Ukuzibandakanya kwamapulmonism kuyinkinga evamile yezokwelapha engabangela imiphumela emibi kakhulu. Ukwelashwa okufanele, okukhulunywe ngokushesha, kubalulekile ekwandiseni amathuba okuthola ngokugcwele. Ukunikeza ukwelashwa okufanele kudinga ukwelashwa okufanele ngokushesha ngangokunokwenzeka.
Kodwa ukwenza ukuxilongwa okulungile kwamapulmonary embolus, futhi ukwenza ngokushesha kangaka, ngezinye izikhathi kungase kube yinto ekhohlisayo.
Izivivinyo ezicacile kakhulu zokufakelwa kwamapulmasi zingadla isikhathi, zibiza futhi zifaka okungenani ezinye izingozi zomtholampilo. Lezi zivivinyo akufanele zisetshenziswe ngokungakhethi.
Ochwepheshe baye bashintsha indlela yesinyathelo esilandelayo ukuze kukhishwe ngokushesha noma ukuxilonga i-pulmonary embolus ngaphandle kokudalula abantu ekuhlolweni okungadingekile. Uma udokotela wakho esolwa ukuthi kungenzeka ube ne-pulmonary embolus, ungalindela ukuthi asebenzise le ndlela yokuhlola yokuthatha izinyathelo ezintathu.
Isinyathelo Sokuqala
Esikhathini esisodwa udokotela uhlola ngokushesha ukuthi kungenzeka ukuthi i-pulmonary embolus yenzeke. Uzokwenza lokhu kuhlola ngokucabangela izimpawu ezichazwe kanye nezimo zemitholampilo ezenzeke kuzo.
Kunezinhlelo ezimbalwa zokubheka izinkomba eziye zaqalwa odokotela ukuba basebenzise ekulinganiseni amathuba okubamba i-pulmonary. Uhlelo lokufaka amanxeba asetshenziswe kaningi luhlelo lwe- Wells score , olucatshangelwayo:
- Kungakhathaliseki ukuthi izimpawu zikhomba ukuthi i- vein thrombosis ejulile ikhona
- Kungakhathaliseki ukuthi zonke ezinye izifo ezitholakalayo zibonakala zingenangqondo kakhulu kunezitho zamapulmoni
- Kungakhathaliseki ukuthi izinga lenhliziyo lingaphezu kwezingu-100 ngomzuzu
- Kungakhathaliseki ukuthi kukhona umlando wokuhlinzwa okwakamuva noma okunye ukukhubazeka
- Kungakhathaliseki ukuthi kukhona umlando wangaphambili we-pulmonary embolus noma thrombosis ejulile ye-vein
- Kungakhathaliseki ukuthi i- hemoptysis (ukukhwehlela igazi)
- Kungakhathaliseki ukuthi umdlavuza ukhona yini
Amaphuzu okuphawula anikezwe ngayinye yalezi zici eziyisikhombisa futhi amaphuzu aphelele we-Wells ahlanganisiwe. Ngamaphuzu e-Wells esesandleni, udokotela anganquma ukuthi kungenzeka yini ukuthi i-pulmonary embolus iphansi, ephakathi, noma ephakeme.
PERC
Uma kuvela ukuthi kukhona kuphela amathuba okungaphansi kwamapulmonary embolus esekelwe kuloluhlolo lokuhlola, udokotela angasebenzisa uhlelo olwengeziwe lwamagoli: uhlelo lwePulmonary Embolus Rule-Out Criteria (PERC).
Isistimu ye-PERC inganquma ukuthi kungenzeka yini ukuthi i-pulmonary embolus iphansi kakhulu kangangokuthi ukuhlolwa okunye kufanele kumeke ngokuphelele. Iqukethe imigomo eyisishiyagalombili:
- Ubudala obungaphansi kweminyaka engu-50
- Ukushaya kwenhliziyo ngaphansi kwekhulu
- I-blood oxygen saturation okungenani amaphesenti angu-95
- Ayikho i-hemoptysis
- Akukho ukusetshenziswa kwe-estrogen
- Akukho mlando we-thrombosis ejulile ye-vein noma i-pulmonary embolus
- Akukho ukuvuvukala komlenze
- Akukho ukuhlinzwa noma ukuhlukunyezwa okudinga ukunakekelwa esibhedlela eminyakeni emine edlule
Uma zonke izilinganiso eziyisishiyagalombili zePARC zikhona, akukho ukuhlolwa okuqhubekayo kwamapulmonus embolus kunconywa ngoba ubungozi obuhambisana nokuhlolwa okungeziwe kuzokwandisa kakhulu ingozi yokulahlekelwa ukuhlanganiswa kwamapulmasi.
Isinyathelo Sokubili
Uma kungenzeka ukuthi i-pulmonary ihambisana nesinyathelo esisodwa isinqunyelwe ukuba isisemkhatsini, noma uma kungenzeka emitholampilo ye-pulmonary embolus iphansi kodwa izilinganiso ze-PERC azizange zihlangabezane, isinyathelo esilandelayo ukuthola ukuthola i-D-dimer igazi.
Ukuhlolwa kwe-D-dimer kuthatha ukuthi ngabe sekukhona yini izinga elingavamile lomsebenzi wokugcoba egazini, njengokungathi kuyoba khona uma umuntu enesifo se-vein thrombosis noma i-pulmonary embolus.
