Ntshav ua ib feem ntawm peb lub cev. Hauv ib tus neeg hnyav 70 kg, muaj kwv yees li 5.5 litres ntshav! Nws ua tsaug rau nws tias peb cov hlwb tau txais oxygen thiab cov as-ham, thiab muab cov pa roj carbon dioxide. Nws yog ua tsaug rau nws txoj kev txav los ntawm cov hlab ntsha uas cov duab ntawm peb lub cev yog tswj. Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tsum tau saib xyuas kev noj qab haus huv ntawm cov ntshav, zoo li lwm yam kabmob. Ib qho kev ntsuam xyuas uas yuav pab txheeb xyuas ntau cov txheej txheem pathological uas cuam tshuam rau cov ntshav yog qhov txuas ntxiv coagulogram (hemostasiogram).
Ob peb lo lus hais txog ntshav txhaws
Ua ntej peb mus ncaj qha rau qhov coagulogram qhia, cia peb saib yog vim li cas qhov kev ntsuam xyuas no yuav tsum ua txhua. Lub coagulogram txiav txim siab lub xeev ntawm cov ntshav txhaws.
Dab tsi yog qhov system nozoo li no? Lub coagulation system muaj ob lub ntsiab txuas: sab nraud hemostasis, lossis platelet, thiab sab hauv, lossis coagulation.
Platelet hemostasis ua haujlwm los ntawm kev sib txuas ntawm platelets (cov hlwb hemostatic tseem ceeb hauv cov ntshav) mus rau qhov chaw ntawm kev puas tsuaj rau cov hlab ntsha. Thaum txaus ntawm cov platelets sib sau, lawv ruaj khov ua ke, tiv thaiv cov ntshav los ntawm cov hlab ntsha ntxiv. Xws li cov ntshav txhaws sai sai, tso tseg los ntshav tam sim, tab sis nws yog luv luv.
Nyob rau theem ob, coagulation hemostasis tau qhib. Nws cov txheej txheem yog complex thiab yog muab los ntawm tshwj xeeb cov ntshav proteins uas yog synthesized nyob rau hauv daim siab - cov yam tseem ceeb clotting. Nrog rau synchronized thiab ua haujlwm zoo ib yam ntawm cov proteins no (muaj 12 ntau yam nyob rau hauv tag nrho), cov ntshav thickens, thiab fibrin fibers poob rau hauv cov hlab ntsha no - cov ntaub so ntswg stabilizes nws thiab tiv thaiv nws los ntawm disintegrating. Yog li, coagulation hemostasis yuav siv sij hawm ntev dua, tab sis tib lub sij hawm nws yuav tsum tsis txhob los ntshav.
Ntev coagulogram - qhov no yog qhov kev tshuaj ntsuam uas tso cai rau koj txheeb xyuas qhov ua txhaum ntawm ob lub tshuab ntawm hemostasis.
Npaj rau kev xeem
Yuav kom cov ntsuas ntawm cov coagulogram txuas ntxiv kom ua tau zoo tshaj plaws thiab muaj kev ntseeg siab ntawm cov txheej txheem hauv lub cev, thaum ua qhov kev soj ntsuam, koj yuav tsum ua raws li cov cai hauv qab no:
- pub ntshav tsuas yog thaum sawv ntxov teev;
- yuav tsum tau nqa tawm ntawm lub plab khoob, thiab koj yuav tsum tsis kamnoj zaub mov 12 teev ua ntej kuaj. Nws tso cai haus dej thiab noj tshuaj;
- tsawg kawg ib hnub ua ntej kev pub ntshav yuav tsum dhau yam tsis muaj kev tawm dag zog lub cev, haus cawv, thiab yuav tsum tsis txhob muaj kev hloov pauv tseem ceeb hauv kev noj haus;
- txiav luam yeeb yam tsawg ib teev ua ntej pub ntshav;
- Cov txiaj ntsig yuav cuam tshuam los ntawm qee yam tshuaj. Yog tias koj noj acetylsalicylic acid, anticoagulants lossis lwm yam tshuaj uas cuam tshuam rau cov ntshav viscosity, koj yuav tsum ceeb toom koj tus kws kho mob;
- yog tias koj muaj qhov tsis zoo tshwm sim thaum kuaj ntshav (kiv taub hau, xeev siab) kuj qhia rau tus kws saib mob.
Tom qab ua kom tiav cov ntshav, tsis txhob siv caj npab ntev li ib teev, vim qhov no yuav ua rau hematoma.
