Kuphatikizika pang'ono

Kuphatikizika kwamitsempha kumatanthauza chovala (embolus) chomwe chimachokera ku gawo lina la thupi ndipo chimayambitsa kusokonezeka kwadzidzidzi kwa magazi kulowa m'chiwalo kapena gawo lina la thupi.

"Embolus" ndi magazi kapena chidutswa cha chipika chomwe chimakhala ngati magazi. Mawu oti "emboli" amatanthauza kuti pali chipilala chimodzi kapena chidutswa chimodzi. Clot ikamayenda kuchokera pomwe idapangidwira kupita kwina m'thupi, imatchedwa embolism.

Kuphatikizika kwamphamvu kumatha kuyambitsidwa ndi kuundana kumodzi kapena zingapo. Mitsempha imatha kukwera mumtsempha ndikuletsa magazi. Kutsekeka kumafera njala zamagazi ndi mpweya. Izi zitha kubweretsa kuwonongeka kapena kufa kwa minofu (necrosis).

Zojambula zam'mimba nthawi zambiri zimachitika m'miyendo ndi m'mapazi. Emboli zomwe zimachitika muubongo zimayambitsa sitiroko. Zomwe zimachitika mumtima zimayambitsa matenda amtima. Malo osadziwika kwambiri ndi impso, matumbo, ndi maso.

Zowopsa zakuyimba kwamphamvu ndizophatikizira:

• Nyimbo zosadziwika bwino monga matenda a atrial fibrillation
• Kuvulala kapena kuwonongeka kwa khoma lamitsempha
• Zinthu zomwe zimapangitsa kuti magazi aziundana

Vuto lina lomwe limayika pachiwopsezo chachikulu (makamaka kuubongo) ndi mitral stenosis. Endocarditis (matenda amkati mwa mtima) amathanso kuyambitsa mitsempha yamagazi.

Gwero lofala la embolus limachokera kumalo owumitsa (atherosclerosis) mu aorta ndi mitsempha ina yayikulu yamagazi. Kuundana kumeneku kumatha kumasuka ndikutsikira mpaka miyendo ndi mapazi.

Kuphatikizika kumatha kuchitika pomwe chovala mumitsempha chimalowa mbali yakumanja kwa mtima ndikudutsa pa bowo kumanzere. Chovalacho chimatha kusunthira kumtunda ndikuletsa magazi kupita kuubongo (stroke) kapena ziwalo zina.

Ngati gulu likuyenda ndikulowa m'mitsempha yopatsira magazi m'mapapu, amatchedwa pulmonary embolus.

Simungakhale ndi zizindikiro zilizonse.

Zizindikiro zimatha kuyamba mwachangu kapena pang'onopang'ono kutengera kukula kwa mimbayo komanso kuchuluka kwake komwe kumatseka magazi.

Zizindikiro za kuphatikizika kwam'mimba kapena miyendo zimatha kuphatikizira:

• Dzanja lozizira kapena mwendo
• Kutsika kapena kuchepa kwa dzanja kapena mwendo
• Kusasuntha m'manja kapena mwendo
• Ululu m'dera lomwe lakhudzidwa
• Dzanzi ndi kumva kulasalasa m'manja kapena mwendo
• Mtundu wotumbululuka wa mkono kapena mwendo (pallor)
• Kufooka kwa mkono kapena mwendo

Zizindikiro zamtsogolo:

• Matuza a khungu omwe amadyetsedwa ndi mtsempha wokhudzidwa
• Kukhetsa (kutsetsereka) kwa khungu
• Kukokoloka kwa khungu (chilonda)
• Imfa yaminyewa (necrosis; khungu ndi mdima ndipo lawonongeka)

Zizindikiro za chotsekemera m'thupi zimasiyanasiyana ndi chiwalo chomwe chimakhudzidwa koma chingaphatikizepo:

• Kupweteka mu gawo la thupi lomwe likukhudzidwa
• Kuchepetsa kwakanthawi kwa ziwalo

Wothandizira zaumoyo atha kupeza kutaya kapena kuchepa kwa magazi m'manja kapena mwendo. Pakhoza kukhala zizindikiro zakufa kwa mnofu kapena zilonda.

