Prothrombin Performance index (PTI) yog ib qho tseem ceeb tshaj plaws hauv kev kuaj mob uas qhia txog lub xeev ntawm cov coagulation system. Nws yog qhia raws li feem pua. Raws li ntau yam xwm txheej, kev tshuaj xyuas rau PTI tau sau tseg. Cov qauv hauv cov neeg noj qab haus huv yog 95-105%.
ntshav coagulation yog ua nyob rau hauv ob txoj kev - sab hauv thiab sab nraud. Tus nqi PTI cuam tshuam raws nraim txoj hauv kev hauv lub cev.
YProthrombin yog dab tsi?
Kev tsim cov ntshav txhaws thiab ntshav txhaws tshwm sim nyob rau hauv kev cuam tshuam ntawm cov protein tshwj xeeb - thrombin, uas, nyob rau hauv kev cuam tshuam ntawm qee cov txheej txheem biochemical, hloov pauv los ntawm prothrombin. Yog li, prothrombin protein yog qhov thib ob ntshav coagulation yam. Nws yog synthesized nrog kev koom tes ntawm vitamin K nyob rau hauv daim siab.
Prothrombin Performance index (raws li ceev) tso cai rau koj los txiav txim qhov kev ua ntawm prothrombin. Qhov kev kuaj no yog xam raws li feem pua ntawm tus neeg mob cov ntshav plasma qhov tseem ceeb nrog cov qauv tswj. Txhawm rau tswj kev ua haujlwm ntawm coagulation system, kev kuaj ntshav rau PTI tau sau tseg. norm nyob rau hauv ntau yamcov chav kuaj yuav txawv me ntsis, tab sis qhov sib txawv no tsis tseem ceeb. Lawv nyob ntawm cov reagents uas lub chaw kuaj ua haujlwm. Hauv qee qhov xwm txheej, piv txwv li, nrog varicose leeg, mob plawv, lossis tom qab phais plawv, tus kws kho mob tau teeb tsa cov qauv rau cov neeg mob, vim tias. Hauv cov xwm txheej no, nws yog ib qho tsim nyog kom ua tiav cov ntshav hypocoagulation (txo qis hauv nws cov coagulability). Qhov no yog ua los tiv thaiv cov ntshav txhaws.
Leej twg raug xa mus kuaj IPT?
Feem ntau, hauv kev kawm ntawm PTI, cov qauv rau cov poj niam yog tib yam li cov txiv neej. Qhov ntsuas no hloov tsuas yog thaum cev xeeb tub, thiab muaj ntau qhov laj thawj rau qhov no, uas peb yuav tham txog me ntsis tom qab. Yuav ua li cas yog qhov kev kuaj ntshav biochemical PTI? Cov qauv ntawm txoj kev tshawb no, piv txwv li, thaum noj indirect anticoagulants, tuaj yeem yog ob zaug qis dua. Cov neeg mob noj cov tshuaj no yuav tsum tau saib xyuas IPT thiab INR tsis tu ncua. Kev tshawb fawb ntawm PTI yog qhov yuav tsum tau ua hauv cov xwm txheej hauv qab no:
- Ua ntej ua haujlwm.
- Cov neeg noj tshuaj tiv thaiv kab mob txhawm rau tiv thaiv cov ntshav txhaws.
- Cov poj niam thaum cev xeeb tub.
- Cov neeg muaj kab mob ntawm cov kab mob coagulation, xws li varicose leeg.
- Rau cov kab mob autoimmune.
- Nrog atherosclerosis thiab kab mob plawv.
- Nrog rau daim siab pathologies, piv txwv li, cirrhosis.
- Rau vitamin K deficiency.
- Nrog antiphospholipid syndrome.
- Rau kev tshuaj ntsuam xyuas ntawm coagulation system.
Lub sijhawmcev xeeb tub yuav tsum tau kuaj PTI. Cov qauv hauv cov poj niam thaum cev xeeb tub yog me ntsis siab dua li lwm tus neeg noj qab haus huv. Qhov no yog vim muaj kev hloov pauv hauv keeb kwm ntawm hormonal thiab cov tsos ntawm ib qho ntxiv uteroplacental ncig.
PTI thaum cev xeeb tub: tus qauv
Thaum cev xeeb tub, txhua tus poj niam yuav tsum tau mus kawm coagulogram. Xws li:
- YPTI (prothrombin index).
- INR (International Normalized Ratio).
- APTT (tsim lub sijhawm thromboplastin ib nrab).
- YFibrinogen.
