Trombosis aa hohonu

ʻO ka thrombosis hohonu (DVT) kahi ʻano e hana ʻia ke kūpulu ke koko i loko o kahi aa i loko o kahi ʻāpana o ke kino. Hoʻopili nui ia i nā veins nui i ka wāwae o lalo a me ka ʻūhā, akā hiki ke hana i nā aa hohonu, e like me nā lima a me nā pelvis.

Kūleʻa ka DVT i nā mākua ma mua o ka makahiki 60. Akā hiki ke hana i kēlā me kēia makahiki. Ke haki a neʻe i kahi kahe o ke koko, kapa ʻia ia he embolism. Hiki i kahi embolism ke paʻa i loko o nā kīʻaha koko i ka lolo, nā mumū, ka puʻuwai, a i ʻole kahi wahi ʻē aʻe, a hiki i ka hōʻino nui.

Hiki ke hana i nā kahe o ke koko ke lohi a hoʻololi paha kekahi i ke kahe o ke koko i nā veins. ʻO nā kumu pilikia me:

• ʻO ka catemaker catheter i hala i loko o ke aa i ke aʻa
• Noho hoʻomaha a noho paha i kahi kūlana no ka lōʻihi loa, e like me ka huakaʻi mokulele
• Mōʻaukala ʻohana o nā huʻa koko
• Nā haki i ke pelvis a i ʻole nā ​​wāwae
• Hānau i loko o nā mahina 6 i hala iho nei
• Hapai keiki
• Ka momona
• ʻO ke kāpili hou (ʻo ka hip, ke kuli, a me nā pelvic wahine)
• Nui a hewahewa ke koko e hana ʻia e ka iwi o ka iwi, e mānoanoa ana ke koko ma mua o ka maʻamau (polycythemia vera)
• Loaʻa i kahi catheter noho lōʻihi (wā lōʻihi) i loko o kahi kīʻaha koko

ʻOi aku ke kō ʻana o ke koko i kekahi mea i loaʻa i kekahi mau pilikia a i ʻole nā ​​maʻi, e like me:

• Kanesa
• ʻO kekahi mau maʻi autoimmune, e like me ka lupus
• Puhi paka
• ʻO nā kūlana e hoʻonui i ka ulu ʻana o ke koko
• Lawe i nā estrogens a i ʻole nā ​​lāʻau kaohi hānau (ʻoi aku ka kiʻekiʻe o kēia makaʻi me ka puhipaka)

Noho no nā wā lōʻihi ke hiki i ka huakaʻi ke hoʻonui i ka makaʻu no DVT. ʻOi paha kēia ke loaʻa iā ʻoe i hoʻokahi a ʻoi paha o nā kumu pilikia i helu ʻia ma luna.

Hoʻopili nui ʻo DVT i nā veins nui i ka wāwae o lalo a me ka ʻūhā, pinepine ma kekahi ʻaoʻao o ke kino. Hiki i ke kelepa ke ālai i ke kahe o ke koko a kumu:

• Hoʻololi i ka ʻili o ka ʻili (ʻulaʻula)
• ʻEha wāwae
• Pahu ka wāwae (edema)
• ʻO kaʻili e mahana i ka pā

E hana i kāu mea mālama ola i kahi hoʻokolohua kino. Hōʻike paha ka hōʻike i kahi wāwae ʻulaʻula, pehu, a palupalu paha.

ʻO nā hoʻāʻo ʻelua i hana pinepine ʻia e kuhikuhi i kahi DVT:

• Hōʻoia ke D-dimer
• Doppler ultrasound hōʻike o ka wahi o ka hopohopo

Hana ʻia kahi pelvic MRI inā aia ke kōkō koko i loko o ke pelvis, e like me ma hope o ka hāpai ʻana.

