Qhov sib txawv tseem ceeb ntawm PE thiab DVT yog tias, hauv PE (pulmonary embolism), qhov occlusion tshwm sim hauv cov hlab ntsha pulmonary los ntawm cov thrombus uas tsim nyob rau hauv lub plawv txoj cai thiab cov hlab ntsha uas tau muab tshem tawm thiab tso rau hauv cov hlab ntsws thaum lub sij hawm., nyob rau hauv DVT (qhov tob vein thrombosis), occlusion tshwm sim nyob rau hauv cov leeg sib sib zog nqus ntawm ceg los ntawm ib tug thrombus.
PE yog dab tsi?
Pulmonary embolism lossis PE yog cov txheej txheem uas cov thrombi tsim nyob rau hauv lub plawv sab xis thiab cov hlab ntsha hauv lub cev tau raug tshem tawm thiab tso rau hauv cov hlab ntsha pulmonary. Cov hlab ntsha femoral yog qhov chaw tshaj plaws ntawm emboli.
Kev cuam tshuam ntawm cov hlab ntsha los ntawm embolus ventilates, tab sis tsis perfuse, thaj tsam ntawm lub ntsws uas tau txais cov khoom los ntawm cov hlab ntsha tshwj xeeb. Qhov no thaum kawg ua rau qhov chaw tuag impairing gas perfusion. Thaum kawg, thaj tsam hauv qab-perfused ntawm lub ntsws poob vim qhov txo qis ntawm cov khoom siv surfactant. Tab sis qhov infarction ntawm thaj av ntawd tsis zoo li vim tias cov ntshav ob leeg tuaj rau hauv cov ntaub so ntswg ntawm lub bronchial hlab ntsha.
Daim duab 01: mob hauv siab yog ib qho cim ntawm PE
Me me Pulmonary Embolism
Thaum lub embolus occludes lub davhlau ya nyob twg, tus neeg mob tsim pleuritic mob hauv siab thiab ua tsis taus pa. Txog peb hnub tom qab, tus neeg mob tuaj yeem tsim hemoptysis. Txawm li cas los xij, tsis tshua muaj, tus neeg mob ua npaws.
Massive Pulmonary Embolism
Nov yog ib yam mob uas tsis tshua muaj uas lub ntsws vau, vim muaj kev cuam tshuam hauv cov hlab ntsha uas cov ntshav ntws tawm ntawm txoj hlab ntaws sab xis. Yog li, tus neeg mob tau mob hauv siab mob hnyav thiab, kuj tshwm hws thiab daj ntseg.
Thaum muaj ntau yam emboli rov tshwm sim, tus neeg mob tau ua tsis taus pa, uas zuj zus zuj zus mus ob peb lub lis piam. Tsis tas li ntawd, tseem muaj lwm cov tsos mob xws li syncope ntawm exertion, qaug zog, thiab angina.
Tshuaj Kho Mob
Ib feem coob ntawm pulmonary emboli txhim kho ntsiag to. Txawm li cas los xij, lwm cov tsos mob suav nrog;
- Sudden onset of dyspnea
- Pleuritic mob hauv siab
- Hemoptysis, yog tias muaj mob tshwm sim
Kev tshawb nrhiav
Cov kev tshawb fawb hauv qab no pab kom paub tseeb tias qhov kev soj ntsuam ntawm qhov tsis txaus ntseeg ntawm pulmonary embolism thiab kwv yees qhov cuam tshuam ntawm kev cuam tshuam.
- x-ray
- ECG
- kuaj ntshav xws li suav ntshav tag nrho, PT/INR
- Plasma D-dimer
- Radionuclide qhov cua / perfusion scanning
- USS
- CT
- MRI
Kev tswj hwm
Cov pa oxygen siab yog tsim nyog rau txhua tus neeg mob, nrog rau kev ua xua thiab pw tsaug zog. Nws yog ib qho tseem ceeb sib npaug ntawm kev siv tshuaj tiv thaiv coagulation siv heparin ua raws li warfarin. Nyob rau hauv cov ntaub ntawv ntawm ib tug loj pulmonary embolism, intravenous kua yuav tsum tau noj kom tsim nyog. Yog tias tsim nyog, cov tshuaj inotropic tuaj yeem muab tau. Fibrinolytic therapy thiab phais embolectomy yog lwm yam kev xaiv muaj. Tsis tas li ntawd, kev kho anticoagulation nrog warfarin yuav tsum tau txuas ntxiv los tiv thaiv kev txhim kho yav tom ntej ntawm emboli.
DVT yog dab tsi?
Deep vein thrombosis lossis DVT yog qhov occlusion ntawm cov hlab ntsha sib sib zog nqus los ntawm thrombus. DVT ntawm ob txhais ceg yog daim ntawv ntau tshaj plaws ntawm DVT, thiab nws muaj qhov txaus ntshai ntawm kev tuag.
