I-embolism embolism (PE) ibangelwa i-clot yegazi efaka umthambo we-pulmonary , isitsha esikhulu segazi esiholela emaphashini, noma elinye lamagatsha awo. Ngokuvamile, i-PE ivela lapho i-clot yegazi eyenza emilenzeni, i-vein thrombosis ejulile (DVT), ukuhlanekezela nokuhamba ukuya emithanjeni yegazi yamaphaphu. Izimpawu zokumbumbana kwe-pulmonary zifaka inkinga yokuphefumula, ubuhlungu besifuba, nokukhwehlela igazi.
Abantu abaningi baphuthukisa ngokuphulukiswa, kepha amaphesenti angaba ngu-30 alabo abangaphenduli PE abahlali. Njengoba ukwelashwa, izinga lokufa lizungeze amaphesenti angu-5.
Izimpawu
Umthambo we-pulmonary unomsebenzi obalulekile wokuphatha igazi emaphashini ukuba agcwaliswe nge-oxygen, ngakho ukuvinjelwa kwegazi okugeleza ngaphakathi kwalesi sitsha segazi kuthinta amaphaphu nenhliziyo, futhi kuveza izimpawu zomoya ophansi emzimbeni wonke.
Izimpawu ezivame kakhulu zokumbumbana kwe-pulmonary yilokhu:
- Ukuphefumula, okuqala ngokuzumayo, ngokuvamile ngaphakathi kwemizuzwana embalwa ye-PE
- Ngokungazelelwe, ubuhlungu obukhulu besifuba
- Ukukhwehlela
- Ukushaya igazi
- Ubuhlungu besifuba se-Pleuritic, okuyinto ubuhlungu besifuba obubi kakhulu uma uthola umoya
- Ukushisa
- Umfutho wegazi ophansi, isilinganiso senhliziyo esanda, ukuphefumula okusheshayo
- Ukubukeka okwesibhakabhaka noma okuluhlaza okwezindebe neminwe
- I-arrhythmias ye-cardiac (izintambo zenhliziyo yenhliziyo), njenge -fibrillation ye-atrial , nezimpawu ezihlobene noma imiphumela embi (isb. Ukukhanda, ukulahlekelwa kwekhono)
- Izimpawu noma izimpawu ze-DVT emlenzeni owodwa noma zombili zomlenze
Ubukhulu be-embolism ye-pulmonary ngokuvamile kubhekwa ubukhulu be-clot. Uma i-pulmonary embolus ikhulu, icala livame ukuchazwa njenge-PE enkulu. Lokhu kungabangela ukuvinjelwa okuphawulekayo komshini we-pulmonary, okuholela ekucindezelekeni okunzima kwengqondo, ukwehla okuyingozi emzimbeni wegazi, nokwehla okukhulu okwenziwe nge-oksijeni yegazi, noma ukulamba okomoya okwenzeka ebuchosheni nasemzimbeni wonke.
Ukuhlangana okuncane kwamapulmoni kubangela izimpawu ezingabonakali kodwa kuyisimo esiphuthumayo sezokwelapha esingase sibulale uma sishiywa singaphathwa. Amagundane egazi amancane ngokuvamile avimbela elinye lamagatsha amancane emithini yamapulmonary futhi angase avule ngokuphelele umkhumbi omncane we-pulmonary, ekugcineni uholele ekutheni i- pulmary infarction , ukufa kwesinye sezimpawu zamaphaphu.
Izimbangela
Ama-clots egazi, okuthiwa i- thromboemboli , akhiqiza i-PE avame ukubangelwa yi-DVT emithanjeni ejulile ye-groin noma ithanga.
I-DVT nama-Lungs
Kulinganiselwa ukuthi cishe amaphesenti angu-50 abantu abane-DVT engaphathwa kabi bayothola i-pulmonary embolus.
