Apo munhu anowanikwa kuti ane chirwere chinoputika chepummoni, chirwere chakakodzera chinoenderana nokuti vane mamiriro ekurwadziwa kwepfungwa anenge akasimba kana asina kugadzikana.
For Relatively Stable People
Vanhu vakawanda vanoona kuti vane mapurmary embolus vanosimbiswa zvakanaka kubva pamagariro emwoyo. Izvi zvinoreva kuti ivo vanoziva uye vakangwarira, uye ropa ravo rinomanikidzira haisi nengozi pasi.
Kune vanhu ava, kurapwa ne anticoagulant zvinodhaka (ropa rakanyanyisa) zvinowanzotanga pakarepo. Kurapa kwokutanga kunoderedza zvikuru njodzi yavo yekufa kubva pamapurmary anowanzogara.
Mazuva 10 Okutanga
Kwemazuva gumi okutanga mushure mekugadzirwa kwemapurmari, chirwere chinosanganisira imwe yeiyo anticoagulant madhiragi:
- Low molecular weight (LMW) heparin, yakadai saLovenox kana Fragmin. Izvi ndizvo zvakagadzirwa zvakachena zveheparin zvinogona kupiwa nejecha rejecha panzvimbo yepravenously.
- Fondaparinux, imwewo mishonga inokonzerwa neheparin-yakafanana nemishonga.
- Heparin isina kukanganiswa, heparin "yekare" yakapiwa mukati.
- Rivaroxiban (Xarelto) kana apixaban (Eliquis), maviri e "itsva mouth anticoagulant drugs" ( NOAC ) iyo inotsiva mumuromo weCoumadin . Aya maviri emishonga yeNoAC ndiyo chete inogamuchirwa kuitira kurapa kwakanyanya kweplmm embolus.
Zvose izvi zvinodhaka zvinoshanda nekudzivisa kuvhara kwezvinhu , mapuroteni muropa rinokurudzira kugadzirisa.
Nhasi, vanachiremba vakawanda vachashandisa rivaroxiban kana apixaban munguva yekutanga kwemazuva gumi ekurapa muvanhu vanogona kutora mishonga yemuromo. Kana zvisina kudaro, LMW heparin inowanzoshandiswa.
10 Mazuva kusvika 3 Mwedzi
Mushure memazuva gumi okutanga erapi, kurapwa kunosarudzwa kwenguva refu yekurapa. Muzviitiko zvakawanda, chirwere ichi chenguva refu chinopfuurira kwemwedzi mitatu uye mune dzimwe nguva kusvikira kune gore.
Izvi zvinoshandiswa kwenguva refu nguva dzose zvinosanganisira imwe yeimwe yeA NOAC zvinodhaka. Nokuda kwechikamu ichi chemishonga (ndiko kuti, mushure mekutanga kwemazuva gumi), mishonga yaNoAC dabigatran (Pradaxa) ne edoxaban (Savaysa) inobvumidzwawo kuti ishandiswe, kuwedzera kune rivaroxiban uye apixaban. Mukuwedzera, Coumadin inosarudzo yehutano husingaperi.
Indefinite Treatment
Mune vamwe vanhu, chirwere chekare chinonzi antiticoagulation chinofanira kushandiswa nguva isipi mushure mekugadzirwa kwepermonary, zvichida kwehupenyu hwavo hwose. Kazhinji, ava vanhu vanowira mune chimwe chezvikamu zviviri:
- Vanhu vane chirwere chepmonta kana chirwere chakakomba chemhepo chinopisa pasina chinokonzera chinokonzera chinokonzera.
- Vanhu vane chikonzero chinogumbura chinogona kunge chisingagumi, sekenza inoshanda, kana kuti chimiro chekuberekwa kweropa kusingawanzi ropa kuvhara.
Kana Anticoagulant Zvinodhaka Hazvikwanisi Kushandiswa
Mune vamwe vanhu, anticoagulant zvinodhaka hazvisi nzira. Izvi zvinogona kunge zviripo nokuti njodzi yekuwedzerwa ropa kudarika yakareba kana kuti ingangodaro yakave yakagadziriswa pamapurus pasinei nekurapa anticoagulation therapy.
Muvanhu ava, vena cava firisi inofanira kushandiswa. A vena cava firimu chinhu chinoshandiswa mumutambo weperior vena cava (mutsara mukuru unounganidza ropa kubva kumigumo yakadzika uye unoununura pamwoyo) nenzira yekugadzira catheterization.
Izvi zvinoshandiswa "musungo" weropa ropa rakasununguka uye kudzivirira kuti vasvike pakubuda kwepermonary.
