He ʻūpā koko anei kou i loko o kahi aa koko ma kou lima? (Axillo-Subclavian Vein Thrombosis) - E kamaʻilio kākou e pili ana i kēia!

Ke manaʻo nei ʻoe i kekahi manawa i kahi ʻeha ʻoi koke ma kou lima, pehu, a i ʻole he kala polū? A i ʻole ke ʻano o kou lima he mae a kaumaha paha? ʻAʻole kēia he mau hōʻailona e hoʻowahāwahā ʻia. Hiki paha ke lilo i ʻūpā koko i loko o kahi aa nui ma kou lima a i ʻole ka ʻāʻī. Ma nā ʻōlelo lapaʻau, kapa mākou i kēia (Axillo-Subclavian Vein Thrombosis) a i ʻole (ASVT) . Mai hopohopo, e kamaʻilio mākou e pili ana i kēia ma ke ʻano maʻalahi e hiki ai iā ʻoe ke hoʻomaopopo.

He aha kēia (Axillo-Subclavian Vein Thrombosis)?

I ka ʻōlelo maʻalahi, ʻo Axillo-Subclavian Vein Thrombosis (ASVT) ka wā e hana ʻia ai kahi clot koko i loko o ka aʻa subclavian , kahi aʻa nui ma kou poʻohiwi, a i ʻole ka aʻa axillary, kahi aʻa ma kou armpit. E noʻonoʻo i kou mau aʻa e like me nā paipu wai. Inā paʻi ʻia kahi iwi ʻaoʻao a ʻāpana ʻiʻo paha kokoke i kēia aʻa, hiki iā ia ke ālai i ke kahe koko a hana i kahi clot koko.

Hoʻokumu pinepine ʻia kēia ʻano ma muli o ka ʻeha ma kou lima luna, a i ʻole ke kaumaha ma kou lima mai nā neʻe hou ʻana. Kapa kekahi poʻe iā ia he Paget-Schroetter syndrome , aʻo kekahi poʻe kapa ia he effort-induced thrombosis , ʻo ia hoʻi "he ʻōpū koko i hoʻokumu ʻia e ka hoʻoikaika kino."

He mea kākaʻikahi anei kēia (Deep Vein Thrombosis - DVT)?

ʻAe, hiki iā ʻoe ke loaʻa kēlā pilikia. ʻO (ASVT) he ʻano maʻi i kapa ʻia ʻo (Deep Vein Thrombosis) a i ʻole (DVT) . ʻO (DVT) ka wā e hana ʻia ai kahi clot koko i loko o kahi aa koko hohonu i loko o ke kino. Akā ʻo ka hapa nui o ka manawa a mākou e kamaʻilio ai e pili ana i (DVT) ke kamaʻilio nei mākou e pili ana i nā clots koko e hana ʻia ma nā wāwae. Hoʻokumu pinepine ʻia lākou e nā mea e like me ka momona, ka hana ʻole o ke kino, ka ʻelemakule, a i ʻole nā ​​​​maʻi ʻē aʻe e pili ana i nā aa koko.

Eia nō naʻe, ʻo nā ʻūpā koko ma ka lima, i kapa ʻia ʻo ASVT, e kū pinepine ma muli o kahi ulia a i ʻole mai ka hoʻohana lōʻihi ʻana o ka lima. Hiki ke ʻokoʻa nā hōʻailona a me nā lāʻau lapaʻau no kēia mau kūlana ʻelua i kekahi manawa.

ʻO wai ka mea i ʻoi aku ka paʻakikī ke hoʻomohala i kēia (ASVT)?

