I-thrombosis enamandla kakhulu (DVT) yisimo lapho ama-clots egazi akha khona emithanjeni ejulile yemilenze. I-DVT ibalulekile ngezizathu ezimbili: I-DVT ngokwayo ingabangela izimpawu ezinzima, kanti i-DVT ivame ukuholela esimweni esisongela impilo ye- pulmonary embolus .
I-DVT ingavela emithanjeni engaphezu kwamadolo (okungukuthi, emithanjeni ye-ileofemoral ye-groin kanye nethanga endaweni) noma emithanjeni engaphansi kwamadolo (okungukuthi, emithanjeni yamathole).
Ingozi ye-pulmonary embolus iyancipha kakhulu uma i-DVT ihlukaniswe nendawo yethole.
Ubani othola i-DVT?
I-DVT ivame ukubonwa kubantu abaye bahlala isikhathi eside, isibonelo, ngokulandela ukuhlinzwa okusha, ukushaywa yisifo , ukukhubazeka, noma ukutakula okuvela emathunjini. I-DVT iphinda ivele njalo kaningi kubantu abanezinhlungu noma isifo senhliziyo, futhi (ikakhulukazi kwabesifazane) kulabo abakhuluphele futhi ababhemayo. Ukusetshenziswa kwamaphilisi okulawula ukubeletha kanye ne-hormone therapy esikhundleni sokukhulisa kakhulu kwandisa ingozi ye-DVT.
Izimpawu ze-DVT
Izimpawu ezivame kakhulu ze-DVT zivuvukala, ubuhlungu nokubomvu emlenzeni othintekile. Lezi zimpawu zingahluka kusukela kumnene kuya ekukhubaza.
Ukuhlonza i-DVT
Uma i-DVT ikhona, ukwelashwa okusheshayo nge-anticoagulation therapy (bheka ngezansi) kuzokwehlisa ngokuphawulekayo izimpawu, kanye nezinkinga zokuthuthukisa u-pulmonary embolus. Kodwa-ke, izimpawu ezifanayo ezibonwa nge-DVT ziphinde zenzeke kwezinye izimo zezokwelapha - kufaka phakathi izifo zesikhumba, izinyembezi zezinsizi, izinhlobo eziningana zamadolo, nokuvuvukala kwemivamisa yemilenze yangaphandle - futhi ukwelashwa kwazo zonke lezi zimo kuhlukile .
Ngakho-ke, noma nini lapho i-DVT icatshangwa khona, kubalulekile ukwenza ukuxilongwa okucacile.
Esikhathini esedlule, ukuxilongwa ngokuqinile kwe-DVT kudinga inqubo engavamile ebizwa ngokuthi i-venography, lapho idayi igxilwe khona emithanjeni yomlenze, futhi imifanekiso ye-x-ray yenziwa, ifuna izivimbelo ezibangelwa ama-blood clots. Ngenhlanhla, isidingo se-venography siphendulwe ngokuphelele eminyakeni yamuva ngokutholakala kwezivivinyo ezimbili ezingekho-invasive - impedance plethysmography nokucindezela i-ultrasound .
In impedance plethysmography, i-cuff (efana nengcindezi yegazi yegazi) ifakwe eduze kwethanga futhi igxilwe, ukuze icindezele imilenze yomlenze. Umthamo wethole ulinganiswa (ngokusebenzisa ama-electrode afakwe lapho). I-cuff ibuye ihlanjululwe, ivumele igazi eliye "liboshwe" emtholamini ozophuma emithanjeni. Isilinganiso sevolumu yethole siphindwa. Uma i-DVT ikhona, umehluko wevolumu (nge-cuff ehlanjululwe ngokumelene ne-cuff deflated) izoba ngaphansi kwesigqila-ekhombisa ukuthi imithanguzo ivinjelwe kancane nge-clot yegazi.
