Umuyoboro wimbitse (DVT) hamwe na embolisme yimpaha ubufasha bwambere¶

** Venous tromboembolism (VTE) ** ikubiyemo ibintu bibiri bifitanye isano nubuvuzi: ** Umuyoboro wimbitse wa Thrombose (DVT) *, aho uturemangingo twamaraso ( trombus *) tuba imbere mumitsi yimbitse, ubusanzwe mubyana, ikibero, ikibuno, cyangwa ukuboko hejuru, hamwe na ** ibihaha byangiza ubuzima byihuta byangiza ubuzima. umutima, kandi icumbitse imbere mu mitsi nyamukuru y'ibihaha.

Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS) hamwe n’ikigo cya Leta zunze ubumwe z’Amerika gishinzwe kurwanya no gukumira indwara (CDC), ngo amaraso y’imitsi y’imitsi ni yo ya gatatu mu mitsi y’imitsi itera impfu ku isi yose (inyuma y’umutima ndetse n’ubwonko), ihitana abantu ibihumbi magana buri mwaka. Icy'ingenzi, Embolism ya Pulmonary ni imwe mu mpamvu zishobora kwirindwa zitera urupfu rutunguranye: niba imitsi yimbitse ya Thrombose yo mu kuguru yamenyekanye hakiri kare kandi ikavurwa hakoreshejwe imiti igabanya ubukana ("kumena amaraso") mbere yuko icika, cyangwa niba ikosa rikomeye nka ** gukanda inyana ifunze, yabyimbye ** irashobora kwirindwa.

Kumenya gutandukanya itandukaniro riri hagati yimitsi isanzwe hamwe na Thrombose Yimbitse, uburyo bwo kubona igituza gitunguranye no guhumeka amabendera atukura ya Pulmonary Embolism, nicyo wakora muminota mike mbere yuko inkeragutabara ziza zirokora ubuzima.

Kora ubu¶

Niba ukeka ko amaraso yamenetse mu gihimba (DVT) cyangwa amaraso yagiye mu bihaha (Pulmonary Embolism), kurikiza ibi bikorwa bitandatu byihuse:

1. ** Niba hari ibimenyetso byerekana ibimenyetso bya Pulmonary Embolism (PE) bihari, hamagara nimero yawe yihutirwa ako kanya **: Niba umuntu arwaye ** guhumeka gutunguranye, kudasobanutse guhumeka neza **, ** igituza gikaze, umugongo, cyangwa urubavu bikabije iyo uhumeka neza cyangwa ukorora **, ** umuvuduko wumutima wiruka (gukubitwa inshuro 100 kumunota) Amerika na Kanada, 112 mu bihugu by’Uburayi, cyangwa 999 mu Bwongereza (cyangwa reba ibyacu nimero yihutirwa ububiko). Ntukigendere mu bitaro ukekwaho PE.
2. ** Wicare umurwayi wa Embolism Pulmonary Embolism igice cya kabiri kandi ugumane rwose **: Fasha umuntu uzi ubwenge ufite PE ukekwaho kuba yicaye mumwanya wa ** woroheje igice cya kabiri (dogere 45) ** yegamiye imbere gato cyangwa ashyigikiwe n umusego, guhanagura imyenda ifatanye mumajosi no mukibuno, kandi ukomeze gutuza kugirango ugabanye ogisijeni. Ntukemere ko bagenda ku ngazi kugira ngo bahure na ambilansi.
3. ** NTAKIGEZE gukanda, gusiga, kuzunguza ifuro, cyangwa gushyira imbunda ya massage ya percussive kumaguru ukekwaho DVT **: Abantu benshi bibeshya ububabare bwimbitse, bubabaza bwinyana yamaraso yinyana "imitsi ikururwa" cyangwa "ifarashi ya charley" nyuma yindege ndende cyangwa kubagwa hanyuma bakagerageza kuyisohora cyane cyangwa gukoresha imbunda ya massage yimbitse. ** Gukanda ukuguru hamwe na DVT kumena kumubiri wamaraso yoroheje kuva kurukuta rwimitsi **, akohereza mumutima no mubihaha nka Embolism nini yica cyane mumasegonda.
4. ** Niba ufite ibimenyetso bya DVT mumaguru cyangwa ukuboko (udafite ibimenyetso byigituza / guhumeka), shaka umunsi umwe wo kwisuzumisha ultrasound ** duplex compression ultrasound. Ntutegereze icyumweru kugirango usabe gahunda isanzwe.
5. ** Kuruhuka ingingo yabyimbye witonze kandi NTUGENDE cyangwa ngo ukore imyitozo **: Mugihe utegereje isuzumabumenyi ukekwaho kuba ari DVT, hagarika kugenda, kwiruka, cyangwa kurambura ukuguru. Uruhuke utuje ukuguru gushigikiwe muburyo butabogamye ku buriri cyangwa ku buriri, kandi wirinde kwambuka amaguru cyangwa kwambara amasogisi maremare yo mu ivi azenguruka inyana.
6. ** Witegure gutangira Amaboko-Gusa CPR niba PE nini itera gusenyuka **: Embolisme nini "indogobe" ishobora guhagarika burundu amaraso ava mumitsi yiburyo yumutima (guhungabana), bitera gucika intege bitunguranye bikurikirwa no gufatwa k'umutima. Niba umuntu atitabye kandi agahagarika guhumeka bisanzwe (cyangwa akora gusa gasi rimwe na rimwe), ubirambike hejuru yubutaka hanyuma utangire byihuse, byihuse amaboko-gusa CPR kuri compression 100 kugeza 120 kumunota.