Txhua qhov kev ntsuas no tseem ceeb heev. Yog li, qhov nce hauv PTI nyob rau theem kawg ntawm cev xeeb tub mus rau 150% lossis ntau dua tuaj yeem qhia txog kev pheej hmoo ntawm placental abruption. Thiab nrog qhov txo qis hauv qhov ntsuas no ua ntej yug menyuam hauv qab 80%, muaj kev pheej hmoo los ntshav thaum yug menyuam lossis lub sijhawm tom qab yug menyuam. Yog li, nws yog ib qho tseem ceeb tshwj xeeb rau kev soj ntsuam cov coagulation system thaum kawg ntawm cev xeeb tub. Txhawm rau ua qhov no, dhau qhov kev soj ntsuam ntawm PTI. Tus nqi ntawm qhov ntsuas no thaum cev xeeb tub txawv ntawm 90 txog 120%.
Qhov nce hauv PTI qhia li cas?
Yog li, peb pom tias thaum cov ntshav thickens, tus nqi ntawm PTI nce. Cov qauv ntawm qhov ntsuas no hauv cov neeg noj qab haus huv yog li ntawm 95 txog 105%. Kev nce hauv qhov ntsuas prothrombin tuaj yeem qhia txog kev pheej hmoo ntawm kev tsim kab mob xws li:
- mob plawv mob plawv.
- Thromboembolism.
- YPolycythemia.
- kab mob oncological.
- Txhob Cia Siabplacenta nyob rau hauv cov poj niam cev xeeb tub.
IPT qis txhais li cas?
Thaum noj tshuaj anticoagulants, qib ntawm IPT tuaj yeem poob mus rau 45-40%. Nrog kev hem thawj ntawm cov ntshav txhaws, koob tshuaj ntawm cov tshuaj no yog tswj los ntawm kws kho mob. Tom qab nce lossis txo cov koob tshuaj, kev tshuaj xyuas rau PTI yog qhov yuav tsum tau ua. Tus nqi rau cov neeg mob no yog txiav txim los ntawm tus kws kho mob tuaj koom. Yog tias qhov ntsuas prothrombin tsis tau txo qis thaum noj cov tshuaj tiv thaiv coagulants, qhov no yuav qhia tau tias, piv txwv li, vitamin K tsis muaj peev xwm, kab mob loj ntawm daim siab lossis kab mob plab feem ntau, thiab hauv cov poj niam cev xeeb tub ua ntej yug menyuam, qhov kev pheej hmoo ntawm los ntshav thaum cev xeeb tub.
INR yog dab tsi?
Qhov ntsuas no yog tus qauv rau kev txiav txim siab ntshav coagulation. Tus nqi INR teb rau kev ua haujlwm ntawm qee cov ntshav proteins, uas yog cov khoom ua kom ntshav khov. Xws li cov proteins yog tsim nyob rau hauv daim siab nrog kev koom tes ntawm vitamin K. Cov coagulation yam tseem ceeb teb rau kev noj cov tshuaj - indirect anticoagulants, piv txwv li, "Dabigatran", "Warfarin" los yog lawv cov analogues. Hauv qhov no, hypocoagulation tshwm sim, i.e. ntshav txhaws yog qeeb qeeb. Rau qee tus neeg mob, qhov no tseem ceeb heev, ntau tus ntawm lawv raug yuam kom noj cov tshuaj tiv thaiv kab mob rau lub neej.
PTI ntshav kuaj. INR: normal
Hauv coagulogram, ntxiv rau PTI tsom xam, lwm qhov ntsuas tseem ceeb heev. Thaum cov neeg mob tau txais cov tshuaj tiv thaiv tsis ncaj ncees, PTI txo qis. Tab sis rau kev soj ntsuam PTI, cov qauv hauv txhua qhov chaw kuajtej zaum yuav txawv me ntsis, yog li ib tug qauv xeem tau qhia - INR. Cov kws kho mob siv nws los tswj cov ntshav coagulation system thaum cov neeg mob noj cov tshuaj anticoagulants. Yog li, nyob rau hauv cov ntaub ntawv no, tus INR yog muab nyob rau hauv parallel nrog xws li ib tug ntsuas raws li kev kuaj ntshav rau PTI. Tus qauv ntawm INR hauv cov neeg noj qab haus huv yog los ntawm 0.8 mus rau 1.2. Thaum noj cov tshuaj tiv thaiv coagulants, cov hlab ntshav poob qis, hypocoagulation tshwm sim, thiab INR tuaj yeem nce 2-3 zaug ntawm tus qauv, piv txwv li, thaum phais plawv lossis varicose leeg los tiv thaiv cov ntshav txhaws. Yog tias cov ntshav ua tuab, nws cov coagulability nce thiab, raws li, INR txo.
