Ua paʻakikī anei iā ʻoe ke hanu, ua ʻeha nui kou umauma i kou hanu hohonu ʻana? A i ʻole ua manaʻo koke ʻoe i kou puʻuwai e kuʻi wikiwiki ana, e hou ana, a e hopohopo ana me ke kumu ʻole? ʻOiai ke manaʻo pinepine nei mākou he hōʻeha puʻuwai kēia, hiki ke lilo i mea ʻokoʻa loa a he mea weliweli loa paha. I kēia lā, e kamaʻilio mākou e pili ana i kekahi ʻano koʻikoʻi, akā he mea hoʻōla ola i kapa ʻia ʻo 'Pulmonary Embolism'.
I ka ʻōlelo maʻalahi, he aha ka Pulmonary Embolism?
ʻO ka Pulmonary Embolism (PE) he ʻūpā koko e hana ʻia ana i loko o kahi kīʻaha koko (vein) e hoʻolako ana i ke koko i kou mau māmā. I kēia manawa ke noʻonoʻo nei paha ʻoe, "Pehea e hana ʻia ai kahi ʻūpā koko i loko o nā māmā?" ʻO ka ʻoiaʻiʻo, ʻaʻole hana ʻia kēia ʻūpā koko i loko o nā māmā. ʻO ka hapa pinepine, hana ʻia ia ma kahi ʻē aʻe o ko mākou kino, ʻoi aku hoʻi ma nā aʻa hohonu o ko mākou mau wāwae a i ʻole nā lima. Kāhea mākou i kēia ʻo Deep Vein Thrombosis (DVT).
E noʻonoʻo i nā kīʻaha koko i loko o kou kino e like me kahi pūnaewele o nā alanui. ʻO kēia ʻūpā koko e hana ʻia ma kou wāwae, e like me ke kaʻa, e hele ana ma kēlā alanui me ke koko, e hele ana ma ka puʻuwai, a ma hope e paʻa i loko o kahi kīʻaha koko liʻiliʻi i loko o nā māmā. Ua like ia me ke kaʻa nui i paʻa ma ke alanui liʻiliʻi.
Ke paʻa ke koko i loko o nā māmā, ʻekolu mau mea nui e hana ʻia:
1. Ua kaupalena ʻia ke kahe ʻana o ke koko i nā māmā.
2. E emi ana nā pae oxygen i loko o nā māmā.
3. Piʻi ke koko i loko o nā kīʻaha koko i pili i nā māmā.
He pilikia olakino kēia. Inā ʻaʻole e mālama koke ʻia, hiki iā ia ke hōʻeha i ka puʻuwai a i ʻole ka māmā a hiki i ka make. Hōʻike nā haʻawina e pili ana i ka hapakolu (33%) o ka poʻe me kēia maʻi e make ma mua o ka ʻike ʻia ʻana a me ka mālama ʻia ʻana.
Akā ʻo ka nūhou maikaʻi, inā ʻike ʻia ka maʻi i ka manawa kūpono a mālama pono ʻia, ʻaʻole pinepine kēia maʻi e make.
He aha nā hōʻailona o kēia maʻi? E makaʻala koke!
Hiki ke ʻokoʻa nā hōʻailona o ka embolism pulmonary (PE) mai kēlā kanaka a kēia kanaka. Aia ia i ka nui o ke koko i hoʻopaʻa ʻia a me nā hopena. ʻAʻole paha i loaʻa i kekahi poʻe kekahi mau hōʻailona. Eia nō naʻe, e ʻike ka hapa nui o ka poʻe i hoʻokahi a ʻoi aku paha nā hōʻailona.
ʻO nā hōʻailona nui a me nā hōʻailona mua loa, ʻo ia ka pōkole koke o ka hanu a me ka ʻeha o ka umauma e hoʻonui ana me ka hanu hohonu a i ʻole ka hoʻoikaika kino.
Inā loaʻa iā ʻoe kekahi a ʻoi aku paha o kēia mau hōʻailona, e ʻimi koke i ke kōkua lapaʻau. ʻOi aku ka maikaʻi o ka hele ʻana i ka Emergency Treatment Unit (ETU) o ka haukapila. Hiki i ka mālama koke ʻana ke hōʻemi nui i ka pilikia o ka make.
