Koj puas tau siv tshuaj hu ua Heparin? Tej zaum tom qab phais mob, lossis kom tiv thaiv cov ntshav txhaws, tus kws kho mob yuav muab cov tshuaj no rau koj. Txawm li cas los xij, txawm tias tsis tshua muaj, cov tshuaj heparin no tuaj yeem ua rau peb lub cev tsim cov ntshav txhaws ntau dua thiab txo cov platelets. Qhov ntawd yog qhov peb hu ua 'Heparin-Induced Thrombocytopenia' lossis '(HIT)'. Tsis txhob txhawj, qhov no yuav zoo li nyuaj me ntsis, tab sis cia peb tham txog nws yooj yim.
Heparin yog dab tsi? Vim li cas HIT thiaj tshwm sim?
Hais yooj yim xwb, heparin yog
ib yam tshuaj anticoagulant (ua kom cov ntshav nyias). Nws yog siv los tiv thaiv cov ntshav txhaws hauv peb cov hlab ntsha. Cov kws kho mob tau sau ntawv kom siv tom qab phais loj, lossis kom yaj cov ntshav txhaws uas twb tau tsim lawm. Txawm li cas los xij, tsis tshua muaj, thaum muab heparin rau qee tus neeg, nws tuaj yeem ua rau muaj kev tsis haum tshuaj. Qhov no yog thaum peb
lub cev tiv thaiv kab mob sib xyaw nrog heparin thiab ua kom peb cov ntshav platelets ua haujlwm. Platelets yog ib hom cell uas pab tiv thaiv peb cov ntshav. Yog li, thaum cov ntshav platelets ua haujlwm li no, es tsis txhob tiv thaiv cov ntshav txhaws,
lawv pib ua cov ntshav txhaws yam tsis tsim nyog (thrombosis). Tib lub sijhawm, tus lej ntawm cov ntshav platelets kuj txo qis sai (thrombocytopenia). Qhov no yog vim li cas qhov mob no qee zaum hu ua 'Heparin-Induced Thrombocytopenia and Thrombosis (HITT)'.
Xav txog seb, nws txawv me ntsis uas cov tshuaj uas muab los tiv thaiv cov ntshav txhaws yuav ua rau cov ntshav txhaws ntau ntxiv thiab txo cov ntshav platelets, puas yog? Tab sis nws tuaj yeem tshwm sim.
Muaj ob hom HIT tseem ceeb.
Cov kws kho mob faib qhov mob '(HIT)' no ua ob hom tseem ceeb: 1.
HIT I (Hom 1): Hauv qhov no, koj cov ntshav platelet txo qis me ntsis hauv ob peb hnub thawj zaug tom qab pib noj heparin, tab sis lawv rov qab mus rau qhov qub hauv ob peb hnub.
Qhov no tsis yog ib qho mob txaus ntshai , thiab tsis muaj kev pheej hmoo ntawm cov ntshav txhaws, yog li tsis tas yuav kho tshwj xeeb. 2.
HIT II (Hom 2): Qhov no yog hom uas peb yuav tsum txhawj xeeb txog. Hauv qhov no, peb lub cev tiv thaiv kab mob ua kom cov ntshav platelets teb rau heparin. Qhov no ua rau cov ntshav platelet txo qis, thiab muaj
kev pheej hmoo ntawm cov ntshav txhaws loj . Feem ntau, thaum peb tham txog '(HIT)', peb feem ntau txhais tau tias hom txaus ntshai no hu ua '(HIT II)'.
Leej twg yuav muaj feem ntau dua los tsim qhov HIT no?
Txhua tus neeg uas siv heparin, txawm tias siv npaum li cas los xij, tuaj yeem muaj tus mob no. Txawm li cas los xij, pom tau tias
cov poj niam hnub nyoog tshaj 40 xyoo muaj feem yuav muaj tus mob no ntau dua. Cov kws kho mob tseem tsis tau paub meej tias vim li cas qee tus neeg thiaj muaj qhov tsis haum rau heparin thiab lwm tus tsis muaj. Qhov no
Nws tsis yog ib qho mob uas pom ntau heev. Qhov mob "(HIT)" no tshwm sim rau ib pawg neeg me me, kwv yees li 5%, uas noj heparin ntau tshaj plaub hnub. Cov tsos mob ntawm HIT yog dab tsi? Peb yuav paub nws li cas?
