Uma umuntu etholakele ukuthi ube ne-pulmonary acolus, i-treatment efanele ixhomeke ukuthi isimo sabo senhliziyo sisimeme noma sizinzile.
Kubantu abaqinile abaqinile
Iningi labantu elibhekene ne-pulmonary embolus lizinzile ngokucacile kusuka esimweni sengqondo senhliziyo. Okungukuthi, bayazi futhi baqaphile, futhi ukucindezelwa kwegazi akusiyo phansi kabi.
Kulaba bantu, ukwelashwa ngezidakamizwa ze-anticoagulant (igazi elincane) ngokuvamile kuqale ngokushesha. Ukwelashwa kwasekuqaleni kuncipha kakhulu amathuba abo okufa ngenxa yokuzibandakanya kwamapayipi okuphindaphindiwe.
Izinsuku zokuqala ezingu-10
Ezinsukwini eziyishumi zokuqala ngemva kokusebenza kwe-pulmonary, ukwelashwa kunezidakamizwa ezilandelayo ze-anticoagulant:
- I-heparin ye-molecular weight (LMW) ephansi, njenge-Lovenox noma i-Fragmin. Lezi yiziqu ezihlanjululwayo ze-heparin ezinganikezwa ngomjovo wesikhumba esikhundleni se-intravenously.
- I-Fondaparinux, esinye isidakamizwa esifana ne-heparin esingaphansi kwesisu.
- Heparin engasebenzi, i-heparin "endala" enikezwa ngaphakathi.
- I-Rivaroxiban (i-Xarelto) noma i-apixaban (i-Eliquis), amabili "yezidakamizwa ezintsha zomlomo we-anticoagulant" (i- NOAC ) engummeleli womlomo weCoumadin . Lezi zidakamizwa ezimbili ze-NOAC yizona kuphela ezivunyelwe ukwelashwa okunamandla kwe-pulmonary embolus.
Zonke lezi zidakamizwa zisebenza ngokuvimbela izici zokuvala , amaprotheni egazini elikhuthaza ukuhlushwa.
Namuhla, odokotela abaningi bazosebenzisa i-rivaroxiban noma i-apixaban phakathi nezinsuku zokuqala ezingu-10 zokwelapha kubantu abakwazi ukuthatha imithi yomlomo. Ngaphandle kwalokho, i-LMW i-heparin isetshenziswa kakhulu.
Izinsuku ezingu-10 kuya ezinyangeni ezintathu
Ngemuva kwezinsuku eziyishumi zokuqala zokwelapha, ukwelashwa kukhethwe ukwelashwa isikhathi eside. Ezimweni eziningi, le thrafikhi yesikhathi eside iqhutshwa okungenani izinyanga ezintathu futhi kwezinye izimo kuze kube unyaka.
Le ukwelashwa kwesikhashana isikhathi eside njalo iqukethe noma yimuphi wezidakamizwa ze-NOAC. Kulesi sigaba sokwelashwa (okungukuthi, emva kwezinsuku eziyishumi zokuqala), izidakamizwa ze-NOAC dabigatran (Pradaxa) ne-edoxaban (Savaysa) nazo zivunyelwe ukusetshenziswa, ngaphezu kwe-rivaroxiban ne-apixaban. Ngaphezu kwalokho, i-Coumadin iyindlela yokuthola ukwelashwa kwesikhathi eside.
Ukungapheli Ukwelashwa
Kwamanye abantu, ukwelashwa kwe-antiticoagulation yesikhathi eside kufanele kusetshenziswe ngokungapheli emva kokuhlanganiswa kwamapulmonary, kungenzeka impilo yabo yonke. Ngokuvamile, laba bantu bawela kwesinye sezigaba ezimbili:
- Abantu abaye baba ne-pulmonary embolus noma i- thrombosis ejulile ye-vein ngaphandle kwesizathu esibangela ukuveza.
- Abantu okubangela ukuthi imbangela yokuvusa ingabe isingapheli, njengomdlavuza osebenzayo, noma i-genetic predisposition ukuba i-clotting engavamile yegazi.
Uma ama-Anticoagulant Izidakamizwa Awakwazi Ukusetshenziswa
Kwamanye abantu, izidakamizwa ze-anticoagulant aziyona inketho. Lokhu kungase kube ngoba ingozi yokuphuma kwegazi ngokweqile iphezulu kakhulu noma kungenzeka ukuthi yayine-pulmonary embolus naphezu kokwelashwa okwanele kwe-anticoagulation.
Kulaba bantu, isihlungi se-vena cava kufanele sisetshenziswe. Isihlungi se-vena cava yi-device efakwe ku-inferior vena cava (i-vein enkulu eqoqa igazi kusuka emaphethelweni aphansi futhi ayihambisa enhliziyweni) ngenqubo yokucwaninga.
Lezi zihlungi ze-"trap" zegazi eziphukile futhi zibavimbele ekufinyeleleni ukujikeleza kwe-pulmonary.