Risk Factors
Patient factor
- Kev rog
- nce hnub nyoog
- Kev cev xeeb tub
- Varicose veins
- Kev siv tshuaj tiv thaiv qhov ncauj
- tsev neeg keeb kwm
Kev phais mob
Txhua qhov kev phais mob ntev tshaj peb caug feeb
kho mob
- mob plawv mob plawv
- kev phem
- kab mob plab hnyuv loj
- Nephrotic Syndrome
- Hematological kab mob
- Pneumonia
Tshuaj Kho Mob
Lub qis qis DVT feem ntau pib hauv cov hlab ntsha distal thiab qhov chaw kho mob ntawm tus mob no feem ntau suav nrog,
- pab
- o ntawm ceg qis
- Qhov kub nce hauv qis qis
- Kev tawm tsam ntawm cov leeg nqaij tawv nqaij
Txawm hais tias cov tsos mob no nquag tshwm sim ib sab nws tseem tuaj yeem muaj lawv ob sab. Tab sis ob tog DVT yuav luag ib txwm cuam tshuam nrog kev ua phem thiab qhov txawv txav hauv IVC.
Thaum twg tus neeg mob pom cov tsos mob tau hais los saum no, nws yuav tsum tau coj cov kev pheej hmoo ntawm DVT los txiav txim siab. Thaum kuaj xyuas, yuav tsum tau saib xyuas tshwj xeeb rau kev txheeb xyuas txhua yam mob phem. Txij li thaum nws muaj peev xwm muaj pulmonary embolism ua ke nrog DVT, nws tseem ceeb heev kom kuaj xyuas cov tsos mob thiab cov tsos mob ntawm pulmonary embolism.
Daim duab 02: Daim duab ultrasound ntawm cov hlab ntsha sib sib zog nqus
Ntxiv mus, cov kws kho mob siv cov txheej txheem kho mob hu ua Wells qhab nia los ntsuas cov neeg mob raws li lawv qhov yuav muaj DVT.
Kev tshawb nrhiav
Qhov tseem ceeb tshaj, qhov kev xaiv ntawm kev tshawb nrhiav nyob ntawm Wells tus qhab nia ntawm tus neeg mob.
- D dimer kuaj yog rau cov neeg mob uas tsis tshua muaj tshwm sim ntawm DVT. Yog tias cov txiaj ntsig zoo li qub, tsis tas yuav muaj kev tshawb nrhiav ntxiv kom tsis suav nrog DVT.
- Cov neeg mob uas nws qhov kev xeem D dimer yog qhov siab thiab cov neeg mob uas muaj qhov nruab nrab mus rau qhov muaj feem yuav tau txais kev ua haujlwm ntawm compression ultrasound.
Tib lub sijhawm, nws tseem ceeb heev rau kev tshawb xyuas kom tsis suav nrog cov kab mob hauv qab xws li mob plab pelvic malignancies.
Kev tswj hwm
Txoj kev tswj hwm suav nrog kev kho mob anticoagulation ua lub hauv paus, ua ke nrog kev nce siab thiab kev ua kom tsis haum. Thrombolysis yuav tsum raug xam tias yog ib qho kev xaiv nkaus xwb yog tias tus neeg mob muaj kev hem thawj rau lub neej Nyob rau hauv txoj kev kho anticoagulation, LMWH yog thawj zaug tswj hwm thiab ua raws li coumarin anticoagulant xws li warfarin.
Qhov Zoo sib xws ntawm PE thiab DVT yog dab tsi?
Ob leeg PE thiab DVT yog vim muaj cov hlab ntsha los ntawm cov hlab ntsha los yog cov embolus
Qhov txawv ntawm PE thiab DVT yog dab tsi?
PE vs DVT |
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| Pulmonary embolism yog cov txheej txheem ntawm thrombi tsim nyob rau hauv lub plawv sab xis, thiab cov hlab ntsha hauv lub cev tau raug tshem tawm thiab muab tso rau hauv cov hlab ntsha pulmonary. | Deep vein thrombosis or DVT is the occlusion of a deep vein by a thrombus. |
| Occlusion tshwm sim hauv pulmonary vasculature. | Occlusion tshwm sim nyob rau hauv cov leeg tob ntawm ob txhais ceg. |
| Tshuaj kho mob | |
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| Kev Tshawb Fawb | |
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| Kev tswj hwm | |
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Kev tswj hwm ntawm DVT suav nrog kev kho tshuaj tiv thaiv kab mob ua lub hauv paus ua ke nrog kev nce siab thiab kev ua kom tsis haumThrombolysis yuav tsum raug suav hais tias yog ib qho kev xaiv tsuas yog tias tus neeg mob nyob rau hauv lub neej muaj kev phom sij. Hauv kev kho anticoagulation, LMWH yog thawj zaug tswj hwm thiab ua raws li coumarin anticoagulant xws li warfarin |
Summary – PE vs DVT
Nyob rau hauv cov ntsiab lus, PE yog qhov mob uas thrombi tsim nyob rau hauv lub plawv txoj cai thiab cov hlab ntsha system tau dislodged thiab tso rau hauv cov hlab ntsha pulmonary. DVT, ntawm qhov tod tes, yog qhov occlusion ntawm cov leeg sib sib zog nqus ntawm ob txhais ceg vim qhov tsim ntawm thrombi. Raws li, nyob rau hauv PE, occlusion yog nyob rau hauv lub pulmonary hlab ntsha, thaum, nyob rau hauv DVT lub occlusion yog nyob rau hauv ib tug sib sib zog nqus hlab ntsha ntawm ceg. Yog li, qhov no yog qhov txawv ntawm PE thiab DVT.