Yog tias koj noj tshuaj heparin, koj tus kws kho mob feem ntau yuav kuaj xyuas seb koj cov ntshav muaj pes tsawg, tshwj xeeb tshaj yog cov ntshav platelets. Cov ntshav platelets tsawg tuaj yeem yog ib qho cim qhia ntxov ntawm HIT. Kwv yees li ib nrab ntawm cov neeg uas muaj HIT yuav muaj cov ntshav txhaws tshiab. Qhov no tuaj yeem yog cov hlab ntsha tob (DVT) hauv ceg lossis pulmonary embolism (PE). Saib xyuas cov tsos mob no: Tsis tas li ntawd xwb, koj yuav pom mob, mob qhov, lossis pob khaus ntawm daim tawv nqaij ntawm qhov chaw txhaj tshuaj heparin. Qhov tseem ceeb tshaj plaws: Yog tias koj noj tshuaj heparin thiab muaj cov tsos mob no, nrhiav kev kho mob thaum muaj xwm txheej ceev tam sim ntawd. Qhov no tsis yog ib yam dab tsi uas yuav tsum ncua.
Thaum twg HIT tshwm sim?
Feem ntau, cov tsos mob pib tshwm sim li ntawm tsib hnub mus rau ob lub lis piam tom qab pib siv heparin. Txawm li cas los xij, lawv kuj tuaj yeem tshwm sim rau lwm lub sijhawm:- Kev HIT Thaum Ntxov: Qhov no tuaj yeem tshwm sim hauv ib mus rau peb hnub tom qab pib siv heparin. Qhov no yuav tshwm sim ntau dua yog tias koj tau siv heparin ua ntej (feem ntau hauv peb lub hlis). Tom qab ntawd, koj lub cev "nco qab" heparin, tsim cov tshuaj tiv thaiv kab mob tawm tsam nws, thiab npaj txhij los teb sai sai.
- Refractory HIT: Qhov mob no tuaj yeem nyob ntev li ntau lub lis piam tom qab tsis siv heparin lawm.
- Kev pib mob qeeb HIT: Qhov no tshwm sim tom qab kev kho mob heparin raug tso tseg. Feem ntau nws tshwm sim tsib hnub lossis ntau dua tom qab tso tseg kev kho mob.
Dab tsi ua rau qhov HIT no tiag tiag?
'HIT' tshwm sim thaum cov tshuaj heparin khi rau cov protein hu ua 'PF4' (Platelet Factor 4) hauv peb cov platelets. Cov heparin no thiab 'PF4' sib xyaw ua ke los tsim ib qho 'Heparin-PF4 complex'. Thaum peb pom tias 'Heparin-PF4 complex' hauv peb lub cev, peb lub cev tiv thaiv kab mob txhawj xeeb thiab pib ua cov tshuaj tiv thaiv kab mob tawm tsam nws. Cov tshuaj tiv thaiv kab mob no mus thiab khi rau 'Heparin-PF4 complex' ntawd. Qhov ntawd yog qhov pib. Thaum cov tshuaj tiv thaiv kab mob no khi, cov platelets tam sim ntawd qhib thiab pib ua cov ntshav txhaws. Ua li no, ntau 'PF4' raug tso tawm los ntawm cov platelets uas ua cov ntshav txhaws. Tom qab ntawd 'PF4' tshiab tuaj txog kuj khi rau heparin, tsim ntau 'Heparin-PF4 complex'. Cov tshuaj tiv thaiv kab mob rov qab los thiab khi rau nws dua, ntau cov ntshav txhaws tsim ... Qhov no txuas ntxiv zoo li kev sib xyaw ua ke. Vim yog tag nrho cov ntshav txhaws no, cov platelets hauv lub cev raug siv sai sai. Yog li ntawd, cov platelet theem txo qis. Vim yog qhov ntshav txhaws ntau dhau no, cov ntshav txhaws loj, uas ua rau tuag taus tuaj yeem tsim, thaiv peb cov leeg thiab cov hlab ntsha. Cov yam ua rau muaj kev pheej hmoo rau HIT yog dab tsi?
Muaj ntau yam ua rau muaj kev pheej hmoo ntawm kev mob HIT:- Koj yog poj niam los txiv neej: Cov poj niam muaj feem yuav raug HIT ntau dua.
- Hom tshuaj heparin siv: Qee qhov kev tshawb fawb qhia tias qhov kev pheej hmoo ntawm HIT yuav txawv nyob ntawm hom tshuaj heparin uas koj noj. Piv txwv li, muaj qee qhov pov thawj tias kev siv unfractionated heparin es tsis txhob siv low-molecular-weight heparin yuav txo qhov kev pheej hmoo. Txawm li cas los xij, xav tau kev tshawb fawb ntxiv txog qhov no.
- Noj heparin tom qab phais: Cov neeg uas noj heparin los tiv thaiv cov ntshav txhaws tom qab phais yuav muaj feem ntau dua los tsim HIT dua li cov neeg uas noj nws los kho cov ntshav txhaws uas twb muaj lawm. Qhov kev pheej hmoo no yog siab tshwj xeeb tshaj yog tom qab phais pob txha, phais plawv, thiab cardiopulmonary bypass .