I-anatomy yomzimba ihlelwe ngendlela eyenza i-DVTs ikwazi ukufakwa emaphashini. Imisipha emilenzeni, lapho i-DVTs ijwayele ukwakha, ihlangene ndawonye njengoba igazi libuyela ehlangothini lwesokudla senhliziyo ngokusebenzisa umvuthwandaba omkhulu, i-inferior vena cava (IVC). Kusukela ohlangothini lwesokudla senhliziyo, igazi lihamba liya emaphashini nge-arteriary arteries ukuze livuselele ukunikezwa kwe-oxygen. Njengoba i-clot yegazi ihamba emithanjeni emilenzeni kuya enhliziyweni, yonke imithwalo yegazi, kuhlanganise neyenhliziyo, inkulu kunemivimbo emilenzeni. Uma i-clot yegazi ingena emaphashini, noma kunjalo, izitsha zihamba kancane kancane, futhi yilapho lapho ama-clots eboshwe khona eminye yemithambo ye-pulmonary, eholela ku-PE.
Lezi zindwangu zegazi zingase ziboshwe kunoma yimiphi imithwalo yegazi yamaphaphu. Ama-clots amancane angase afakwe emithanjeni encane yegazi yamaphaphu. Ama-clots amakhulu egazi alala emithonjeni emikhulu yegazi, ephazamisa ikhono lamapayipi okwenza igazi lifanele ngokwanele ukuze lisetshenziswe kuwo wonke umzimba, nemiphumela engase ibe yingozi.
Ukumiswa kokuqamba ukufaka ama-clots amaningi kakhulu
Iningi labantu abane-PE, noma ngaphandle kwe-DVT esandulele, banezimo zezokwelapha noma izimo ezihlobene nokungaqedi kwegazi okungajwayelekile. Izimbangela ezivame kakhulu nezimbangela eziyingozi ekubunjweni kwe-clot yegazi yizi:
- Ukungahambi kahle ngenxa yokukhubazeka ngokomzimba, ukuphumula kombhede isikhathi eside, noma ukulala esibhedlela
- Ukuhlala isikhathi eside ngesikhathi sokugibela imoto ende noma indiza yendiza
- Umlando we-embolism yamapayipi yangaphambilini
- Umlando wezingcezu zegazi zangaphambilini, njenge-DVT, isifo sohlangothi, noma ukuhlasela kwenhliziyo
- Ukuphazamiseka kwegazi lokugubha
- Ukubhema
- Umlando womdlavuza kanye / noma ukusetshenziswa kwe-chemotherapy
- Umlando wokuhlinzwa
- Ukuphumula kwegazi, ikakhulukazi i-femur (ithanga) ithambo
- Ukukhuluphala
- I-hormone therapy (kuhlanganise nokwelashwa kwe-hormone)
- Ukusebenzisa iphilisi yokulawula ukuzalwa
- Ukukhulelwa noma ukukhulelwa kwamuva
Ukuxilongwa
Ukuxilongwa kwe-PE kuqala ngokuhlolwa komtholampilo wakho bese kungabandakanya ukuhlolwa okukhethekile okungase kusekele, kuqinisekise, noma kungabandakanyi ukuxilongwa kwe-PE.
Ukuhlolwa Kwemitholampilo
Isinyathelo sokuqala ekuhloleni i-PE ngukulinganisa udokotela wakho ukuthi ngabe unethuba lokuba liphakeme noma liphansi. Udokotela wakho wenza lokhu kulinganiselwa ngokwenza umlando wezokwelapha ngokucophelela, ukuhlola izingozi zakho ze-DVT, ukwenza ukuhlolwa kwangokwenyama, ukulinganisa ukuhlushwa kwe-oksijini egazini lakho, mhlawumbe nokwenza i- ultrasound test ukufuna i-DVT.
Izivivinyo ezingapheli
Ngemuva kokuhlolwa komtholampilo wakho, ungase udinge ukuhlolwa okuqondile, njengokuhlolwa kwegazi noma ukuhlolwa kwe-imaging.
