Chirongwa chepulmonary (PE) chinokonzerwa neropa rinoputika mumasitoriyamu arteri , ropa guru rinotungamirira mapapu, kana rimwe rematavi aro. Kazhinji, PE inowanikwa apo ropa rinoputika mumakumbo, chirwere chakasimba chevhutu (DVT), kuputika uye kufamba kune mishonga yeropa yemapapu. Zviratidzo zveprommoni embolism dzinosanganisira dambudziko rokufema, kurwadziwa kwepfupa, nekukandira ropa.
Vanhu vazhinji vanovandudza nekurapwa, asi kusvika 30 muzana yevaya vasina kutendeuka PE havaiti. Nekurapwa, hutachiwana hwehutano hwakapoteredza 5 muzana.
Zviratidzo
Iyo mishonga yemapurmita ine basa rinokosha rokutakura ropa kumapapu kuti azadzike nemhepo, saka kuvhiringidzwa kweropa kunopinda mukati meiyo mudziyo weropa kunokanganisa mapapu nemwoyo, uye zvinounza zviratidzo zveakisijeni yakadzika mumuviri wose.
Zviratidzo zvinowanzozivikanwa zveprommonary embolism ndeizvi:
- Kupfupika kwemhepo, iyo inotanga kamwe kamwe, kazhinji mukati memasekondi mashomanana e PE
- Pakarepo, kurwadziwa kwepfupa kwakanyanya
- A chifukidziro
- Kuchema ropa
- Pleuritic chest pain, iyo chirwere chepfupa chakanyanya kuipa apo iwe unotora mweya
- Wheezing
- Kutsika kweropa, kuwedzera kwemwoyo, kukurumidza kufema
- Chimiro chebhuruu kana chitema chemiromo neminwe
- Cardiac arrhythmias (mwoyo rhythm irregularities), yakadai seyetrial fibrillation , uye zviratidzo zvakabatana kana zvinokonzera kukuvadza (semuviri werufu, kurasika kwekuziva)
- Zviratidzo kana zviratidzo zveDVT mune rimwe kana makumbo maviri
Kuoma kwemaprommoni embolism inowanzotariswa nehukuru hwevharo. Kana mishonga inoputika yakakura, nyaya yacho inowanzotsanangurwa sehukuru PE. Izvi zvinogona kukonzera kuvhara kwemishonga yemapurmita, zvichiita kuti munhu aoremerwe nehutano hwemwoyo, kudonha kunopisa muropa, uye kudonha kwakanyanya mumhepo yeakisi yeropa, kana kuti kushaya oxygen iyo inokanganisa uropi uye muviri wose.
Chimwe chidiki chinokonzerwa nemapurmone chinokonzera zviratidzo zvishoma kudarika asi ichiri chirwere chekukurumidzira chinogona kuuraya kana chikasatorwa. Zvishoma zvishoma ropa rinowanzovhara rimwe rematavi maduku emushonga wepammonary uye rinogona kuvhara zvachose mudziyo muduku wemapurmonary, pakupedzisira uchitungamirira kumapurumine infarction , rufu rwechikamu chemapapu emapapu.
Zvinokonzera
Ivhapa reropa, rinonzi thromboemboli , rinogadzira PE rinowanzokonzerwa neDVT mumvura yepamusoro yekumera kana mahudyu.
DVT uye Makomba
Inofungidzirwa kuti vanenge 50 muzana yevanhu vane DVT vasina kutongerwa vachawana chirongwa chemapummoni.
Utumbi hwemuviri hwakagadzirirwa nenzira inoita kuti DVTs iwane nyore kupinda mumapapu. Mitsipa mumakumbo, apo DVTs inowanzogadzira, kuungana pamwechete sezvo ropa rinodzokera kurutivi rworudyi rwemoyo kuburikidza nemuviri mukuru, inferior vena cava (IVC). Kubva kurudyi rwomwoyo, ropa rinotungamira kumapapu kuburikidza nemapiritsi emapuraneti kuti avandudze kugovera kwomweya. Sezvo ropa rinoputika mumvura mumakumbo mumakumbo kusvika pamwoyo, yese yemidziyo yeropa, kusanganisira iyo yemwoyo, yakakura kudarika mutsvo mumakumbo. Apo ropa rinopinda mumapapu, zvisinei, midziyo inowedzera zvishoma nezvishoma, uye apa ndipo panovhara mazamu mune rimwe remapiritsi emapinmoni, anotungamirira ku PE.
Aya mavhavha eropa anogona kuvharirwa mune chero yemidziyo yeropa yemapapu. Zviduku zviduku zveropa zvinogona kuiswa mumidziyo miduku yeropa yemapapu. Mabheti makuru eropa anowanikwa mumidziyo yakawanda yeropa, inopesana nemakapu ekukwanisa kukonzera ropa zvakakwana kuti ishandiswe mumuviri wose, pamwe nemigumisiro yakaipa.
