Kubatana kwepulmonary chirwere chinowanzoita chirwere chinogona kuunza migumisiro yakaipa kwazvo. Kurapa kwakakodzera , kwakaburitswa nokukurumidza, kwakakosha pakugadzirisa mikana yekuzorora zvakakwana. Kupa kurapwa kwakakodzera kunoda kuita chirwere chakakodzera nokukurumidza sezvinobvira.
Asi kugadzirisa zvakakodzera kufungidzirwa kwemapurmonary embolus, uye kuita kudaro nokukurumidza, dzimwe nguva kungangove kwakaoma.
Mhinduro dzakajeka zvikuru dzemaprommoni embolus dzinogona kuva nguva, dzinodhura, uye dzinosanganisira zvimwe zvinetso zvekurapwa. Aya maedzo haafaniri kushandiswa pasina kusarura.
Nyanzvi dzakabva dzashanduka nzira nhanhatu dzakagadzirirwa kuti dzirambe dzichibuda kunze kana kuti dziongorore hutachiona husina kuvhara pasina kuisa vanhu kuzvidzidzo zvisina kufanira. Kana chiremba wako achifungidzira iwe unogona kunge wakagadzikana, unogona kutarisira kuti iye ashandise nzira iyi yechitatu yekuongorora.
Step One
Muchitsauko mumwe chiremba anokurumidze kuongorora mukana wekuti chikwata chemapurmoni chakaitika. Iye achaita chiongorori ichi nekufungisisa zviratidzo zvinotsanangurwa uye mamiriro ekurapa mavari.
Zvimwe zvirongwa zvekuongororwa zvakagadziridzwa kuti vanachiremba vashandise mukufungidzira kuvepo kweplmm embolus. Nhamba yekuongororwa inoshandiswa kakawanda ndiyo Wells scoring system , iyo inofungisisa:
- Kunyangwe zviratidzo zvichiratidza kuti mvura yakadzika yepinein thrombosis iripo
- Chero zvimwe zvose zvinogona kuongororwa zvinoratidzika sezvishoma kudarika zvinonzi pulmonary embolus
- Pasinei nokuti kutora kwomwoyo kunopfuura 100 kurohwa paminiti
- Pasinei nokuti pane nhoroondo yekuvhiyiwa kwekupedzisira kana zvimwe zvisiri izvo
- Pasinei nokuti pane nhoroondo yepammoni yakagadzirwa kare kana yakadzika yepinin thrombosis
- Pasinei nokuti pane hemoptysis (kukohwa ropa)
- Pasinei nekenza iripo
Tarisa zvikamu zvakagoverwa kune chimwe nechimwe chezvinhu izvi zvinomwe uye huwandu hweWorse huwandu hwakaverengwa. Nezvikamu zveHurumende zviri muruoko, chiremba anokwanisa kuona kana mikana yemapulmonary embolus iri pasi, yapakati, kana yakakwirira.
PERC
Kana zvikaitika kuti pane kungova nepfupi kudarika kwemapurmonary embolus inotarisana nekuongororwa kwechipatara, chiremba angashandisawo dzimwe nyanzvi dzekuongorora zviyo: Pulmonary Embolus Rule-Out Criteria (PERC) system.
Purogiramu yeP PERC inokwanisa kuona kana mikana yemapulmoni yakagadzikana yakanyanya kuderera zvokuti kuwedzerwa kuedza kunofanira kumira zvachose. Inoumbwa nemitemo gumi nemasere:
- Zera risingapfuuri makore makumi mashanu
- Nhamba yemwoyo pasi pe100
- Ropa reoksijeni rinogadzirisa zvinenge 95 muzana
- Kwete hemoptysis
- Kwete esrogen kushandiswa
- Kwete nhoroondo yemvura yakadzika yepinein or pulmonary embolus
- Hapana gumbo rinokurira
- Kwete kuvhiyiwa kana kushungurudzika kunoda kubhadharwa mumavhiki mana apfuura
Kana zvikamu zvese zvisere zvepurojekiti yePERC iripo, hapana kuongororwa kweplummum embolus inorumbidzwa sezvo njodzi inobatanidza nekuwedzerwa kuwedzerwa ichapfuura zvakanyanya pangozi yekushayikwa kwepermonary embolus.
Nhanho II
Kana mukana wepermonary unobatanidzwa mune imwe nhanho unotsanangurwa kuva pakati, kana kuti kliniki inenge yakagadzikana yepermonary embolus iri pasi asi chirongwa che PERC chisati chasangana, danho rinotevera nderokuwana D-dimer ropa test.
Chiyero cheD-dimer chinotarisa kuti pane kuve kwemaitiro asina kujairika ekugadzirisa basa mukati meropa, rakadai seringave riripo kana munhu ave ane chirwere chakadzika chepinesis or pulmonary embolus.
Kana kliniki inogona kunge yePV iri pasi kana kuti iri pakati uye D-dimer muedzo hauna kunaka, chirongwa cheplmmum chinowanzogona kubudiswa kunze uye chiremba achaenderera mberi kuzotarisa zvimwe zvinokonzera zviratidzo.
Chiyero cheD-dimer chinogona kushandiswa chete kutonga kunze kwemaplmum embolus, kwete kuti kuongororwa. Saka kana chirwere cheD-dimer chakanakisisa (kana kana kliniki yemunhu yepmmonic embolus yainzi yakakwira mune imwe danho rimwe), inguva yekutatura katatu.