E hana ʻia paha nā hoʻokolohua koko e nānā inā loaʻa ka manawa nui i ke kāpili ʻana o ke koko, e like me:

• Hoʻoikaika i ka protein C kūpaʻa (nā hōʻoia no ka Factor V Leiden mutation)
• Nā pae Antithrombin III
• Nā Antibroidolipid nā mea ʻohā
• Helu piha koko (CBC)
• Ke hoʻāʻo nei i nā genetic e nānā i nā hoʻololi e hoʻonui i ka ulu ʻana o ke koko, e like me ka prothrombin G20210A hoʻololi.
• Lupus anticoagulant
• Protein C a me nā pae protein S

E hāʻawi kāu mea hāʻawi iā ʻoe i ka lāʻau e wīwī i kou koko (i kapa ʻia he anticoagulant). E mālama kēia i nā clots hou mai ka hana ʻana a i ʻole nā ​​mea kahiko mai ka nui ʻana.

ʻO Heparin ka lā lapaʻau mua loa e loaʻa iā ʻoe.

• Inā hāʻawi ʻia ka heparin ma o kahi aa (IV), pono ʻoe e noho i ka haukapila. Eia nō naʻe, hiki ke mālama ʻia ka hapanui o ka poʻe me ka noho ʻole i ka haukapila.
• Hiki ke hāʻawi ʻia i ka heparin haʻahaʻa molekoki haʻahaʻa e ka pahu ʻana ma lalo o kou ʻili i hoʻokahi a i ʻole ʻelua mau manawa i ka lā. ʻAʻole pono ʻoe e noho i ka haukapila ʻoiai ka lōʻihi, a i ʻole, inā kuhikuhi ʻia ʻoe i kēia ʻano heparin.

ʻO kekahi ʻano o ka lāʻau hoʻomāliʻi koko i kapa ʻia ʻo warfarin (Coumadin a i ʻole Jantoven) e hoʻomaka ʻia me ka heparin. Lawe ʻia ʻo Warfarin e ka waha. Lawe ʻia i mau lā e hana pono loa.

ʻO kekahi papa o nā mea lahilahi koko e hana ʻokoʻa ma mua o warfarin. ʻO nā laʻana o kēia papa o nā lāʻau, i kapa ʻia nā anticoagulants waha pololei (DOAC), e komo pū me rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradax), a me edoxaban (Savaysa). Hana kēia mau lāʻau i kahi ala like me ka heparin a hiki ke hoʻohana koke ʻia ma kahi o ka heparin. E hoʻoholo kāu mea nāna e hāʻawi i ka lāʻau pono iā ʻoe.

E lawe paha ʻoe i ka lahilahi o ke koko no 3 mau mahina. Lōʻihi kekahi mau kānaka, a i ʻole no ke koena o ko lākou ola, ke kaukaʻi ʻia i kā lākou makaʻu no kahi ʻeke ʻē aʻe.

Ke lawe nei ʻoe i kahi lāʻau lahilahi o ke koko, ʻoi aku ka nui o ke kahe o ke koko, ʻoiai mai nā hana āu i hana ai i nā manawa āpau. Inā ʻoe e lawe i ka lahilahi o ke koko ma ka home:

• E lawe i ka lāʻau e like me ke kuhikuhi a kāu mea hāʻawi.
• E noi i ka mea nāna e hāʻawi aku i kāu mea e hana ai inā ʻoe e nalo i kahi lāʻau.
• E kiʻi i nā hoʻokolohua koko e like me ka ʻōlelo a kou mea e hāʻawi pono ai e lawe i ka lāʻau kūpono. Pono mau kēia mau hoʻāʻo me warfarin.
• E aʻo pehea e lawe ai i nā lāʻau ʻē aʻe a i ka wā e ʻai ai.
• E ʻike pehea e nānā ai i nā pilikia i hoʻokumu ʻia e ka lāʻau.

