Thrombolytic therapy: cov lus qhia, txiaj ntsig, npe tshuaj

Cov txheej txheem:

Thrombolytic therapy: cov lus qhia, txiaj ntsig, npe tshuaj
Thrombolytic therapy: cov lus qhia, txiaj ntsig, npe tshuaj
Anonim

Thrombolytic therapy: indications, tshwm sim

Kev sib cais thiab sib cais ntawm cov ntshav txhaws yog ua los ntawm kev siv cov txheej txheem xws li thrombolysis. Nws yog nqa tawm lawm los yog artificially (tshuaj). Hauv thawj kis, ntshav enzymes zom cov hlab me me. Cov ntshav txhaws loj tuaj yeem yaj tsuas yog nyob rau hauv kev cuam tshuam ntawm thrombolytics. Cov tshuaj rau thrombolysis yog muab los ntawm tus kws kho mob uas tuaj koom thaum txo qhov tshwm sim ntawm myocardial infarction, ischemic stroke, thiab kho cov kab mob plawv.

Thrombolytics - yog dab tsi?

Thrombolytics
Thrombolytics

Thrombolytic tshuaj yog cov tshuaj uas ua kom cov ntshav txhaws. Lawv muaj cov fibrin strands, uas yog coagulated proteins. Kev tsim cov ntshav txhaws yog ib feem ntawm kev tiv thaiv ntuj tsim ntawm tib neeg lub cev, tsim los txhawm rau txhim kho kev puas tsuaj rau cov hlab ntsha thaum raug mob. Nyob rau hauv tus neeg mob uas muaj ib tug predisposition rau thrombosis, los yog nrog ib tug ua ke ntawm cov yam tsis zoo, cov ntshav txhaws tsim nyob rau hauv cov hlab ntsha tsis zoo. Tsis tu ncua, cov thrombus ib nrab thaiv cov lumen ntawm lub nkoj, cuam tshuam cov ntshav ncig hauv nws.

Yog tias cov ntshav txhaws tag nrho cov hlab ntsha loj, cov kws kho mob tsuas muaj ob peb teev ua haujlwm thiab yog li cawm tus neeg mob txoj sia.

Thrombolytics yuav tsum paub qhov txawv ntawm cov tshuaj uas muaj cov txiaj ntsig zoo sib xws, txhawm rau tiv thaiv kev loj hlob ntawm cov kab mob plawv. Cov tshuaj no yog npaj rau kev tshem tawm cov ntshav txhaws thaum muaj xwm txheej ceev, lawv tau txhaj ncaj qha rau hauv cov hlab ntsha.

Fibrinolytic tshuaj yog siv rau thrombolysis ntawm cov hlab ntsha loj, nrog rau kev sib cais ntawm cov ntshav txhaws hauv cov neeg mob debilitated lossis cov neeg laus, thaum lub cev tsis tuaj yeem zom cov ntshav ntawm nws tus kheej. Vim yog thrombosis, ischemia tshwm sim - ib qho mob ntawm cov hlab ntsha ntawm ntau yam kabmob thiab cov pa oxygen tshaib plab ntawm cov ntaub so ntswg. Thaum cov ntshav txhaws sib cais, nws tawg tawm thiab txhaws cov hlab ntsha ua rau lub cev tseem ceeb. Yog li ntawd, ib qho embolism lossis thromboembolism tshwm sim.

Indications thiab contraindications

Indications thiab contraindications
Indications thiab contraindications

Lub sijhawm teem sijhawm ntawm thrombolytics yog qhov muaj txiaj ntsig ntawm tus kws kho mob tuaj koom, leej twg yuav twv yuav raug coj mus rau hauv tus account qhov qhia thiab contraindications rau lawv siv. Cov tshuaj siv ntau tshaj plaws nrog kev ua haujlwm thrombolytic yog siv los kho thrombosis thiab thromboembolism.

Cov lus qhia rau kev kho thrombolytic:

  • Cerebral stroke;
  • mob plawv mob plawv;
  • YThrombophlebitis;
  • Pulmonary embolism (tel);
  • Thrombosis ntawm cov hlab ntsha tseem ceeb hauv pathologies ntawm cov hlab plawv system.

Ib ntshav txhaws tuaj yeem tsim txawm tias tom qab kev phais mob zoo, lossis tom qab raug mob hnyav. Nrog cov teeb meem ntawm varicose leeg, thrombophlebitis tsim - cov txheej txheem inflammatory ntawm phab ntsa ntawm cov hlab ntsha nrog kev tsim cov ntshav txhaws. Lub insidiousness ntawm cov ntshav txhaws yog tias ntev ntev lawv tsis pom cov tsos mob tshwm sim. Tus neeg mob pom tias nws mob hnyav, tsuas yog muaj qhov txhaws tag nrho ntawm lub nkoj thiab qhov tsis zoo ntawm nws tus mob.

