Zviratidzo zvepermonary emboli-blockckages mu arteriyuta kumapapu anowanzokonzerwa neropa-inogona kusiyana zvikuru. Zvichienderana nehuwandu hwemapapu ako hunobatanidzwa uye ukuru hwekuvhara, iwe unogona kuwana zvimwe zviratidzo nezviratidzo, zvakadai sezvinotevera:
- kusuruvara kwepakarepo kunowedzera kuwedzera nekuedza
- Hurwa hupfuyo hunogona kuipa kana iwe ukafema zvikuru
- Marwadzo paunenge uchikanda, kudya, kukotama, kana kumira
- Urombo hunotambudza nekurovedza muviri asi hahusi zvachose kana uchizorora
- Chikoro, chinogona kukonzera mucus inouraya
Zvimwe zviratidzo nezviratidzo, zvinogona kusanganisira zvinotevera:
- Kuchema kwemakumbo kana kuzvimba, kana maviri, kazhinji mumhuru
- Ganda rinoputika kana bhuu-yakagadzirwa ganda
- Fever
- Sweating
- Kukurumidza kana kusina kukanganisa mwoyo
- Lightheadedness kana chirwere
Chii Chiri Kuitika Panguva Yechipupuriro Chomupulmonary?
Munguva yepermon embolism kana PE , inonyanya kuitika ndeyekuti ropa rinoputika rinobva pamwoyo kusvika kumapapu, kuburikidza nemapuraneti . Iyo mapirinari arteri mapazi ekupa ropa kumapapu ose nemagazi eropa zvinogona kuiswa panzvimbo dzakasiyana-siyana dziri munzira, mumidziyo inoisa ropa kumapapu. Kana ropa rakavhara rakakura zvakakwana, rinogona kubatika uye rinodzivisa zvachose mudziyo mukuru, unogona kutyisa upenyu. Izvo zvinogonawo kuti ropa rinenge riri duku zvokuti rinowanzoenda risingaoneki, zvichiita kuti chikamu chiduku chemapapu chive nemigumisiro yaro.
Kuongorora nekurapa
Kuongororwa kwakasiyana-siyana kunogona kuitwa kuti uongorore mishonga yemapulmonary emboli, kusanganisira ventilation-perfusion scan, D-dimer, kana pulmonary angiogram.
Mishonga yemapurmonary emboli inobva paukuru uye huwandu hwenhizha. Kana zviratidzo zvisiri zvakanyanya, ropa rakapfava rinogona kushandiswa uye rinodzivirira kudzivirira humwe huripo hunosimudzwa hunoti hutorwa.
Pamakwenzi makuru, mazamu akaoma, mishonga inoputika semashonga yakafanana neaya anoshandiswa kuzarura midziyo yemwoyo panguva yekurwisa kwemoyo ingashandiswa.
Nei Varwere Vane Kanzera Vari Panjodzi Nokuda Kwokuumbwa Kwemhepo?
Apo masayendisiti anotsvaga njodzi yePV, vanoona sangano rose rezvirwere izvo zvinowanzoisa munhu kuti ave nazvo. Iko kuti, mapepa ndeimwe yezviitiko zvakasiyana siyana zvinogona kuitika kana munhu achiwedzera ropa mumakumbo avo, chirwere chinonzi seousous thromboembolism , kana VTE.
Inofananidzwa nehuwandu hwevanhu, chiitiko cheVTE uye PE yakanyanya kune varwere vane kenza; chirwere chekenza chirwere chinenge kachina kana zvichida kuti chive nechirwere chepromboembolism, chinosanganisira zvose zvemapurmoni embolism uye yakadzika yepinein thrombosis. Mvura yakadzika inonzi thrombosis, kana kuti DVT, inoreva zvakananga kuvhara ropa iro rinoita mumvura yakaipa, kazhinji mumakumbo, asi inogonawo kuitika kune imwe nzvimbo. Kugadzikana kwakaoma zvikuru kweDVT kunoitika kana chikamu chevhavha chichibuda uye ichifamba nenzira yeropa kusvika pamwoyo uye zvakare mapapu , zvichiita kuti kuvharwa kunzi seP PE. Iwe unogona kuva ne PE asi usina DVT, zvisinei.