Danho rechitatu
Danho rechitatu rinosanganisira kuongorora kufungidzira kufungidzira. Kazhinji, chimwe chezvinhu zvitatu zvekuedzwa zvichashandiswa.
CT Scan
The CT scan is computer-ray-ray technique inobvumira chiremba kuti aongorore mishonga yemapurmoni kuti aone kana kune chigadziro chinokonzerwa neropa. Mushandi wepakati akaiswa muropa mukati mekuedzwa kuti abatsire kuoneka mishonga.
The CT scan yakarurama kupfuura 90 muzana yenguva yekuona mishonga yemapurmoni uye iko zvino inonzi inofanirwa kuedza sarudzo kana kufungidzira kunofanirwa kuita kuti kuongororwa.
V / Q Scan
AV / Q scan (iyo inonziwo ventilation / perfusion scan) inopisa mapapu inoshandisa dhiyabhorosi, injowa mumota, kuongorora kubuda kweropa kumapfupa emapapu. Kana mishonga yemapurmiti inenge yakadzivirirwa nekwakagadzika, chikamu chinowirirana chemapapu chinogamuchira chinoderera kudarika chiyero chakanaka chevhisi yakaoma.
Nhasi kuongorora kweV / Q kunowanzoshandiswa kune vanhu vasingafanirwi kujekesa mazai ose anodiwa neT CT scan, uye kune avo vane CT scan isinganzwisisiki.
Pulmonary Angiogram
Kwemakumi emakore chidzidzo checatheterization chinonzi pulmonary angiogram chaive chiyero chegoridhe chekuongorora chirwere chemapurmari, asi ichi chiyero chave chave chichiendeswa neT CT scan.
Ne pulmonary angiogram, dhayi inoshandiswa kuburikidza ne catheter inowanikwa mumapuraneti yepermonary kuitira kuti chero ropa rinogona kuonekwa pa x-ray. Ichi chiyero chisingaiti chinogona kudiwa pane dzimwe nguva kana CT scan kana kuti V / Q scan isingashandiswi kana kuti migumisiro iyi kubva muzviedzo haisati yakwana.
Muvanhu vasina kusimba
Chirongwa chemapurmoni chinogona kukonzera kukanganisa kwepfungwa yemwoyo. Kutaura zvazviri, chirongwa chemapurmoni chinowanzotaridzika kuva chinokanganisa kune vechidiki vanofa kamwe kamwe.
Kana munhu ane chirwere chakakomba chepfungwa uye chirwere chemapurm inoratidzika kunge chinokonzera, chirongwa chetatu chekuongorora chirongwa hachigoneki. Muvanhu ava, kurapwa kunowanzoitwa pakarepo, pamwe chete nemamwe mabasa ekudzorera, kusati kwasarudzwa kugadziriswa kweplmum embolus kunogona kuitwa.
Kusiyanisa Kuziva
Mukuona kuti kuvharana kwemapurmari, zvakakoshawo kuti chiremba atonge kunze kwechimwe chirwere chekurapa ane zviratidzo zvinogona kufanana nezvaya zveplmm embolus. Mamiriro ezvinhu anofanirwa kufungidzirwa (ndiko kuti, kusiyana-siyana kwekutsvaga) kakawanda kunosanganisira kuora mwoyo , mwoyo kusakwanisa , pericarditis , tamponade yemwoyo , pneumonia, uye pneumothorax .
I- electrocardiograms , chifu x-rays, uye echocardiograms dzinowanzowanikwa panguva dzekuongorora zvipatara zvekufungidzirwa kwehutano hwemwoyo kana mapapu zvinowanzokwanisika kutonga kunze kwemamwe mamiriro ezvinhu.
Kunyange kana chimwe chezvipi izvi zvinowanikwa, izvi hazvirevi kuti mishonga yemapemmoni inoratidzika kunze, nokuti munhu anogona kuva nemamiriro maviri panguva imwechete-uye zvirwere zvakawanda zvepfungwa zvinowedzera dambudziko remapurus embolus. Saka kana pane chikonzero chekufungidzira kuti zvinogona kuitika pamapurmonary mushure mekunge mumwe muongorori wakaitwa, zvinokosha kutora matanho ekuwedzera anodiwa kuti apedzise kuongororwa kwekuongorora.
> Sources:
> Klok FA, Kruisman E, Spaan J, et al. Kuenzaniswa kweThe Revised Geneva Chikwata neThe Wells Rule For Kuongorora Clinical Probability Of Pulmonary Embolism. J Thromb Haemost 2008; 6:40. DOI: 10.1111 / j.1538-7836.2007.02820.x
> Raja AS, Greenberg JO, Qaseem A, et al. Kuongororwa Kwevarwere Nevanokurudzirwa Pulmonary Embolism Yakanakisisa: Mazano Akanakisisa Okushandisa Kubva Kiraiti yeMitungamiri Yezvikamu zveAmerican College of Physicians. Ann Intern Med 2015; 163: 701. DOI: 10.7326 / M14-1772
> Singh B, Mommer SK, Erwin PJ, et al. Pulmonary Embolism Rule-Out Criteria (Perc) MuPulmonary Embolism - Revisited: Ongororo Yakarongeka Uye Meta-Kuongorora. Emerg Med J 2013; 30: 701. DOI: 0.1136 / emermed-2012-201730
> Smith SB, Geske JB, Maguire JM, et al. Kutanga Anticoagulation Inobatanidza Nokufa Kunopedzisira Kuita Pulmonary Embolism. Chest 2010; 137: 1382. DOI: 10.1378 / chest.09-0959