Tsis muaj contraindications rau kev siv thrombolytics:

  • mob qhov ntswg, plab hnyuv, los ntshav urogenital uas tshwm sim thaum lub sijhawm kho, nrog rau 2 lub lis piam dhau los ua ntej nws.
  • Kev raug mob, kev raug mob, kev phais uas tshwm sim hauv 10 hnub dhau los, yog tias cov xwm txheej no cuam tshuam rau tus txha caj qaum lossis lub hlwb - lub sijhawm nce mus txog 2 lub hlis.
  • Hemorrhagic stroke hauv rau lub hlis tas los..
  • Pathologies ntawm lub circulatory system muaj feem xyuam rau cov ntshav txhaws.
  • ntshav siab, tsis tswj los ntawm tshuaj.
  • ntshav platelets qis.
  • Kev ua xua, tus neeg intolerance rau thrombolytics thiab lawv cov khoom.
  • Kev pheej hmoo siab ntawm aortic aneurysm, kev phais, pericarditis.
  • Kev tsis txaus siab ntawm tus mob pancreatitis.

Thrombolytics tau sau nrog ceev faj hauv cov kab mob hauv qab no:

  • hnub nyoog tshaj 75;
  • Kev cev xeeb tub;
  • History of diabetes mellitus;
  • Ntseeg pathologies ntawm lub plawv, siab, raum;
  • Hlawv npog thaj tsam loj;
  • pob txha tawg tsis ntev los no;
  • cuaj lub hlis tsis tau dhau mus txij li qhov kawg thrombolysis.

Yog tias koj muaj kev fab tshuaj thiab kab mob somatic, koj yuav tsum qhia koj tus kws kho mob txog nws.

Kev faib tawm ntawm thrombolytics

Classification ntawm thrombolytics
Classification ntawm thrombolytics

Tam sim no muaj 4 tiam ntawm cov tshuaj fibrinolytic. Txawm hais tias muaj ntau lub sijhawm dhau los txij li kev tsim cov tshuaj thawj zaug hauv nruab nrab ntawm lub xyoo pua xeem, cov tshuaj no tseem siv nrog kev ua haujlwm zoo.

  • Thawj tiam kev npaj ua haujlwm (Streptodecase, Fibrinolysin, Streptokinase, Urokanase) yog cov enzymes ntuj tsim cov txheej txheem ntuj teb rau kev tsim cov ntshav txhaws. Qhov kev pheej hmoo ntawm lawv siv yog tias cov proteins txawv teb chaws hauv lawv tuaj yeem ua rau anaphylactic poob siab. Tsis tas li ntawd, cov tshuaj no tuaj yeem ua rau los ntshav vim yog ua kom muaj cov ntshav enzyme.
  • tshuaj tiam thib ob (Alteplase, Actilyse, Remombinant Prourokinase) - tsim siv biotechnology los ntawm kev qhia cov noob tsim nyog rau cov kab mob E. coli. Cov tshuaj no tsis muaj kev phiv los ntawm cov tshuaj thawj tiam, vim nws cov enzymes ua hauv zos, ncaj qha ntawm qhov chaw ntawm thrombosis.
  • Tim Nkij teb chaws tshuaj (Tenecteplase, Reteplase, Lanoteplase) - xaiv thiab ntev ua rau cov ntshav txhaws nrog kev pab ntawm cov khoom xyaw nquag.
  • Plaub-tiam ua ke tshuaj (Urokinase-Plasminogen) - muaj cov nyhuv sai dua, raug dua thiab kav ntev.

Cov tshuaj thib ob uas muaj kev kwv yees ua tau thiab kawm txog cov kev mob tshwm sim feem ntau tau sau tseg. Kev txiav txim ntawm cov tshuaj niaj hnub no tseem tsis tau kawm tiav.

Thrombolysis rau lub plawv nres, mob stroke yog ua los yog hauv zos. Hauv thawj kis, cov tshuaj tau txhaj rau hauv cov hlab ntsha, thiab nws cov enzymes siv sijhawm ntev heev kom ncav cuag lub thrombus. Nrog kev tswj hwm hauv zos, cov tshuaj xa mus rau thrombus siv lub catheter, thrombolysis tshwm sim sai.

Kev ntsuas kev ua tau zoo thiab teeb meem

Kev ntsuam xyuas kev ua tau zoo thiab teeb meem
Kev ntsuam xyuas kev ua tau zoo thiab teeb meem

Kev ntsuas qhov ua tau zoo ntawm kev siv thrombolytics yog ua los ntawm kev siv cov txheej txheem ntawm kev kuaj:

  • Computed tomography;
  • Magnetic resonance imaging;
  • Coronary angiography.