Nenzira yakawanda, idzi mabheti eropa anogona kuumba mumuviri wako mukati mevheti yezvikonzero zvakasiyana-siyana, kusanganisira zvinotevera:
- Kukuvadza kwemukati wehomwe yemukati
- Kukuvadza kumapfupa anokonzerwa nehuviri, chemakemikari, kana zvipenyu
- Kuva nekuvhiyiwa, kuchengetedza kukuvara kwakakomba, kuva nechirwere kana chirwere chinokonzera kutuka, uyewo mamwe maitiro ezvirwere zvemuviri
- Chirwere kana mamiriro ekuyerera kweropa kunonoka, sezvakaitwa mushure mekuvhiyiwa, kana panguva yekurara kwenguva yakareba, kana panguva yendiza refu paunenge uchifamba
- Mimwe mamiriro ezvinhu anoita kuti ropa rako rive rakakura kana kuti rinogona kuvhara kupfuura rinowanzoitika
- Zvimwe zvizvarwa zvakagara nhaka, somuenzaniso, zvinokonzera V Leiden, izvo zvinowedzera dambudziko rako rekuvhara ropa
- Utachiona hweHormone kana mapiritsi ekuberekwa
Kuvhara uye Kuchenesa Muvarwere Nekenza
Ropa reropa rinowanzoonekwa nevarwere vane kenza, uye vanorwara nekenza vangave vari mukana wekuvhara ropa kwezvikonzero zvakasiyana-siyana, kusanganisira kenza, pachayo, uyewo marapirwo akasiyana-siyana echepenza. Chemotherapy, therapy radiation, uye hormone therapy zvose zvinowedzera dambudziko rekuvhara ropa.
Zvinogona kuoneka sechinyorwa, asi kushungurudzwa kweropa kunogonawo kuva kwakajairika kune vanhu vane kenza yeropa. Izvi zvinogona kunzwisiswa sezvizvi: kazhinji, kana pane dambudziko nehurongwa hwekuvhara muviri, munhu angave pangozi yekubuda ropa zvakanyanya kana kuvhara, zvichienderana nemamiriro ezvinhu.
Basa Rokuvhara-Kuchengetedza Mishonga
Kwose-kudzivirira-kurapa mishonga hakukurudzirwi mune zvekunze nekenza, kunyanya avo vanoonekwa vari pangozi yeVTE; zvisinei, kune avo vari pangozi yeVTE uye kune avo vane myeloma vanowana zvinodhaka zvinonzi immunomodulators, zvakadai semishonga yekudzivirira-chevha inogona kuongororwa, maererano nenyanzvi dzemakadzi.
Ikozvino maitiro ekutarisira chimwe chinhu chinonzi low-molecular-weight heparin (LMWH), iyo inoda injections. Zvimwe, vatsva vanopfuvura ropa vanowanikwa, asi kune uchapupu hushoma hwekuti vanachiremba vafunge apo pavanenge vachifunga kuita shanduko kubva kuLMWH kune rimwe remashoko aya.
Mune kumwe kuongorora kwechangobva kuitika, apo yakapiwa sarudzo yekufungidzira yeLMWH maererano nesimbi yemuromo yakaenzana nekubudirira, vazhinji vanorwara nekenza zvinonzwisisika vakasarudza muromo wemuromo. Nyanzvi dzinoti, zvisinei, kuti chisarudzo chekushandura chinoda kunyatsoongorora kubatana pakati pemukirwere wevarwere nekodzero yehutano, nevanowanzoita zvinorwara.
PE / VTE mune varwere neCheccer Blood Cancers
Zvidzidzo zvepakutanga zvakaratidza kuti mishonga yakasimba yakadai sekenza yepabonde nemukenza wemapapu,, kazhinji, inogona kuwedzera njodzi yeropa reropa pane yeropa reropa, rinosanganisira leukemia , lymphoma, uye myeloma. Pakave nedzimwe dzidzo kubva pane izvo zvinopesana nepfungwa iyi, zvisinei, uye zvinogona kunge zviri iyo iyo mhando dzekenza yeropa uye nemunhu umwe neumwe unorwara zvinokanganisa ngozi yako nenzira dzinokosha.