ʻOiai hiki i kekahi ke loaʻa i kēia maʻi, ʻoi aku ka nui o ka pilikia o kekahi poʻe. ʻO kēia mau mea:

• ʻEleu mau , olakino maikaʻi .
• Nā poʻe ʻōpio ma waena o nā makahiki 15 a me 45 .
• ʻO ka poʻe e pāʻani ana i nā haʻuki (e like me nā mea kīloi wikiwiki i ka kriket, nā mea ʻauʻau, nā mea hāpai kaumaha) a i ʻole ka poʻe e hana me ko lākou mau lima i hāpai mau ʻia (e like me nā mea pena kiʻi, nā mea uila, ka poʻe e hana ana i nā hana hāpai kaumaha). E noʻonoʻo wale, ke hana ʻoe me kou mau lima i hāpai ʻia a wili ʻia ma ke ʻano like, kau ʻia ke kaomi ma luna o kēlā mau aa koko.
• ʻO nā kānaka me kekahi mau maʻi koko koko genetic .

Aia kekahi mau ʻano like ʻole o ke ʻano o ka maʻi ʻaʻai (ASVT)?

ʻAe, aia ʻelua ʻano nui o (ASVT):

1. ASVT mua:ʻO kēia ke ʻano maʻamau, i hana ʻia e nā neʻe lima ikaika a hana hou ʻia.

2. ASVT lua: Hoʻokumu ʻia kēia e kekahi mau mea lapaʻau i hoʻokomo ʻia i loko o kou umauma luna. Eia kekahi laʻana:

• (Central venous catheter) (kahi paipu i hoʻokomo ʻia i loko o kahi aʻa nui)
• (Defibrillator) (kahi mea hana e hoʻihoʻi i ka hana o ka puʻuwai)
• (Pacemaker) (he mea hana e kaohi ai i ka puʻuwai)
• (Puka lāʻau lapaʻau) (He mea liʻiliʻi i waiho ʻia ma lalo o ka ʻili e hāʻawi i ka lāʻau lapaʻau)

Hiki i kēia mau mea hana ke hoʻopili i nā kīʻaha koko a me nā ʻūpā koko.

Pehea ka maʻamau o (ASVT)?

ʻOiaʻiʻo, ʻaʻole maʻamau ka ASVT. Wahi a nā helu helu, loaʻa ia i hoʻokahi a ʻelua paha mau kānaka i kēlā me kēia 100,000 i kēlā me kēia makahiki. Eia nō naʻe, he 10% a 20% wale nō o nā DVT āpau ma ka ʻaoʻao o luna i hoʻokumu ʻia e ASVT. No laila, mai kēlā kuanaʻike, he helu koʻikoʻi ia.

He aha nā hōʻailona o ka maʻi ʻaʻai (ASVT)?

Inā loaʻa iā ʻoe ka ASVT, hiki iā ʻoe ke ʻike i hoʻokahi a ʻoi aku paha o kēia mau hōʻailona:

• ʻEha lima: Hoʻomaka koke, i kekahi manawa koʻikoʻi.
• Nā aa koko ʻike ʻia ma nā lima: Hiki ke ʻike ʻia nā aa koko e pehu ana ma muli o ke kahe koko i kaupalena ʻia.
• ʻIli polū (Cyanosis): Hiki ke polū ka ʻili ma nā lima. ʻO ke ʻano kēia, ua nele i ka oxygen.
• Manaʻo kaumaha a luhi paha ma ka lima: E paʻakikī paha iā ʻoe ke hāpai a hoʻoneʻe paha i kou lima.
• Pehu koke o ka lima: Hoʻomaka koke ka lima e pehu.

ʻO ka mea nui, i kekahi mau hihia (10% - 20%) hiki i kēia ʻūpā koko ke hemo mai ke aʻa, hele ma ke kahe koko, a hele i nā māmā. Ua kapa ʻia kēia he Pulmonary Embolism (PE) . He kūlana weliweli loa kēia. Hiki iā ia ke hōʻeha nui i nā māmā, a hiki ke hoʻoweliweli i ke ola. No laila, inā hoʻomaka ʻoe e ʻike i kekahi o kēia mau hōʻailona, ​​​​pono ʻoe e ʻike i ke kauka me ka hoʻonele ʻole i ka manawa.

No ke aha e hana ʻia ai kēia (ASVT)?