Main indications
Tam sim no nws yog lub sijhawm los nrhiav seb cov xwm txheej tseem ceeb thiab cov kab mob ntawm lub cev xav tau kev tshuaj xyuas coagulogram txuas ntxiv:
- Yuav tsum kuaj ua ntej kev phais.
- Kev kuaj cev xeeb tub, ob qho tib si ua ntej tus me nyuam thiab ua ntej kev phais.
- mob hnyav gestosis ntawm cov poj niam cev xeeb tub.
- Kev tshuaj xyuas lub sijhawm ntawm kev kho cov ntshav thinners ("Heparin", "Warfarin", "Aspirin").
- Kev kuaj mob rau qhov xav tias muaj ntshav txhaws (hemophilia, thrombocytopenic purpura, hemorrhagic vasculitis).
- ThaumCov kab mob ntawm cov hlab plawv uas ua rau muaj kev pheej hmoo ntawm cov ntshav txhaws (mob plawv ischemic, arrhythmias, tshwj xeeb tshaj yog atrial fibrillation).
- kab mob varicose.
- Kev tsis txaus ntseeg ntawm kev nthuav tawm intravascular coagulation (DIC).
- Cov kab mob siab nrog kev loj hlob ntawm cirrhosis, vim lawv muaj kev ua txhaum ntawm kev sib txuas ntawm coagulation yam.
- Ntshai txog kev txhim kho cov ntshav txhaws thiab thromboembolism.
Raws li tuaj yeem pom los ntawm cov npe saum toj no, kev txuas ntxiv coagulogram yog ib qho kev kawm tseem ceeb uas tsim nyog rau kev kuaj mob ntawm ntau yam kab mob ntawm cov ntshav thiab cov kab mob hauv nruab nrog cev.
Lub sijhawm kom tau txais txiaj ntsig
Txhua tus uas xeem qhov kev xeem no yog xav paub ntau npaum li cas cov coagulogram ua tiav. Tau kawg, cov txiaj ntsig yuav tsis tshwm sim sai, txij li tus kws kho mob xav tau lub sijhawm los ua txhua qhov kev tshwm sim. Qhov no feem ntau yuav siv li ob hnub ua haujlwm. Qhov ntawd yog, yog tias koj dhau qhov kev xeem rau hnub Friday, feem ntau yuav, cov txiaj ntsig yuav npaj rau hnub Tuesday-Wednesday.
Key indicators
Cov ntsuas ntsuas twg raug txiav txim thiab dab tsi suav nrog hauv cov coagulogram txuas ntxiv? Cov no yuav txawv ntawm chav kuaj, tab sis cov tseem ceeb tau teev tseg hauv qab no:
- fibrinogen;
- prothrombin lub sij hawm thiab prothrombin Performance index, uas ua ke ua rau lub thoob ntiaj teb normalized piv;
- Yprothrombin;
- ua kom lub sijhawm thromboplastin ib nrab;
- antithrombin III.
Qee lub chaw kuaj mob kuj kuaj rau lupusAnticoagulant, D-dimer, protein-C thiab protein-S.
Fibrinogen
Fibrinogen yog ib qho ntawm cov coagulation yam uas tau hais los saum no, cov proteins ua ke hauv daim siab. Nws suav nrog hauv kev ua haujlwm ntawm ib qho ntawm cov theem kawg ntawm coagulation hemostasis thiab tseem ceeb heev rau stabilizing cov ntshav txhaws thiab ua kom tsis txhob los ntshav. Nyob rau theem kawg, nws hloov mus ua fibrin - ib qho khoom siv tsis sib haum xeeb.
Adult norm: 2-4 g/l.
Fibrinogen yog qhov taw qhia tseem ceeb ntawm txhua yam uas muaj nyob rau hauv cov coagulogram txuas ntxiv, zoo rau kev txiav txim siab muaj cov txheej txheem mob hnyav hauv lub cev. Feem ntau, nrog rau kev nce qib ntawm fibrinogen, erythrocyte sedimentation tus nqi nce.