Uma amathuba emitholampilo we-PE aphansi noma aphakathi futhi ukuhlolwa kwe-D-dimer kungalungile, ukuhlanganiswa kwe-pulmonary ngokuvamile kungagunyazwa futhi udokotela uzoqhubeka nokucabangela ezinye izimbangela ezingabangela izimpawu.
Isivivinyo se-D-dimer singasetshenziswa kuphela ukulawula ukuhlanganiswa kwe-pulmonary, hhayi ukwenza ukuxilongwa. Ngakho uma ukuhlolwa kwe-D-dimer kulungile (noma uma kungenzeka umtholampilo womuntu we-pulmonary embolus kuthathwa njengesinyathelo esiphezulu esisodwa), yisikhathi sesinyathelo sesithathu.
Isinyathelo Sesithathu
Isinyathelo sesithathu sinesifundo se-imaging sokuxilongwa. Ngokuvamile, olunye lwezinhlobo ezintathu zokuhlola luzosetshenziswa.
I-CT Scan
I- CT scan iyindlela yokusebenzisa i-x-ray evumela ukuthi udokotela ahlolisise imishanguzo ye-pulmonary ukuze abone ukuthi kukhona yini ukuvinjelwa okubangelwa i-clot yegazi. I-ejenti yokuphambene ijojowe egazini ngesikhathi sokuhlolwa ukusiza ngeso lengqondo imishanguzo.
I-CT scan inembile kunamaphesenti angama-90 esikhathi sokubona i-pulmonary embolus futhi manje ibhekwa njengesivivinyo sokuzikhethela uma ukucabangela kuyadingeka ukuze kutholakale ukuxilongwa.
V / Q Scan
Ukuskena kwe-AV / Q (okubizwa nangokuthi ukuskena kwe-ventilation / perfusion) kungumshini wokumaphaza osebenzisa idayisi e-radioactive, ukujova emgodini, ukuhlola ukugeleza kwegazi emathangeni amaphaphu. Uma umthambo we-pulmonary uvinjiwe kancane ngamagumbi, ingxenye ehambisanayo yamathishu emaphaphu ithola kancane kunani elijwayelekile lombala omsakazo.
Namuhla ukuhlolwa kwe-V / Q kuvame ukusetshenziswa kubantu abangeke bavezwe kuwo wonke ama-radiation adingekayo yi-CT scan, futhi kulabo abathintekayo nge-CT.
I-Angiogram yePulmonary
Kwaphela amashumi eminyaka isifundo se-catheterization esibizwa ngokuthi i-pulmonary angiogram kwakuyisilinganiso segolide sokuxilongwa kwe-pulmonary embolus, kodwa lokhu kuhlolwa sekuye kwaxhaswa yi-CT scan.
Nge-angiogram ye-pulmonary, idayi ijojowe ngekathetha elifakwa emthonjeni wepaymoni ukuze noma yikuphi ama-clots egazi angabonwa nge-x ray. Lesi sivivinyo esingavamile singasadingeka ngezikhathi ezithile uma ukuhlolwa kwe-CT noma ukuhlolwa kwe-V / Q kungasetshenzisiwe noma imiphumela yilezi zivivinyo ayifaneleki.
Kubantu abangaqinisekile
I-pulmonary embolus ingabangela ukuwa kwesifo senhliziyo ngokushesha. Eqinisweni, i-pulmonary embolus ivame ukuba yilabo abasha abafa ngokuzumayo.
Uma umuntu enezinkinga ezinkulu ze-cardiovascular and pulmonary embolus kubonakala sengathi iyimbangela, uhlelo oluhlelekile lokuxilonga lwezinyathelo ezintathu alunakwenzeka. Kulaba bantu, ukwelashwa kuvame ukuphathwa masinyane, kanye neminye imizamo yokuvuselela, ngaphambi kokuba kutholakale ukuxilongwa okucacile kwe-pulmonary embolus.
Ukuhlonza okuhlukile
Ekuhloleni i-pulmonary embolus, kubalulekile futhi ukuthi udokotela akwazi ukulawula ezinye izifo zezokwelapha ezinezimpawu ezingalingana nezomzimba we-pulmonary. Izimo okudingeka zicatshangelwe (okungukuthi, ukuhlonza ukuhlukana) ngokuvamile zihlanganisa ukuhlaselwa kwenhliziyo , ukwehluleka kwenhliziyo , i- pericarditis , i-tamponade yenhliziyo , i-pneumonia, ne- pneumothorax .
Ama- electrocardiograms , amathumba ama-x-rays, kanye nama- echocardiograms avame ukutholakala ngezikhathi ezithile zokuhlolwa kwemitholampilo ngenxa yokukhathazeka kwenhliziyo noma yamaphaphu ngokuvamile okwanele ukulawula lezi ezinye izimo.
Ngisho noma enye yalezi ezinye izifo ezitholwayo, lokho akusho ukuthi imithi ye-pulmonary igxiliwe ngaphandle, ngoba umuntu angase abe nezimo ezimbili ngesikhathi esifanayo-futhi eziningi zezifo zenhliziyo zikhulisa ingozi ye-pulmonary embolus. Ngakho-ke uma kusenesizathu sokusola ukuthi kungenzeka ukuphazamiseka kwamapuloni emva kokunye ukuxilongwa kwenziwa, kubalulekile ukuthatha izinyathelo ezengeziwe ezidingekayo ukuze uqedele ukuhlolwa kokuhlola.
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