Bvunzo yeD-Dimer: Zvainogona Kukuudza Uye Zvaisingakwanise Kukuudza Nezvekuvharwa Kweropa

Key tora kutora

• Bvunzo yeD-dimer ibvunzo yekuti hapana chinoratidza kuti chirwere chacho chabuda, kwete bvunzo yekuti hapana chinoratidza kuti chirwere chacho chabuda, inonyanya kubatsira kana mhedzisiro yacho isina kunaka uye fungidziro yekuti chiremba anowana chirwere ichi yakaderera.
• Kukwidzwa kweD-dimer hakurevi kuti pane ropa rakagwamba. Kutapukirwa, kuvhiyiwa, kukuvara, pamuviri, kenza, chirwere chechiropa nekukwegura zvese zvinowedzera D-dimer.
• Kuonekwa kweD-dimer isina kunaka hakubvisi ropa rakagwamba kana mukana wekuti chirwere chibude wakakwira; mifananidzo inodiwa pasinei nemhedzisiro yeD-dimer muzviitiko zvakadaro.
• Kuganhurirwa kweD-dimer, mayuniti uye nzira dzekuongorora dzakasiyana pakati pemarabhoritari, saka mhedzisiro inobva mumarabhoritari akasiyana haienzaniswe zvakananga.
• Kuunganidzwa kweropa kunotora maminetsi mashoma; bvunzo yeD-dimer pachayo haitauri kuti ropa rakagwamba riri kupi.

Pakuona

Uyewo anozivikanwa se

• Kuongororwa kweropa reD dimer
• Kuedzwa kwechikamu chekuora kwefibrin
• Kuyedzwa kweD-dimer yehuwandu / kunzwisiswa kwakanyanya kweD-dimer
• MuIndia, inowanzo bvunzwa se "clot test", "DD test" kana "D-dimer report" pamwe chete ne coagulation profile (PT/INR, aPTT)

Chii chinonzi bvunzo yeD-dimer?

Kana muviri waita clot, unoisa pasi mesh ye cross-linked fibrin. Kana clot iyoyo ikapwanyika zvakare ne enzyme plasmin, zvidimbu zvidiki zvinoburitswa muropa. Chimwe chezvidimbu izvozvo iD-dimer. Kuyedzwa kweD-dimer kunoyera huwandu hwezvidimbu izvi.

Saka D-dimer inoratidza kuumbwa kweropa uye kuputsika kuri kuitika pane imwe nzvimbo mumuviri. Haritauri kuti ropa racho rakaita sei, kuti rakaita sei, rakakura sei kana kuti rakura sei. Harigoni kusiyanisa ropa rakaita seropa riri mutsinga yegumbo neropa rakaita seropa rinokonzerwa nepneumonia, kuvhiyiwa kuchangobva kuitwa kana kuti kukuvara.

Marabhoritari akasiyana anoshandisa mapuratifomu akasiyana ekuyedza. Mamwe anotaura muzvikamu zveD-dimer uye mamwe muzvikamu zvakaenzana zvefibrinogen, izvo zvinopetwa kaviri. Nekuda kweizvi, nhamba kubva kune imwe rabhoritari haifanirwe kuenzaniswa zvakananga nenhamba kubva kune imwe. Nguva dzose verenga mhinduro uchienzanisa nereferensi yakadhindwa pamushumo iwoyo chaiwo.

Nei bvunzo yeD-dimer yaitwa?

• Kufungidzirwa kwe deep vein thrombosis (DVT): chidya kana chidya chinorwadza, chakazvimba, chinodziya. Kusanzwa zvakanaka kweD-dimer mumurwere akaonekwa seasingawanzoitiki paDVT kunoita kuti DVT isakwanise kushandiswa pakuongorora makumbo.
• Kufungidzirwa kwe pulmonary embolism (PE): kutadza kufema kamwe kamwe, kurwadziwa pachipfuva, kurova kwemoyo nekukurumidza kusingatsananguriki. D-dimer inoshandiswa mushure mekuongororwa kwekiriniki (senge Wells kana Geneva), kwete isati yasvika.
• Kuvharika kweropa mutsinga kunofungidzirwa (DIC): D-dimer inoumba chimwe chikamu cheDIC scoring panel pamwe chete ne platelet count, prothrombin time uye fibrinogen. D-dimer yega haiongorore DIC.
• Kusarudza nguva yekudzivirira ropa kuvhara: Mune vamwe varwere vane venous thrombosis isina kukonzerwa, D-dimer yakayerwa mushure mekumira kwekudzivirira ropa kuvhara inogona kubatsira nyanzvi kuona njodzi yekudzoka kweropa. Ichi chisarudzo chenyanzvi, kwete chenguva dzose.
• Kufungidzirwa kuti aorta yakatsemuka: D-dimer dzimwe nguva inoshandiswa sechikamu chekuongorora njodzi, asi haitsivi mifananidzo yekukurumidzira kana paine fungidziro yekuti yakachekwa.

