Kev mob ntsws txoj leeg ntshav khov

Kev mob ntsws nqig mus sib txhi (DVT) yog ib qho mob uas tshwm sim thaum ntshav txhaws hauv txoj hlab ntshav tob hauv ib qho ntawm lub cev. Nws feem ntau cuam tshuam cov leeg loj hauv qis ceg thiab ceg, tab sis tuaj yeem tshwm sim hauv lwm txoj leeg, xws li sab caj npab thiab pelvis.

DVT muaj rau cov laus tshaj 60 xyoo. Tab sis nws tuaj yeem tshwm sim thaum muaj hnub nyoog li cas. Thaum cov ntshav khov ua haujlwm thiab txav mus los ntawm cov hlab ntshav, nws hu ua embolism. Txoj hlab ntsws tuaj yeem mus daig rau hauv cov hlab ntshav hauv lub hlwb, lub ntsws, lub siab, lossis lwm thaj chaw, ua rau muaj kev puas tsuaj loj.

Cov ntshav txhaws tuaj yeem tsim thaum qee yam qeeb lossis hloov qhov ntshav ntws ntawm txoj hlab ntshav. Yam txaus ntshai muaj xws li:

• Ib lub plhaw ntiv tes kis las uas tau dhau ntawm txoj leeg hauv qhov puab tais
• So lub txaj lossis zaum hauv ib qho chaw ntev ntev, xws li kev mus ncig dav hlau
• Tsev neeg keeb kwm ntshav txhaws
• Lov pob txha hauv lub plab mog lossis ob txhais ceg
• Yug menyuam tsis pub dhau 6 lub hlis
• Cev xeeb tub
• Kev pham
• Kev phais tam sim no (feem ntau yog ntsag, hauv caug, lossis phais plab mog ntawm poj niam)
• Ntau cov qe ntshav tau tsim los ntawm cov pob txha pob txha, ua rau cov ntshav yuav tuab dua li ib txwm (polycythemia vera)
• Muaj tus kav dej (nyob ib ntus) nyob rau hauv cov hlab ntsha

Ntshav feem ntau yuav txhaws hauv tus neeg uas muaj qee yam teebmeem lossis tsis meej, xws li:

• Mob Cancer
• Qee qhov teeb meem tiv thaiv kab mob autoimmune, xws li mob lupus
• Ua luam yeeb
• Cov mob uas ua rau nws muaj feem yuav txhim kho cov ntshav txhaws
• Noj tshuaj estrogens lossis tshuaj txwv (qhov kev pheej hmoo no tseem ntau dua nrog kev haus luam yeeb)

Zaum ntev ntev thaum mus ncig yuav ua rau muaj kev pheej hmoo ntau ntxiv rau DVT. Qhov no feem ntau yuav zoo thaum koj tseem muaj ib lossis ntau qhov kev pheej hmoo muaj nyob rau saud.

DVT feem ntau cuam tshuam rau cov leeg loj hauv qis ceg thiab txhais ceg, feem ntau nyob ntawm ib sab ntawm lub cev. Cov ntshav khov tuaj yeem thaiv cov ntshav kev thiab ua rau:

• Hloov xim tawv nqaij (liab)
• Mob ceg
• Ceg o (edema)
• Cov tawv nqaij uas hnov ​​sov rau qhov kov

Koj tus kws kho mob yuav kuaj mob lub cev. Txoj kev kuaj mob yuav pom liab, o, lossis txhais ceg nyoos.

Ob qhov kev ntsuam xyuas uas feem ntau tau ua ua ntej txhawm rau kuaj xyuas DVT yog:

• D-dimer ntshav kuaj
• Doppler ultrasound kuaj ntawm thaj tsam ntawm kev txhawj xeeb

Pelvic MRI tuaj yeem ua yog tias cov ntshav txhaws hauv lub plab mog, xws li tom qab cev xeeb tub.

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

• Kev ua kom muaj protein C tiv thaiv (tshawb xyuas rau Qhov Hloov V Leiden hloov)
• Antithrombin III qib
• Antiphospholipid cov tshuaj tiv thaiv
• Ua kom tiav cov ntshav suav (CBC)
• Kev kuaj caj ces saib mus rau kev hloov pauv uas ua rau koj muaj feem yuav tsim tau cov ntshav txhaws, xws li prothrombin G20210A hloov pauv
• Lupus anticoagulant
• Protein C thiab protein S qib

Koj tus kws kho mob yuav muab tshuaj rau koj kom koj cov ntshav nyias (hu ua anticoagulant). Qhov no yuav ua rau ntau txhaws ntawm kev tuaj yeem lossis cov laus dhau los ntawm kev loj dua.

Heparin feem ntau yog thawj yam tshuaj koj yuav tau txais.

• Yog tias heparin tau txais los ntawm txoj hlab ntshav (IV), koj yuav tsum nyob hauv tsev kho mob. Txawm li cas los xij, feem ntau cov neeg tuaj yeem kho tau yam tsis tau pw hauv tsev kho mob.
• Tsawg molecular hnyav heparin tuaj yeem muab los ntawm kev txhaj tshuaj hauv qab koj cov tawv nqaij ib zaug lossis ob zaug ib hnub. Koj yuav tsis tas yuav nyob hauv tsev khomob ntev npaum li cas, lossis txhua lub sijhawm, yog tias koj raug hais kom siv hom heparin.

Ib hom tshuaj ntshav rau cov ntshav hu ua warfarin (Coumadin lossis Jantoven) yuav raug pib nrog heparin. Warfarin noj ntawm qhov ncauj. Nws siv sijhawm ob peb hnub los ua haujlwm tiav.