I nā hihia kakaʻikahi, pono ʻoe i ke kaha ma kahi o a i ʻole hoʻohui i nā anticoagulants. Pili paha ke ʻoki kino:

• Ke kau nei i kahi kānana i ke aa nui o ke kino e pale ai i nā kahe o ke koko mai ka hele ʻana i nā māmā
• Ke wehe nei i kahi koko nui mai ke aʻa a i ʻole ka hoʻopili ʻana i nā lāʻau lapaʻau

E hāhai i nā ʻōkuhi ʻē aʻe i hāʻawi ʻia iā ʻoe e mālama i kāu DVT.

Hele pinepine ʻo DVT me ka pilikia ʻole, akā hiki i ke ʻano ke hoʻi. Hiki ke ʻike koke ʻia nā ʻōuli a i ʻole ʻaʻole hoʻomohala iā lākou no 1 a ʻoi paha mau makahiki ma hope. Ke hāpai nei i nā stocking compression i ka manawa a ma hope o ka DVT e kōkua ai i ka pale ʻana i kēia pilikia.

Pākuʻi ʻia paha nā pilikia o DVT:

• ʻO ka embolism pulmonary fatal (ʻoi aku ka haki o ke koko i ka ʻūhā a hele i nā ake māmā ma mua o ke kahe o ke koko i ka wāwae haʻahaʻa a i ʻole nā ​​ʻāpana ʻē aʻe o ke kino)
• ʻO ka ʻeha mau a me ka pehu ʻana (post-phlebitic a i ʻole post-thrombotic Syndrome)
• ʻO nā veins varicose
• Ulcer hoʻōla ʻole (hoʻemi ʻia)
• Hoʻololi i ke kala o ka ʻili

Kāhea i kāu mea hāʻawi inā loaʻa iā ʻoe nā ʻōuli o DVT.

E hele i ka lumi pilikia a kāhea paha i ka helu pilikia kūloko (e like me 911) inā he DVT kāu a hoʻomohala ʻoe:

• ʻEha ʻeha
• ʻApu ʻana i ke koko
• Hanu paʻakikī
• Mauleʻa
• Ka nalowale o ka ʻike
• Nā hōʻailona koʻikoʻi ʻē aʻe

E pale aku iā DVT:

• E neʻe pinepine i kou mau wāwae i ka wā o nā huakaʻi mokulele, nā huakaʻi kaʻa, a me nā hanana ʻē aʻe āu e noho ai a i ʻole moe i lalo no nā wā lōʻihi.
• E lawe i nā lāʻau lapaʻau lahilahi i ka lāʻau a kāu mea hāʻawi.
• MAI Puhi. E kamaʻilio i kāu mea hāʻawi inā makemake ʻoe i ke kōkua e haʻalele.

DVT; Kāpena koko i nā wāwae; Thromboembolism; ʻO ka maʻi post-phlebitic; Post-thrombotic maʻi pale; Venous - DVT

• Trombosis o ka aa hohonu - hoʻokuʻu
• Lawe iā warfarin (Coumadin, Jantoven) - he aha e nīnau aku ai i kāu kauka
• Lawe iā warfarin (Coumadin)

• Trombosis venous hohonu - iliofemoral
• Nā aa koko hohonu
• ʻŌpū koko Venous
• Nā aa koko hohonu
• Trombosis Venous - pūʻulu

Kearon C, Akl EA, Ornelas J, et al. ʻO Antithrombotic therapy no ka maʻi VTE: ka papa kuhikuhi CHEST a me ka hōʻike papa loea. Umauma. 2016; 149 (2): 315-352. PMID: 26867832 pubmed.ncbi.nlm.nih.gov/26867832/.

Kline JA. ʻO ka pulmona embolism a me ka thrombosis hohonu o ke aʻa. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 78.

Lockhart ME, Umphrey HR, Weber TM, Robbin ML. Nā moku ākea. I: Rumack CM, Levine D, eds. ʻIkioma ultrasound. 5th lā. Piladelapia, PA: Elsevier; 2018: chap 27.

ʻO Siegal D, Lim W. Venombo thromboembolism. I: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Nā Kumumanaʻo a me ka Hoʻomeheu. ʻEpekema 7 Piladelapia, PA: Elsevier; 2018: chap 142.