Thrombosis e tebileng ea methapo

Deep vein thrombosis (DVT) ke boemo bo etsahalang ha lesela la mali le hlaha ka har'a methapo e kahare ho karolo ea 'mele. E ama haholo methapo e meholo leotong le seropeng, empa e ka hlaha methapong e meng e tebileng joalo ka matsohong le thekeng.

DVT e atile haholo bathong ba baholo ho feta lilemo tse 60. Empa e ka ba teng ka lilemo tsohle. Ha lesela le khaoha 'me le tsamaea ka har'a mali, le bitsoa embolism. Embolism e ka tšoarella methapong ea mali bokong, matšoafong, pelong, kapa sebakeng se seng, e lebisang tšenyo e mpe.

Ho koala mali ho ka hlaha ha ho hong ho lieha kapa ho fetola phallo ea mali methapong. Mabaka a kotsi a kenyelletsa:

• Catheter ea pacemaker e fetisitsoeng ka har'a mothapo oa mokokotlo
• Ho phomola betheng kapa ho lula sebakeng se le seng nako e telele haholo, joalo ka leeto la sefofane
• Nalane ea lelapa ea makoala a mali
• Ho robeha hoa noka kapa maoto
• Ho beleha nakong ea likhoeli tse 6 tse fetileng
• Boimana
• Botenya
• Ho buuoa haufinyane (hangata ho buuoa ka letheka, lengole kapa ho buuoa ka pelvic ea basali)
• Lisele tse ngata haholo tsa mali li etsoa ke mokoko, li etsa hore mali a be motenya ho feta tloaelo (polycythemia vera)
• Ho ba le catheter ea ho lula (nako e telele) ka sejaneng sa mali

Mali a ka koahela motho ea nang le mathata kapa mathata a itseng, a kang:

• Kankere
• Mathata a mang a autoimmune, joalo ka lupus
• Ho tsuba koae
• Maemo a e nolofalletsang ho ba le mali a mangata
• Ho noa li-estrogen kapa lipilisi tsa thibelo ea bokhachane (kotsi ena e phahame le ho feta ka ho tsuba)

Ho lula nako e telele ha u tsamaea ho ka eketsa kotsi ea DVT. Sena se ka etsahala haholo ha o na le mabaka a mang a kotsi a thathamisitsoeng kaholimo.

DVT e ama haholo methapo e meholo leotong le ka tlase la serope, hangata lehlakoreng le leng la 'mele. Lefu le ka thibela phallo ea mali mme la baka:

• Liphetoho mmala oa letlalo (bofubelu)
• Bohloko ba maoto
• Ho ruruha ha leoto (edema)
• Letlalo le utloang le futhumetse ha le ts'oaroa

Mofani oa hao oa tlhokomelo ea bophelo o tla etsa tlhahlobo ea 'mele. Teko e kanna ea bontša leoto le lefubelu, le ruruhileng kapa le bonolo.

Liteko tse peli tse atisang ho etsoa pele ho fumana DVT ke:

• Teko ea mali ea D-dimer
• Tlhahlobo ea Doppler ultrasound sebakeng seo ho amehang ka sona

MRI ea pelvic e ka etsoa haeba lesela la mali le le ka mpeng, joalo ka kamora ho ima.

Liteko tsa mali li ka etsoa ho hlahloba hore na u na le menyetla e eketsehileng ea ho koala mali, ho kenyelletsa:

• Ho hanyetsoa ha protheine C (ho hlahloba phetoho ea Factor V Leiden)
• Methati ea Antithrombin III
• Li-antibodies tsa Antiphospholipid
• Palo e felletseng ea mali (CBC)
• Ho etsa liteko tsa liphatsa tsa lefutso ho sheba liphetoho tse u nolofalletsang ho ba le mali, joalo ka phetoho ea prothrombin G20210A
• Lupus anticoagulant
• Protheine C le liprotheine S.

Mofani oa hau o tla u fa moriana oa ho tšesa mali a hau (a bitsoang anticoagulant). Sena se tla etsa hore liphahlo tse ngata li se ke tsa theha kapa tsa khale hore li se ke tsa hola.

Heparin hangata ke moriana oa pele oo u tla o fumana.

• Haeba heparin e fanoa ka mothapo (IV), o tlameha ho lula sepetlele. Leha ho le joalo, batho ba bangata ba ka phekoloa ntle le ho lula sepetlele.
• Boima ba limolek'hule tse boima bo ka fanoa ka ente e tlasa letlalo la hao hang kapa habeli ka letsatsi. Mohlomong ha ho hlokahale hore u lule sepetlele halelele, kapa ho hang, haeba u laetsoe mofuta ona oa heparin.

Mofuta o mong oa moriana o fokotsang mali o bitsoang warfarin (Coumadin kapa Jantoven) o ka qalisoa le heparin. Warfarin e nkoa ka molomo. Ho nka matsatsi a 'maloa ho sebetsa ka botlalo.