Hōʻike ka papa ma lalo nei i nā hōʻailona maʻamau o kēia maʻi.
| Hōʻailona | Wehewehena |
|---|---|
| Ka paʻakikī koke o ka hanu ʻana | ʻOiai inā ʻoe e noho wale ana me ka hana ʻole, hiki iā ʻoe ke manaʻo koke i ka pōkole o ka hanu. |
| ʻEha ʻoi o ka umauma | Hoʻonui kēia ʻeha i ka wā e hanu ana, e ʻū ana, a i ʻole e kūlou ana. I kekahi manawa hiki ke like me ka ʻeha o ka hōʻeha puʻuwai. Hiki ke loaʻa ma ka umauma, ka lima, ka poʻohiwi, ka ʻāʻī, a i ʻole ka ʻauwae. |
| Kuke | Hiki ke puka mai ke koko me ka huʻa. |
| Nā palpitations o ka puʻuwai | Hiki ke piʻi koke ka helu o ka puʻuwai (pulse). |
| Pōʻino a i ʻole ka nawaliwali | Hiki ke poniuniu , māʻule, a nalowale paha ka ʻike. |
| Nā hiʻohiʻona ʻē aʻe | Ka hou nui ʻana, ka ʻili keʻokeʻo a polū paha, ka hanu ʻana o ka hanu, a me ka hopohopo i wehewehe ʻole ʻia. |
No kekahi poʻe, hiki ke ulu mālie kēia mau hōʻailona i nā lā a i ʻole nā pule. E ʻoi aku ka koʻikoʻi o nā hōʻailona i ka hala ʻana o ka manawa. Eia nō naʻe, no kekahi poʻe, ulu nā hōʻailona koʻikoʻi i loko o nā minuke o ka hoʻomaka ʻana o ke ʻano.
No ke aha e hana ʻia ai kēia? He aha nā kumu pilikia?
E like me kaʻu i ʻōlelo ai ma mua, ʻo ka Pulmonary Embolism (PE) ke kumu o kahi clot koko (DVT) e hana ʻia ma kahi ʻē aʻe o ke kino, ʻoi aku hoʻi ma nā wāwae, e haki ana a paʻa i loko o nā māmā. No laila, ʻo nā mea āpau e hiki ai ke hana i kēia mau clots koko e hiki ke hana i ka PE.
ʻO kekahi mau kumu nui:
- Ke noho mālie ʻana o ke kino no ka manawa lōʻihi: Ke noho ʻoe ma kahi moe ma hope o kahi ʻoki ʻana, a i ʻole ke noho ʻoe ma ke kūlana like i ka wā o kahi mokulele lōʻihi a holo kaʻa paha, hiki ke lohi ke kahe koko ma nā wāwae a hiki ke hana ʻia nā ʻūpā koko.
- Ka hōʻino ʻana i nā aʻa koko: ʻO nā ulia pōpilikia, nā haki (ʻoi aku hoʻi o ka ʻūhā, ke kuli, a i ʻole ka wāwae), a me ke ʻoki kino nui e hōʻino i nā aʻa koko a hoʻonui i ka pilikia o nā ʻūpā koko.
- Nā kūlana olakino ʻē aʻe: Nā kūlana e like me ka hāʻule ʻana o ka puʻuwai, ke kanesa, a me ka hahau ʻana.
- Nā loli i ke kāpili ʻana o ke koko: Loaʻa paha i kekahi poʻe nā maʻi kāpili koko genetic. Eia kekahi, hiki ke hoʻonui iki ʻia kēia pilikia i ka poʻe e lawe ana i nā pila hoʻomalu hānau a i ʻole ka lāʻau lapaʻau hoʻololi hormone.
Aia ma lalo iho kekahi o ka poʻe i ʻoi aku ka pilikia no kēia maʻi. Inā loaʻa iā ʻoe kekahi a ʻoi aku paha o kēia mau mea pilikia, he mea nui e kamaʻilio me kāu kauka e pili ana i ia mea.
- Loaʻa a i ʻole he ʻūpā koko ma ka wāwae (Deep Vein Thrombosis - DVT).
- Ke hana ʻia nei ke ʻoki kino a i ʻole e moe ana no ka manawa lōʻihi.
- Puhi paka.
- ʻOiai ma luna o 60 mau makahiki.