- Ukuhlolwa kwe-D-dimer: Uma kungenzeka ukuthi kungenzeka ukuthi i-PE ingaphansi, udokotela wakho angalawula ukuhlolwa kwe-D-dimer . Ukuhlolwa kwe-D-dimer ukuhlolwa kwegazi okulinganisa ukuthi ngabe kube yini izinga elingavamile lomsebenzi wokugubha egazini lakho, okulindelwe uma une-DVT noma i-PE. Uma kungenzeka ukuthi imitholampilo ye-PE iphansi futhi ukuhlolwa kwakho kwe-D-dimer kungalungile, i-PE ingasuswa, futhi udokotela wakho uzoqhubeka ehlola ezinye izimbangela ezingabangela izimpawu zakho.
Uma kungenzeka ukuthi i-PE inqatshelwe ukuthi iphakeme, noma uma ukuhlolwa kwakho kwe-D-dimer kulungile, ngokuvamile kuvame ukuhlolwa kwe-V / Q (ukushenxa kwe-ventilation / perfusion) noma ukuhlolwa kwe-CT kwesifuba kwenziwa.
- Ukuskena kwe-V / Q: Ukuskena kwe-AV / Q yinkena yokumaphaza esebenzisa idayisi e-radioactive, injected in vein, ukuhlola ukugeleza kwegazi emathangeni akho emaphaphu. Uma umthambo we-pulmonary tour uvinjiwe kancane yi-embolus, ingxenye ehambisanayo yamathishu emaphaphu ithola kancane kunani elijwayelekile ledayi e-radioactive.
- I-CT scan: I- CT scan iyindlela yokusebenzisa i-x-ray evumelanako, evumela ukuthi udokotela wakho abone ngeso lengqondo imithwalo yakho ye-pulmonary ukuze ubone ukuthi unesithiyo esibangelwa yini.
I-Angiogram yePulmonary
I-angiogram ye-pulmonary ivame ukubhekwa njengezinga legolide lokukhomba i-PE, kodwa izivivinyo ezingenakuvunywa zingagcinwa noma zilawule ukuxilongwa. Uma ukuxilongwa kwakho kungacacile, kungase kudingeke ube ne-angiography ye-pulmonary.
I-angiogram ye-pulmonary is a test diagnostic lapho idayi ijozwa khona nge-tube ngaphakathi komshini we-pulmonary ukuze noma yikuphi i-clots yegazi ingabonwa nge-x ray. Ngenxa yokuthi i-angiography ye-pulmonary yi-test invasive eyenza ingozi yokucindezeleka, udokotela wakho uzozicabangela ngokucophelela izingozi nezinzuzo ngaphambi kokuncoma lokhu kuhlolwa kuwe.
Ukwelapha
Uma ukuxilongwa kwe-pulmonary embolus kuqinisekiswa, ukwelashwa sekuqalile ngokushesha. Uma unethuba eliphakeme kakhulu le-pulmonary embolus, ukwelashwa kwezokwelapha kungase kuqalwe ngisho nangaphambi kokuthi ukuxilongwa kwakho kuqinisekiswe.
I-Blood Thinners - Ama-Anticoagulants
Ukwelashwa okuyinhloko kwe-pulmonary embolus kusetshenziswa izidakamizwa ze-anticoagulant, igazi elincane, ukuvimbela ukuqhuma kwegazi okuqhubekayo.
I-blood thinners ngokuvamile esetshenziselwa ukwelashwa kwe-PE ingukuthi i-IV (intravenous) i-heparin noma i-heparin etholakala yi-injection engaphansi (isikhumba), njenge-Arixtra, noma i-fondaparinux. Umndeni we-heparin wezidakamizwa unikeza umphumela we-anticoagulant ngokushesha futhi usize ekuvimbeleni amanye ama-clots egazi ekwakheni.
I-Clot Busters- I-Thrombolytics
Uma i-PE inkulu noma idala ukungahleleki kwenhliziyo, ukuhlinzeka nge-anticoagulation ngokuvamile akwanele. Kulezi zimo, ama-puppy-clocking-agents, okuthiwa i-thrombolytics, angase agwetshwe ukuze ahlakaze i-clot yegazi. Le mithi, ehlanganisa ama-fibrinolytic agents afana ne-streptokinase, ihloselwe ukuqeda i-clot yegazi evimbela umthambo we-pulmonary.