Ua rau qhov tsis zoo ntawm cov qib fibrinogen
Cov hauv qab no yog cov kab mob tseem ceeb uas ua rau muaj kev nce hauv fibrinogen hauv cov ntshav:
- kab mob sib kis thiab kis kab mob, kis kab mob thiab tshwm sim los ntawm lwm yam kab mob: kab mob, fungi, protozoa. Ntawd yog, qhov ntsuas no tsis qhia txog tus kab mob tshwj xeeb, tab sis tsuas yog lees paub tias nws muaj nyob hauv lub cev;
- mob cerebrovascular mob stroke (stroke);
- thaiv ntawm lub lumen ntawm cov hlab ntsha coronary nrog kev txhim kho ntawm necrosis ntawm cov leeg phab ntsa (myocardial infarction);
- kab mob ntawm endocrine system, tshwj xeeb tshaj yog hypothyroidism;
- amyloidosis yog ib yam kab mob tshwj xeeb uas yog tus cwj pwm los ntawm kev tsim cov protein ntau ntawm amyloid thiab nws cov deposition nyob rau hauv cov kabmob sab hauv, uas ua rau kev ua haujlwm tsis zoo;
- malignant neoplasms tuaj yeem ua rau muaj kev nce hauv fibrinogen;
- cov xwm txheej ntxhov siab rau lub cev (hlaws, raug mob, kev phais mob);
Kev txo qis hauv fibrinogen hauv cov ntshav tuaj yeem pom hauv cov xwm txheej hauv qab no:
- disseminated intravascular coagulation syndrome (DIC);
- kab mob siab heev nrog kev txhim kho cirrhosis;
- cev xeeb tub nrog mob hnyav toxicosis;
- hypo- thiab beriberi;
- pob txha pob txha neoplasms (myeloid leukemia);
- xab nrog nab venom,
- noj anabolic thiab androgens.
Activated partial thromboplastin time
APTT yog lwm qhov taw qhia ntawm lub hauv paus hemostasis, uas qhia txog lub sijhawm tsim cov ntshav txhaws thaum calcium chloride txuas rau nws.
Tus qauv rau tus neeg laus: 26-45 vib nas this.
Shortened APTT tej zaum yuav raug pom:
- nrog rau cov kab mob siab hnyav nrog kev loj hlob ntawm cirrhosis;
- tsis txaus ntawm cov vitamin K, uas yog synthesized nyob rau hauv daim siab thiab yog tsim nyog rau tag nrho cov ua hauj lwm ntawm clotting yam;
- kab mob sib kis kab mob (systemic lupus erythematosus);
- DIC hauv theem hypercoagulable (1st theem);
- APTT nyob ntawm theem ntawm cov ntshav txhaws: thaum lawv txo qis, APTT hloov.
Lub sijhawm ntev ntawm lub sijhawm ua haujlwm ib nrab thromboplastin, thiab yog li ntawd, kev qeeb ntawm cov ntshav coagulation yog txiav txim los ntawm:
- rau hemophilia- kab mob keeb kwm uas tsim cov coagulation factor VIII (nrog hemophilia A) lossis yam IX (nrog hemophilia B) cuam tshuam;
- DIC hauv theem hypocoagulation (2nd theem);
- antiphospholipid syndrome - kab mob autoimmune uas cov tshuaj tiv thaiv rau ib tus kheej phospholipids raug tsim; yog ib qho ua rau nchuav menyuam.
Prothrombin sijhawm
Qhov ntsuas no kuj ua rau lub cev hemostasis thiab qhia lub sijhawm hloov pauv ntawm fibrinogen mus rau fibrin (theem kawg ntawm coagulation). Yog li ntawd, lub sij hawm prothrombin ncaj qha nyob ntawm tus nqi ntawm fibrinogen hauv lub cev: nrog kev txo qis hauv nws qib, lub sij hawm prothrombin lengthens.
Tus qauv rau tus neeg laus: 11-16 vib nas this.
Kev nce ntxiv ntawm lub sijhawm prothrombin tau pom nyob rau hauv cov xwm txheej hauv qab no:
- hypofibrinogenemia, uas tuaj yeem ua rau los yog kis tau (feem ntau pom hauv daim siab cirrhosis);
- dysfibrinogenemia yog ib yam kab mob uas tshwm sim los ntawm kev ua txhaum ntawm cov qauv ntawm fibrinogen hauv nws qhov qub;
- DIC;
- noj cov tshuaj uas yaj cov fibrin (fibrinolytic therapy);
- noj tshuaj uas yog pawg ntawm cov tshuaj tiv thaiv kab mob ncaj qha ("Heparin");
- nce ntshav bilirubin;
- Ysystemic lupus erythematosus.
txo qis ntawm lub sijhawm prothrombin tshwm sim:
- nrog DIC hauv theem hypercoagulable (1st theem);
- cov xwm txheej tau teev tseg raws li cov theem ncefibrinogen.