Kev kuaj mob ntawm cov hlab ntsha yog nqa tawm 1-2 teev tom qab pib thrombolysis siv x-rays nrog kev qhia txog tus neeg sawv cev sib txawv.

cov qauv kev ua tau zoo:

  • 0 - tus neeg sawv cev sib txawv tsis txav los ntawm lub nkoj;
  • 1 - ib feem me me ntawm qhov sib txawv tau dhau los ntawm lub thrombus;
  • 2 - ib nrab ntawm qhov sib txawv tau dhau los ntawm thaj chaw uas muaj ntshav txhaws;
  • 3 - qhov kev hla dhau ntawm thaj chaw tau rov qab los.

Raws li qhov tshwm sim ntawm thrombolysis, cov teeb meem tuaj yeem tshwm sim - hyperthermia, txo cov ntshav siab, ua xua rau cov tshuaj, los ntshav. Yog tias muaj teeb meem, koj yuav tsum sab laj nrog kws kho mob tam sim, tsis txhob kho tus kheej.

Lus npe tshuaj thrombolytic

Daim ntawv teev cov tshuaj thrombolytic
Daim ntawv teev cov tshuaj thrombolytic

Muaj ob txoj hauv kev ntawm thrombolysis - xa cov activated plasmin mus rau thrombus, thiab ua kom cov plasminogen, uas txhim kho qhov tsim ntawm plasmin.

Kev faib cov tshuaj los ntawm kev ua haujlwm:

  • Cov tshuaj ncaj qha ntawm cov ntshav plasma, ncaj qha ua rau fibrin;
  • Cov tshuaj tsis ncaj-tus neeg sawv cev uas ua kom tsim cov plasmin los ntawm plasminogen;
  • Cov tshuaj sib xyaw ua ke uas sib xyaw ua ke ntawm thawj ob pawg.

Thrombolytics:

  • Fibrinolysin (Plasmin). Cov khoom xyaw tseem ceeb yog profibrinolysin cais tawm ntawm tib neeg cov ntshav. Maj mam yaj cov hlab ntsha txhaws, yog li nws pom tau tias tsis muaj txiaj ntsig zoo. Yuav siv thaum tsis muaj lwm yam tshuaj zoo.
  • Streptokinase. Analogues: Kabikinase, Celiaza, Avelizin. Cov nyhuv nyuaj ntawm cov tshuaj nrog plasminogen txhawb kev tsim cov plasmin. Cov tshuaj yog tsim los ntawm kab lis kev cai ntawm streptococcus, yog li tus neeg mob lub cev tuaj yeem tsim cov tshuaj tiv thaiv rau nws hauv 1-6 lub hlis. Cov cuab yeej ntawm Streptokinase no raug tso tseg los ntawm kev siv cov vitamins lossis corticosteroids ua ntej nws siv.
  • Urokinase. Analogs: Urokidan, Abbokinase. Cov tshuaj activates plasminogen, tig mus rau hauv plasmin, tsim los ntawm lub raum hlwb. Tsis ua xua, tsis provoke tsim cov tshuaj tiv thaiv.
  • Proukinase. Tsim los ntawm DNA ntawm tib neeg lub raum embryonic hlwb hauv glycosylated thiab non-glycosylated daim ntawv, activates plasminogen.
  • APSAK. Kev sib xyaw ntawm Streptokinase nrog plasminogen yog ntxiv rau qhov no nrog cov khoom siv acetyl rau kev ua kom nrawm ntawm cov hlab ntsha. Analogues: Eminase, Anistreplaza.
  • Tissue plasminogen activator. Ua los ntawm cov ntaub ntawv DNA recombinant. Cov tshuaj protease dissolves thrombus thaum cuam tshuam nrog fibrin, tsis ua rau muaj kev tsis haum tshuaj, tsim cov tshuaj tiv thaiv, lossis kev cuam tshuam hemodynamic. Cov tshuaj muaj txiaj ntsig zoo dua li Urokanase thiab Streptokinase.
  • Staphylokinase. Cov tshuaj muaj txiaj ntsig zoo uas tsim los ntawm cov kab mob Staphylococcus aureus, tsis muaj qhov ua xua. Tsis muaj neeg tuag hauv cov neeg siv tshuaj.

Thrombolytics yuav tsum tau siv rau kev kho mob thrombosis nyob rau hauv txhua yam pathologies ntawm lub plawv thiab cov hlab ntsha. Lawv muaj peev xwm cawm tau tus neeg mob txoj sia, rov qab ua nws lub peev xwm ua haujlwm. Txhawm rau tiv thaiv kev rov tshwm sim ntawm thrombosis, tus neeg mob tau muab tshuaj anticoagulants thiab cov tshuaj tiv thaiv kab mob.

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