Ukwelashwa kwe-thrombolytic kunomngcipheko omkhulu kunokwelashwa ngama-anticoagulants, kufaka phakathi ingozi enkulu yokucindezeleka okukhulu kwegazi. Uma i-pulmonary embolus ikhulu kakhulu ngokwanele ukuba isongela ukuphila, ingozi yalezi zindlela zokwelashwa ingase ibe ngaphezu kwezinzuzo ezikhona.
Ukuhlinzwa
Ukwelashwa yindlela engasusa ngqo i-PE. Inqubo evamile yokuhlinzeka, ebizwa ngokuthi ukuhlinzwa kokusebenza komzimba, iyingozi kakhulu futhi ayiphumeli ngaso sonke isikhathi, ngakho igcinelwe abantu abanethuba eliphansi kakhulu lokusinda ngaphandle kwalo.
Ukubhekana
Ngemuva kwesigaba sokuqala se-PE, ungase udinge uhlelo lokuhlala isikhathi eside ukuvimbela ama-PE angeke akwenze, futhi kungadingeka ulungise imiphumela ye-PE yakho uma kubangele ukulimala okungapheli.
Imithi
Emva kokuthola ukwelashwa okuphuthumayo ngegazi le-IV elincane noma i-clot-busting agent egayelwe, ungadinga ukuthatha umlomo (ngomlomo) imithi ye-anticoagulant izinyanga, noma ngisho neminyaka. Ngokomkhuba uCoumadin ube yisidakamizwa esizikhethelayo, kodwa eminyakeni yamuva nje izidakamizwa ezintsha ze-anticoagulation - apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) ne-dabigatran (Pradaxa) - ziye zasetshenziselwa ukusetshenziswa kokuvikela isikhathi eside isikhathi eside I-PE.
I-IVC Filter
Uma uhlakulela ama-PE aphindaphindiwe, ungase udingeke ukuthi isihlungi sibekwe ku-vena cava yakho engaphansi, okuyisigqoko esikhulu esisemathunjini esihlanganisa izivilini zakho zomlenze enhliziyweni yakho. Isihlungi se-IVC singanqamulela amanye ama-clots angase aphule emithanjeni emilenzeni yakho ngaphambi kokuba ahambe aye emaphashini.
Ukulandela Ukulandela Nokuvuselela
Uma uhlangabezana nama-PE aphindaphindiwe, ungase uhlakulele imiphumela yesikhathi eside njenge- pulmonary hypertension noma i-infarction ye-pulmonary (ukufa) yengxenye yamaphaphu. Uma uhlangabezana nalezi zinkinga, kungase kudingeke ulandelele ne-pulmonologist ukuze umsebenzi wakho wokuphefumula uphethwe futhi uphathwe uma kudingeka.
Izwi elivela
I-pulmonary embolus ivame ukubonwa kubantu abanesimo sezokwelapha noma izimo ezibeka phambili ku-DVT.
Uma unamabonakaliso abonisa ukuthi u-pulmonary embolus, okufana nokuphuza okuncane okungazelelwe, okungaqondakali noma ubuhlungu besifuba, kubalulekile ukuthi uhlolwe udokotela ngokushesha.
Ngokuvamile, i-PE yinto evamile kakhulu enomphumela ongcono kakhulu uma iphethwe ngezokwelapha okufika ngesikhathi.
> Imithombo:
> Barbero E, Bikdeli B Chiluiza D. Ukusebenza kokuHlola okuPhuthumayo kokuQala ngokuzimela Kubikezela imiphumela kuMagulane ane-Aculism Embolism Acolism. I-Thromb Haemost. 2018 Mar. 19 ini: 10.1055 / s-0038-1637746. [I-Epub ngaphambi kokuphrinta]
> Bikdeli B, Jiménez D, Kirtane AJ, et al. Ukubuyekezwa okuhlelekile kokusebenza kahle nokuphepha kwezihlungi eziphansi ezingenakutholakala ze-vena caval. I-Resrom Res. 2018 Mar 17; 165: 79-82. i-doi: 10.1016 / j.thromres.2018.03.014. [I-Epub ngaphambi kokuphrinta]