Ntshav yog cov kua dej tseem ceeb tshaj plaws rau tib neeg lub cev, vim tias nws pab txhawb lub cev nrog oxygen thiab ntau yam khoom noj tseem ceeb rau lub cev. Nws kuj tseem pab txhawb kom nrawm tshem tawm cov khoom lag luam metabolic uas tsis xav tau. Hauv cov tshuaj, hypocoagulation yog qhov tsis tshua muaj pathology. Nws yog tus cwj pwm los ntawm kev txo qis peev xwm ntawm tib neeg cov ntshav kom khov. Muaj ntau ntau hom hypocoagulation. Lawv yuav sib tham.
Qhov laj thawj tseem ceeb
Muaj ntau qhov laj thawj rau qhov tshwm sim ntawm qhov tsis tshua muaj pathology li hypocoagulation syndrome (DIC), ntawm qhov tseem ceeb tshaj plaws yog:
- qib kev ua haujlwm siab, lossis nce siab ntawm cov tshuaj tiv thaiv coagulants;
- ua haujlwm tsis txaus, lossis tsis muaj cov tshuaj tiv thaiv.
Yog tias peb tham txog qhov laj thawj kawg rau kev txhim kho hypocoagulation, ces nws yuav yog vim muaj kev cuam tshuam los yog tsis txaus ntawm cov txheej txheem plasma coagulation, nrog rau thrombocytopathy. Qhov tsis tshua muaj pathology tuaj yeem tshwm sim los ntawm qee yamCov kab mob loj, feem ntau yog kab mob siab, lwm yam kab mob siab, nrog rau ntshav poob.
Kev txo qis hauv cov ntshav tuaj yeem tshwm sim vim qee yam kab mob tshwm sim, ntshav ntshav, nrog tsis muaj vitamin K thiab folic acid hauv lub cev, nrog rau DIC. Rau cov laj thawj rau qhov tsis zoo ntawm cov ntshav txhaws, koj tuaj yeem ntxiv cov txiaj ntsig ntawm lub cev ntawm qee cov tshuaj uas siv hauv cov tshuaj los kho thrombosis thiab txhim kho tus mob nrog hypercoagulation.
Cov tsos mob tseem ceeb
Hypocoagulation yog ib yam kab mob uas tshwm sim los ntawm kev rov los ntshav thiab ntshav hemorrhages, uas tuaj yeem tshwm sim ntawm tus kheej lossis vim muaj kev raug mob me. Txawm tias cov txheej txheem phais yooj yim tshaj plaws tuaj yeem ua rau muaj kev phom sij heev rau tus neeg mob hypocoagulation. Kev kho mob tshwm sim ntawm hypocoagulation raws txoj hauv kev ntawm cov ntshav coagulation nyob ntawm seb qhov ua rau ua rau cov ntshav coagulation deterioration. Los ntshav yuav tshwm sim ntawm daim tawv nqaij nyob rau hauv daim ntawv ntawm cov dots los yog pob me me. Hemorrhage tuaj yeem tshwm sim tsis tau tsuas yog nyob rau hauv qhov chaw subcutaneous, tab sis kuj nyob rau hauv cov leeg thiab pob qij txha.
Thrombotic Syndrome
nce ntshav txhaws thiab thrombosis tuaj yeem yog vim:
- nce qhov concentration ntawm procoagulants hauv cov ntshav;
- ua kom ntau dhau ntawm procoagulants, piv txwv li kev tsim siab ntawm cov kab mob ua kom ntshav khov;
- txo qis qis lossis txo qis ntawm kev ua haujlwm anticoagulant;
- txo qis los yogKev tiv thaiv ntawm kev ua haujlwm fibrinolytic.
thawj hom hypercoagulation yog qhov tsawg dua. Raws li ib txwm muaj, muaj ntau ntau procoagulants nyob rau hauv cov ntshav tshaj qhov tsim nyog rau cov ntshav txhaws. Tab sis qhov no "muaj peev xwm" ntawm procoagulants yog khaws cia los ntawm kev pib ntawm anticoagulants thiab fibrinolytic yam. Txawm li cas los xij, muaj cov xwm txheej thaum hypercoagulation cuam tshuam nrog kev nce ntxiv hauv cov ntshav plasma lossis platelet procoagulants (nrog rau cov tsos mob hyperprothrombinemia, hyperfibrinogenemia, thrombocytosis). Lub hauv paus, raws li txoj cai, yog ib qho nyuaj heev ntawm procoagulants, nce nyob rau hauv thrombopoiesis los yog ib tug manifested hemoconcentration.
YHemorrhagic Syndrome
Cov txheej txheem hauv qab no qhia txog kev txo cov ntshav txhaws:
- txo cov tsub zuj zuj ntawm procoagulants hauv cov ntshav;
- kev ua kom tsis zoo ntawm procoagulants;
- siab ceev lossis ntau dhau ntawm cov tshuaj tiv thaiv coagulants;
- siab concentration lossis ntau dhau ntawm cov khoom ua haujlwm fibrinolytic.
