Mitsempha yambiri yamagazi imakhala mu mitsempha yayikulu ya magazi, kusokoneza kuthekera kwa mapapu kuti azitulutsa magazi mokwanira kuti agwiritsidwe ntchito mthupi lonse, ndipo zotsatira zake zingakhale zoopsa.
Kuwonetsera Kukonza Magazi Owonjezera
Anthu ambiri omwe ali ndi PE, ali ndi kapena popanda DVT yapitayi, ali ndi matenda kapena zochitika zogwirizana ndi zovulaza magazi. Zomwe zimayambitsa zowopsa kwambiri ndizimene zimapangidwira kupanga magazi:
- Kutuluka chifukwa cha kuuma kwa thupi, kupuma kwa nthawi yayitali, kapena kuchipatala
- Kukhala kwa nthawi yaitali pakwera maulendo aatali kapena ndege ndege
- Mbiri yakale ya embolism ya pulmonary yapitayi
- Mbiri yakale yamagazi a m'mbuyomu, monga DVT, stroke, kapena mtima
- Matenda olepheretsa magazi
- Kusuta
- Mbiri ya khansa ndi / kapena ntchito ya chemotherapy
- Mbiri ya opaleshoni
- Kugunda kwa mafupa, makamaka chikazi (ntchafu) fupa
- Kunenepa kwambiri
- Mankhwala opanga mahomoni (kuphatikizapo mankhwala othandizira mahomoni)
- Kugwiritsa ntchito mapiritsi oyenera kubadwa
- Mimba kapena mimba yatsopano
Kudziwa
Kusanthula kwa PE kumayamba ndi kafukufuku wa dokotala wanu ndipo pakhoza kukhala mayesero apadera omwe angathe kuthandizira, kutsimikizira, kapena kupatulapo matenda a PE.
Kufufuza zachipatala
Chinthu choyamba pozindikira kuti PE ndikulingalira kwa dokotala wanu ngati muli ndi mwayi wokhala nawo wapamwamba kapena otsika. Dokotala wanu amapanga chiwerengero ichi pochita mbiri yachipatala mosamala, poyang'ana zoopsa zanu za DVT, kuyesa kuunika, kuyerekezera ndondomeko ya okosijeni m'magazi anu, ndipo mwinamwake mukuyesera ultrasound kuyesa DVT.
Mayesero Osaoneka
Dokotala wanu atafufuza, mungafunike kuyesedwa, monga kuyesera magazi kapena kuyesera.
- Yesero la D-Dimer: Ngati mwayi wanu wa PE ukuganiza kuti ndi wotsika, dokotala wanu akhoza kulamula mayeso a D-dimer . Mayeso a D-dimer ndi kuyesa kwa magazi komwe kumayesa ngati pakhala palibenso njira yodzidzimitsa yothandizira m'magazi anu, zomwe mukuyembekeza ngati muli ndi DVT kapena PE. Ngati nthenda ya kuchipatala ya PE ndi yochepa ndipo mayeso anu a D-dimer ali olakwika, a PE akhoza kutulutsidwa, ndipo dokotala wanu apitirize kulingalira zina zomwe zingayambitse zizindikiro zanu.
Ngati mwayi wanu wa PE ukuweruzidwa kukhala wapamwamba, kapena ngati D-dimer yeseso ndi yabwino, kawirikawiri mwina V / Q scan (kupuma / kutsekemera) kapena CT scan ya chifuwa chachitika.
- Kuyeza kwa V / Q: AV / Q kuyesa ndi mapulogalamu a mapulogalamu omwe amagwiritsidwa ntchito ndi dothi la radioactive, jekeseni mu mitsempha, kuti awonetse kutuluka kwa magazi m'mapapu anu. Ngati mitsempha yothamanga yozembera imakhala yotsekedwa ndi chigoba, mbali imodzi ya mapepala a mapapo imapindula pang'ono kusiyana ndi dye ya radioactive.
- CT scan: CT scan ndi njira yopanda mphamvu, yowakompyuta yomwe imathandiza dokotala kuti aziwoneka mitsempha yanu ya pulmona kuti awone ngati muli ndi vuto lopweteka.
Chidziwitso Chachidziwitso
Kuyambira kale, kuyang'ana kwa mapulaneti kumatengedwa ngati ndondomeko ya golide yodziwitsa PE, koma mayesero osagonjetsedwa angathe kutsimikiziridwa kapena kutulutsa matendawa. Ngati matenda anu sakudziwika bwino, mungafunikire kukhala ndi pulmonary angiography.
Kuchokera kwapopysiyamu ndiyeso yowonetsera yomwe dzira imayidwira kudzera mu chubu kupita mu mitsempha ya pulmonary kotero kuti magazi aliwonse akhoza kuwonetsedwa pa x-ray. Chifukwa chakuti angiography ndi mankhwala ovuta omwe amachititsa kuti pakhale mavuto, dokotala wanu adzafufuza mosamala zowopsa ndi zopindulitsa musanayambe kukuyitanitsani mayesero awa.
Chithandizo
Kamodzi kafukufuku wa mankhwalawa amatsimikiziridwa, mankhwala ayamba mwamsanga. Ngati muli ndi mwayi waukulu kwambiri wa mapulogalamu a pulmonary, mankhwala angayambe ngakhale musanatsimikizidwe kuti matendawa ndi otani.
