thrombosis miri emi (DVT) na pulmonary embolism enyemaka mbụ¶

** venous thromboembolism (VTE)** na-agụnye ọnọdụ ahụike abụọ jikọrọ aka na ya: Deep Vein Thrombosis (DVT), bụ nke mkpụkọ ọbara (* thrombus*) na-etolite n'ime akwara miri emi, na-abụkarị nwa ehi, apata ụkwụ, pelvis, ma ọ bụ ogwe aka elu, yana ** pulmonary embolism (PE) nke na-apụta mgbe ihe mberede na-eme na ndụ. rụrụ arụ, na-aga n'akụkụ aka nri nke obi, wee banye n'ime akwara akwara nke ngụgụ.

Dị ka Òtù Ahụ Ike Ụwa (WHO) na Ụlọ Ọrụ Na-ahụ Maka Nchịkwa na Mgbochi Ọrịa nke United States (CDC) si kwuo, mkpụkọ ọbara venous bụ nke atọ na-akpata vaskụla vaskụla ọnwụ n'ụwa nile (n'azụ nkụchi obi na ọrịa strok), na-egbu ọtụtụ narị puku mmadụ kwa afọ. N'ụzọ dị mkpa, pulmonary embolism bụ otu n'ime ihe ndị a na-egbochi egbochi ọnwụ mberede: ọ bụrụ na a na-amata ọrịa Thrombosis miri emi na ụkwụ n'oge ma na-agwọ ya ọgwụ anticoagulant ("ọbara thinning") tupu ọ gbajie, ma ọ bụ ọ bụrụ na a ga-ezere mmejọ dị oke egwu dị ka ** ịhịa aka n'ahụ, nwa ehi fụrụ akpụ ** a ga-ezere igbochi iku ume.

Ịmara ka esi amata ọdịiche dị n'etiti akwara akwara nkịtị na thrombosis miri emi, otu esi achọpụta igbe mberede na iku ume na-acha uhie uhie nke Pulmonary Embolism, na ihe ị ga-eme na nkeji oge tupu ndị ọrụ ahụike abịarute na-azọpụta ndụ.

Mee nke a ugbu a¶

Ọ bụrụ na ị na-enyo enyo na ọ nwere mkpụkọ ọbara na aka (DVT) ma ọ bụ mkpụkọ ọbara nke gara na ngụgụ (Pulmonary Embolism), soro omume isii ndị a ozugbo:

1. ** Ọ bụrụ na ihe ịrịba ama ọ bụla nke pulmonary embolism (PE) dị, kpọọ nọmba mberede mpaghara gị ozugbo ***: Ọ bụrụ na mmadụ amalite ** na mberede, mkpụmkpụ ume na-akọwaghị ***, ** obi dị nkọ, azụ, ma ọ bụ ọgịrịga nke na-akawanye njọ mgbe ị na-eku ume ma ọ bụ ụkwara. ** isi ọwụwa / ịda mba na mberede ***, kpọọ 911 na United States na Canada, 112 gafee European Union, ma ọ bụ 999 na United Kingdom (ma ọ bụ lelee anyị). nọmba mberede ndekọ). Akwọla onwe gị n'ụlọ ọgwụ maka PE a na-enyo enyo.
2. **Nọdụ n'oche onye ọrịa pulmonary embolism nke ọma ma debe ha kpam kpam *: Nyere onye maara ihe nke a na-enyo enyo na PE nọ ọdụ na ** ntụsara ahụ ọkara kwụ ọtọ (ogo 45) na-adabere ntakịrị n'ihu ma ọ bụ na-akwado ya site na ohiri isi, tọpụ uwe siri ike n'olu na n'úkwù, ma mee ka ha dị jụụ iji belata oriri oxygen. Ekwela ka ha rịdata na steepụ iji zute ụgbọ ihe mberede.
3. ** AGHỊGHỊ ịhịa aka n'ahụ, ite, ụfụfụ, ma ọ bụ tinye egbe ịhịa aka n'ahụ na ụkwụ DVT a na-enyo enyo ***: Ọtụtụ ndị na-emegharị miri emi, ihe mgbu na-egbu mgbu nke ọbara nwa ehi maka "anụ ahụ dọtara" ma ọ bụ "ịnyịnya Charley" mgbe ogologo ụgbọ elu ma ọ bụ ịwa ahụ gasịrị ma gbalịa ịcha ya ike ma ọ bụ jiri egbe ịhịa aka n'ahụ dị omimi. **Iji DVT ịhịa aka n'ụkwụ na-agbaji ọbara dị nro na-esi na mgbidi vein pụta ***, na-ebuga ya ozugbo n'ime obi na ngụgụ dị ka nnukwu ihe mgbu Pulmonary na-egbu egbu n'ime sekọnd.
4. ** Ọ bụrụ na ị nwere ihe ịrịba ama nke DVT n'otu ụkwụ ma ọ bụ ogwe aka (na-enweghị mgbanaka obi / iku ume), nweta nyocha ahụike nke ultrasound nke otu ụbọchị: Ọ bụrụ na otu nwa ehi, apata ụkwụ, ma ọ bụ ogwe aka na-apụta ìhè ** fụrụ akpụ (buru ibu na gburugburu karịa akụkụ nke ọzọ) ngalaba mberede ma ọ bụ ụlọ ọgwụ diagnostic ngwa ngwa ** taa *** maka venous duplex compression ultrasound. Echela otu izu maka oge ọbịbịa nke ụlọ ọrụ.
5. **Jisie ike n'akụkụ fụrụ akpụ wee ghara ịgagharị ma ọ bụ mega ahụ ***: Ka ị na-eche maka nyocha nke DVT a na-enyo enyo, kwụsị ije ije, ịgba ọsọ, ma ọ bụ ịgbatị ụkwụ. Jisie ike na ụkwụ na-akwado ịnọpụ iche n'ihe ndina ma ọ bụ ihe ndina, ma zere ịgafe ụkwụ gị ma ọ bụ yikwasị sọks dị elu ikpere nke na-emegharị nwa ehi.
6. **Dịrị njikere ịmalite naanị CPR aka-naanị ma ọ bụrụ na nnukwu PE na-akpata ọdịda ***: Nnukwu “saddle” pulmonary embolism nwere ike igbochi ịgbapụta ọbara site na ventricle aka nri nke obi.ihe mgbochi mgbochi), na-akpata nkụda mmụọ na mberede na-esochi obi njide. Ọ bụrụ na onye ahụ anabataghị ya ma kwụsị iku ume nke ọma (ma ọ bụ naanị na-eme ka ọ na-afụ ụfụ mgbe ụfọdụ), dọba ha n'elu elu siri ike wee malite ngwa ngwa ngwa ngwa. CPR naanị aka na 100 ruo 120 compressions kwa nkeji.

flowchart TD
    A["Mberede mkpirisi ọbara a na-enyo enyo (VTE)"] --> B{"Mkpụkpọ ume na mberede, mgbu obi Pleuritic, obi ịgba ọsọ, ma ọ bụ ịda mba?"}
    B -->|"Ee (Embolism Pulmonary A na-enyo enyo)"| C["Kpọọ ụgbọ ihe mberede mberede (911/112/999) ozugbo"]
    C --> D["Oche onye ọrịa ọkara kwụ ọtọ (ogo 45) + tọpụkwa akwa akwa"]
    D --> E["Nọgidenụ na-enwe ndidi kpamkpam; Malite CPR ma ọ bụrụ na azaghị ya"]
    B -->|"Mba (Ihe mgbaàmà na-ejedebe na otu ụkwụ ma ọ bụ ogwe aka)"| F{"Ọzịza nke akụkụ 1, ọkụ, anụ ahụ na-acha uhie uhie/acha odo odo, na oke nwa ehi/ apata ụkwụ?"}
    F -->|"Ee (Thrombosis miri emi a na-enyo enyo)"| G["Kwụsị: Ọ dịghị mgbe ịhịa aka n'ahụ, ite, ụfụfụ-Roll, ma ọ bụ gbatịa akụkụ ahụ"]
    G --> H["Jisie Ike zuru ike; Ejela ije na-enweghị isi"]
    H --> I["Ụgbọ njem taa gaa ụlọ ọgwụ ER maka otu ụbọchị Venous Ultrasound"]
    F -->|"Mba"| J["Nyochaa ihe kpatara ihe egwu (ịwa ahụ na nso nso a, Ogologo ụgbọ elu, estrogen, ọrịa kansa)"]