flowchart TD
    A["Ukekwaho Amaraso Yihutirwa (VTE)"] --> B{"Ubuke butunguranye bwo guhumeka, ububabare bwo mu gatuza Pleuritis, Umutima wiruka, cyangwa gucika intege?"}
    B -->|"Yego (Ukekwaho Embolism Ikekwa)"| C["Hamagara Ambulance yihutirwa (911/112/999) Ako kanya"]
    C --> D["Intebe Yumurwayi Semi-Upright (Impamyabumenyi 45) + Imyambarire Yoroheje"]
    D --> E["Komeza kwihangana rwose; Tangira CPR niba idashubije"]
    B -->|"Oya (Ibimenyetso bigarukira ku kuguru kamwe cyangwa ukuboko)"| F{"1-Kubyimba kuruhande, Ubushyuhe, Umutuku / Uruhu rw'umuyugubwe, & Inyana yimbitse / Kubabara ikibero?"}
    F -->|"Yego (Bikekwa ko Thrombose ikabije)"| G["Hagarara: Ntukigere ukora Massage, Rub, Foam-Roll, cyangwa Kurambura ingingo"]
    G --> H["Kuruhuka amaguru atuje; Ntugende bitari ngombwa"]
    H --> I["Ubwikorezi Uyu munsi Mubitaro ER kumunsi umwe wa Ultrasound"]
    F -->|"Oya"| J["Kurikirana ibintu bishobora guteza ingaruka (Kubaga vuba, Indege ndende, Estrogene, Kanseri)"]

Nigute ushobora kumenya imitsi yimbitse (DVT) vs imitsi isanzwe¶

Kuberako kimwe cya kabiri cyabantu bose batera DVT babanza gutekereza ko bakuyemo imitsi yinyana cyangwa bakaryama ukuguru kwabo birasekeje, bazi kugereranya imyenda yimitsi ihangayikishije imitsi ni ngombwa.

Imbonerahamwe Yimbitse (DVT) vs Imbonerahamwe yo kugereranya imitsi¶

Kubara ibyago byawe byamavuriro: amanota yahinduwe amanota ya DVT¶

Mu ishami ryihutirwa ryibitaro kwisi yose, abaganga bakoresha ibipimo bya ** Wells kuri DVT ** kugirango basuzume bishoboka ko ukuguru kubabaza cyangwa kubyimba ari amaraso. Urashobora gusubiramo ibi bintu 10 byugarije amavuriro kugirango wumve impamvu abaganga bafatana uburemere ibimenyetso byihariye byamaguru (buri kintu kongeramo ** + 1 ingingo **):

