Embolism ea methapo

Arterial embolism e bolela seaparo (embolus) se tsoang karolong e ngoe ea 'mele mme se baka tšitiso ea tšohanyetso ea phallo ea mali ho setho kapa karolo ea' mele.

"Embolus" ke leqhoa la mali kapa sengoathoana se etsang joalo ka lehloa. Lentsoe "emboli" le bolela hore ho na le lehloa kapa sekotoana se fetang bonngoe. Ha lesela le tsamaea ho tloha sebakeng seo le thehileng ho sona ho ea sebakeng se seng 'meleng, le bitsoa embolism.

Embolism ea methapo e ka bakoa ke ho koaloa ho le leng kapa ho feta. Maqeba a ka tšoarella mothapong 'me a thibele phallo ea mali. Thibelo e bolaoa ke tlala ea lisele tsa mali le oksijene. Sena se ka baka tšenyo kapa lefu la lisele (necrosis).

Hangata emboli ea methapo e hlaha maotong le maotong. Li-emboli tse hlahang bokong li baka stroke. Tse hlahang pelong li baka lefu la pelo. Libaka tse sa tloaelehang li kenyelletsa liphio, mala le mahlo.

Lisosa tse kotsi tsa embolism ea methapo li kenyelletsa:

• Lipina tsa pelo tse sa tloaelehang joalo ka fibrillation ea atrial
• Ho lematsa kapa ho senya lebota la mothapo
• Maemo a eketsang tšelo ea mali

Boemo bo bong bo hlahisang kotsi e kholo ea ho emisa (haholo-holo bokong) ke mitral stenosis. Endocarditis (ts'oaetso ea kahare ea pelo) le eona e ka baka methapo ea methapo.

Mohloli o tloaelehileng oa embolus o tsoa libakeng tsa ho thatafala (atherosclerosis) aorta le methapo e meng e meholo ea mali. Mahlooho ana a ka robeha mme a theohele maotong le maotong.

Ho ikoetlisa ho makatsang ho ka etsahala ha lesela le kenang ka lehlakoreng le letona la pelo ebe le feta ka lesoba ka lehlakoreng le letšehali. Lera leo le ka fetela mothapong 'me la thibela phallo ea mali ho ea bokong (stroke) kapa litho tse ling.

Haeba lesela le tsamaea 'me le lula ka har'a methapo e fanang ka phallo ea mali matšoafong, le bitsoa pulmonary embolus.

Mohlomong ha u na matšoao.

Matšoao a ka qala kapele kapa butle butle ho latela boholo ba mothapo le hore na o thibela phallo ea mali hakae.

Matšoao a embolism ea methapo matsohong kapa maotong a ka kenyelletsa:

• Letsoho le batang kapa leoto
• Ho fokotseha kapa ho se na pulse letsohong kapa leotong
• Ho hloka motsamao letsohong kapa leotong
• Bohloko sebakeng se amehileng
• Ho ba lerootho le ho hlohlona letsohong kapa leotong
• 'Mala o moputsoa oa letsoho kapa leoto (pallor)
• Bofokoli ba letsoho kapa leoto

Matšoao a morao-rao:

• Blisters ea letlalo e fepeloang ke methapo e amehileng
• Ho tsholla (letlalo)
• Khoholeho ea letlalo (seso)
• Lefu la dinama tse nyenyane (necrosis; letlalo le lefifi 'me le senyehile)

Matšoao a "clot" ea setho se fapana le setho se amehang empa a ka kenyelletsa:

• Bohloko ba setho sa mmele se amehang
• Ts'ebetso ea litho tsa nakoana e fokotsehile

Mofani oa tlhokomelo ea bophelo a ka fumana khatello ea mali e fokotsehile kapa a se na eona, le khatello ea mali e fokotsehile kapa a se na letsoho le leoto. Ho kanna ha ba le matšoao a lefu la lisele kapa seso.

Liteko tsa ho fumana embolism ea methapo kapa ho senola mohloli oa emboli li ka kenyelletsa:

• Angiography ea pheletso kapa setho se amehileng
• Tlhahlobo ea Doppler ultrasound ea pheletsong
• Duplex Doppler tlhahlobo ea ultrasound ea bofelo
• Echocardiogram
• MRI ea letsoho kapa leoto
• Tlhatlhobo ea myocardial echocardiography (MCE)
• Boitsebiso bo botle
• Tlhahlobo ea Transcranial Doppler ea methapo ea boko
• Transesophageal echocardiography (TEE)

Lefu lena le ka ama liphetho tsa liteko tse latelang:

• D-lefifi
• Ntlha ea VIII tlhahlobo
• Isotope e ithuta ka setho se amehileng
• Ketsahalo ea Plasminogen activator inhibitor-1 (PAI-1)
• Teko ea pokello ea Platelet
• Litekanyo tsa li-tissue-type plasminogen activator (t-PA)

Mokokotlo oa methapo o hloka kalafo e potlakileng sepetlele. Morero oa kalafo ke ho laola matšoao le ho ntlafatsa phallo ea mali e kenang sebakeng se amehileng sa 'mele. Sesosa sa "clot", haeba se fumanoe, se lokela ho phekoloa ho thibela mathata a mang.

