Embolism ʻaʻano

ʻO ka embolism arterial e pili ana i kahi ʻōpala (embolus) i hele mai kahi ʻaoʻao ʻē aʻe o ke kino a hana i kahi kahamaha ʻole o ke kahe o ke koko i kahi lālā a i ʻole ʻāpana kino.

ʻO kahi "embolus" kahi kīʻaha koko a i ʻole kahi ʻāpana o ke ʻano e like me ka ʻōpala. ʻO ka huaʻōlelo "emboli" ʻo ia hoʻi aia ma mua o hoʻokahi kāhiko a i ʻole ʻāpana o ka pā. Ke hele ka lole mai ka pūnaewele kahi i hana ai i kahi wahi ʻē aʻe i ke kino, ua kapa ʻia ia he embolism.

Hoʻokumu ʻia kahi embolism arterial e hoʻokahi a ʻoi paha clots. Hiki ke hoʻopaʻa i nā clots i loko o ke aʻa a ālai i ke kahe o ke koko. Hoʻopōloli ka ālai i nā mea o ke koko a me ka oxygen. Hiki i kēia ke hopena i ka hōʻino a i ʻole ka make ʻana o ka ʻaʻa (nekrosis).

Kū pinepine ka emboli arterial i nā wāwae a me nā wāwae. ʻO Emboli i kū i ka lolo ke kumu o ka hahau ʻana. ʻO nā mea i kū i ka puʻuwai e hoʻouka i ka puʻuwai puʻuwai. ʻO nā pūnaewele liʻiliʻi e pili pū me nā puʻupaʻa, nā ʻōpū, a me nā maka.

ʻO nā kumu pilikia no ka embolism arterial:

• ʻO nā mele naʻau maʻamau e like me ka fibrillation atrial
• Ka hōʻeha a i ʻole ka hōʻino ʻana i ka paia artery
• Nā kūlana e hoʻonui ai i ke kāpili ʻana o ke koko

ʻO kekahi kūlana e waiho i kahi makaʻu nui no ka embolization (ʻo ia hoʻi i ka lolo) ka stenosis mitral. Endocarditis (maʻi o ka loko o ka puʻuwai) hiki i ke kumu o ka emboli arterial.

ʻO kahi kumu maʻamau no ka embolus mai nā wahi o ka paʻakikī (atherosclerosis) i ke aorta a me nā moku koko nui ʻē aʻe. Hiki i kēia mau mea keakea ke haki a kahe i nā wāwae a me nā wāwae.

Hiki i ka embormation paradoxical ke hana i ka wā e komo ai kahi ʻōpala i kahi aa i loko o ka ʻaoʻao ʻākau o ka puʻuwai a hele i loko o kahi lua i ka ʻaoʻao hema. Hiki i ka ʻōpelu ke neʻe i kahi aʻa a ālai i ke kahe o ke koko i ka lolo (hahau) a i ʻole nā ​​mea ʻē aʻe.

Inā hele kahi ʻōpala a moe i nā aʻa e hāʻawi ana i ke kahe o ke koko i nā akemāmā, ua kapa ʻia ia he embolus pulmonary.

ʻAʻohe ou mau ʻōuli.

Hoʻomaka a hoʻomaka a lohi paha nā ʻōuli ma muli o ka nui o ka embolus a me ka nui o ka palaka ʻana i ke kahe o ke koko.

Nā hōʻailona o ka embolism arterial i nā lima a i ʻole nā ​​wāwae e hoʻopili pū ʻia:

• ʻO ka lima anuanu a wāwae paha
• Hoʻoemi a ʻaʻohe lāʻau iki i ka lima a me ka wāwae
• Ka nele o ka neʻe ʻana i ka lima a me ka wāwae
• ʻEha ma ka wahi i pā
• Numbness a me ke kani ʻana i ka lima a me ka wāwae
• ʻO kaʻeleʻele pale o ka lima a me ka wāwae (pallor)
• Ka nāwaliwali o ka lima a me ka wāwae

Nā hōʻailona hope:

• ʻO nā pā o ka ʻili i hānai ʻia e ke aʻa pili
• Kaheʻe ʻana (sloughing) o ka ʻili
• Ka holo ʻana o ka ʻili (ulcer)
• ʻO ka make ʻana o ka mānoanoa (nekrosis; ʻeleʻele a ʻino hoʻi ka ʻili)

Hoʻololi nā ʻōuli o kahi ʻōpala i kahi meaola me ka meaola i pili akā hiki ke hoʻopili ʻia:

• ʻEha ma ka ʻaoʻao o ke kino e pili ana
• Hoʻemi iki i ka hana a ke kino

ʻIke paha ka mea mālama ola i ka hōʻemi ʻana a i ʻole ka lāʻau, a ua emi a ʻaʻohe kaomi o ke koko i ka lima a me ka wāwae. Aia paha he mau hōʻailona o ka make a me ka gangrene.