Deficiency ntawm procoagulants (1st mechanism) tuaj hla ntau zaus. Nws tuaj yeem txhais tau los ntawm thrombocytopenia, thrombocytopathy, tsis muaj zog lossis ua haujlwm tsis zoo ntawm ntau yam plasma ua rau txhaws.
Coagulopathy ntawm kev noj
Kev siv coagulopathy tshwm sim vim yog kev siv cov procoagulants loj thaum lub sijhawm nthuav dav davintravascular coagulation (DIC). Hauv qhov no, ib hom coagulopathy hloov pauv lwm qhov: theem ntawm hypercoagulability (DIC) dhau mus rau theem ntawm hypocoagulation, thiab thrombotic dysgenitalism yog qhov nyuaj (ntxiv) los ntawm kev tsim cov hemorrhagic syndrome. Qhov no hybrid, complex qauv ntawm coagulopathy yog hu ua thrombohemorrhagic syndrome (THS).
DIC hauv tus menyuam
Nyob rau hauv ib tug me nyuam yaus, tshwj xeeb tshaj yog ib tug me nyuam yug tshiab, muaj ib tug nyiam los tsim DIC vim yog tom qab hypocoagulation yam. Nov yog:
- qib qis ntawm procoagulants, antithrombin III thiab plasminogen;
- nrawm decompensation ntawm microcirculation tswvyim;
- Kev tshem tawm tsis zoo ntawm cov kab mob ua kom coagulation thiab cov khoom lag luam fibrin degradation (FDP) los ntawm phagocytic thiab fibrinolytic tswvyim.
Hauv ntau qhov sib txawv ntawm TGS yog qhov tseem ceeb, kev hloov pauv ntawm nws thawj theem mus rau lwm qhov tshwm sim dhau kaum feeb lossis ob peb teev. Feem ntau tus mob no muaj tus cwj pwm tsis zoo, hauv cov xwm txheej no, nws lub sijhawm ntsuas los ntawm ntau teev lossis ob peb hnub.
Kev kho mob
Tsis ntseeg, kev ua txhaum cai tsis tu ncua yuav ua rau muaj kev cuam tshuam tsis zoo ntawm cov ntshav thiab cov ntshav, nrog rau qhov tseeb, kev ua haujlwm ntawm ntau lub tshuab. Ib qho tseem ceeb heev ntawm cov ntshav yog lub peev xwm los ntshav. Yog tias cov txheej txheem no cuam tshuam, hypocoagulation yuav tshwm sim.
Yog tias tsis muaj ntshav txhaws, cov kws kho mob pom zoo kom uakev kuaj mob tag nrho thiab txiav txim siab qhov ua rau ua txhaum cai no. Kev kho mob ntawm qhov teeb meem no feem ntau nyuaj thiab ntev heev. Yog hais tias pathology yog congenital, kev kho mob yuav tsum tau qhia. Hauv qhov mob hnyav, cov neeg mob feem ntau tau mus pw hauv tsev kho mob.
kev kho mob
Rau kev kho mob hypocoagulation, cov tshuaj sib txawv tuaj yeem siv tau. Cov kws kho mob feem ntau sau cov tshuaj fibrinolysis inhibitors. Cov tshuaj no tuaj yeem txo qis cov ntshav txhaws thiab muaj cov nyhuv hemostatic. Kev kho mob suav nrog kev siv cov coagulants cais los ntawm cov neeg pub ntshav ntshav. Feem ntau siv daim txhuam cev hemostatic lossis thrombin. Txhawm rau kho tus neeg mob tus mob thaum lub sijhawm hypocoagulation, fibrinogen yog muab. Indirect coagulants kuj tau siv ntau zaus: piv txwv li, vitamin K, uas txhawb kev tsim cov prothrombin thiab cuam tshuam rau fibrinogen. Synthetic analogue ntawm cov vitamin no yog Vikasol. Nws raug sau tseg rau kev kho ntawm hypoprothrombinemia thiab rau kev noj ntau dhau ntawm cov tshuaj tiv thaiv coagulants nrog kev ua tsis ncaj.
txhawm rau kho cov hlab ntshav tsis zoo, feem ntau siv protamine sulfate - ib qho tshuaj uas cais tawm ntawm cov phev ntawm qee cov ntses. Nws tau pom tias txo cov teebmeem ntawm kev siv heparin ntau dhau. Nws yuav ua tau zoo rau kev hloov ntshav plasma nrog cov yam ntxwv uas nws muaj rau cov ntshav txhaws zoo dua.
Txhim kho qhov xwm txheej ntawm tus neeg, cov tshuaj ib txwm siv yuav tsum tau sim kom ua tau zoo. Ntxiv rau, cov neeg mob raug qhia kom ntxiv raunoj cov zaub mov uas muaj cov amino acids, as-ham, folic acid, phosphorus thiab calcium. Txawm li cas los xij, nrog kev tsim cov ntshav qis, koj yuav tsum mus ntsib kws kho mob sai li sai tau.