E like me kā mākou i ʻōlelo ai ma mua, ʻo ke kumu nui ka neʻe pinepine ʻana o ka lima. E noʻonoʻo, ke hāpai mau nei ʻoe i nā mea kaumaha a i ʻole e pāʻani ana i nā haʻuki. A laila hiki i nā ʻiʻo a puni kou poʻohiwi a me kou ʻauwae ke luhi a pehu. Hiki i kēia mau ʻiʻo pehu ke hoʻopaʻa i nā kīʻaha koko ma laila (ʻoi aku hoʻi nā aʻa subclavian a i ʻole axillary).

I ka hala ʻana o ka manawa, hiki i kēia kaomi ke hōʻino i ka paia o ke aʻa a hoʻoulu i ka hana ʻana o nā ʻiʻo ʻeha. A laila e ʻūlū ana ke aʻa mai loko mai, e hōʻemi ana i ka nui o ke koko e hiki ke kahe ma o ia mea. Hiki i kēia ke alakaʻi i ke kahe koko maikaʻi ʻole a me ka hoʻonui ʻia o ka pilikia o nā ʻūpā koko. I kekahi manawa ua kapa ʻia kēia ʻano ʻo Thoracic Outlet Syndrome (TOS).Ua kapa ʻia hoʻi ia. ʻO ia hoʻi, ua haiki ka hakahaka ma ka ʻaoʻao o luna o ka umauma (thoracic outlet), e hoʻoulu ai i ke kaomi ma luna o nā aʻa koko a me nā aʻalolo.

I kekahi manawa, hiki ke hana ʻia ka ASVT e kahi mea ʻē ma ka iwi ʻaoʻao mua, a i ʻole nā ​​​​loli i nā ʻiʻo a i ʻole nā ​​​​ligaments a puni nā aa koko ma ka ʻāpana armpit a me ka poʻohiwi.

Pehea e ʻike ai ke kauka i kēia (ASVT)?

Ke hele ʻoe i ke kauka me nā hōʻailona i ʻōlelo ʻia ma mua, e nānā mua ʻo ia iā ʻoe. E hiki i ke kauka ke ʻike i nā mea e like me ka pehu ʻana ma kou lima, nā loli o ke kala, a me nā aa koko e pehu ana i ka nānā koke ʻana.

A laila, pono paha ʻoe e hana i kekahi mau hoʻokolohua e hōʻoia:

• (Duplex ultrasound): ʻO kēia ka hoʻāʻo mua i hana ʻia. Hoʻohana ia i nā nalu kani e nānā i ke kahe o ke koko i loko o nā aa koko a e ʻike inā he mau ʻūpā koko. He hoʻāʻo maʻalahi a ʻeha ʻole kēia.
• ʻO ka venography i alakaʻi ʻia e ka catheter: I kekahi manawa hana ʻia kēia hoʻāʻo. Ma kēia hoʻāʻo, hoʻokomo ʻia kahi ʻōmole liʻiliʻi a lahilahi (catheter) ma o kahi aʻa koko i kahi i manaʻo ʻia ai ke koko ʻūlū, a hoʻokomo ʻia kahi kala kūikawā i loko o ke aʻa koko ma o ka catheter. A laila lawe ʻia nā kukuna X e ʻike i kahi i ālai ʻia ai ke aʻa koko a pehea ka nui o ke koko ʻūlū.
• (CTA - angiography tomography kamepiula): Ua like kēia me ka CT scan, akā nānā pono ia i nā kīʻaha koko. Hana ʻia hoʻi ia ma ka hoʻokomo ʻana i kahi kala.
• (MRA - magnetic resonance angiography): He hoʻāʻo e hoʻohana ana i kahi scan MRI e nānā i nā kīʻaha koko.

Hiki i kēia mau hoʻokolohua ke hoʻoholo pololei inā loaʻa ke kūlana (ASVT), kahi o ia mea, a pehea ke koʻikoʻi.

He aha nā lāʻau lapaʻau no (ASVT)?