Otu esi amata thrombosis miri emi (DVT) na akwara nkịtị¶

N'ihi na ọkara nke ndị niile na-azụlite DVT na mbụ na-eche na ha dọtara anụ ahụ nwa ehi ma ọ bụ hie ụra n'ụkwụ ha na-atọ ọchị, ịmara otú e si atụnyere mkpụkọ venous megide eriri anụ ahụ dị oke egwu.

Deep Vein Thrombosis (DVT) vs tebụl ntụnyere eriri akwara¶

Ịgbakọ ihe ize ndụ ụlọ ọgwụ gị: Akara Wells Agbanwere maka DVT¶

Na ngalaba mberede ụlọ ọgwụ n'ụwa nile, ndị dọkịta na-eji ** Wells Criteria maka DVT ** iji chọpụta ihe gbasara puru omume na ụkwụ na-egbu mgbu ma ọ bụ fụrụ akpụ bụ mkpụkọ ọbara. Ị nwere ike nyochaa ihe ize ndụ ụlọ ọgwụ iri a iji ghọta ihe kpatara ndị dọkịta ji ewere akara mgbaàmà ụkwụ kpọmkwem (ihe ọ bụla na-agbakwụnye **+1 isi **):

1. ** Ọrịa kansa na-arụ ọrụ** (ọgwụgwọ n'ime ọnwa isii gara aga ma ọ bụ nlekọta ahụike): +1 isi.
2. **Mkpọnwụ akpọnwụ, paresis, ma ọ bụ ihe nkedo plasta/na-eme njem na-adịbeghị anya nke ụkwụ: +1 point.
3. **Dịkịta n'ụra n'oge na-adịbeghị anya maka ụbọchị 3 ma ọ bụ karịa ***, OR ** nnukwu ịwa ahụ n'ime izu iri na abụọ gara aga ** chọrọ mgbakasị izugbe ma ọ bụ mpaghara: +1 isi.
4. ** nro dị n'akụkụ sistemu venous miri emi ** (n'okpuru etiti azụ nwa ehi ma ọ bụ n'akụkụ ukwu ukwu ukwu nke ime): +1 isi.
5. ** Ụkwụ dum fụrụ akpụ** (site n'úkwù/apata ruo na nkwonkwo ụkwụ): +1 isi.
6. ** Ọzịza nwa ehi opekata mpe 3 centimita (1.2 sentimita) buru ibu ** n'okirikiri karịa ụkwụ enweghị akara (a tụrụ 10 cm n'okpuru tuberosity tibial): +1 isi.
7. Pitting edema kpọchiri na ụkwụ mgbaàmà: +1 isi.
8. ** veins elu elu ** (nke a na-ahụ anya, veins elu na-abụghị varicose na-apụta n'ụkwụ fụrụ akpụ ka ọbara na-atụgharị gburugburu ebe mgbochi miri emi): +1 isi.
9. ** Edere DVT n'oge gara aga: +1 isi.
10. • (Rịba ama: Ọ bụrụ na nchoputa ọzọ, dị ka cellulitis ma ọ bụ anya mmiri amaara, ọ dịkarịa ala dị ka DVT, ndị dọkịta na-ewepụ isi 2; akara nke **2 ma ọ bụ karịa ** na-egosi ohere dị elu nke ụlọ ọgwụ na-achọ ihe ngosi ultrasound ozugbo).