Ophwanya Magazi - Anticoagulants
Chithandizo chachikulu cha mankhwala a pulmonary embolus ndi kugwiritsa ntchito mankhwala a antiticoagulant, ochepa magazi, pofuna kuteteza magazi owonjezera.
Amagazi omwe amagwiritsidwa ntchito pochizira PE ndi hepatin kapena IV (intravenous) ya heparin yomwe ingaperekedwe ndi jekeseni (pansi pa khungu), monga Arixtra, kapena fondaparinux. Banja la heparin la mankhwala osokoneza bongo limapereka mphamvu zowonongeka komanso zimathandizira kuti magazi asapangidwe.
Clot Busters- Thrombolytics
Pamene PE ndi yaikulu kapena imayambitsa matenda osokonezeka mtima, mankhwala osokoneza bongo nthawi zambiri sali okwanira. Muzochitika izi, mawotchi amphamvu otchedwa thrombolytics, akhoza kupatsidwa jekeseni kuti asungunuke magazi. Mankhwalawa, kuphatikizapo fibrinolytic agents monga streptokinase, amayenera kupasula magazi omwe amachititsa kuti mitsempha ya pulmonary iwonongeke.
Mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana amachititsa ngozi zambiri kuposa mankhwala omwe amapezeka ndi anticoagulants, kuphatikizapo chiopsezo chachikulu chakumayambitsa magazi. Ngati mankhwalawa ali oopsa kwambiri kuti awononge moyo wawo, chiopsezo cha mankhwalawa chikhoza kuperewera ndi zomwe zingapindule.
Opaleshoni
Kuchita opaleshoni ndi njira yomwe ingachotse mwachindunji PE. Njira yochiritsira yofala kwambiri, yotchedwa operectionomy operesheni, ndi yoopsa kwambiri ndipo siyothandiza nthawi zonse, kotero imasungidwa kwa anthu omwe ali ndi mwayi wochepa wopulumuka popanda izo.
Kulimbana
Pambuyo pa gawo loyambirira la PE, mungafunike kukonza ndondomeko ya nthawi yayitali kuti muteteze anthu ena, ndipo mungafunikire kusintha momwe zotsatira za PE yanu ziwonongeke.
Mankhwala
Mutalandira chithandizo chofulumira ndi magazi a IV omwe ali ndi jekeseni, mukhoza kuyankhula (pamlomo) mankhwala a antiticoagulant kwa miyezi, kapena ngakhale zaka. Kawirikawiri Coumadin wakhala akugwiritsa ntchito mankhwala osokoneza bongo, koma m'zaka zaposachedwa mankhwala osokoneza bongo atsopano - apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) ndi dabigatran (Pradaxa) - akhala akugwiritsidwa ntchito kwakukulu popeweratu nthawi zonse PE.
Vuto la IVC
Ngati mukukula mobwerezabwereza PE, mungafunike fyuluta kuti iyike mu vena cava yanu yochepa, yomwe ndi mitsempha yaikulu ya m'mimba yomwe imagwirizanitsa mitsempha yanu ya mwendo kumtima wanu. Fyuluta ya IVC ingalowetsenso zitsulo zomwe zingasunthike kuchokera kumitsempha ya miyendo yanu musanapite ku mapapo.
Kutsata Utsogoleri ndi Kukonzanso
Ngati mumakhala ndi PE, mukhoza kukhala ndi zotsatira za nthawi yaitali monga kupweteka kwapopeni kapena matenda a mapapo (imfa) ya gawo la mapapo. Ngati mukukumana ndi mavutowa, mungafunikire kutsatirana ndi katswiri wamapiritsi kuti mpweya wanu uziyang'aniridwa ndikuchitidwa ngati mukufunikira.
Mawu Ochokera
Kuphatikiza maulendo kaŵirikaŵiri kumawoneka mwa anthu omwe ali ndi matenda kapena zochitika zomwe zimapangitsa DVT kukhalapo.
Ngati muli ndi zizindikiro zosonyeza kupuma kwa pulmonary, monga kupweteka kwadzidzidzi, kosadziwika bwino kapweya kapena kupweteka pachifuwa, ndikofunika kuti muwone dokotala nthawi yomweyo.
Kwachidziwikire, kachilombo ka mtundu wa PE ndi kofala kwambiri komwe kamakhala ndi zotsatira zowonjezereka ngati ikuyang'aniridwa ndi chithandizo cha panthawi yake.
> Zotsatira:
> Barbero E, Bikdeli B Chiluiza D. Kuchita Kafukufuku Woyambirira wa Kuyeza Kwachindunji Wodzipereka Amalongosola Zotsatira Zotsatira kwa Odwala ndi Chidziwitso Chodziwika Kwambiri. Thromb Haemost. 2018 Mar 19. Chitani: 10.1055 / s-0038-1637746. [Epub patsogolo pa kusindikiza]
> Bikdeli B, Jiménez D, Kirtane AJ, et al. Kuwongolera mwatsatanetsatane zothandiza ndi chitetezo cha zowonongeka zotsika zotsika vena caval. Tsamba la Thromb. 2018 Mar 17; 165: 79-82. lembani: 10.1016 / j.thromres.2018.03.014. [Epub patsogolo pa kusindikiza]