Ndiani anofanira kuongororwa uku?

• Vanhu vane zviratidzo zvinoratidza kuti vane DVT kana PE vane zviratidzo zveDVT kana PE izvo chiremba wavo akaongorora kuti ndizvo zviri kuitika. yakaderera kana yepakati mukana wekiriniki.
• Varwere vari kuongororwa DIC kana vaine chirwere chakakomba che sepsis, kukuvara kukuru, matambudziko ekusununguka kana mamwe magomarara.
• Varwere vakasarudzwa vane venous thromboembolism isina kukonzerwa vari kuongororwa nachiremba weropa kuti varambe vachidzivirira ropa kuti rirambe richibuda kwenguva yakareba sei.

Ndiani asingafaniri kuita bvunzo iyi?

• Vanhu pa yakakwirira mukana wekuti PE kana DVT zviitike, vanoda kutorwa mifananidzo zvakananga, nekuti D-dimer isina kunaka haizochinji maitiro ekuongorora.
• Vanhu vasina zviratidzo zvechirwere vari kutsvaga bvunzo ye "kuongorora ropa rakagwamba". D-dimer haisi bvunzo yekuongorora ropa muvanhu vane hutano hwakanaka uye inowanzoburitsa mhedzisiro yakakwira inotungamira mukuongororwa kusingakoshi.
• Vanhu vane mhedzisiro yakakwira inenge isingadzivisike uye isingatsananguriki, semuenzaniso pakarepo mushure mekuvhiyiwa kukuru, kunze kwekunge paine mubvunzo chaiwo wekiriniki uri kubvunzwa.

Izvo zvisingakwanise kuonekwa kana kusaonekwa nebvunzo yeD-dimer

• Haikwanise kuwana ganda rakagwamba. D-dimer yakasimudzwa haipe ruzivo rwekuti ndeipi tsinga iri kubatwa. Mifananidzo inodiwa.
• Hazvigone kusimbisa DVT kana PE. Kunyatsojeka kwacho kwakaderera. Vanhu vazhinji vane D-dimer yakakwira havana ropa rakagwamba zvachose.
• Hazvigone kubvisa kuumbwa kweropa muvarwere vane mukana mukuru wekuti ropa ribviswe. Muboka iri, D-dimer yakajairika ichiri kusiya njodzi isingagamuchirwi, saka kufungidzira kunoenderera mberi zvakadaro.
• Maronda madiki, akare kana kuti ekare anogona kusawedzera D-dimer zvakakwana. Kubuda kweropa mutsinga diki dzemutsinga dzemutsinga, kubuda kweropa mutsinga dzemutsinga dzemutsinga uye kuungana kweropa kwagara kuripo kwemazuva kana mavhiki akati wandei zvinogona kukonzerwa nemhedzisiro yakajairika kana kuti inenge yakajairika.
• Kurwisa ropa kunoderedza D-dimer. Murwere atova ne heparin, warfarin kana mushonga unorwisa ropa kubva muropa angave aine D-dimer yakajairika pasinei ne thrombosis.
• Hazviongorore njodzi yekubuda ropa uye hazvitsivi PT/INR, aPTT kana platelet count.
• Haiongorore kenza, COVID-19, chirwere chemwoyo kana sitiroko, kunyangwe D-dimer ichigona kukwira mune zvese izvi.

"Hazvina kuonekwa" kana kuti D-dimer yakajairika inotsanangura zvakayerwa neongororo iyi panguva iyoyo. Hazvina kufanana neganda rakavharika rakabviswa. Kana kutadza kwako kufema, kurwadziwa pachipfuva kana kuzvimba kwemakumbo kukaramba kuripo kana kuipa pasinei neD-dimer yakajairika, dzokera kuna chiremba wako.

Bvunzo dzakabatana asi dzakasiyana: kuenzanisa kwebvunzo yeD-dimer

Miedzo iyi inopindura mibvunzo yakasiyana. Hapana kana imwe chete yakanakisa pasi rose; bvunzo yekutanga chaiyo inoenderana nezviratidzo zvekiriniki uye kuti mukana wekuti ropa ribvire ungaonekwa sei.