Kugadziriswa Kwekuumba Kuwedzerwa Kwakawanda Blood Clots
Vanhu vakawanda vane PE, vane kana vasina DVT yakatarisana, vane mamiriro ekurapa kana mamiriro ezvinhu ane chokuita nekuvhara ropa kusina kunaka. Zvinonyanya kukonzera uye njodzi dzinokonzerwa neropa rekuvhara ropa ndezvi:
- Kusagadzikana pamusana pomuviri wechirwere, kubhedha kwemazuva akawanda, kana kupararira
- Anogara kwenguva yakareba kwenguva yakareba panguva yekutasva motokari refu kana ndege ndege ndege
- Nhoroondo yemapurmoni yapfuura embolism
- Nhoroondo dzekare dzakatema ropa, dzakadai seDVT, kurohwa, kana kuora mwoyo
- Dambudziko rekuvhara ropa
- Kusvuta
- Nhoroondo yekenza uye / kana kushandisa chemotherapy
- Nhoroondo yekuvhiyiwa
- Kuputika kwepfupa, kunyanya femur (chidya) bone
- Kuwedzera muviri
- Hormone therapy (kusanganisira hormone replacement therapy)
- Kuberekwa kwepiritsi inoshandiswa
- Kubata kana kutora pamuviri mutsva
Kuziva
Kuongororwa kwePV kunotanga nekliniki yekuongororwa kwechiremba uye zvino inogona kusanganisira kuongororwa kwakaenzana kunogona kutsigira, kusimbisa, kana kusabvisa kuongororwa kwe PE.
Clinical Assessment
Nhanho yekutanga mukuona kuti PE ndeyekufungidzira kwachiremba wako kana iwe mukana wako wekuve wakakwirira kana kuti wakaderera. Chiremba wako anoita izvi kuenzanisa nekuita nhoroondo yezvokurapa zvakanyatsonaka, kuongororwa nezvengozi yako yeDVT, kuita chiitiko chekuongorora, kuenzanisa kukosha kweokisijeni muropa rako, uye zvichida uchiedza kuedza kuongorora DVT.
Noninvasive Tests
Mushure mekuongororwa kwachiremba wako, iwe unogona kuedza kuongororwa, zvakadai sekuongororwa kweropa kana kuenzanisa.
- D-dimer muedzo: Kana mikana yako yeP PE inofungidzirwa kuti yakaderera, chiremba wako anogona kuraira kuedza kweD-dimer . Chiyero cheD-dimer chiratidzo cheropa chinotarisa pasinei nekuve kwemaitiro asina kukodzera ekugadzirisa ropa muropa rako, izvo zvinotarisirwa kana uine DVT kana PE. Kana kliniki yehutachiwana yePV yakaderera uye D-dimer yako kuedza haina kunaka, PE inogona kubudiswa kunze, uye chiremba wako acharamba achifunga zvimwe zvinokonzera zviratidzo zvako.
Kana mukana wako weP PE unotongwa kuti wakakwirira, kana kuti D yako yeD-dimer inobatsira, saka kazhinji kana V / Q scan (ventilation / perfusion scan) kana CT scan yebhokisi iri kuitwa.
- V / Q scan: AV / Q scan is map lung scan that uses a radioactive dye, injected into a vein, to evaluate the flow of blood in your lung lungs. Kana kushanyira mishonga yemapurisa yakadzivirirwa nechigunwe, chikamu chinowirirana chemapapu chinogamuchira zvishoma kudarika chiyero chemavara anogadziriswa.
- CT kuongorora: CT scan isiri isina kuvhiringidzika, yakashandiswa nekodhiyumu inyanzvi iyo inobvumira chiremba wako kufungidzira maitiro ako emapurmoni kuti aone kana iwe uine chigumbuso chinokonzerwa nechigumbuso.
Pulmonary Angiogram
Chirwere chemapurmayimiramu chagara chichionekwa segoridhe yegoridhe yekucherechedza PE, asi maitiro asingabvumirwi anogona kusimbiswa kana kutonga kunze kwekuongororwa. Kana kuongorora kwako kusina kujeka, iwe unogona kunge uine pulmonary angiography.
A pulmonary angiogram chirwere chekuongororwa umo dhayi inorovedzwa kuburikidza nehuputi muchipinda chemapurmonary kuitira kuti chero ropa rinogona kuonekwa pa x-ray. Nokuti pulmonary angiography inguva yakaoma inotyisa inotakura dambudziko rezvinetso, chiremba wako achanyatsocherechedza njodzi uye zvibvumirano asati akurudzira ichi chiedzo kwauri.
Kurapa
Kamwe kuongororwa kweplummum embolus kunoratidzwa, kurapwa kwakatanga nokukurumidza. Kana iwe uine mukana wakareba kwazvo wemapulmoni embolus, chirwere chekurapa chingatangwa kunyange usati wataridzirwa.