1. ** Kanseri ifatika ** (kuvura mumezi 6 ashize cyangwa ubuvuzi bwa palliative): ** + ingingo 1 **.
2. ** Ubumuga, paresi, cyangwa plaster iherutse / kugenda boot boot immobilisation ** yamaguru: ** + 1 point **.
3. ** Vuba aha kuryama muminsi 3 cyangwa irenga **, CYANGWA ** kubagwa gukomeye mubyumweru 12 bishize ** bisaba anesthesia rusange cyangwa mukarere: ** + 1 point **.
4. ** Ubwuzu bwaho hafi yimitsi yimbitse ** (munsi yinyuma-yinyuma yinyana cyangwa kuruhande rwibibero byimbere): ** + 1 point **.
5. ** Ukuguru kwose kubyimba ** (kuva ikibuno / ikibero kugeza kumaguru): ** + 1 point **.
6. ** Inyana kubyimba byibura santimetero 3 (santimetero 1,2) nini ** mu muzenguruko kuruta ukuguru kutagira ibimenyetso (bipimye cm 10 munsi yigituntu cya tibial): ** + 1 point **.
7. ** Gutera edema ** kugarukira kumaguru yerekana ibimenyetso: ** + ingingo 1 **.
8. ** Imitsi yimitsi itagaragara ** (igaragara, imitsi itagaragara ya varicose igaragara kumaguru yabyimbye mugihe amaraso azenguruka kuziba cyane): ** + 1 point **.
9. ** Byanditswe mbere DVT ** mubihe byashize: ** + ingingo 1 **.
10. *.

Kumenya Embolism ya Pulmonary (PE): iyo umwenda ugeze mu bihaha¶

Iyo agace ka DVT kavunitse (* embolize *), kajugunywa hejuru binyuze mumitsi minini yinda mu gice cyiburyo cyumutima, kikayijugunya neza mumashami ** yimitsi yimitsi ** yibihaha.

Icy'ingenzi, ** abagera kuri 40 ku ijana by’abarwayi basuzumwe indwara y’ubuzima bwa Pulmonary Embolism ntabwo bigeze bagira ububabare bugaragara bwamaguru cyangwa kubyimba mbere **, haba kubera ko umwenda wabaye bucece mu mitsi yimbitse, cyangwa kubera ko ikirenge cyose cyavunitse icyarimwe bakajya mu bihaha.

Uburyo Embolism Yimpyiko Yica (Umutima Wiburyo, ntabwo ari ogisijeni nkeya)¶

Igitekerezo gikunze kugaragara ni uko Embolism ya Pulmonary ikubabaza gusa ugabanya urugero rwa ogisijeni mugice cyumubiri. Mubyukuri, binini ** Byinshi cyangwa Byinshi ("Saddle") Embolism Yimpyiko ** yica binyuze muri ** acute Obstructive Shock hamwe no kunanirwa kwa Ventricular **:

1. Iyo umwenda munini ucometse kuri 50% cyangwa irenga yibiti byumuvuduko wamaraso, uruzitiro ruto ** ** Ventricle iburyo ** yumutima bigomba guhita bivoma kurukuta rwamatafari rwumuvuduko.
2. Umupira wiburyo wa ventricle iburyo hanze, urambuye, kandi birananirana, kuburyo ** hafi ntamaraso ashobora kunyura mumahaha kugirango agere ibumoso bwa Ventricle **.
3. Kuberako umuyaga wibumoso uza ubusa, umuvuduko wamaraso wubwonko hamwe nimiyoboro yimitsi ya coronari igwa kuri zeru, bigatera gucika intege gitunguranye (** syncope **), kumenagura ububabare bwo mu gatuza, na ** Pulseless Electrical Activity (PEA) ifata umutima **.

