Pulmonary embolus

Lub ntsws ntsws embolus yog qhov txhaws ntawm cov leeg ntshav hauv lub ntsws. Qhov feem ntau ua rau ntawm qhov blockage yog ntshav txhaws.

Mob ntsws embolus feem ntau tshwm sim los ntawm ntshav txhaws uas nthuav dav hauv cov hlab ntshav sab nraud lub ntsws. Qhov feem ntau cov ntshav txhaws yog ib qho nyob rau hauv txoj hlab ntshav ntawm tus ncej puab lossis ntawm lub plab mog (thaj tsam duav). Hom ntshav ntawd hu ua kev sib zog nqus ntshav khov yam tseem ceeb (DVT). Cov ntshav txhaws ua txhaum tag thiab khiav mus rau hauv lub ntsws qhov chaw nws pw.

Cov kev tsis tshua pom tshwm sim muaj xws li huab cua npuas, cov roj ua kua, cov kua dej ua kua, lossis cov koog ntawm cov cab lossis cov qog hlwb.

Koj ntxim yuav tau tus mob no yog koj lossis koj tsev neeg muaj keeb kwm mob ntshav txhaws lossis muaj qee yam ua muaj txhaws txhaws. Qhov mob ntsws embolus yuav tshwm sim:

• Tom qab yug menyuam tas
• Tom qab lub plawv nres, phais lub plawv, lossis mob hlab ntsha tawg
• Tom qab raug mob hnyav, kub nyhiab, lossis pob txha lov ntawm lub duav lossis pob txha pob txha
• Tom qab phais, feem ntau ua pob txha, sib koom, lossis phais lub hlwb
• Thaum lossis tom qab lub dav hlau ntev lossis caij tsheb caij
• Yog tias koj muaj mob qog noj ntshav
• Yog tias koj noj tshuaj tswj tsis pub muaj menyuam lossis tshuaj kho estrogen
• Lub sijhawm pw ntev lossis pw hauv ib qho chaw tau ntev

Cov teeb meem uas ua rau ntshav txhaws:

• Cov kab mob tiv thaiv nruab nrog cev tiv thaiv uas ua rau nws ntshav txhaws.
• Inherited mob uas yuav ua rau cov ntshav txhaws. Ib qho tsis zoo no yog antithrombin III deficiency.

Cov tsos mob tseem ceeb ntawm tus mob ntsws ntsws ntsws ntsig suav nrog kev mob hauv siab uas tej zaum yog ib qho hauv qab no:

• Hauv qab caj pas lossis ntawm ib sab
• Ntse lossis nkaug
• Hlawv, mob, lossis rau npus, hnov ​​hnyav
• Feem ntau mob heev dua rau kev ua pa
• Koj yuav khoov los yog puag koj lub hauv siab kom teb qhov mob

Lwm cov tsos mob tuaj yeem suav nrog:

• Kiv taub hau, pom ntaj, lossis tsaus muag
• Theem cov pa ntshav qis hauv cov ntshav (hypoxemia)
• Ua pa ceev los hawb pob
• Lub plawv dhia ceev ceev
• Ntxhov siab
• Mob ceg, liab, lossis o
• Cov ntshav siab qis
• Dheev hnoos, muaj peev xwm hnoos tau ntshav lossis hnoos qeev
• Ua tsis taus pa uas pib dheev thaum pw tsaug zog lossis exertion
• Qib qis ua npaws
• Bluish ntawm daim tawv nqaij (cyanosis) - muaj tsawg dua

Tus kws kho mob yuav kuaj ib ce thiab nug txog koj cov tsos mob thiab keeb kwm kev kho mob.

Kev kuaj sim hauv qab no yuav ua kom pom seb koj lub ntsws ua haujlwm npaum li cas:

• Arterial ntshav roj
• Mem tes oximetry

Kev ntsuam xyuas cov duab hauv qab no tuaj yeem pab txiav txim xyuas qhov twg ntshav txhaws nyob:

• Kev ntsuas hluav taws xob xoo
• CT angiogram ntawm lub hauv siab
• Kev mob ntsws / lub tshuab nqus pa tawm, kuj hu ua V / Q scan
• CT pulmonary angiogram

Lwm yam kev xeem uas yuav muaj xws li:

• Hauv siab CT scan
• D-dimer ntshav kuaj
• Doppler ultrasound kev soj ntsuam ntawm ob txhais ceg
• Echocardiogram
• ECG

Yuav kuaj ntshav ntxiv los saib seb koj puas muaj feem ua tau ntshav txhaws ntau ntxiv, xws li:

• Antiphospholipid cov tshuaj tiv thaiv
• Kev kuaj ntsuas keeb los saib xyuas rau cov kev hloov uas ua rau koj muaj feem yuav txhim kho cov ntshav txhaws
• Lupus anticoagulant
• Protein C thiab protein S qib

Mob ntsws embolus yuav tsum tau kho tam sim ntawd. Koj yuav tsum tau nyob hauv tsev kho mob:

• Koj yuav tau txais tshuaj kom nyias cov ntshav thiab ua rau koj cov ntshav tsawg zuj zus.
• Yog tias mob hnyav, ua rau mob ntsws txha caj qaum, kev kho mob yuav suav nrog txhaws. Qhov no hu ua kev kho thrombolytic. Koj yuav tau txais cov tshuaj kom yaj ploj.