Varwere Vakwegura Vanopindwa Muropa NezveMyeloid Leukemia
Chimwe chidzidzo chakabudiswa muna 2016 chakaratidza kuti varwere vakwegura vane CML vakanga vane huwandu hwehuwandu hweEV kupfuura varwere vasina kenza, iyo yakanga isingashamisi, sezvo kenza, kazhinji, inofungidzirwa kuwedzera matambudziko ekuvhara. Izvo zvinokonzera matambudziko ekudzivirira hazvina kuwedzera muboka revarwere vanotora zvinodhaka zvinonzi tyrosine kinase inhibitors (kunyanya imwe inonzi imatinib), asi, vachiratidza kuti njodzi mune varwere ava vane CML yakanyatsotungamirirwa nezvikonzero zvinokonzerwa nekenza uye kwete kurapwa.
Childhood Acute Lymphoblastic Leukemia
Kubatana kwepulmonary muhuduku hahuwanzozivikanwa, asi kuva nechirwere (sekudai neukemukemia) kunogona kuwedzera njodzi yeVTE uye PE muvana. Dambudziko guru rezviitiko zveVTE uye PE rinosanganisira catheter inowanikwa pakati, malignancies, uye chemotherapy. VTE inowanikwa muna 2.1-16 kubva muzana yevana vane kenza, asi nhamba yehutano yeCatheter-yakabatana neVTE inotangira kubva pa2.6 kusvika ku36.7 muzana.
Zvakawanda zvehupupuri hweEV muvana vane kenza zvinotarisa kune varwere vane ALL, iyo yakajairika yakawanda yevana. Meta-kuongororwa kwevana vane leukemia yakashuma VTE mu5.2 muzana yevana vane HOSE, asi zviyero zvakataurwa zvakabva pa1 kusvika ku 36 muzana. Kunyanya, kushandiswa kweL-asparaginase, pamwe chete nechemotherapy regimen kusanganisira anthracycline, vincristine, uye steroid, yakagadzira acute lymphocytic leukemia (ALL) chirwere chinoporesa, zvikurukuru muvana-asi chinogonawo kubatanidza nehuwandu hwekuita kweVTE , saka mishonga inodzivirira kuvhara ropa inogona kupiwa kuderedza dambudziko iri.
Acute Promyelocytic Leukemia, Rudzi rwe AML
Kuenzaniswa nekubuda ropa, kukuru kwekuvhara ropa ibasa rakawandisa kune varwere vane acute promyelocytic leukemia, rudzi rushoma rwe AML. Uyu muenzaniso wakanaka wekenza yeropa umo maitiro ehutano emumuviri anokanganisa, kazhinji anotungamirira kubuda ropa, asiwo pamwe nekukwanisa kuvhara. Varwere vane acute promyelocytic leukemia vangaenda kunechiremba vane matambudziko ane kubuda ropa sezvakaita nosebleed izvo zvisingatongogumi, kana kutemwa kusingazoregi. Asi vanogonawo kuva nemhuru yekudzivirira kubva kuDVT, kana kurwadziwa kwepfuva uye kupfupika kwepfupa kubva muropa rekuvhara mumapapu kana PE.
Kuchengetedza Ngozi muAukemia uye Lymphoma
Chidzidzo chePetterson uye vashandi pamwe chete vakaparidzirwa muna 2015 vakaratidza kuti marudzi ose ekenza anowedzera kuwedzera kungozi yeVTE uye kuti huwandu hwehuwandu hwehuwandu hwehutachiona hunosiyana kune zvikamu zvakasiyana-siyana zvekenza; mune iyi yekudzidza, njodzi yakanyanya kuderera yeVTE yakaonekwa nemusoro uye mutsipa makondombera (4.1x) uye pangozi yakanyanya kuonekwa nekenza yepfungwa (47.3x).
Apo boka iri revanotsvakurudza rakaedza kurongedza maitiro akasiyana-siyana kuti vawane pfungwa yekutengesa kweVTE mu lymphoma (maererano nezvimwe zvirwere), vakaona njodzi yacho yakanyanya kuwedzera pakati pevarwere ve lymphoma.