Siyanisawo D-dimer yemhando yepamusoro pamubhedha/panzvimbo yekutarisira kubva pakuyedzwa kwemurabhoritari yemhando yepamusoro. Kuyedzwa kwemhando yepamusoro chete ndiko kunosimbiswa kuti PE isaburitswe zvakachengeteka mukati menzira dzekuongorora.

Maitiro ekugadzirira bvunzo yeD-dimer

Kugadzirira kushoma, asi mirayiridzo inoiswa munharaunda nerabhoritari yega yega. Kana mirairo yenzvimbo yako yekuunganidza zvinhu yakasiyana nechero chinhu chiri pazasi, tevera nzvimbo yako yekuunganidza zvinhu.

• Kutsanya: kazhinji hazvidiwi pakuongororwa kweD-dimer. Idya uye inwa zvakajairika kunze kwekunge ropa rimwe chete richisanganisira bvunzo dzinoda kutsanya.
• Mishonga: Udza chiremba ari kukumbira rubatsiro uye chiremba wephlebotomist nezvemishonga inorwisa ropa (heparin, warfarin, apixaban, rivaroxaban, dabigatran), mishonga inorwisa maplatelet uye chero mushonga wekubvisa ropa kubva muropa. Usamise kana kuchinja chero mushonga wawakanyorerwa pabvunzo iyi, tanga wataura nechiremba anokupa mushonga wacho.
• Zviitiko zvichangoburwa: taura nezvekuvhiyiwa kwazvino, kukuvara, kutyoka kwemuviri, kupinda muchipatara, hutachiona, kufamba daro refu, kurapwa kwegomarara kana kurasikirwa nepamuviri kana kusununguka, sezvo zvese izvi zvine chekuita nedudziro.
• Kunyorova kwemvura mumuviri uye mutsinga: Kunwa mvura yakakwana kunoita kuti kudhonza kuite nyore. Kana uine dambudziko rekushaya simba kwemoyo kana chirwere cheitsvo, usawedzera huwandu hwemvura yaunonwa pabvunzo iyi, ramba wakadzikama kusvika pamuganhu wakatarwa nachiremba wako.
• Nguo: ruoko rwakasununguka runomonereka pamusoro pegokora runobatsira.

Kuberekwa

D-dimer inokwira zvishoma nezvishoma panguva yekuzvitakura kwakajairika uye inoramba ichikwira pakutanga kwekuzvitakura. Kuganhurirwa kwakajairika hakushande zvakanaka panguva yekuzvitakura, uye nzira dzekufungidzira PE panguva yekuzvitakura dzinosiyana. Udza timu kuti une pamuviri kana kuti uchangobva kuberekwa usati watorwa.

Children

D-dimer haiwanzo shandiswa kuvana uye nguva dzekuongororwa dzinosiyana zvichienderana nezera, kunyanya kuvana vachangozvarwa. Mhedzisiro yevana inoda kududzirwa kwevana.

Vakuru vakuru

D-dimer inowedzera nekukura. Vanachiremba vazhinji vanoshandisa nzira yekuchekerera varwere vanopfuura makore makumi mashanu pavanoongorora PE inofungidzirwa, izvo zvinoderedza mifananidzo isina kufanira. Kana chiyero chekugadzirisa zera chichishandiswa zvinoenderana nekuyedza uye nzira yemunharaunda.

Vanhu vatotanga kushandisa mishonga inorwisa ropa

Kurwisa ropa kuti ropa risaungane ropa kunoderedza D-dimer uye kunogona kuunza mhedzisiro yenhema inokurudzira. Kuongororwa uku hakuna ruzivo rwakawanda kune munhu atove ari kurapwa. Ramba uchitora mushonga wako wakanyorerwa uye udza chiremba kuti uri kuutora.

Chirwere cheitsvo kana chiropa

D-dimer inowanzova yakanyanya muzvirwere zveitsvo zvisingaperi uye muzvirwere zvechiropa zvisingaperi, zvisinei nekuti pane kuumbwa kweropa. Izvi zvinoderedza kushanda kwechikamu chepakati chemasero mumapoka aya.