Yuav kuaj mob HIT li cas? (Kev kuaj mob)
Muaj ntau yam kev kuaj ntshav uas yuav pab txiav txim seb koj puas muaj HIT:- Cov Qib Platelet: Qhov no tuaj yeem xyuas seb koj cov platelet suav puas qis (thrombocytopenia).
- Kev tsim cov ntshav txhaws: Kev kuaj ntshav qhia seb koj cov ntshav puas txhaws.
- Cov theem ntawm cov tshuaj tiv thaiv kab mob PF4: Qhov ntau ntawm cov tshuaj tiv thaiv kab mob PF4 hauv koj cov ntshav tuaj yeem txiav txim siab seb koj lub cev tiv thaiv kab mob puas ua kom cov ntshav khov. Qhov kev kuaj tshuaj tiv thaiv kab mob no yog qhov lees paub qhov kev kuaj mob ntawm HIT.
Koj tus kws kho mob kuj tseem yuav kom koj ua ultrasound los xyuas seb puas muaj ntshav txhaws hauv koj ob txhais ceg (DVT). Nyob ntawm koj tus mob, lawv kuj tseem yuav kom koj kuaj seb puas muaj ntshav txhaws hauv lwm qhov chaw, xws li koj txhais tes. Txawm li cas los xij, vim tias cov txiaj ntsig ntawm kev kuaj tshuaj tiv thaiv kab mob no siv sijhawm ntev los rov qab los, cov kws kho mob tsis tos kom nws rov qab los ua ntej pib kho. Vim tias HIT yog ib yam mob uas tuaj yeem ua rau tuag taus yog tias tsis kho, kev kho mob raug txiav txim siab raws li koj yuav muaj HIT npaum li cas. Qhov "kev xeem 4Ts" no yog dab tsi?
Qhov kev xeem '4Ts' yog ib qho kev ntsuas uas kwv yees seb koj yuav muaj 'HIT' npaum li cas. Nws muab cov ntaub ntawv uas koj xav tau los pib kho mob yam tsis tas tos cov txiaj ntsig ntawm kev kuaj tshuaj tiv thaiv kab mob. Tus kws kho mob muab qhab nia (ntawm 0 txog 2) rau plaub yam no:- Thrombocytopenia (cov ntshav platelet tsawg): Koj cov ntshav platelet qis npaum li cas?
- Lub Sijhawm (lub sijhawm ntawm kev teb rau heparin): Koj cov ntshav platelet poob qis thaum twg?
- Thrombosis (ntshav txhaws): Puas muaj cov cim qhia tias muaj ntshav txhaws?
- Lwm yam ua rau: Puas muaj lwm yam laj thawj uas tsis yog heparin rau koj cov ntshav platelet qis?
Qhov qhab nia siab dua, qhov muaj feem ntau dua uas koj yuav muaj 'HIT'. Cov kev kho mob rau HIT yog dab tsi?
Kauj ruam thawj zaug hauv kev kho mob yog tsum tsis txhob noj heparin tam sim ntawd. Tom qab ntawd, koj yuav raug hloov mus rau lwm yam tshuaj uas ua rau cov ntshav nyias. Koj cov ntshav platelet yuav tsum pib nce dua hauv ob peb hnub tom qab tsis noj heparin. Txog thaum ntawd, koj tus kws kho mob yuav sau lwm yam tshuaj los pab tiv thaiv cov ntshav txhaws. Muaj ntau yam tshuaj uas siv tau hloov heparin:- Cov tshuaj tiv thaiv thrombin ncaj qha (piv txwv li 'argatroban', 'bivalirudin')
- `Fondaparinux`
- Cov tshuaj tiv thaiv kev ntshav txhaws ncaj qha (cov tshuaj uas tiv thaiv kev txhaws ntshav uas noj tau ncaj qha los ntawm qhov ncauj)
Thaum koj cov ntshav platelet rov qab mus rau qhov qub thiab qhov kev pheej hmoo ntawm cov ntshav txhaws vim HIT tau dhau mus, koj tus kws kho mob yuav hloov koj mus rau lwm yam tshuaj uas ua rau cov ntshav nyias, xws li warfarin. Peb puas tuaj yeem tiv thaiv HIT?
Yeej tsis muaj dab tsi koj ua tau los tiv thaiv HIT. Txawm li cas los xij, kom koj tus kws kho mob saib xyuas koj cov ntshav platelet tas li tuaj yeem pab txo qhov kev pheej hmoo ntawm cov teeb meem los ntawm heparin. Yuav tsum xav li cas yog tias koj muaj HIT?