Lwm chav kawm ntawm cov ntshav ua haujlwm txawv dua li warfarin. Piv txwv ntawm cov tshuaj no, hu ua qhov ncauj anticoagulants (DOAC), suav nrog rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradax), thiab edoxaban (Savaysa). Cov tshuaj no ua haujlwm zoo li ntawv rau heparin thiab tuaj yeem siv tam sim ntawd hloov chaw ntawm heparin. Koj tus kws khomob yuav txiav txim siab yam tshuaj uas haum rau koj.

Feem ntau koj yuav noj ib txoj hlab ntshav ntev li 3 lub hlis. Qee tus neeg siv sijhawm ntev dua, lossis tseem nyob rau tag nrho lawv lub neej, nyob ntawm lawv qhov kev pheej hmoo rau lwm lub cev ntshav.

Thaum koj noj tshuaj ntshav cov ntshav, koj feem ntau yuav los ntshav, txawm tias los ntawm cov haujlwm koj tau ua tas li. Yog tias koj noj tshuaj ntshav nyob hauv tsev:

• Noj cov tshuaj raws li koj tus kws kho mob tau sau tseg.
• Nug tus kws kho mob yuav ua dab tsi yog tias koj tsis nco qab noj.
• Mus kuaj ntshav raws li koj tus kws kho mob qhia kom koj paub tseeb tias koj noj qhov haum lawm. Qhov kev sim no feem ntau xav tau nrog warfarin.
• Kawm yuav noj lwm yam tshuaj thiab noj thaum twg.
• Nrhiav saib yuav ua li cas saib xyuas teeb meem tshwm sim los ntawm cov tshuaj.

Muaj qee zaus, koj yuav tsum muaj kev phais es tsis txhob ntxiv lossis ntxiv rau cov tshuaj thaiv qhov mob. Kev phais mob yuav muaj:

• Tso cov lim hauv lub cev ntshav ntau tshaj plaws los tiv thaiv cov ntshav txhaws ntawm kev mus rau hauv lub ntsws
• Kev tshem tawm ntshav txhaws ntau ntxiv los ntawm txoj hlab ntshav lossis txhaj tshuaj tiv thaiv mob txhaws

Ua raws li lwm cov lus qhia uas koj tau muab los kho koj DVT.

DVT feem ntau yuav ploj mus yam tsis muaj teeb meem, tab sis tus mob yuav rov qab los. Cov tsos mob tuaj yeem tshwm sim tam sim ntawd lossis koj yuav tsis txhim kho lawv li 1 lossis ntau xyoo tom qab. Hnav cov hnab tshos ntim thaum lub sijhawm thiab tom qab DVT tuaj yeem pab tiv thaiv qhov teeb meem no.

Teeb meem ntawm DVT yuav suav nrog:

• Lub cev tuag ua mob ntsws (ntshav txhaws nyob hauv tus ncej feem ntau yuav tawg thiab taug kev mus rau lub ntsws dua li ntshav txhaws nyob rau sab ceg qis lossis lwm qhov ntawm lub cev)
• Kev mob tsis tu ncua thiab o (post-phlebitic lossis post-thrombotic syndrome)
• Varicose leeg
• Tsis muaj qhov txhab kho kom zoo (tsawg dua)
• Hloov xim tawv nqaij

Hu rau koj lub chaw kho mob yog koj muaj DVT cov tsos mob.

Mus rau chav kho mob ceev lossis hu rau tus xov tooj xwm ceev hauv zos (xws li 911) yog tias koj muaj DVT thiab koj txhim kho:

• Kev mob hauv siab
• Kev hnoos ntshav
• Ua pa nyuaj
• Tsaus muag
• Tsis nco qab
• Lwm cov tsos mob hnyav

Txhawm rau tiv thaiv DVT:

• 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.
• Noj cov tshuaj ntshav uas koj cov kws kho mob sau rau.
• TSIS TXHOB haus luam yeeb. Tham nrog koj tus kws kho mob yog koj xav tau kev pab txiav.

DVT; Cov ntshav txhaws hauv ceg; Thromboembolism; Cov mob tom qab phlebitic; Cov mob ntsws tom qab mob ntsws; Venous - DVT

• 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)

• Kev mob ntsws rau cov leeg ntshav liab - iliofemoral
• Cov leeg ntshav tob
• Tso ntshav txhaws hauv cov ntshav
• Cov leeg ntshav tob
• Venous thrombosis - series

Kearon C, Akl EA, Ornelas J, li al. Antithrombotic txoj kev kho rau tus kab mob VTE: Cov CEEV TSHAJ NTUJ thiab cov lus tshaj lij ntawm cov kws tshaj lij. Hauv siabCov. 2016; 149 (2): 315-352. PMID: 26867832 pubmed.ncbi.nlm.nih.gov/26867832/.

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 TshuajCov. 9le ed. Philadelphia, PA: Elsevier; 2018: chap 78.

Lockhart ME, Umphrey HR, Weber TM, Robbin ML. Cov hlab ntsha txuas khoom. Hauv: Rumack CM, Levine D, eds. Kev kuaj mob UltrasoundCov. Thib 5 ed. Philadelphia, PA: Elsevier; 2018: chap 27.

Siegal D, Lim W. Venous thromboembolism. Hauv: Hoffman R, Benz EJ, Silberstein LE, li al, eds. Hematology: Qhov Ntsiab Cai thiab Kev Coj UaCov. 7 tus ed. Philadelphia, PA: Elsevier; 2018: chap 142.