Sehlopha se seng sa litšila tsa mali se sebetsa ka tsela e fapaneng le ea warfarin. Mehlala ea sehlopha sena sa meriana, e bitsoang li-anticoagulants tsa molomo ka kotloloho (DOAC), e kenyelletsa rivaroxaban powder (Xarelto), apixaban (Eliquis), dabigatran (Pradax), le edoxaban (Savaysa). Lithethefatsi tsena li sebetsa ka tsela e ts'oanang le heparin mme li ka sebelisoa hanghang sebakeng sa heparin. Mofani oa hau o tla etsa qeto ea hore na ke meriana efe eu loketseng.

Mohlomong u tla noa mali bonyane likhoeli tse 3. Batho ba bang ba e nka nako e teletsana, kapa esita le bophelo bohle ba bona, ho latela kotsi ea seaparo se seng.

Ha o noa moriana o fokotsang mali, o na le monyetla oa ho tsoa mali, le ho tsoa mesebetsing eo esale o e etsa. Haeba u nka mali a tšesaane lapeng:

• Nka meriana ka tsela eo mofani oa hao a u laetseng eona.
• Botsa mofani oa litšebeletso hore na a etse'ng haeba o hloloheloa tekanyetso.
• Fumana liteko tsa mali joalo ka ha mofani oa litšebeletso a eletsa ho etsa bonnete ba hore u noa tekanyetso e nepahetseng. Hangata liteko tsena lia hlokahala ka warfarin.
• Ithute ho noa meriana e meng le hore na u je neng.
• Fumana hore na u ka shebella joang mathata a bakoang ke moriana.

Maemong a sa tloaelehang, o kanna oa hloka ho buuoa sebakeng sa kapa ho tlatselletsa le li-anticoagulants. Ho buuoa ho ka kenyelletsa:

• Ho beha sefefo mothapong o moholohali oa 'mele ho thibela ho koaloa hoa mali matšoafong
• Ho tlosa leqhubu le leholo la mali mothapong kapa ho kenya meriana e thibang mali

Latela litaelo tse ling tseo u li fuoang ho phekola DVT ea hau.

Hangata DVT e fela ntle le bothata, empa boemo bo ka khutla. Matšoao a ka hlaha hanghang kapa oa se ke oa a hlahisa lilemo tse 1 kapa ho feta kamora moo. Ho roala li-stock stockings nakong ea kamora le ka mor'a DVT ho ka thusa ho thibela bothata bona.

Mathata a DVT a ka kenyelletsa:

• Embolism e bolaeang ea pulmonary (maqeba a mali lethekeng a na le monyetla oa ho robeha le ho ea matšoafong ho feta maqeba a mali leoto le ka tlase kapa likarolo tse ling tsa 'mele)
• Bohloko bo sa feleng le ho ruruha (post-phlebitic or post-thrombotic syndrome)
• Metsing ea varicose
• Lisosa tse sa phekoleng (tse sa tloaelehang)
• Liphetoho mmala oa letlalo

Bitsa mofani oa hau haeba u na le matšoao a DVT.

E-ea kamoreng ea maemo a tšohanyetso kapa letsetsa nomoro ea ts'ohanyetso ea lehae (joalo ka 911) haeba u na le DVT 'me u ba le:

• Bohloko ba sefuba
• Ho kgohlela madi
• Ho phefumoloha ho thata
• Ho akheha
• Ho lahleheloa ke kelello
• Matšoao a mang a matla

Ho thibela DVT:

• Tsamaisa maoto hangata ha u le maetong a malelele ka sefofane, maetong a likoloi, le maemong a mang ao u lutseng kapa u paqametsoeng ho ona nako e telele.
• Nka meriana e fokotsang mali eo mofani oa hao au laelang eona.
• U SE KE UA tsuba. Bua le mofani oa hau haeba u hloka thuso ho tlohela.

DVT; Tšelo ea mali maotong; Thromboembolism; Lefu la Post-phlebitic; Lefu la post-thrombotic; Mokhukhu - DVT

• Bothata ba methapo ea pelo - ho tsoa
• Ho nka warfarin (Coumadin, Jantoven) - seo u ka se botsang ngaka ea hau
• Ho nka warfarin (Coumadin)

• Tebileng venous thrombosis - iliofemoral
• Metsing e tebileng
• Lefu la mali la mali
• Metsing e tebileng
• Venous thrombosis - letoto la lihlooho tse

Kearon C, Akl EA, Ornelas J, le al. Phekolo ea Antithrombotic bakeng sa lefu la VTE: Tataiso ea CHEST le tlaleho ea sehlopha sa litsebi. Sefubeng. 2016; 149 (2): 315-352. PMID: 26867832 pubmed.ncbi.nlm.nih.gov/26867832/.

Kline JA. Embolism ea pulmonary le thrombosis e tebileng ea methapo. Ka: Marako RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Likhopolo le Tloaelo ea Kliniki. La 9th. Philadelphia, PA: Elsevier; 2018: khaolo ea 78.

Lockhart ME, Umphrey HR, Weber TM, Robbin ML. Likepe tsa pheriferale. Ka: Rumack CM, Levine D, eds. Tlhahlobo ea Ultrasound. La 5th. Philadelphia, PA: Elsevier; 2018: khaolo ea 27.

Siegal D, Lim W. Venous thromboembolism. Ka: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Melao-motheo le Tloaelo ea Motheo. La 7th. Philadelphia, PA: Elsevier; 2018: khaolo ea 142.