Meriana e kenyelletsa:

• Li-anticoagulants (joalo ka warfarin kapa heparin) li ka thibela maqhubu a macha ho theha
• Meriana ea li-antiplatelet (joalo ka aspirin kapa clopidogrel) e ka thibela maqeba a macha ho theha
• Li-painkillers tse fanoang ka methapo (ka IV)
• Thrombolytics (joalo ka streptokinase) e ka qhala maqeba

Batho ba bang ba hloka ho buuoa. Tsamaiso e kenyelletsa:

• Ho feta ha mothapo (arterial bypass) ho etsa mohloli oa bobeli oa phepelo ea mali
• Ho tlosoa ha lesela ka catheter ea ballo e kenngoeng mothapong o amehileng kapa ka ho buuoa ka bolokolohi mothapong (embolectomy)
• Ho buloa ha mothapo o nang le catheter ea balune (angioplasty) e nang le stent kapa ntle le eona

Hore na motho o sebetsa hantle hakae ho latela hore na lesira le hokae le hore na le koetse phallo ea mali le hore na thibelo e bile teng nako e kae. Embolism ea methapo e ka ba mpe haholo haeba e sa phekoloe kapele.

Sebaka se amehileng se ka senyeha ruri. Ho khaoloa hoa hlokahala ho fihlela ho 1 maemong a mane.

Li-emboli tsa methapo li ka khutla le kamora kalafo e atlehileng.

Mathata a ka kenyelletsa:

• MI e matla
• Ho tšoaetsoa ke lisele tse amehileng
• Tšabo ea septic
• Leqeba (CVA)
• Ho fokotseha ha nakoana kapa ka ho sa feleng kapa tahlehelo ea mesebetsi e meng ea litho
• Ho hloleha ha liphio nakoana kapa ho sa feleng
• Lefu la dinama tse nyenyane (necrosis) le seso se kekang
• Tlhaselo ea nakoana ea ischemic (TIA)

E-ea kamoreng ea maemo a tšohanyetso kapa u letsetse nomoro ea lehae ea maemo a tšohanyetso (joalo ka 911) haeba u na le matšoao a kholo ea mmele.

Thibelo e qala ka ho fumana mehloli ea mali e ka hlahang. Mofani oa hau a ka fana ka li-thinner tsa mali (joalo ka warfarin kapa heparin) ho thibela maqeba ho theha. Lithethefatsi tsa antiplatelet le tsona li ka hlokahala.

U na le ts'oaetso e kholo ea atherosclerosis le clots haeba u:

• Mosi
• Etsa boikoetliso bo fokolang
• Eba le khatello e phahameng ea mali
• Ho ba le li-cholesterol tse sa tloaelehang
• E-ba le lefu la tsoekere
• Ba nonne haholo
• U imetsoe kelellong

• Embolism ea methapo
• Tsamaiso ea potoloho ea mali

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Gerhard-Herman MD, Gornik HL, Barrett C, le al. Tataiso ea 2016 AHA / ACC mabapi le taolo ea bakuli ba nang le methapo ea methapo ea methapo e tlase: kakaretso ea phethahatso: tlaleho ea American College of Cardiology / American Heart Association Task Force mabapi le Tataiso ea Tloaelo ea Bongaka. J Ke Coll Cardiol. 2017; 69 (11): 1465-1508. PMID: 27851991 e fetotsoe.ncbi.nlm.nih.gov/27851991/.

Goldman L. Atamela ho mokuli ea nang le lefu la pelo le methapo. Ka: Goldman L, Schafer AI, li-eds. Phekolo ea Goldman-Cecil. La 26th. Philadelphia, PA: Elsevier; 2020: khaolo ea 45.

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.

Wyers MC, Martin MC. Matšoao a bohloko a mesenteric. Ka: Sidawy AN, Perler BA, bahlophisi. Rutherford's Vasculry and Endovascular Therapy. La 9th. Philadelphia, PA: Elsevier; 2019: khaolo ea 133.