Prothrombin index thiab INR
Prothrombin Performance index thiab INR yog cov ntsuas uas tau txiav txim siab ua ke nrog lub sijhawm prothrombin. Thiab yog hais tias tus prothrombin Performance index thiab lub sij hawm yuav txawv nyob ntawm seb lub chaw soj nstuam, ces lub thoob ntiaj teb normalized piv (INR) yog tus txheej txheem kuaj mob uas yog tib yam nyob rau hauv tag nrho cov chaw kuaj mob nyob rau hauv lub ntiaj teb no.
Prothrombin Performance index (PI) yog qhov ntsuas ntsuas uas suav los ntawm kev faib tus neeg mob lub sijhawm prothrombin los ntawm tus qauv prothrombin lub sijhawm thiab muab faib los ntawm 100%.
Thaum xam INR, tus neeg mob cov ntshav muab piv nrog cov ntshav plasma.
Norm PI hauv tus neeg laus: 95-105%.
INR norm: 1-1, 25.
Ua txhaum INR
nce hauv qhov sib piv thoob ntiaj teb normalized (INR) tshwm sim:
- nrog rau daim siab mob hnyav nrog kev txhim kho cirrhosis;
- txo qis hauv vitamin K concentration (tshwm sim hauv kab mob plab hnyuv, ua rau daim siab puas);
- amyloidosis;
- kab mob raum nrog kev txhim kho ntawm nephrotic syndrome, uas yog tshwm sim los ntawm kev nce permeability ntawm glomeruli ntawm capillaries ntawm ob lub raum thiab poob ntawm cov protein los ntawm lub cev;
- DIC;
- kab mob caj ces yam ntxwv los ntawm qhov tsis txaus ntawm cov ntshav txhaws (xws li hemophilia);
- hypo- thiab dysfibrinogenemia;
- noj tshuaj tiv thaiv kab mob.
Qhov txo qis hauv qhov ntsuas no yog ib txwm:
- rau cev xeeb tub hauv lub peb hlis ntuj kawg (qhov nce hauv INR yog suav tias yog ib txwm muaj rau qhov nolub sij hawm);
- thrombosis thiab thromboembolism;
- noj qee yam tshuaj (cov tshuaj hormones: tshuaj tiv thaiv qhov ncauj, corticosteroids).
Antithrombin III
Qhov ntsuas no ntawm qhov txuas ntxiv coagulogram hais txog cov kab ke anticoagulation ntawm cov ntshav, uas yog, ntawm qhov tsis sib xws, tiv thaiv nws cov ntshav txhaws.
Nws tuaj yeem txo qis nrog cov kab mob hauv qab no:
- kab mob siab;
- noob caj noob ces antithrombin deficiency;
- DIC;
- septic mob;
- thrombosis thiab thromboembolism.
Qhov nce hauv nws qib yog yam ntxwv:
- rau tus kab mob kis kab mob hnyav;
- kab mob pancreas;
- txo qhov concentration ntawm vitamin K.
Coagulogram thaum cev xeeb tub
Kev kuaj mob yuav tsum tau ua rau cev xeeb tub yog ib coagulogram. Kev npaj coagulogram txuas ntxiv thaum cev xeeb tub yog ua raws li cov hnub hauv qab no:
- Tom qab sau npe.
- Ntawm 22-24 lub lis piam.
- Ntawm 30-36 lub lis piam.
Qee qhov ntsuas ntawm qhov ntev coagulogram yuav txawv ntawm cov poj niam cev xeeb tub. Yog li, lawv ib txwm muaj qhov luv APTT, nce qib ntawm fibrinogen, thiab ncua sij hawm thrombin.
Kuv tuaj yeem kuaj qhov twg?
Koj tuaj yeem dhau qhov txuas ntxiv coagulogram hauv "Hemotest", "Invitro".
Hnub kawg rau kev tshuaj xyuas, tus nqi thiab cov ntsuas ntsuas uas tau txiav txim siab yog kwv yees li qub.
Yog li, txuas ntxiv coagulogram hauv"Hemotest" raug nqi 1720 rubles thiab ua tiav hauv ib hnub. Nov yog cov ntsuas hauv qab no tau txiav txim: APTT, antithrombin III, INR, fibrinogen, thrombin time.
Ntxiv rau qhov ntsuas tau teev tseg saum toj no, cov coagulogram txuas ntxiv hauv "Invitro" kuj suav nrog cov ntsiab lus ntawm D-dimer. Hnub Kawg - tseem 1 hnub ua haujlwm, tus nqi - 2360 R.