ʻO ka mea maikaʻi loa, aia nā lāʻau lapaʻau kūpono no ASVT. ʻO ka lāʻau lapaʻau nui i kapa ʻia ʻo thrombolysis a i ʻole thrombolytic therapy .

ʻO kēia ke komo ʻana i kahi lāʻau lapaʻau e hoʻoheheʻe i ke koko a wehe iā ia, e like me ka mea i ʻōlelo ʻia ma mua, pololei i loko o ke aʻa koko kahi i loaʻa ai ke koko ma o kahi ʻōmole liʻiliʻi (catheter) . Hoʻoheheʻe kēia i ke koko a hoʻihoʻi i ke kahe koko i loko o ke aʻa koko.

I kekahi manawa, hele pū ʻia kēia lāʻau lapaʻau (thrombectomy) me kahi mea i kapa ʻia ʻo (thrombectomy) . ʻO ia hoʻi, ua wehe ʻia ke koko ma ke ʻano mechanical a i ʻole ma o ke ʻoki liʻiliʻi.

Ma hope o kēia mau lāʻau lapaʻau, e hāʻawi ʻia ʻoe i ka lāʻau hoʻomāmā koko, e like me Warfarin a i ʻole nā ​​​​lāʻau lapaʻau hou ʻē aʻe, no kekahi mau mahina e pale ai i ke kūkulu hou ʻana o nā ʻōpū koko. He mea nui loa e lawe i kēia lāʻau lapaʻau no ka lōʻihi o ka manawa a kāu kauka e haʻi aku ai iā ʻoe.

Eia kekahi, e hāʻawi aku ke kauka iā ʻoe i kēia mau ʻōlelo aʻoaʻo:

• E hōʻemi i ka hoʻohana ʻana i ka lima i hoʻopilikia ʻia a hiki i ka nalowale loa ʻana o nā hōʻailona.
• E hoʻokiʻekiʻe iki i kou mau lima i ka wā hiki (e hoʻokiʻekiʻe i nā lima).
• Hoʻōla kinoE nānā. E kōkua kēia iā ʻoe e hoʻihoʻi i ka neʻe a me ka ikaika i kou lima.
• E ʻaʻahu i kahi ʻaʻahu komo (e like me ke kāmaʻa paʻa) ma ka lima i hoʻopilikia ʻia. E kōkua kēia i ka hōʻemi ʻana i ka pehu a hoʻomaikaʻi i ke kahe koko.

E pono anei ke ʻoki kino?

I kekahi mau hihia, ʻae. Hiki ke ʻōlelo ʻia ke ʻoki kino e wehe loa i ka mea paʻa a hōʻemi i ka pilikia o ke kūkulu hou ʻana o nā ʻōpū koko. Pili kēia ʻoki kino i ka wehe ʻana i ka mea paʻa. No ka laʻana, hiki ke wehe ʻia kahi ʻāpana o ka iwi ʻaoʻao mua a i ʻole kahi ʻāpana ʻiʻo e hana ana i ka mea paʻa. ʻAe kēia i ke koko e kahe manuahi ma o ke aʻa.

He aha kā mākou e hana ai e pale aku i ka ulu ʻana o (ASVT)?

ʻOiai ʻaʻole hiki ke pale loa ʻia, aia kekahi mau mea hiki iā mākou ke hana e hōʻemi i ka pilikia:

• E hoʻoneʻe mālie mau i nā ʻiʻo i loko o kou mau lima a e hana i nā hoʻomaʻamaʻa e like me nā kīkoʻo .
• Mai hana nui i kou mau lima.
• Inā ʻoe e hāpai ana i nā kaumaha a i ʻole e hoʻoikaika kino ana, e hoʻomaha iki ma waena .
• I nā manawa hiki, e hoʻāʻo e hana me kou lima ʻaʻole i hoʻomalu ʻia (e.g. inā he lima ʻākau ʻoe, e hoʻohana i kou lima hema i ka wā hiki).

Pehea lā ke kūlana ma hope o ka lāʻau lapaʻau?