ʻO nā hoʻāʻo e kuhikuhi i ka embolism arterial a i ʻole hōʻike i ke kumu o emboli e komo pū paha:

• ʻO ka Angiography o ka hopena a i ʻole nā ​​ʻokena
• ʻO ka hōʻike ultrasound Doppler o kahi hopena
• ʻO ka hoʻokolohua ultrasound Duplex Doppler o ka hopena
• ʻEchocardiogram
• MRI o ka lima a i ʻole ka wāwae
• ʻO ka myocardial contrad echocardiography (MCE)
• Plethysmography
• ʻO ka hōʻike Transcranial Doppler o nā aʻa i ka lolo
• Echocardiography Transesophageal (TEE)

Hiki paha i kēia maʻi ke hoʻopili i nā hopena o nā hōʻike aʻe:

• D-dimer
• ʻIke kumu VIII
• ʻImi Isotope o ka meaola i loli
• ʻO ka Plasminogen activator inhibitor-1 (PAI-1) ʻoihana
• Hōʻike hōʻuluʻulu platelet
• ʻO nā pae activator plasminogen-tissue-type (t-PA) pae

Pono ka embolism arterial i ka lāʻau wikiwiki ma kahi haukapila. ʻO nā pahuhopu o ka mālama ʻana e kaohi i nā ʻōuli a me ka hoʻomaikaʻi ʻana i ke kahe o ke kahe i hoʻopau ʻia i ka wahi i hoʻopilikia ʻia o ke kino. ʻO ke kumu o ka hopena, inā loaʻa, pono e mālama ʻia e pale i nā pilikia hou.

Loaʻa i nā lāʻau:

• Hiki i nā Anticoagulants (e like me warfarin a i ʻole heparin) ke pale i nā clots hou mai ka hana ʻana
• ʻO nā lāʻau Antiplatelet (e like me aspirin a i ʻole clopidogrel) hiki ke pale aku i nā clots hou mai ka hana ʻana
• Hāʻawi ʻia nā painkillers ma o ke aa (e IV)
• Hiki i ka Thrombolytic (e like me streptokinase) ke hoʻonā i nā clots

Pono kekahi poʻe i ke ʻoki. Nā kaʻina hana me:

• Bypass o ke aʻa (by arterial bypass) e hana i kahi kumu lua o ka hāʻawi koko
• Lawe ʻia ka lole ma o ka cathe balloon i hoʻonoho ʻia i loko o ke aʻa i hoʻopili ʻia a i ʻole ma o ke kaha ākea ma ke aʻa (embolectomy)
• ʻO ka wehe ʻana o ke aʻa me kahi catheter balloon (angioplasty) me ka stent a i ʻole me ka stent

Aia ke ʻano o ka hilinaʻi ʻana o ke kanaka ma ka wahi o ka ʻaʻai a me ka nui o ka ālai ʻana o ke kūpina i ke kahe o ke koko a no ka lōʻihi o ka paʻa ʻana. Hiki ke koʻikoʻi ke embolism arterial inā ʻaʻole e mālama koke ʻia.

Hiki ke hōʻino mau ʻia ka wahi i hoʻopili ʻia. Pono ka hoʻonui i 1 a 4 mau hihia.

Hiki i ka emboli arterial ke hoʻi mai ma hope o ke kūleʻa maikaʻi ʻana.

Komo pū nā pilikia:

• Acute MI
• ʻO ka maʻi i loko o kaʻiʻo i hoʻopili ʻia
• Hoʻoweliweli Septic
• Hahau (CVA)
• ʻO ka hōʻemi kūlohelohe a paʻa paha o ka hana o nā meaola ʻē aʻe
• Hewa kuʻuna a paʻa mau paha
• ʻO ka make o ka maʻi (nekrosis) a me ka gangrene
• Hoʻouka ischemic kuewa (TIA)

E hele i ka lumi pilikia a kāhea paha i ka helu kūloko kūloko (e like me 911) inā loaʻa nā ʻōuli o ka embolism arterial.

Hoʻomaka ka pale ʻana me ka loaʻa ʻana o nā kumuwaiwai kūpono o ke kōkuʻu koko. Kākau paha kāu mea hāʻawi i nā mea lahilahi o ke koko (e like me warfarin a i ʻole heparin) e pale ai i nā clots mai ka hana ʻana. Pono paha nā lāʻau Antiplatelet.

Loaʻa iā ʻoe kahi atherosclerosis a ʻoi aku ke kiʻekiʻe inā ʻoe:

• Puhi
• Hana hoʻoikaika kino iki
• Loaʻa i ke koko kiʻekiʻe
• Loaʻa i nā pae kolesterol kūpono
• Loaʻa diabetes
• Kaumaha kaupaona
• Hoʻopilikia ʻia

• Embolism ʻaʻano
• ʻŌnaehana puni

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Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA / ACC alakaʻi ma luna o ka hoʻokele o nā mea maʻi me ka maʻi o ke ākea o ka ʻaoʻao ʻoi loa: hōʻuluʻulu mana: kahi hōʻike o ka American College of Cardiology / American Heart Association Task Force e pili ana i nā kuhikuhi kuhikuhi Clinical. ʻO J Am Coll Cardiol. 2017; 69 (11): 1465-1508. PMID: 27851991 pubmed.ncbi.nlm.nih.gov/27851991/.

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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.

Nā Loio MC, Martin MC. ʻO ka maʻi arterial mesenteric ākea. I: Sidawy AN, Perler BA, hua. ʻO Rutherford's Vascular Surgery a me Endotherapy Therapy. 9th ed. Piladelapia, PA: Elsevier; 2019: chap 133.