Ukucindezela i-ultrasound kuyinhlobonhlobo yindlela esebenzisa ngokuvamile i-ultrasound, lapho amagagasi omsindo asetshenziselwa izicubu nge-probe, futhi isithombe sakhiwa ngamagagasi omsindo abuyelayo. Ekucindezelweni kwe-ultrasound, i-probe ye-ultrasound ifakwe phezu kwe-vein, futhi isithombe se-ultrasound se-vein sikhiqizwa. I-vein yabe icindezelekile (ngokuyiqhubekela phambili nge-probe ye-ultrasound). Uma i-DVT ikhona, umvuthwandaba ufana "uqinile" (ngenxa yobukhona be-clot), futhi ukunciphisa kwawo kuncishisiwe.
Lapho i-DVT icatshangwa, ukuxilongwa kungase kuqinisekiswe noma kunqatshwe ngokusebenzisa enye yalezi zivivinyo ezingavunyelwe.
Ngoba izibhedlela ezimbalwa kakhulu zivame ukwenza i-plethysmography, kanti zonke izibhedlela zesimanje zenza izivivinyo eziningi ze-ultrasound usuku ngalunye, ukuhlolwa kwe-ultrasound ukucindezela kuvame ukusetshenziswa kakhulu ekuhloleni i-DVT.
Ukwelashwa kwe-DVT
Ukwelashwa okuyisisekelo kwe-DVT ukusetshenziswa kwezidakamizwa ze-anticoagulant ("abambalwa begazi"), kokubili ukuvimbela ukuqhuma kwegazi okuqhubekayo emithanjeni yomlenze, nokunciphisa amathuba okuthuthukisa i-pulmonary embolus.
Ngokushesha uma i-DVT itholakale, ngokuvamile kunconywa ukuba ukwelashwa kuqalwe ngokushesha ngezinye zeziqephu ze-heparin (njenge-Arixtra, noma i-fondaparinux) enganikezwa ngamagciwane angaphansi kwesikhumba.
Lezi zidakamizwa zinikeza umphumela ngokushesha we-anticoagulation.
Uma lokhu sekuqalile ukwelashwa okunamandla, ukwelashwa okungapheli neCoumadin kungaqaliswa. Ngokuvamile kuthatha izinsuku eziningana ngesonto noma ngaphezulu ngaphambi kokuba i-Coumadin iphumelele ngokuphelele, futhi isilinganiso sayo esifanele sinqunywe. Lapho umthamo we-Coumadin ushintshiwe futhi isidakamizwa sisebenza ngendlela efanele, i-heparin etholakalayo ingamiswa.
Ngesikhathi umuthi omusha we-anticoagulation Pradaxa ( dabigatran ) uhlolwe ezigulini ezine-DVT futhi ubonakala usebenza kahle, awukaze wamukelwa yi-FDA ngalolu hlelo.
I-anticoagulation therapy ye-DVT ivame ukuqhubeka okungenani izinyanga ezintathu. Uma i-DVT iphindaphindiwe, uma imbangela eyinhloko (njengokwehluleka kwenhliziyo ) isabonakala, noma uma kwenzeka isidumbu esikhulu se-pulmonary, ukwelashwa kuvame ukuqhubeka ngokungapheli.
Ngaphandle kwe-anticoagulation, kubalulekile ukuthi abantu abane-DVT bahambe njalo, futhi bagweme izimo lapho bazodinga ukuhlala khona isikhathi eside. Izitokisi zokucindezela, ezisiza imilenze yegundane ibuyele emuva enhliziyweni, nazo ziyasiza futhi kufanele zibhekwe ngokuqinile okungenani iminyaka emibili ngemuva kokuthi i-DVT ivele.
Ngokwelashwa okwanele, iningi labantu abane-DVT lingakwazi ukululama ngokuphelele.
Imithombo:
Cushman M, Tsai AW, White RH, et al. I-thrombosis ejulile ye-vein ne-embolism ye-pulmonary in cohorts amabili: uphenyo lwesikhathi eside lwe-thromboembolism etiology. Am J Med 2004; 117: 19.
Goodacre S. Emtholampilo. I-thrombosis ejulile. U-Ann Intern Med 2008; 149: I-ITC3.