Hypocoagulation. Yuav tsum muaj xwm txheej dabtsi?
Hauv kev tshuaj xyuas ntawm PTI, tus qauv yog los ntawm 95 txog 100%, thiab INR yog los ntawm 0.8 txog 1.2. Nco qab tias cov neeg noj qab haus huv tiag tiag yuav tsum muaj cov qauv zoo li no. Tab sis muaj cov xwm txheej thaum nws yog ib qho tseem ceeb kom tswj tau qhov INR qhov tseem ceeb ntawm cov lej siab, feem, PTI ntsuas yuav qis dua tus qauv, piv txwv li. Qhov no yuav yog lub xeev ntawm hypocoagulation. Qhov mob no yog ua tiav los ntawm kev noj cov tshuaj tiv thaiv tsis ncaj qha. Qhov koob tshuaj ntawm cov tshuaj tsuas yog txiav txim los ntawm kws kho mob. Cov neeg mob noj cov tshuaj no tas li yuav tsum tau kuaj ntshav INR tsis tu ncua.
- Thaum atrial fibrillation, INR qhov tseem ceeb yuav tsum tau khaws cia li ntawm 2, 0-3, 0.
- mob hnyav - PE (pulmonary embolism) - kuj yuav tsum tswj hwm qib INR hauv 2, 0-3, 0.
- Tom qab phais raulub plawv yuav tsum tau anticoagulants, thaum nyob rau hauv cov ntaub ntawv ntawm aortic valve hloov, cov INR tooj yuav tsum tau khaws cia nyob rau hauv qhov tsim nyog thaj tsam ntawm 2.0-3.0, thiab nyob rau hauv cov ntaub ntawv ntawm mitral valve hloov - nyob rau theem ntawm 2.5-3.5.
- Rau qee lub plawv valve tsis xws luag (mitral lossis aortic kab mob) thiab kev tiv thaiv ntawm thromboembolism, qib ntawm qhov ntsuas no yuav tsum nyob rau hauv 2, 0-3, 0.
- Hauv kev kho mob venous thrombosis, tus lej INR yuav tsum sib haum rau 2, 0-3, 0.
Thaum INR qhov tseem ceeb poob qis dua qhov kev txwv, qhov koob tshuaj "Warfarin" lossis nws cov tshuaj analogues tau nce. Qhov no tsuas yog ua tiav raws li kev saib xyuas ntawm tus kws kho mob thiab kev sim kuaj. Tab sis kev nce hauv hypocoagulation (qhov nce ntawm INR qhov tseem ceeb) saum toj ntawm txoj kev uas yuav siv tau kuj tuaj yeem cuam tshuam kev noj qab haus huv ntawm cov neeg mob. Qhov no yog qhov txaus ntshai nyob rau hauv thawj qhov chaw nrog ntau yam los ntshav. Lawv tuaj yeem yog ob qho tib si sab hauv (uterine, gastric lossis intracavitary), thiab sab nraud, uas tshwm sim los ntawm ntau yam kev raug mob lossis kev txiav. Yog tias INR cov nuj nqis siab tshaj qhov pom zoo tau teev tseg rau qee yam mob, ces koob tshuaj anticoagulants yuav tsum raug txo. Qee tus neeg mob yuav tsum tau saib xyuas qib INR rau lub neej.
Yuav kuaj ntshav li cas rau INR thiab PTI?
Ntshav rau cov kev tshawb fawb no raug coj mus rau hauv chav kho mob. Cov ntshav venous raug coj mus rau hauv lub raj kuaj nrog cov tshuaj anticoagulant, uas feem ntau yog sodium citrate. Qhov sib piv ntawm cov ntshav sau thiab cov tshuaj anticoagulant yuav tsum yog 9: 1. Cov qauv coj los sib xyaw zoo.los ntawm inverting lub raj kom tsis txhob muaj cov hlab ntsha. Cov ntshav raug xa mus rau qhov chaw kuaj mob tam sim ntawd. Kev soj ntsuam yuav tsum tau ua tsis pub dhau ob teev tom qab kuaj ntshav. Kev ua tsis tau raws li cov xwm txheej no tuaj yeem cuam tshuam qhov tshwm sim ntawm kev tshuaj xyuas. Ntshav feem ntau yog pub rau sawv ntxov ntawm lub plab khoob, tab sis yog tias tsim nyog, qhov kev tshuaj xyuas no tuaj yeem ua rau lwm lub sijhawm los ntawm cito, i.e. urgently.