Ropa Vanokanganisa - Anticoagulants
Chirwere chikuru chemapurmonary embolus ndechokushandiswa kweanticoagulant zvinodhaka, ropa rakanyanyisa, kudzivirira kuwedzerwa ropa.
Izvo ropa rinopisa rinowanzoshandiswa kurapwa kweE PE ndeye IV (intravenous) heparin kana kuti inobva heparin inogona kupiwa nejasi rinenge riri pasi peganda), rakadai seArixtra, kana fondaparinux. Mhuri yeheparin yezvinodhaka inopa anticoagulant zvinoitika nokukurumidza uye inobatsira kudzivirira mamwe mapfupa eropa kubva pakuumba.
Clot Busters- Thrombolytics
Apo pePi yakakura kana kuti inokonzera kusagadzikana kwemwoyo, anticoagulation therapy haigoni kukwana. Mune mamiriro ezvinhu aya, mashizha ane simba ane simba, anonzi thrombolytics, anogona kujowa kuti aparadze ropa rinoputika. Iyi mishonga, iyo inosanganisira fibrinolytic agents se streptokinase, inotarisirwa kusunungura ropa ravha rinodzivisa arteriyamu arteri.
Thrombolytic therapy inokonzera ngozi yakawanda kudarika kurapa neanticoagulants, kusanganisira pangozi yakakura yekushungurudzika kwakakomba kweropa. Kana iyo mishonga yakakonzera yakaoma zvakakwana kuisa upenyu pangozi, njodzi yekurapa iyi inogona kuderedzwa nezvinobatsira.
Surgery
Kuvhiya inzira inogona kubvisa zvakananga PE. Nzira inoshandiswa pakuvhiya inowanzozivikanwa, inonzi chirongwa chekushandura muviri, inowanzova nengozi uye haisi iyo inoshanda nguva dzose, saka yakachengeterwa vanhu vane mukana wakaoma zvikuru wokupona pasina iyo.
Kutsungirira
Mushure mekutanga kwekutanga kwePE, ungada chirongwa chekugara kwenguva refu chekudzivirira humwe hutachiona hweHIV kuti hurege kuitika, uye iwe unogona kudikanwa kugadzirisa migumisiro ye PE yako kana yakakonzera kukuvara kusingaperi.
Mishonga
Mushure mokunge makagamuchira kurapwa nokukurumidza neropa reAIDS rinopfurikidza kana mujenya we-clot-busting inopindwa, unogona kutora muromo (nemuromo) anticoagulant mishonga kwemwedzi, kana kunyange nemakore. Nenzira Dzakakosha Coumadin ave ari mushonga wekusarudza, asi mumakore achangobva kupfuura, mutsva anticoagulation madhiragi - apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) uye dabigatran (Pradaxa) - vauya kushandiswa kwose kwekudzivirira kwenguva refu PE.
IVC Filter
Kana iwe uchikura uchidzokorora PE, iwe unogona kudikanwa firiji inogona kuiswa mune yako yakaderera vena cava, iyo ndiyo mimba huru yemimba inobatanidza mitsipa yako yemakumbo kumwoyo wako. An IVC filter inogona kukanganisa mamwe mapepa angasununguka kubva mumashure mumakumbo ako vasati vaenda kumapapu.
Pulmonary Follow and Rehabilitation
Kana uine hutachiwana hweHIV, iwe unogona kukura nemigumisiro yakareba yakadai sepermonary hypertension kana chirwere chemapmonta (rufu) rwechikamu chemapapu. Kana iwe uchinetseka nematambudziko aya, ungada kuitevera ne pulmonologist kuitira kuti kufema kwako kuongororwe uye kurapwa sezvinodiwa.
Shoko Rinobva
Kubatana kwepulmonary kunonyanya kuonekwa kune vanhu vane mishonga kana mamiriro ezvinhu anotangira DVT.
Kana iwe uine zviratidzo zvinoratidza kufungidzirwa kwepermonary, zvakadai sekupfupika, kusina kutsanangurira kufema kwepfupa kana kurwadziwa kwepfupa, zvakakosha kuti iwe uonekwe nechiremba pakarepo.
Kakawanda, PE inowanzove yakawanda iyo ine mhinduro yakawanda kana ichitarisirwa nehutano hwakakodzera.
> Sources:
> Barbero E, Bikdeli B Chiluiza D. Kubudirira kweKuongorora Kwokutanga Kwekujekesa Kuzvimiririra Kunopupurira Migumisiro yevarwere neApute Pulmonary Embolism. Thromb Haemost. 2018 Mar 19. doi: 10.1055 / s-0038-1637746. [Epub mberi kwekunyora]
> Bikdeli B, Jiménez D, Kirtane AJ, et al. Kugadziriswa kwakarongeka kwehutano nekuchengeteka kwekugadziriswa kwepamusoro vena caval filters. Thromb Res. 2018 Mar 17; 165: 79-82. doi: 10.1016 / j.thromres.2018.03.014. [Epub mberi kwekunyora]