Heparin-Induced Thrombocytopenia (HIT) yog ib qho mob hnyav uas tuaj yeem ua rau tuag taus yog tias tsis kho sai. Cov ntshav txhaws loj hauv caj npab thiab ceg tuaj yeem ua rau cov kab mob ntawd puas tsuaj mus sij hawm ntev. Cov ntshav txhaws uas cuam tshuam rau cov kab mob tseem ceeb tuaj yeem ua rau tuag taus. Hmoov zoo, nrog kev paub ntau ntxiv txog HIT thiab cov kev xaiv kho mob zoo dua, cov feem pua ntawm kev ciaj sia tau zoo dua. Kev kuaj pom thaum ntxov, ua ntej cov ntshav txhaws loj tshwm sim, yog qhov tseem ceeb rau qhov tshwm sim zoo.Thaum koj tus kws kho mob pom cov cim qhia ntawm HIT, xws li cov ntshav platelet qis, lawv tuaj yeem sau ntawv kho mob kom txo qhov kev pheej hmoo ntawm cov ntshav txhaws txaus ntshai. Kuv yuav saib xyuas kuv tus kheej li cas?
Koj yuav tsum tau mus ntsib koj tus kws kho mob tsis tu ncua kom saib xyuas koj cov ntshav platelet thiab xyuas kom tseeb tias koj tsis muaj ntshav txhaws. Tsis tas li ntawd xwb, koj tus kws kho mob yuav paub txog tej yam tshwm sim tsis zoo (xws li los ntshav rau qee tus neeg) thaum hloov ntawm heparin mus rau tshuaj anticoagulant tshiab. Lub sijhawm no, nws yog ib qho tseem ceeb heev uas yuav tsum noj koj cov tshuaj raws li tau sau tseg. Txawm tias koj tsis tau muaj ntshav txhaws los xij, koj yuav tsum noj tshuaj anticoagulant uas tsis yog heparin tsawg kawg yog ib hlis. Yog tias koj tau muaj ntshav txhaws, koj yuav tsum noj nws ntev dua. Txoj kev zoo tshaj plaws los saib xyuas koj tus kheej yog qhia rau txhua tus kws kho mob uas kho koj yav tom ntej tias koj tau muaj qhov teeb meem no. Yog tias koj tau muaj 'HIT', koj yuav tsum tsis txhob noj tshuaj heparin dua.
Yog tias koj pom muaj kev hloov pauv hauv koj lub cev thaum noj tshuaj heparin, nrhiav kev kho mob thaum muaj xwm txheej ceev tam sim ntawd. Heparin-Induced Thrombocytopenia (HIT) yog ib qho mob tsis tshua muaj, tab sis txhua yam cim ntawm cov ntshav txhaws yog qhov loj heev uas yuav tsis quav ntsej. Yog tsis kho, HIT tuaj yeem ua rau tuag taus. Nrog kev kho mob, koj cov ntshav platelet yuav tsum rov qab mus rau qhov qub thiab koj qhov kev pheej hmoo ntawm cov ntshav txhaws yuav tsum txo qis. Tham nrog koj tus kws kho mob txog cov tshuaj zoo tshaj plaws los siv es tsis txhob siv heparin mus tom ntej. Cov Lus Xaus Kawg coj mus tsev
- Txawm hais tias heparin yog ib yam tshuaj tseem ceeb uas tiv thaiv cov ntshav txhaws, nws tsis tshua muaj peev xwm ua rau muaj mob hnyav hu ua 'Heparin-Induced Thrombocytopenia (HIT).'
- Qhov tshwm sim hauv qhov no yog tias es tsis txhob tiv thaiv cov ntshav txhaws, cov ntshav txhaws nce ntxiv thiab cov platelets txo qis.
- Saib xyuas cov tsos mob xws li o ntawm koj ob txhais ceg/caj npab, mob, mob hauv siab, thiab ua pa nyuaj. Yog tias koj pom cov no, mus ntsib kws kho mob tam sim ntawd.
- Yog tias kuaj pom tias muaj 'HIT', thawj qhov uas yuav tsum ua yog tsum tsis txhob noj heparin. Tom qab ntawd koj yuav tsum siv lwm yam tshuaj uas ua rau cov ntshav nyias.
- Yog koj tau muaj 'HIT', sau cia rau hauv koj cov ntaub ntawv kho mob thiab qhia rau txhua tus kws kho mob uas koj mus ntsib yav tom ntej. Koj yuav tsum tsis txhob noj tshuaj heparin dua li.
Vam tias cov ntaub ntawv no yuav pab tau koj. Nyob zoo! Heparin, Thrombocytopenia, Ntshav txhaws, Platelets, Anticoagulant, HIT, Side effect, Ntshav txhaws, Platelets, Heparin, Side effect
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Tsis muaj lus teb tau muab tso tawm. Ntxiv koj cov lus tawm ntawm no thawj zaug.
Ntxiv koj cov lus