Ibimenyetso bya Embolism ya Pulmonary vs Imbonerahamwe yo kugereranya umutima¶

Gusobanukirwa Triad ya Virchow: ninde ufite ibyago byinshi byo gutembera kw'amaraso?¶

Mu 1856, umuganga Rudolf Virchow yerekanye ** imiterere itatu ya physiologiya ("Triad ya Virchow") ** itera amaraso gutembera bidasanzwe mumitsi yumuntu. Hafi ya buri DVT na PE ibisubizo biva kuri kimwe cyangwa byinshi muribi bitatu:

1. ** Stasis ya Venusi (Amaraso atinze cyangwa yuzuye) **:
   • Bitandukanye nimiyoboro y'amaraso, imitsi yo mumaguru yawe ntigira imitsi yumutima uyisunika; bishingikiriza rwose kumitsi yinyana yawe ** inyunyuza imitsi yimbitse ** burigihe uteye intambwe ("pompe yimitsi yinyana").
   • ** Imbarutso **: Kwicara utimuka kuri ** 4 + amasaha ** mu ntebe yindege ifunganye, imodoka, bisi, cyangwa intebe yimikino / biro; kuryama mu buriri bw'ibitaro nyuma yo kubagwa cyangwa umusonga; kwambara amaguru ya plaster cyangwa orthopedic igenda; kumugara nyuma yubwonko cyangwa igikomere cyumugongo; cyangwa gutwita bitinze (aho nyababyeyi iremereye ikanda kumitsi ya iliac).
2. ** Hypercoagulability ("Sticky" Amaraso akunda kwambara) **:
   • ** Imbarutso Yabonye **: ** Kanseri ifatika na chimiotherapie ** (ibibyimba birekura poroteyine za pro-coagulant, bikagwira ibyago byo kwambara inshuro 4 kugeza kuri 7); ** Inda n'ibyumweru 6 byambere Nyuma yo kubyara ** (mugihe umubiri usanzwe uzamura ibintu byambaye inshuro eshanu kugirango wirinde kuva amaraso mugihe cyo kubyara); ** Imiti irimo Estrogene ** (ibinini byo kuboneza urubyaro byo kuboneza urubyaro, imiti ya estrogene / impeta, hamwe no kuvura imisemburo ya hormone); ** Kunywa itabi / vaping **; ** COVID-19 cyangwa indwara zanduye **; umubyibuho ukabije; n'indwara yo mu mara (Crohn's / ulcerative colitis).
   • ** Indwara ya Genetic Clotting Disorders (Thrombophilias) **: ** Factor V Leiden mutation ** (igaragara hafi ya 5% yabantu bakomoka muburayi), ** Prothrombin G20210A mutation **, ** Syndrome ya Antifosifolipide **, hamwe nubusembwa bwa anticagulants (Protein C, Protein S,)
3. ** Gukomeretsa kwa Endoteliyale (Kwangirika kumurongo w'imbere y'urukuta rw'imitsi) **:
   • ** Imbarutso **: Orthopedic ** kubaga ikibuno cyangwa ivi **, kubaga pelvic / inda yo kubaga, kuvunika amagufwa, guhahamuka kumaguru, imiyoboro y'amaraso ** PICC / imiyoboro y'amaraso yo hagati / pacemakers ** (# 1 itera ** Upper-Extremity DVT ** mumaboko no mubitugu subclavian), cyangwa mbere ya DVT inkovu.

Nigute ushobora kwirinda DVT na PE mugihe cyindege ndende, ingendo zo mumuhanda, no gukira nyuma yo kubagwa¶

Waba winjiye mu ndege mpuzamahanga yamasaha 10, utwaye imodoka hirya no hino, cyangwa ugakira murugo nyuma yo kubagwa, gukurikiza amategeko yoroshye yubukanishi nogutwara amazi bigabanya ibyago byo kwandura imitsi kugera kuri 80%:

• ** Kora "Amapompe Yicaye Yicaye" kandi Inyana izamura buri minota 30 **: Mugihe wicaye ku ntebe yindege cyangwa kumeza, buri saha yigice kora ** 20 pompe yihuta, ifite imbaraga **: shyira agatsinsino hasi hanyuma ukure amano yawe hejuru ugana hejuru ya shine yawe (kurambura inyana) hanyuma uzamure inyana zawe hejuru (wuzuze amasegonda 3). Iyi ntoki ikanyunyuza imitsi yinini * yonyine yimitsi yinyana zawe hanyuma igahindura amaraso adahagaze agasubira mumutima wawe.
• ** Andika intebe ya aisle hanyuma ugende muminota 3 buri saha 1 kugeza 2 **: Mugihe cyindege cyangwa gariyamoshi bimara amasaha arenga 4, haguruka ugendere munzira buri saha cyangwa ibiri; murugendo rurerure rwimodoka, hagarara ahagarara kuruhuka buri masaha 2 kugirango uzenguruke byihuse imodoka.
• ** Wambare ububiko bwa compression bwarangije (15-20 mmHg cyangwa 20-30 mmHg) niba ufite ibintu bishobora guhura n'ingaruka **: Bikwiye neza neza ivi-ndende ** yarangije amasogisi yo guhunika ** (ifatanye cyane ku kaguru kandi igenda irekura inyana) ikubye kabiri umuvuduko wamaraso atembera mumitsi yimbitse. Bishyire mugitondo mbere yuko amaguru yawe yabyimba, kandi urebe neza ko umurongo wo hejuru ** utigera umanuka mumurongo wa reberi ufashe inyuma y'amavi yawe ** (ikora nka tourneque kandi * itera * ibibyimba).
• ** Gumana amazi menshi kandi wirinde inzoga nyinshi cyangwa ibinini byo kuryama mu ndege *: Akazu k’indege kotswa igitutu gafite ubutumburuke buke bwo munsi y’ubutayu (munsi ya 15%), bikagutera umwuma kandi bikagabanya ubukana bwamaraso yawe ( hemoconcentration *). Kunywa mililitiro 250 (8 ounci) y'amazi kuri buri saha mu kirere, irinde umwuma wa alcool, kandi ** ntuzigere ufata ibinini bikomeye byo kuryama byogusinzira ** bigutera gusohokera wicaye mucyicaro cyo hagati kandi amavi yawe yunamye amasaha 8 agororotse udahinduye umwanya.
• ** Ntuzigere unyura amaguru ku mavi cyangwa ngo ukande inyuma yinyana zawe cyane kuruhande rwintebe **: Kwambuka ivi rimwe kurindi kurindi bihita byerekeza kumitsi ya ** popliteal ** inyuma yivi. Shira ibirenge byombi hasi kandi ugumane umwanya munsi yintebe imbere yawe usobanutse bihagije kugirango urambure amaguru.

Ibibazo bikunze kubazwa¶

Inkomoko yagenzuwe¶

• ** Ibigo bishinzwe kurwanya no gukumira indwara (CDC) **: * Thromboembolism ya Venusi (Amaraso): Hagarika umwambaro, ukwirakwiza ubukangurambaga bwijambo, ibintu bishobora guteza ingaruka, no gukumira ingendo ndende * (Amerika).
• ** Sosiyete y'Abanyamerika ya Hematologiya (ASH) **: * Amabwiriza ngenderwaho y’ubuvuzi bwo gucunga imiyoboro ya Thromboembolism: Gusuzuma no kuvura indwara ya DVT na Embolism y’ibihaha * (Amerika / Mpuzamahanga).
• ** Umuryango w’ibihugu by’i Burayi byita ku ndwara z'umutima (ESC) **: * Amabwiriza yo gusuzuma no gucunga Embolism Acute Pulmonary * (Umuryango w’ubumwe bw’ibihugu by’Uburayi).
• ** Ikigo cyigihugu gishinzwe ubuzima n’ubuvuzi bwiza (NICE) & NHS **: * Indwara ziterwa na Thromboembolique: Gusuzuma, Gucunga, no Kwipimisha Thrombophilia (NG158) * (Ubwongereza).
• ** Ishyirahamwe ryumutima wabanyamerika (AHA) **: * Ubuyobozi bwa Embolism nini na Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombose, na Hypertension Chronique Thromboembolique * (Amerika).
• ** Thrombose Canada & Umuryango w’ubuzima ku isi (OMS) **: * Ubuyobozi bw’amavuriro kuri Thrombose Yimbitse, Gutwita-Associated VTE, hamwe n’umushinga WO WANDITSWE ku ngaruka z’ingendo * (Kanada / Mpuzamahanga).

Kuyobora¶

• Indwara y'umutima
• Indwara
• Amaboko-gusa CPR
• Shock