- ʻO ka hāpai ʻana a i ʻole nā pule 6 mua ma hope o ka hānau ʻana.
- Loaʻa i ka maʻi kanesa.
- ka hoʻohana ʻana i nā lāʻau hormonal e like me nā pila hoʻomalu hānau.
- Momona - ʻOi aku ka nui o ke kino (BMI) ma mua o 30.
- Loaʻa kahi moʻolelo ʻohana o nā ʻōpū koko.
- ʻO ka loaʻa ʻana o nā maʻi mau ʻē aʻe e like me ka maʻi diabetes a me ka maʻi puʻuwai.
- ʻO ka loaʻa ʻana o kahi catheter venous waena lōʻihi (kahi paipu i hoʻokomo ʻia i loko o kahi aʻa ma ka lima a i ʻole ka wāwae) e hāʻawi i nā mea e like me ka saline.
Pehea e ʻike ai i ka maʻi? (Diagnosis)
Ke hele ʻoe i ka haukapila, e nānā pono ke kauka i kāu mau hōʻailona a me nā kumu pilikia. A laila, e kauoha lākou i kekahi mau hoʻokolohua e hōʻoia i ka maʻi.
| Hoʻāʻo | I ka ʻōlelo maʻalahi, he aha kāna hana? |
|---|---|
| Nā hoʻāʻo koko | Eia ka hoʻāʻo D-dimerHe kūikawā kēia hoʻāʻo. Ana ia i kahi protein i hana ʻia i ka wā e heheʻe ai kahi ʻūpā koko i loko o ke kino. Inā haʻahaʻa kēia pae, haʻahaʻa ka manawa e loaʻa ai ka PE. |
| ʻO ke kauka CT Angiogram | He scan CT kūikawā kēia. Hoʻokomo ʻia kahi kala kūikawā (contrast) i loko o kahi aa koko i loko o kou lima, a lawe ʻia nā kiʻi ʻekolu-dimensional (3D) o nā kīʻaha koko i loko o kou mau māmā. Inā he ʻūpā koko, hiki ke ʻike maopopo ʻia. |
| ʻO ke kiʻi ʻana o nā wāwae ma o ka ultrasound | Hana ʻia kēia scan e nānā i nā ʻūpā koko (DVT) i loko o nā aa koko hohonu o nā wāwae. Inā he DVT, ʻo ia paha ke kumu o nā hōʻailona o ka māmā. |
| Nā hoʻokolohua ʻē aʻe | Eia kekahi, hana ʻia kahi X-ray o ka umauma, kahi Echocardiogram e nānā i ka hana o ka puʻuwai, a me kahi pulse oximeter e ana i nā pae oxygen. |
Pehea e mālama ʻia ai?
Hana pinepine ʻia ka mālama ʻana no ka PE ma ka haukapila, no ka mea, pono e nānā pono ʻia kou kūlana. Aia ka lōʻihi o ka mālama ʻana ma ke koʻikoʻi o ke koko.
ʻO ka lāʻau lapaʻau nui ka hāʻawi ʻana i nā lāʻau lapaʻau e pale ai i ke kāpili ʻana o ke koko . Kāhea mākou i kēia mau anticoagulants a i ʻole nā mea hoʻokahe koko .
ʻO ka mea nui, ʻaʻole e hoʻoheheʻe kēia mau lāʻau i nā ʻūpā koko e kū nei. Pale wale lākou i ke kūkulu ʻana o nā ʻūpā koko hou a me ka nui ʻana o nā ʻūpā koko e kū nei. Hoʻoheheʻe mālie ʻia nā ʻūpā koko e kū nei ma o nā kaʻina hana kūlohelohe o ke kino ponoʻī.
- Nā lāʻau lapaʻau anticoagulant: Hāʻawi ʻia kēia mau mea ma ke ʻano he inikini a i ʻole nā pila. Pono paha ʻoe e lawe i kēia mau lāʻau no 3-6 mau mahina, a i ʻole kekahi manawa ʻoi aku ka lōʻihi. Mai ho'ōki i ka lawe ʻana i kēia mau lāʻau no kekahi kumu ke ʻole kāu kauka e haʻi aku iā ʻoe.
