Mitsempha yakuya

Deep vein thrombosis (DVT) ndichikhalidwe chomwe chimachitika magazi akaundana m'mitsempha mkati mwa gawo lina la thupi. Amakhudza kwambiri mitsempha ikuluikulu m'munsi mwendo ndi ntchafu, koma imatha kupezeka m'mitsempha ina yakuya, monga m'manja ndi m'chiuno.

DVT imakonda kwambiri anthu achikulire azaka zopitilira 60. Koma zimatha kuchitika msinkhu uliwonse. Khola likasweka ndikuyenda m'magazi, limatchedwa kuphatikizika. Kuphatikizika kumatha kukakamira mumitsempha yamagazi muubongo, mapapo, mtima, kapena dera lina, zomwe zimawononga kwambiri.

Kuundana kwa magazi kumatha kupangika pamene china chimachedwetsa kapena kusintha kayendedwe ka magazi m'mitsempha. Zowopsa ndi izi:

• Catheter ya pacemaker yomwe idadutsa mumitsempha yam'mimba
• Kupuma pogona kapena kukhala pamalo amodzi kwakanthawi, monga kuyenda pandege
• Mbiri ya banja yamagazi
• Kupasuka m'mimba kapena miyendo
• Kubereka m'miyezi 6 yapitayi
• Mimba
• Kunenepa kwambiri
• Opaleshoni yaposachedwa (makamaka opareshoni yamchiuno, bondo, kapena chiuno chachikazi)
• Maselo ochulukirapo am'magazi amapangidwa ndi mafupa, ndikupangitsa magazi kukhala okulirapo kuposa zachilendo (polycythemia vera)
• Kukhala ndi catheter wokhalamo (wanthawi yayitali) mumtsuko wamagazi

Magazi amatha kuphimba munthu amene ali ndi mavuto kapena zovuta zina, monga:

• Khansa
• Matenda ena amadzimadzi, monga lupus
• Kusuta ndudu
• Zinthu zomwe zimapangitsa kuti pakhale mwayi wopanga magazi
• Kutenga mapiritsi a estrogens kapena oletsa kubereka (ngozi iyi ndiyokwera kwambiri ndikusuta)

Kukhala nthawi yayitali mukamayenda kumatha kuwonjezera chiopsezo cha DVT. Izi ndizotheka mukakhala ndi chimodzi kapena zingapo mwaziwopsezo zomwe zatchulidwa pamwambapa.

DVT imakhudza kwambiri mitsempha yayikulu pansi pa mwendo ndi ntchafu, nthawi zambiri mbali imodzi ya thupi. Chotsekacho chitha kuletsa kuyenda kwa magazi ndikuyambitsa:

• Kusintha kwa khungu (kufiira)
• Kupweteka kwa mwendo
• Kutupa kwamiyendo (edema)
• Khungu lomwe limamva kutentha kukhudza

Wothandizira zaumoyo wanu adzakuyesani. Mayesowa atha kuwonetsa mwendo wofiira, wotupa, kapena wofewa.

Mayeso awiri omwe nthawi zambiri amachitidwa koyamba kuti apeze DVT ndi awa:

• Kuyesa magazi kwa D-dimer
• Kufufuza kwa Doppler ultrasound komwe kumakhudzidwa

MRI ya m'chiuno imatha kuchitika ngati magazi atsekemera ali m'chiuno, monga pambuyo pathupi.

Kuyezetsa magazi kumatha kuchitidwa kuti muwone ngati muli ndi mwayi wowonjezera magazi, kuphatikiza:

• Kutsegulidwa kwa protein C (kuyang'anira kusintha kwa Factor V Leiden)
• Magulu a Antithrombin III
• Mankhwala a Antiphospholipid
• Kuwerengera kwathunthu kwa magazi (CBC)
• Kuyesera kwa majini kuti muyang'ane kusintha komwe kumakupangitsani kuti mukhale ndi zotupa zamagazi, monga kusintha kwa prothrombin G20210A
• Lupus anticoagulant
• Mapuloteni C ndi milingo ya mapuloteni S

Wopezayo amakupatsani mankhwala ochepetsa magazi anu (otchedwa anticoagulant). Izi zidzateteza kuundana kuti zisapangike kapena zakale kuti zisakulire.

Heparin nthawi zambiri ndi mankhwala oyamba omwe mungalandire.

• Ngati heparin imaperekedwa kudzera mumtsempha (IV), muyenera kukhala mchipatala. Komabe, anthu ambiri amatha kuchiritsidwa osakhala kuchipatala.
• Maselo ochepa a heparin amatha kuperekedwa ndi jakisoni pansi pa khungu lanu kamodzi kapena kawiri patsiku. Simungafunikire kukhala mchipatala nthawi yayitali, kapena ayi, ngati mwapatsidwa mtundu uwu wa heparin.

Mtundu umodzi wa mankhwala ochepetsa magazi otchedwa warfarin (Coumadin kapena Jantoven) atha kuyambitsidwa limodzi ndi heparin. Warfarin amatengedwa pakamwa. Zimatenga masiku angapo kuti zigwire bwino ntchito.