Txhais tau
Yog tias muaj cov tsos mob tshwj xeeb ntawm hypocoagulation tshwm sim, koj yuav tsum sab laj nrog kws kho mob tam sim ntawd, vim qhov no tuaj yeem ua rau muaj ntau yam tsis zoo, uas yuav tau tham hauv qab no. Nws yog ib qho tseem ceeb heev uas yuav tau mus soj ntsuam raws sij hawm, uas yuav pab txheeb xyuas thiab tshem tawm cov ua rau hypocoagulation. Kuv yuav tsum hais tias kev kho mob ntawm tus kab mob no yog qhov nyuaj thiab ntev, thiab tshwj xeeb tshaj yog mob hnyav, tus neeg mob tuaj yeem mus pw hauv tsev kho mob.
Yog tias qhov kev ntsuam xyuas pom tau tias hypocoagulation yog los ntawm keeb kwm, tus neeg mob kuj tseem yuav tau txais kev kho mob tas mus li nrog qee yam tshuaj.
Yog li, dab tsi yog qhov tshwm sim ntawm hypocoagulation? Tus neeg mob thawj zaug tshwm me me, thiab tom qab ntawd hematomas loj heev, thiab lawv tuaj yeem tsim txawm tias me ntsis siab ntawm daim tawv nqaij nrog ntiv tes. Tsis tas li ntawd, ib tug neeg uas muaj tus kab mob los ntshav no tuaj yeem yws ntawm qhov tsis tu ncua thiab hnyav qhov ntswg, nrog rau cov ntshav hauv cov quav. Ntxiv los ntshav tuaj yeem pib hauv cov hnyuv, nrog rau hauv cov mucous daim nyias nyias ntawm qhov ncauj kab noj hniav. Hauv cov xwm txheej hnyav tshaj plaws, cov hlab ntsha hauv hlwb kuj tuaj yeem tshwm sim, uas tuaj yeem ua rau muaj qhov tshwm sim loj heev, suav nrogthiab tuag.
Hypocoagulation thaum cev xeeb tub
Qhov teeb meem loj tshaj plaws thiab txaus ntshai tshaj plaws thaum cev xeeb tub yog DIC, uas ua rau pom kev los ntshav, nrog rau thrombosis, thiab lawv, dhau los, tuaj yeem ua rau tuag taus. Feem ntau hauv cov poj niam thaum cev xeeb tub, hypercoagulability tau pom. Thiab hypocoagulation hauv 30% ntawm cov neeg mob tuaj yeem ua rau tuag taus ntawm tus neeg mob cev xeeb tub, tab sis tsuas yog tus poj niam tsis tau txais kev kho mob raws sijhawm.
Thiab qhov teeb meem no pib nrog kev ua txhaum ntawm hemostasis, uas microclots tsim hauv cov ntshav, uas cuam tshuam cov ntshav ncig. Thiab qhov no, nyob rau hauv lem, ua rau ib tug tseem ceeb txo nyob rau hauv cov ntshav txhaws. Tsis tas li ntawd, qib platelets hauv cov ntshav txo qis, thiab kev pheej hmoo los ntshav nce.
Qhov nrawm thiab qhov hnyav ntawm hypocoagulation hauv cov poj niam cev xeeb tub tuaj yeem sib txawv. Hauv cov tshuaj, ntau hom kev txhim kho ntawm cov kab mob no tau raug txheeb xyuas:
- Hidden (latent).
- Recurrent.
- Chronic.
- Subacute.
- Spicy.
Kuj tseem muaj qhov xob laim nrawm ntawm txoj kev loj hlob ntawm cov kab mob no, tab sis nws tsis tshua muaj ntau. Feem ntau, nyob rau hauv cov poj niam cev xeeb tub, muaj ib tug mob, raws li zoo raws li ib tug ntev daim ntawv ntawm ib tug txo nyob rau hauv cov ntshav txhaws, thiab nyob rau hauv thawj rooj plaub, pathology yuav tshwm sim nrog hypotonic los ntshav. Raws li rau daim ntawv ntev ntawm pathology, nyob rau hauv cov poj niam cev xeeb tub nws tshwm sim feem ntau tawm tsam keeb kwm ntawm ntshav kab mob los yogkab mob plawv.
Qhov tseem ceeb ua rau txo cov ntshav txhaws hauv cov poj niam cev xeeb tub
Hypocoagulation yog ib qho pathology uas feem ntau tshwm sim hauv cov poj niam. Nyob rau hauv cov neeg nyob rau hauv txoj hauj lwm, nws kuj yuav tshwm sim raws li ib tug teeb meem nyob rau hauv inflammatory dab los yog kis kab mob. Feem ntau qhov no pathology tshwm sim vim preeclampsia los yog thaum ntxov detachment ntawm lub placenta nrog tsim ntawm hematoma. Kev txo qis hauv cov ntshav txhaws tuaj yeem tshwm sim hauv cov poj niam cev xeeb tub uas muaj kab mob ntawm cov kabmob tseem ceeb xws li daim siab lossis lub raum.