Kuyesa kuti mupeze zovuta zazing'ono kapena kuwulula komwe amachokera kumaphatikizira:

• Zithunzi za kumapeto kapena chiwalo chokhudzidwa
• Doppler ultrasound kuyesa kumapeto
• Duplex Doppler ultrasound kuyesa kumapeto
• Zojambulajambula
• MRI ya mkono kapena mwendo
• Myocardial kusiyanasiyana echocardiography (MCE)
• Chidziwitso
• Transcranial Doppler kuyesa kwa mitsempha yopita ku ubongo
• Transesophageal echocardiography (TEE)

Matendawa amathanso kukhudza zotsatira za mayeso otsatirawa:

• D-dimer
• Factor VIII kuyesa
• Kuphunzira kwa Isotope kwa chiwalo chokhudzidwa
• Plasminogen activator inhibitor-1 (PAI-1) zochitika
• Mayeso ophatikizira ma Platelet
• Maselo amtundu wa plasminogen activator (t-PA)

Kuphatikizika kwamitsempha kumafunikira chithandizo mwachangu kuchipatala. Zolinga zamankhwala ndikuwongolera zizindikiritso ndikusintha magazi omwe asokonekera kudera lomwe lakhudzidwa. Choyambitsa chovalacho, ngati chikupezeka, chikuyenera kuthandizidwa kupewa mavuto ena.

Mankhwala ndi awa:

• Maanticoagulants (monga warfarin kapena heparin) amatha kuteteza kuundana kwatsopano
• Mankhwala antiplatelet (monga aspirin kapena clopidogrel) amatha kuteteza kuundana kwatsopano
• Opweteka operekedwa kudzera mumtsempha (mwa IV)
• Thrombolytics (monga streptokinase) imatha kusungunuka kuundana

Anthu ena amafunika kuchitidwa opaleshoni. Ndondomeko zikuphatikizapo:

• Kulambalala kwa mtsempha wamagazi (kulowera kwam'mimba) kuti mupange gwero lachiwiri la magazi
• Kutsekedwa kwa khungu kudzera mu kabati kachetter kamene kamaikidwa mumtsempha wokhudzidwa kapena kudzera mu opaleshoni yotseguka pamitsempha (embolectomy)
• Kutseguka kwa mtsempha wamagazi wokhala ndi kabati catheter (angioplasty) wokhala ndi kapena wopanda stent

Momwe munthu amagwirira ntchito zimadalira komwe khungu limagona komanso kuchuluka kwa khungu lomwe lalepheretsa kutuluka kwa magazi komanso kutalika kwa kutsekeka. Kuphatikizika kwamitsempha kumatha kukhala koopsa ngati sichichiritsidwa mwachangu.

Malo okhudzidwawo akhoza kuwonongeka kwamuyaya. Kudulidwa kumafunikira mpaka 1 pamilandu 4.

Mitsempha yamagazi imatha kubwerera ngakhale mutalandira chithandizo chabwino.

Zovuta zingaphatikizepo:

• MI yovuta
• Matenda m'matenda okhudzidwa
• Kusokonezeka
• Chilonda (CVA)
• Kuchepetsa kwakanthawi kapena kosatha kapena kutayika kwa ziwalo zina
• Kusakhalitsa kwa impso kosatha
• Imfa ya minofu (necrosis) ndi chilonda
• Kuukira kwanthawi yayitali (TIA)

Pitani kuchipinda chodzidzimutsa kapena itanani nambala yadzidzidzi yakomweko (monga 911) ngati muli ndi zisonyezo zamankhwala osokoneza bongo.

Kupewa kumayambira ndikupeza komwe kumapezeka magazi. Omwe amakupatsirani mankhwala amatha kupereka mankhwala ochepetsa magazi (monga warfarin kapena heparin) kuti ateteze magazi kuundana. Mankhwala osokoneza bongo amafunikanso.

Muli ndi chiopsezo chachikulu cha atherosclerosis ndi kuundana ngati:

• Utsi
• Musamachite masewera olimbitsa thupi pang'ono
• Khalani ndi kuthamanga kwa magazi
• Mukhale ndi mafuta osadziwika bwino
• Khalani ndi matenda ashuga
• Ndi onenepa kwambiri
• Amapanikizika

• Kuphatikizika pang'ono
• Njira yoyendera

Aufderheide TP. Matenda a m'mitsempha yamitsempha. Mu: Makoma RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018: chap 77.

Gerhard-Herman MD, Gornik HL, Barrett C, ndi al. Chitsogozo cha AHA / ACC cha 2016 pakuwongolera odwala omwe ali ndi zotumphukira zam'munsi zam'mimba: chidule chachikulu: lipoti la American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. J Ndine Coll Cardiol. 2017; 69 (11): 1465-1508. (Adasankhidwa) PMID: 27851991 pubed.ncbi.nlm.nih.gov/27851991/.

Goldman L. Njira kwa wodwala yemwe ali ndi matenda amtima. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. 26 wa. Philadelphia, PA: Elsevier; 2020: chap 45.

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.

Wyers MC, Martin MC. Matenda oopsa a mesenteric. Mu: Sidawy AN, Perler BA, olemba. Rutherford Opaleshoni ya Mitsempha ndi Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019: chap 133.