Gulu lina la opopera magazi limagwira mosiyana ndi warfarin. Zitsanzo zamankhwala amtunduwu, omwe amatchedwa anticoagulants (DOAC), amaphatikizapo rivaroxaban powder (Xarelto), apixaban (Eliquis), dabigatran (Pradax), ndi edoxaban (Savaysa). Mankhwalawa amagwiranso ntchito chimodzimodzi ndi heparin ndipo amatha kugwiritsidwa ntchito nthawi yomweyo m'malo mwa heparin. Wothandizira anu adzasankha mankhwala omwe akuyenera.

Muyenera kuti muchepetse magazi kwa miyezi itatu. Anthu ena amatenga nthawi yayitali, kapena kwa moyo wawo wonse, kutengera chiwopsezo cha khungu lina.

Mukamamwa mankhwala ochepetsa magazi, mumakhala ndi magazi ambiri, ngakhale kuchokera pazomwe mwakhala mukuchita kale. Ngati mukumwa magazi ochepera kunyumba:

• Tengani mankhwalawo monga momwe wothandizira wanu adanenera.
• Funsani wothandizirayo zoyenera kuchita mukaphonya mlingo.
• Pezani mayeso a magazi monga wolangizira wanu akuwonetserani kuti mukumwa mlingo woyenera. Mayesowa nthawi zambiri amafunikira ndi warfarin.
• Phunzirani kumwa mankhwala ena ndi nthawi yoti mudye.
• Pezani momwe mungayang'anire mavuto obwera chifukwa cha mankhwala.

Nthawi zambiri, mungafunike kuchitidwa opaleshoni m'malo kapena kuwonjezera ma anticoagulants. Kuchita opaleshoni kungaphatikizepo:

• Kuyika fyuluta mumitsempha yayikulu mthupi kuti muteteze magazi kuundana m'mapapu
• Kuchotsa khungu lalikulu lamagazi mumtsempha kapena jakisoni mankhwala osokoneza bongo

Tsatirani malangizo aliwonse omwe mwapatsidwa kuti muchiritse DVT yanu.

DVT nthawi zambiri imapita popanda vuto, koma vutoli limatha kubwerera. Zizindikiro zimatha kuonekera nthawi yomweyo kapena mwina simungakhale nazo kwa zaka 1 kapena kupitilira apo. Kuvala masitonkeni panthawi ya DVT komanso pambuyo pake kungathandize kupewa vutoli.

Zovuta za DVT zitha kuphatikiza:

• Kupha kwapulmonary embolism (magazi amatundumukira ntchafu amatha kusiya ndikupita kumapapu kuposa magazi am'magazi kapena ziwalo zina za thupi)
• Kupweteka kwanthawi zonse ndi kutupa (post-phlebitic kapena post-thrombotic syndrome)
• Mitsempha ya Varicose
• Zilonda zosachiritsa (zochepa)
• Kusintha kwa khungu

Itanani omwe akukuthandizani ngati muli ndi zizindikiro za DVT.

Pitani kuchipinda chodzidzimutsa kapena itanani nambala yadzidzidzi yakomweko (monga 911) ngati muli ndi DVT ndipo mukukula:

• Kupweteka pachifuwa
• Kutsokomola magazi
• Kuvuta kupuma
• Kukomoka
• Kutaya chidziwitso
• Zizindikiro zina zoopsa

Kupewa DVT:

• Sungani miyendo yanu nthawi zambiri mukamayenda maulendo ataliatali, mukakwera galimoto, ndi zina zomwe mukukhala kapena kugona kwa nthawi yayitali.
• Tengani mankhwala ochepetsa magazi omwe woperekayo akukupatsani.
• Osasuta. Lankhulani ndi omwe akukuthandizani ngati mukufuna thandizo kuti musiye.

Kufotokozera Magazi kuundana m'miyendo; Thromboembolism; Matenda a post-phlebitic; Matenda a post-thrombotic; Wokondedwa - DVT

• Mitsempha yakuya - kutulutsa
• Kutenga warfarin (Coumadin, Jantoven) - zomwe mungafunse dokotala wanu
• Kutenga warfarin (Coumadin)

• Thrombosis kwambiri venous - iliofemoral
• Mitsempha yakuya
• Kutsekeka kwamagazi
• Mitsempha yakuya
• Vousous thrombosis - mndandanda

Kearon C, Akl EA, Ornelas J, et al. (Adasankhidwa) Thandizo la Antithrombotic la matenda a VTE: Malangizo a CHEST ndi lipoti la akatswiri. Pachifuwa. 2016; 149 (2): 315-352. (Adasankhidwa) PMID: 26867832 pubed.ncbi.nlm.nih.gov/26867832/.

Kline JA. Kuphatikizika kwa pulmonary ndi thrombosis yakuya yamitsempha. Mu: Makoma RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018: mutu 78.

Lockhart ME, Umphrey HR, Weber TM, Robbin ML. Zotengera zotumphukira. Mu: Rumack CM, Levine D, eds. Kuzindikira Ultrasound. 5th ed. Philadelphia, PA: Elsevier; 2018: mutu 27.

Siegal D, Lim W. Venous thromboembolism. Mu: Hoffman R, Benz EJ, Silberstein LE, et al, olemba. Hematology: Mfundo Zoyambira ndi Zochita. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2018: mutu 142.