- Lapaʻau Thrombolytic: He lāʻau lapaʻau kēia i hāʻawi ʻia i nā hihia koʻikoʻi loa a hoʻoweliweli i ke ola. Hana kēia mau lāʻau lapaʻau ma ka hoʻoheheʻe koke ʻana i ke koko. Hāʻawi ʻia lākou ma lalo o ka nānā pono ʻana e nā kauka ma ka ʻāpana mālama koʻikoʻi (ICU).
- Nā ʻano hana ʻē aʻe:I kekahi manawa, inā ʻaʻole lawa ka lāʻau lapaʻau, pono paha ke ʻoki kino a i ʻole kahi catheter e wehe i ke koko. ʻO kekahi koho ʻē aʻe, ʻo ia ke hoʻokomo i kahi kānana Vena Cava. Hoʻohana ʻia kēia e kānana a hopu i nā koko mai nā wāwae ma mua o ko lākou hiki ʻana i nā māmā.
- Nā Kāʻei Hoʻopaʻa: Hiki i kāu kauka ke aʻo aku iā ʻoe e ʻaʻahu i kēia mau ʻano kāʻei kūikawā e mālama i ke kahe koko maikaʻi i kou mau wāwae.
Hiki ke pale ʻia kēia kūlana?
ʻAe, hiki nō i kahi nui. ʻO ke kī ma ʻaneʻi, ʻo ia ka hōʻemi ʻana i ka pilikia o nā ʻūpā koko.
- E hana ikaika: E hoʻoikaika kino i kēlā me kēia lā. Inā noho ʻoe no ka manawa lōʻihi (nā mokulele, nā holo kaʻa, nā hana keʻena), e ala a hele a puni ma ka liʻiliʻi hoʻokahi manawa i ka hola, e hoʻoneʻe ana i kou mau wāwae a me kou mau lima.
- E pale i nā lole paʻa: ʻO ke komo ʻana i nā lole paʻa e hiki ke keakea i ke kahe o ke koko.
- Mai keʻa i kou mau wāwae: Mai noho me kou mau wāwae i keʻa ʻia no ka manawa lōʻihi.
- E mālama i ke kaumaha olakino.
- E pale loa i ka puhipaka.
- E inu i ka wai nui: Hiki i ka maloʻo ʻana ke hoʻomānoanoa i ke koko.
- E makaʻala i kāu mau kumu pilikia: Inā hana ʻia ʻoe i ke ʻoki kino, hāpai ʻoe, a i ʻole he mau kumu pilikia ʻē aʻe kāu, e kamaʻilio me kāu kauka e pili ana i nā hana hiki iā ʻoe ke hana e pale aku ai i nā ʻaʻa koko.
Pono ʻoe e hoʻomaka e ʻoluʻolu i loko o hoʻokahi pule o ka lāʻau lapaʻau. Eia nō naʻe, hiki ke hala nā mahina a i ʻole nā makahiki no ka hoʻoheheʻe loa ʻana o ke koko. I loko o kēia manawa, he mea nui e hahai pono i nā ʻōlelo a kāu kauka.
Leka Lawe-Home
- ʻO ka pulmonary embolism (PE) he ʻūpā koko e hana ʻia ana i loko o kahi kīʻaha koko i loko o nā māmā. He pilikia olakino kēia e hiki ke hoʻoweliweli i ke ola.
- ʻO ka pōkole koke o ka hanu, ka ʻeha o ka umauma i ka wā e hanu hohonu ai, a me ka wikiwiki o ka puʻuwai nā hōʻailona nui. Inā loaʻa kēia mau mea, e hele koke i ka ʻOihana Pōpilikia (ETU) o ka haukapila.
- Hoʻokumu pinepine ʻia kēia mau ʻūpā koko ma nā wāwae (DVT). ʻO ka noho paʻa ʻole no ka manawa lōʻihi, ke ʻoki kino, ka puhipaka, a me ka momona nui nā kumu pilikia nui.
- He kiʻekiʻe loa ka hiki ke hoʻopakele i nā ola ke ʻike ʻia ka maʻi i ka manawa kūpono a mālama ʻia me nā anticoagulants.
- He mea nui loa e lawe i ka lāʻau lapaʻau i kuhikuhi ʻia e kāu kauka no ka manawa piha a hahai i nā ʻōlelo kuhikuhi i hāʻawi ʻia e pale aku i kēia maʻi mai ka hoʻi hou ʻana.











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