I-Vena cava filters ingaba yimpumelelo, kodwa ayithandanga izidakamizwa ze-anticoagulant ngenxa yezingozi ezihilelekile ekusebenziseni kwazo. Lezi zihlanganisa ukucindezeleka endaweni yesihlungi (okungase kuholele ekubhomeni kwe-pulmonary pulmonary), ukuphuma kwegazi, ukufuduka kwesihlungi enhliziyweni, nokuguguleka kwesihlungi.
Izihlungi eziningi zanamuhla ze-vena cava zingasuswa emzimbeni ngenqubo yesibili yokucwaninga uma engasadingeki.
Kubantu abangaqinisekile
Kwabanye abantu, i-pulmonary embolus iyingozi yenhliziyo.
Kulaba bantu, i-embolus inkulu ngokwanele ukudala ukuvimbela okukhulu kwegazi ukuya emaphashini, okuholela ekuweleni kwenhliziyo. Laba bantu bavame ukukhombisa i- tachycardia eyingozi (izinga lentliziyo elisheshayo) nokucindezela kwegazi okuphansi, isikhumba esithuthukile se-sweaty, nokuguqulwa kwengqondo.
Kulezi zimo, ukwelashwa okulula kwe-anticoagulation-okuyinto esebenza ngokuyinhloko ngokuqiniswa kwezindwangu zegazi nokuvimbela ukuvala i-clotting-ayanele. Esikhundleni salokho, kukhona okumele kwenziwe ukuze kuphulwe izibhamu ezenzeke kakade, futhi ubuyisele ukujikeleza kwepulmonary.
Ukwelashwa kwe-Thrombolytic ("I-Clot Busters")
Nge-throbolytic therapy, izidakamizwa ezinobuthi zilawulwa ngokuthi "i-lyse" (aphule) ama-clots asevele awakhiwe. Ngokuphula i-clot enkulu yegazi (noma ama-clots) emthini we-pulmonary, angabuyisa ukusakaza komuntu.
Lezi zidakamizwa (eyaziwa nangokuthi izidakamizwa ze-fibrinolytic ngoba zisebenza ngokuphazamisa i-fibrin emaqenjini) zithwala ingozi enkulu yokuphefumula kwegazi ukuze zisetshenziswe kuphela lapho ukuxhuma kwamapulmonus kusengozini yokuphila ngokushesha. Ama-thrombolytic agents ngokuvamile asetshenziselwa ukugqama okukhulu kwe-pulmonary alteplase, streptokinase, ne-urokinase.
Embolectomy
Uma ukwelashwa kwe-thrombolytic ngeke kusetshenziswe ngoba ingozi yokugwinya ngokweqile kubonakala sengathi iphakeme kakhulu, umzamo ungenziwa ku-embolectomy. Inqubo ye-embolectomy izama ukuhlukanisa i-clot enkulu emthini we-pulmonary, noma ngokuhlinzwa noma ngenqubo yesikhala.
Ukuzikhethela phakathi kwe-catheter-based or embolectomy yokuhlinzwa ngokuvamile kuxhomeke ekutholakaleni kodokotela abanolwazi ngalolu hlelo, kepha ngokukhethwa komuntu okukhethwa yi-catheter-based based embolectomy kukhethwa ngoba ngokuvamile kungenziwa ngokushesha.
Kodwa-ke, inqubo ye-embolectomy yohlobo oluthile ihlale ithatha izingozi ezinkulu-kubandakanya ukuqubuka komthambo we-pulmonary, nge- tamponade yenhliziyo kanye ne- hemoptysis engozini yokuphila (ukuphuma e-airways). Ngakho-ke, i-embolectomy ivame ukwenza kuphela kubantu abahlukunyezwa kakhulu futhi abanengozi enkulu yokufa ngaphandle kokwelapha ngokushesha.
> Imithombo:
> Aymard T, Kadner A, Widmer A, et al. Ukuqhamuka KwamaPulmonary Massive: Embolectomy Yokuhlinzeka Ngokuphikisana Ne-Thrombolytic Therapy - Ingabe Izinkomba Zokuhlinzekwa Kufanele Zibuyiselwe? I-Eur J Cardiothorac Surg 2013; 43:90. I-DOI: 10.1093 / ejcts / ezs123
> Kearon C, Akl EA, Comerota AJ, et al. Ukwelashwa kwe-Antithrombotic ye-VTE isifo: I-Antithrombotic Therapy kanye nokuvimbela i-Thrombosis, 9th: I-American College of Chest Physicians Iziqondiso Ezihlobene Nokwenza Okusemtholampilo. I-Chest 2012; 141: e419S. I-DOI: 10.1378 / isifuba.11-2301
> Kuo WT, van den Bosch MAAJ, Hofmann LV, et al. I-Embolectomy Eqondiswe Catheter, I-Fragmentation, Ne-Thrombolysis Ye-Treatment Of Massive Pulmonary Embolism Ngemva Kokwehluleka Kwe-Thrombolysis Eyisistimu. I-Chest 2008; 134: 250. I-DOI: 10.1378 / chest.07-2846
> I-Tapson VF. Ukubumbana Okumangalisayo KwamaPulmonary. N Engl J Med 2008; 358: 1037. I-DOI: 10.1056 / NEJMra072753