Vena cava filtara inogona kunyatsobudirira, asi haisarirwi neanticoagulant zvinodhaka nekuda kwezvipingamupinyi zvinosanganisira kushandisa kwavo. Izvi zvinosanganisira kuputika panzvimbo yefirati (iyo inogona kutungamirira kumapurmari anoramba achiita embolism), kubuda ropa, kubuda kwefaira kusvika pamwoyo, nekuderera kwefaira.
Mafuta akawanda emazuva ano vena cava anogona kubviswa kubva mumuviri nekugadziriswa kwechipiri chekugadzirisa kana vasingachadiwi.
Kune Vanhu Vasingachinji
Kune vamwe vanhu, chirwere chinonzi pulmonary chinokonzera chirwere chepfungwa.
Muvanhu ava, kubatana kwakakura zvakakwana kukonzera kukanganisa kukuru kweropa kunopinda mumapapu, izvo zvinotungamirira ku kuora kwemwoyo. Vanhu ava vanonyanya kuratidza tachycardia yakanyanya (kukurumidza kwemoyo yenyika) uye kuderera kwemuviri wekutema ropa, yakasvibirira ganda rinoputika, uye rakashandurwa kuziva.
Mune zviitiko izvi, shanduro inoratidzika yeanticoagulation-iyo inonyanya kushanda nekugadzirisa kuvhara ropa uye kudzivirira kupfutidza-hakukwanisi. Pane kudaro, chimwe chinhu chinofanira kuitwa kuti chiparadze chibvumirano chakatoitika, uye kudzorera kupora kwepermonary.
Thrombolytic Therapy ("Chivande Busters")
Ne thrombolytic therapy, zvinodhaka zvinotapurirwa zvinotarisirwa izvo "lyse" (kuputsa) mazamu akave atanga. Nokuputsa ropa rakakura (kana kuti machira) mumapirmita arteri, vanogona kudzorera kushambadzira kwemunhu.
Iyi mishonga (inozivikanwawo semishonga inonzi fibrinolytic nokuti inoshanda kuburikidza nekuvhiringidza fibrin mumagetsi) inotakura dambudziko guru rekuita ropa kunoshandiswa chete kana chirongwa chemapurmoni chiri pakarepo kutyisa upenyu. I-thrombolytic agents iyo inowanzoshandiswa pakuronda kwepulmony embolism ndeye alteplase, streptokinase, uye urokinase.
Embolectomy
Kana thrombolytic therapy isingagoni kushandiswa nokuti dambudziko rekubuda ropa zvakanyanya rinoonekwa sepamusoro-soro, kuedza kunogona kuitwa pakushambadzira. Chimiro chekuita maitiro chinoedza kuvhara chivharo chikuru mumushonga wepammonary, zvichiitwa nekuvhiyiwa kana nekateta nzira.
Kusarudzwa pakati pekateter-based kana kuti chiratidzo chokuvhiya chinowanzoenderana nekuwanika kwechiremba vane ruzivo rweimwe yemitambo iyi, asi kazhinji catheter-based embolectomy inoshandiswa nokuti kazhinji inogona kuitwa nokukurumidza.
Kunyange zvakadaro, maitiro emhando yemhando dzose anotakura njodzi huru-kusanganisira kuputika kwemapurmonary arteri, nekutapira kwemwoyo uye upenyu hunotyisa hemoptysis (kubuda mumhepo). Saka, embolectomy inowanzoitwa kune vanhu vanotongwa kuti havana kunyatsogadzikana uye vane ngozi yakanyanya yekufa vasina kusimbidzika kurapwa.
> Sources:
> Aymard T, Kadner A, Widmer A, et al. Massive Pulmonary Embolism: Kuchengeta Embolectomy Kusiyana neTrombolytic Therapy - Zviratidzo Zvokuvhiya zvinofanira Kudzokororwa Here? Eur J Cardiothorac Surg 2013; 43:90. DOI: 10.1093 / ejcts / ezs123
> Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy yeVTE chirwere: Antithrombotic Therapy uye Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e419S. DOI: 10.1378 / chifuyo.11-2301
> Kuo WT, van den Bosch MAAJ, Hofmann LV, et al. Catheter-Yakatungamirirwa Embolectomy, Kupatsanurwa, Uye Thrombolysis For The Treatment Of Massive Pulmonary Embolism Mushure mekushaya Kushanda kweTystems Thrombolysis. Chest 2008; 134: 250. DOI: 10.1378 / chest.07-2846
> Tapson VF. Acute Pulmonary Embolism. N Engl J Med 2008; 358: 1037. DOI: 10.1056 / NEJMra072753