Lymphoma yakanga iri pakati pezvikamu zvina zvekenza uye kunyanya kuwedzerwa njodzi yeVTE, sezvinotevera:
- Kenza yebongo
- Kenza yepancreatic
- Zvimwe zvinokonzera kudya (esophagus, small intestine, gallbladder, uye bile system)
- Lymphoma
Varwere vane leukemia vakawanikwa vari pakati pengozi munyaya ino.
Pamusoro pezviitiko makumi matatu nematatu zvezviitiko zvinokonzera lymphoma uye 18 zviitiko zvinokonzerwa neukemikari inoshanda mukati mechidzidzo ichi, 14 kubva pazana makumi mashanu (28 muzana) yaive nechepakati yemakateti mukati memwedzi mitatu isati yasvika muitiko weVTE. Zviitiko zvizhinji zvezviitiko zvinokonzerwa neukemikari yakagadzikana ine chronic lymphocytic leukemia (11 kubva pa18, kana 61 muzana), iyo isingawanzobatwa neL-asparaginase, inozivikanwa pangozi yeVTE.
Shoko Rinobva
Zvakakosha kuziva kuti, sechirwere chepachirwere, unogona kunge uri pangozi yakakura yezvinetso neropa remakumbo zvakadai seplmm embolism. Zvisinei, zvinokosha zvakare kuisa dambudziko iri nemaonero. Kakawanda, mikana yekudzidzira embolism yemapummine ichiri pasi.
Kunyange zvazvo kugamuchira kurapwa kuburikidza nekakati catheter yemhepo inogona kuwedzera njodzi ye PE / VTE, kurapa kwakadaro kunogona kuponesa upenyu kune varwere vakawanda vane kenza. Vanachiremba vanoziva nezvezviitiko zveVTE / PE mukuratidzwa kwakasiyana-siyana kwekenza yeropa, uye nemishonga yakasiyana-siyana uye mazano. Sezvo uri murwere akadzidziswa, zivo yako yezviratidzo zve PE / VTE uye kukangwarira kwako kunogona kubatsira chiremba wako kuita nekukurumidza, kana kudiwa kuchika.
> Sources:
> Horsted F, West J, Grainge MJ. Ngozi yehutachimbolism inousous muvarwere vane kenza: kurongeka kwekuongorora uye meta-analysis. PLoS Medicine . 2012; 9 (7): e1001275.
> Ko RH, Thornburg CD. Zvinokonzerwa nehupromboembolism mune vana vane kenza uye zvinetso zveropa. Front Pediatr. 2017; 5: 12.
> Ku GH, White RH, Chew HK, et al. Zvinokonzerwa nevepromboembolism kune varwere vane acute leukemia: zviitiko, zvinokonzera njodzi, uye zvinokonzera kupona. Ropa . 2009; 113 (17): 3911-3917.
> McCulloch D, Brown C, Iland H. Retinoic acid uye arsenic trioxide mukurapa kwekukurumidza promyelocytic leukemia: maonero aripo. Onco Targets Ther. 2017; 10: 1585-1601.
> Petterson TM, Marks RS, Ashrani AA, Bailey KR, Heit JA. Ngozi yekenza-yakanangana nekenza mune zvinokonzera thromboembolism yakawanda: chidzidzo chevanhu. Thromb Res . 2015; 135 (3): 472-478.
> Shinagare AB, Guo M, Hatabu H, et al. Kushandiswa kwepermonary embolism mu oncologic outpatients pamusana wekenza yepamusoro. Cancer . 2011; 117 (16): 3860-3866.
> Smrke A uye Gross PL. Cancer-inosangana neveousous thromboembolism: chiitiko chinoshanda pane zvishoma-masero-weight heparins. Front Med (Lausanne). 2017; 4: 142. Yakabudiswa paIndaneti 2017 Aug 28. nei: 10.3389 / fmed.2017.00142.
> Sorà F, Chiusolo P, Laurenti L, et al. Mapurisa makuru anogamuchirwa pakutanga kweacute promyelocytic leukemia. Mediterr J Hematol Yakakwana Dis 2016; 8 (1): e2016027.
> Lang K, McGarry LJ, Huang H, et al. Kufa uye zviitiko zvevascular pakati pevakwegura vakwegura vane chronic myeloid leukemia: a retrospective kuongorora sangano reSeer-Medicare rakabatana. Clin Lymphoma Myeloma Leuk. 2016; 16 (5): 275-285.e1.