Txawm tias koj yuav tsum tau nyob hauv tsev kho mob, koj yuav tau noj tshuaj hauv tsev kom nyias muaj nyias cov ntshav:

• Tej zaum koj yuav raug muab tshuaj rau koj noj lossis koj yuav tsum tau txhaj tshuaj koj tus kheej.
• Rau qee cov tshuaj, koj yuav tsum tau kuaj ntshav los saib xyuas koj cov koob tshuaj.
• Ntev li cas koj yuav tsum tau noj cov tshuaj no feem ntau nyob ntawm qhov ua rau thiab qhov loj ntawm koj cov ntshav txhaws.
• Koj tus kws kho mob yuav nrog koj tham txog cov teeb meem los ntshav thaum koj noj cov tshuaj no.

Yog tias koj tsis tuaj yeem noj ntshav thinner, koj tus kws kho mob yuav hais kom phais kom tso cov khoom hu ua qis dua vena cava lim (IVC lim). Cov cuab yeej no tau muab tso rau hauv txoj hlab ntshav tseem ceeb hauv koj lub plab. Nws ua kom ntshav txhaws loj ntawm kev mus los rau hauv cov hlab ntshav cov hlab ntsws. Qee zaum, lim dej ib ntus tuaj yeem muab tso tawm thiab tshem tawm tom qab.

Yuav ua li cas tus neeg mob rov zoo los ntawm pulmonary embolus tuaj yeem nyuaj rau kev twv ua ntej. Nws feem ntau nyob ntawm:

• Dab tsi ua rau qhov teeb meem hauv thawj qhov chaw (piv txwv, mob cancer, phais mob loj, lossis raug mob)
• Qhov luaj li cas ntawm cov ntshav txhaws hauv lub ntsws
• Yog tias cov ntshav txhaws hauv lub sijhawm

Qee tus neeg tuaj yeem tsim kev mob plawv ntev thiab mob ntsws.

Txoj kev tuag muaj peev xwm ua tau rau cov neeg mob ntsws heev.

Mus rau chav kho mob maj nrawm lossis hu rau tus npawb xov tooj xwm ceev hauv nroog (xws li 911), yog tias koj muaj cov tsos mob ntsws ntsws.

Kev yuag ntshav tawm tuaj yeem tsim tshuaj txhawm rau pab tiv thaiv DVT rau cov neeg muaj kev pheej hmoo siab, lossis cov neeg raug phais yuav ua rau muaj kev pheej hmoo siab.

Yog tias koj muaj DVT, koj tus muab kev pab yuav sau tshuaj kom txwv cov khoom noj. Hnav lawv raws li cov lus qhia. Lawv yuav txhim kho cov ntshav khiav hauv koj cov ceg thiab txo koj cov kev pheej hmoo ntshav txhaws.

Txav koj ob txhais ceg ntau zaus thaum caij dav hlau mus deb, caij tsheb, thiab lwm yam uas koj tau zaum lossis pw ntev ntev kuj tseem tuaj yeem tiv thaiv tau DVT. Cov neeg muaj feem yuav ua tau ntshav txhaws ntau heev yuav tsum tau txhaj tshuaj tiv thaiv cov ntshav txhaws hu ua heparin thaum lawv ya davhlau ntev dua 4 teev.

Tsis txhob haus luam yeeb. Yog tias koj haus luam yeeb, tsum. Cov poj niam noj tshuaj estrogen yuav tsum txiav kev haus luam yeeb. Kev haus luam yeeb yuav ua rau koj muaj feem mob ntshav txhaws.

Venous thromboembolism; Lub ntsws cov ntshav txhaws; Ntshav - ntsws; Embolus; Tumor embolus; Kev Cim Hlaws - ntsws; DVT - pulmonary embolism; Mob ntsws txhaws - pulmonary embolism; Pulmonary thromboembolism; PE

• Kev mob hlab ntshav tob - ua paug tawm
• Noj tshuaj warfarin (Coumadin, Jantoven) - dab tsi yuav nug koj tus kws kho mob
• Noj warfarin (Coumadin)

• Lub ntsws
• Kev ua pa system
• Pulmonary embolus

Goldhaber SZ. Pulmonary embolism. Hauv: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Plawv Lub Plawv: Phau Ntawv Qhia Txog Cov Tshuaj Mob plawv. 11th ed. Philadelphia, PA: Elsevier; 2019: chap 84.

Kline JA. Pulmonary embolism thiab hlab ntsha sib nqus. Hauv: Phab Ntsa RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Cov Tshuaj Siv Thaum Muaj Xwm Ceev: Cov Ntsiab Lus thiab Kev Siv Tshuaj. 9le ed. Philadelphia, PA: Elsevier; 2018: chap 78.

Morris TA, Fedullo PF. Hlwb thromboembolism. Hauv: Broaddus VC, Mason RJ, Ernst JD, li al, eds. Murray thiab Nadel Cov Ntawv Phau Ntawv Qhia Txog Cov Pa. 6 tus ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 57.