Ịghọta ihe mgbagwoju anya nke Pulmonary (PE): mgbe mkpụkọ ahụ rutere n'akpa ume¶

Mgbe iberi nke DVT gbajiri n'efu (* na-agbaji*), a na-ekpochapụ ya elu site na nnukwu veins nke afọ banye n'akụkụ aka nri nke obi, nke na-ebuba ya ozugbo n'ime alaka ** pulmonary arteries *** nke ngụgụ.

N'ụzọ dị mkpa, ** ihe ruru pasenti 40 nke ndị ọrịa chọpụtara na ha nwere ọrịa Pulmonary Embolism na-eyi ndụ egwu enwebeghị mgbu ụkwụ ma ọ bụ ọzịza tupu oge eruo**, ma ọ bụ n'ihi na mkpụkọ ahụ malitere na nzuzo na veins pelvic miri emi, ma ọ bụ n'ihi na mkpụkọ ụkwụ niile gbajiri ozugbo wee gaa na ngụgụ.

Kedu ka embolism pulmonary na-egbu (nsogbu obi ziri ezi, ọ bụghị naanị oxygen dị ala)¶

Otu echiche na-ezighi ezi bụ na embolism pulmonary na-ewute gị naanị site n'iweda ọkwa oxygen n'ime obere anụ ahụ ngụgụ. N'ezie, nnukwu ** Nnukwu ma ọ bụ Submassive ("Saddle") Pulmonary Embolism *** na-egbu site na ** nnukwu ihe mgbochi na ọdịda ventricular Right **:

1. Mgbe nnukwu mkpirisi plọg 50% ma ọ bụ karịa nke osisi pulmonary arterial, nke nwere obere mgbidi ** Right Ventricle ** nke obi ga-agbanye na mberede na mgbidi brik.
2. Igwe ikuku ventricle aka nri na-apụ apụ, na-ata ahụhụ, ma daa, yabụ ** ọ fọrọ nke nta ka ọ bụrụ na ọ nweghị ọbara nwere ike isi na ngụgụ gafere ruo ventricle ekpe**.
3. N'ihi na ventricle aka ekpe na-apụta n'efu, ọbara mgbali sistemu na ụbụrụ na akwara akwara na-adaba na efu, na-akpata nkụda mmụọ na mberede (** syncope**), na-etipịa ihe mgbu obi, yana ** Ọrụ Eletriki Na-adịghị (PEA) njide obi.

Mgbaàmà nke pulmonary embolism vs Heart Attack ntụnyere tebụl¶

Ịghọta Virchow's Triad: onye nọ n'ihe ize ndụ kachasị maka mkpụkọ ọbara?¶

N'afọ 1856, dibia bekee Rudolf Virchow chọpụtara ** ọnọdụ physiological atọ ("Virchow's Triad")** nke na-eme ka ọbara na-agbakọta nke ọma n'ime akwara mmadụ. Ihe fọrọ nke nta ka ọ bụrụ DVT na PE ọ bụla sitere na otu ma ọ bụ karịa n'ime ihe atọ ndị a:

1. ** Venous Stasis (Ọbara na-agbada ma ọ bụ gbajiri agbaji)**:
   • N'adịghị ka akwara akwara, veins dị n'ụkwụ gị enweghị akwara obi na-agbapụta ha ozugbo; ha na-adabere kpamkpam na ** mọzụlụ nwa ehi na-amanye akwara miri emi *** oge ọ bụla i mere nzọụkwụ ("mgbapụta ahụ ike nwa ehi").
   • ** Ihe na-akpalite ***: Ịnọdụ ala maka ** 4+ awa ** n'oche ụgbọ elu dị mkpagide, ụgbọ ala, ụgbọ ala, ma ọ bụ oche egwuregwu / ọfịs; dina n'àkwà ụlọ ọgwụ mgbe a wachara ya ahụ ma ọ bụ oyi baa; na-eyi akwa nkedo ụkwụ ma ọ bụ akpụkpọ ụkwụ ọkpụkpụ ọkpụkpụ; mkpọnwụ akpọnwụ mgbe ọrịa strok ma ọ bụ ọkpụkpụ azụ; ma ọ bụ afọ ime ime n'oge (ebe akpanwa dị arọ na-agbanye na veins pelvic iliac).
2. ** Hypercoagulability ("Ọbara na-adịgide adịgide" na-enwekarị mkpụkọ)**:
   • ** Ihe ndị enwetara *: ** Ọrịa kansa na-arụ ọrụ na chemotherapy *** ( etuto ahụ na-ahapụ protein pro-coagulant, na-amụba ihe egwu clot 4- ruo okpukpu asaa); Itụrụ ime na izu isii mbụ Post-partum (mgbe anụ ahụ na-ebuli ihe na-akpata mkpụkọ ugboro ise iji gbochie ọbara ọgbụgba n'oge ịmụ nwa); Ọgwụ ndị nwere estren nwere n'ime ya (nchịkọta ọgwụ mgbochi ime ọnụ, mkpọchi estrogen / mgbanaka, na ọgwụgwọ nnọchi homonụ); Singụ sịga/na-asacha; ** COVID-19 siri ike ma ọ bụ ọrịa sistemu; oke ibu; na ọrịa bowel inflammatory (Crohn's / ulcerative colitis).
   • ** Mgbanwe mkpụrụ ndụ ihe nketa nke mkpụrụ ndụ ihe nketa (Thrombophilias)*: ** Ihe kpatara V Leiden mutation (nke dị n'ihe dịka 5% nke ndị sitere na Europe), Prothrombin G20210A mutation, Antiphospholipid Syndrome, na erughi eru nke anticoagulants eke ma ọ bụ Prothrombin III.
3. ** Mmerụ ahụ Endothelial (mmebi nke dị n'ime ime mgbidi vein) ***:
   • ** Ihe na-akpalite ***: Orthopedic ** ịwa ahụ ngbanwe hip ma ọ bụ ikpere **, ịwa ahụ pelvic / afọ, mgbaji ọkpụkpụ, mmerụ ahụ na-adịghị mma n'ụkwụ, intravenous ** PICC Line / Central venous catheters / pacemakers ** (ihe kpatara #1 nke ** Upper-Extremity DVT *** na ogwe aka na ubu), ma ọ bụ DVT vean.

Otu esi egbochi DVT na PE n'oge ụgbọ elu dị ogologo, njem okporo ụzọ, na mgbake mgbe ịwachara ahụ gasịrị¶

Ma ị na-abanye ụgbọ elu mba ụwa nke awa 10, na-anya ụgbọ ala n'ofe mba ahụ, ma ọ bụ na-agbake n'ụlọ mgbe a wachara ya ahụ, itinye usoro nhazi dị mfe na hydration na-ebelata ihe ize ndụ nke clot venous site na pasent 80:

• ** Mee "Pmps Akpụkpọ ụkwụ" na nwa ehi na-ebuli kwa nkeji 30 ọ bụla **: Mgbe ị na-anọdụ n'oche ụgbọ elu ma ọ bụ na tebụl, ọkara elekere ọ bụla na-eme ** 20 nwayọọ nwayọọ na-agbapụta nkwonkwo ụkwụ ike **: gbanye ikiri ụkwụ gị n'ala ma dọta mkpịsị ụkwụ gị elu n'elu ụkwụ gị (na-agbatị nwa ehi), wee pịa mkpịsị ụkwụ gị gbadaa n'ala n'ala (na-ebuli elu ụkwụ gị 3 sekọnd). Nke a na-eji aka na-apịnye nnukwu soleal venous sinuses dị n'ime ụmụ ehi gị ma na-agbanyeghachi ọbara kwụgoro n'ime obi gị.
• ** Debe oche warawara ma jee ije maka nkeji 3 kwa awa 1 ruo 2 ***: Na ụgbọ elu ma ọ bụ ụgbọ oloko na-ewe ihe karịrị awa anọ, bilie na-aga ije n'ụzọ ọ bụla awa ma ọ bụ abụọ; na njem ụgbọ ala dị ogologo, kwụsị n'ebe ezumike kwa awa 2 ọ bụla iji jiri nwayọ na-aga gburugburu ụgbọ ala ahụ.
• ** Yiri sọks mkpakọ gụsịrị akwụkwọ (15-20 mmHg ma ọ bụ 20-30 mmHg) ma ọ bụrụ na ị nwere ihe ndị dị ize ndụ **: Elu ikpere nke dabara nke ọma ** sọks mkpakọ gụsịrị akwụkwọ ** (nke kacha sie ike na nkwonkwo ụkwụ ma jiri nwayọ nwayọ na nwa ehi) okpukpu abụọ ọsọ nke venous ọbara na-eru na veins miri emi. Tinye ha n'ụtụtụ tupu nkwonkwo ụkwụ gị azaa, hụkwa na eriri elu ** ọ dịghị mgbe ọ ga-adaba n'ime eriri roba siri ike n'azụ ikpere gị ** (nke na-eme dị ka njem nlegharị anya na * na-akpata mkpụkọ).
• ** Nọgidenụ na mmiri na-agba mmiri ma zere mmanya na-aba n'anya ma ọ bụ ọgwụ ihi ụra n'ụgbọ elu *: Ụlọ ụgbọ elu nwere nrụgide nwere iru mmiri dị ala (n'okpuru 15%), nke na-akpọnwụ gị ma na-eme ka viscosity ọbara gị sie ike ( hemoconcentration *). Na-aṅụ 250 milliliters (8 ounces) mmiri maka awa ọ bụla n'ikuku, zere ịṅụ mmanya na-aba n'anya, na ** aṅụla ọgwụ ụra siri ike nke na-eme ka ị daa n'oche dị mkpagide na ikpere gị na-ehulata maka awa 8 kwụ ọtọ na-enweghị ọnọdụ mgbanwe.
• ** Agafela ụkwụ gị n'ikpere ma ọ bụ kpagidesi ike n'azụ ụmụ ehi gị na nsọtụ oche **: Ịgafe otu ikpere n'akụkụ nke ọzọ ozugbo na-atụgharị ** vein popliteal ** ozugbo n'azụ nkwonkwo ikpere. Debe ụkwụ abụọ ahụ n'ala ma debe ohere dị n'okpuru oche dị n'ihu gị nke ọma iji gbatịa ụkwụ gị.

Ajụjụ a na-ajụkarị¶

enyochara isi mmalite¶

• ** Centers for Disease Control and Prevention (CDC) **: * venous Thromboembolism (Mkpụkọ ọbara): Kwụsị mkpụkọ ahụ, gbasaa mkpọsa okwu, ihe ize ndụ, na mgbochi njem ogologo oge (United States).
• ** American Society of Hematology (ASH)**: * Ntuziaka Omume Clinical maka Management nke Venous Thromboembolism: Nchọpụta na Ọgwụgwọ nke DVT na Pulmonary Embolism* (United States / International).
• European Society of Cardiology (ESC)*: *Ntuziaka maka nchọpụta na njikwa nke nnukwu akwara akpa ume (European Union).
• ** National Institute for Health and Care Excellence (NICE) & NHS **: * Ọrịa Thromboembolic Venous: Nchọpụta, Nlekọta, na Nnwale Thrombophilia (NG158) (United Kingdom).
• ** American Heart Association (AHA)***: Nchịkwa nke nnukwu na submassive pulmonary embolism, Iliofemoral Deep Vein Thrombosis, na Chronic Thromboembolic Pulmonary Hypertension (United States).
• ** Thrombosis Canada & World Health Organisation (WHO)**: Nduzi nlekọta ahụike gbasara akwara akwara miri emi, VTE metụtara ime ime, yana WHO WRIGHT Project na ihe egwu njem (Canada / International).

Ntuziaka emetụtara¶

• Obi mgbawa
• Ọrịa strok
• CPR naanị aka
• Ujo