Hana maikaʻi loa ka hapa nui o ka poʻe me ASVT ma hope o ka mālama ʻia ʻana. Ua hōʻike ʻia nā haʻawina inā ʻike ʻia a mālama ʻia ka maʻi i ka wā mua, i ka hoʻomaka ʻana o nā hōʻailona, ​​​​aia kahi helu holomua 90% a 95% .

Eia nō naʻe, hiki i kekahi poʻe ke loaʻa i kahi pilikia i kapa ʻia ʻo Post-thrombotic Syndrome (PTS) . I kēia, hiki ke hoʻomau ʻia nā hōʻailona e like me ka ʻeha lōʻihi, ke kaumaha, a me ka pehu ʻana ma ka lima i hoʻopilikia ʻia. No laila, he mea nui e hahai i nā ʻōlelo a kāu kauka ma hope o ka mālama ʻana.

Āhea mākou e ʻike ai i ke kauka i ka wā hikiwawe loa?

Inā ʻike ʻoe i kekahi o nā hōʻailona mua o ASVT, e ʻimi koke i ke kōkua lapaʻau . Mai hoʻokaʻulua, ʻoiai inā ʻike ʻoe i kekahi o kēia mau mea:

• ʻEha umauma
• ʻO ka numbness ma nā lima ʻelua a i ʻole nā ​​​​wāwae
• Ka paʻakikī o ka hanu ʻana (dyspnea)

He mau hōʻailona paha kēia o kahi maʻi weliweli e like me ka Pulmonary Embolism (PE).

(ASVT) Inā pēlā, he aha nā nīnau āu e nīnau ai i ke kauka?

Inā haʻi aku kāu kauka iā ʻoe he ASVT kou, he mea maikaʻi ke nīnau i kekahi mau nīnau e like me kēia:

• He aha nā hoʻololi o ke ʻano o ka nohona e hiki iaʻu ke hana e hōʻemi ai i koʻu pilikia o ke koko?
• Hiki iaʻu ke hoʻomau i ka hoʻoikaika kino a me ka hana lima?
• He aha kaʻu e hana ai e pale aku ai i ke kūkulu hou ʻana o nā ʻūpā koko?
• Pehea ka lōʻihi e pono ai ʻoe e lawe i ka lāʻau hoʻokahe koko?

ʻO ka mea nui e hoʻomanaʻo (Leka Lawe-Home)

Ke lana nei koʻu manaʻo ua ʻoi aku kou maopopo i ka mea a mākou i kūkākūkā ai i kēia lā (Axillo-Subclavian Vein Thrombosis - ASVT). I ka hōʻuluʻulu manaʻo:

• ʻO ka ASVT (ASVT) he ʻaʻa koko e hana ʻia ana i loko o kahi aʻa koko nui ma kou lima a i ʻole kou ʻauwae.
• Hana pinepine ʻia kēia ma muli o ka hoʻohana mau ʻia ʻana o ka lima a luhi hoʻi.
• Hiki paha iā ʻoe ke kānalua inā ʻike ʻoe i nā hōʻailona e like me ka ʻeha koke, ka pehu ʻana, a me ka ʻili polū ma kou lima.
• ʻO ka thrombolysis (lāʻau lapaʻau e hoʻoheheʻe i nā clots koko) a me ka thrombectomy (wehe ʻana i nā clots koko) nā lāʻau lapaʻau nui.
• ʻO ka mea nui loa, ʻo ia ka ʻike mua ʻana i ka maʻi a hoʻomaka i ka lāʻau lapaʻau. Inā hana ʻoe pēlā, ʻoi aku ka maikaʻi o kou manawa e hoʻōla piha ai.

Inā loaʻa iā ʻoe kēia mau hōʻailona, ​​mai makaʻu a e ʻike koke i ke kauka. E noho olakino!

ʻO ka thrombosis aʻa axillo-subclavian, ASVT, ʻūpā koko, nā aʻa lima, ʻeha poʻohiwi, pehu lima, DVT, Pulmonary Embolism, Paget-Schroetter syndrome