Chii chinoitika panguva yebvunzo yeD-dimer

• Kunyoresa uye cheki: ruzivo rwako nemirairo yachiremba yauri kukumbira zvasimbiswa.
• Kuunganidzwa kweropa: tourniquet inoiswa, ganda riri pagokora remukati rinocheneswa, uye ropa rinodhonzwa muchubhu yecitrate, kazhinji ine bhuruu rakachenuruka pamusoro. Chubhu inofanira kuzadzwa kusvika pamutsetse wakatarwa, sezvo kuzadza pasi pechiso kunogona kuita kuti sampuro isashande.
• Duration: tsono inowanzova mutsinga kweinenge miniti imwe chete. Kudhonza kwese kunotora maminitsi angangoita mashanu, uye vanhu vazhinji vanenge vachipinda nekubuda munzvimbo yekuunganidzira mukati memaminitsi gumi nemashanu kusvika makumi matatu.
• Pashure: Kumanikidzwa kunoiswa kweminiti imwe kana mbiri uye jira diki rinoiswa. Mabasa enguva dzose anogona kutangazve ipapo ipapo. Dzivisa kusimudza zvinhu zvinorema neruoko irworwo kweawa imwe chete kana zvakadaro kana nzvimbo yacho ichirwadza.
• Processing: Muenzaniso wacho unoongororwa uchishandisa automated coagulation analyzer. Mumadhipatimendi e emergency, D-dimer inowanzoitwa nekukurumidza nekuti mhedzisiro yacho inokanganisa sarudzo dzinoitwa ipapo ipapo; nguva dzose murwere anodzoka kubasa anotora nguva yakareba uye inosarudzwa nerabhoritari yega yega.

Kunzwisisa mushumo wako weD-dimer

Verenga nhamba uchienzanisa nereferensi uye chikamu chakadhindwa pamushumo wako wega. Zvinhu zviviri zvinofanira kufanana usati waenzanisa zvine musoro: sisitimu yechikamu (DDU kana FEU) uye puratifomu yekuyedza.

• Mhedzisiro iri pasi pechikamu cherabhoritari: Mumurwere ane chiremba akatoona kuti kuumbwa kweropa hakugoneki, izvi zvinoita kuti DVT kana PE zvisaitike zvekuti mifananidzo haiwanzodiwi. Hazvirevi kuti hapana kuumbwa kweropa kunogona kuitika.
• Mhedzisiro iri pamusoro pechikamu cherabhoritari: Izvi zvinoreva kuti fibrin iri kuputsika pane imwe nzvimbo. Izvi zvinowanzoitika, kazhinji hazvina chikonzero chekugwamba kweropa, uye hazvisirizvo zvinoonekwa. Danho rinotevera rinowanzo shandiswa kufungidzira zvinhu zvichibva pazviratidzo, makumbo eDoppler kana pane zvinofungidzirwa kuti DVT, CTPA kana V/Q scan kana paine zvinofungidzirwa kuti PE.
• Mhedzisiro yepamusoro-soro: nhamba dzakakwira dzine mukana mukuru wekuve ne thrombosis, asi hapana nhamba imwe chete inosimbisa kuumbwa kweropa, uye hapana chiyero chiri pamusoro apa chekuti mifananidzo inogona kudziviswa.

Bvunzo yeD-dimer haimbofi yakatsanangurwa yoga. Inotsanangurwa pamwe chete nezviratidzo zvako, zvakawanikwa pakuongorora, zvinhu zvine njodzi uye mamakisi ehutano hwekiriniki nachiremba akaikumbira. Mhedzisiro inosiyana zvichienderana nemamiriro ezvinhu ekiriniki emunhu wega wega.

Kana mhedzisiro yeD-dimer inogona kutsausa

Zvikonzero zveD-dimer yakakwidzwa zvisiri pamutemo kana kuti isina kukwidzwa zvakananga

• Kukura kuri kuwedzera, kunyangwe pasina chirwere
• Kubata pamuviri uye nguva yekusununguka
• Kuvhiyiwa kwazvino, kukuvara, kutyoka kana kukuvadzwa kwakanyanya
• Kutapukirwa uye sepsis, kusanganisira pneumonia yakanyanya uye dengue
• Gomarara rinoita basa
• Chirwere chechiropa chisingaperi uye chirwere cheitsvo chisingaperi
• Kurwiswa kwemoyo munguva pfupi yapfuura, sitiroko, atrial fibrillation kana kutadza kwemoyo
• Chirwere chekuzvimba uye che autoimmune
• Kubuda ropa zvakanyanya, kutsva kana thrombolysis ichangobva kuitika
• Rheumatoid factor nemamwe ma antibodies e heterophile anokanganisa bvunzo
• Zvichienderana nepuratifomu, sampuli dzakabviswa ropa zvakanyanya kana kuti dzakapiswa nemafuta.

Zvikonzero zvekudzikiswa kweD-dimer zvisiri izvo

• Kurapa kwemishonga inorwisa ropa rakatanga
• Gwara diki, rakaparadzaniswa netsinga dzemudumbu dziri kure, kana kuti chikamu chidiki chetsinga
• Zviratidzo zvinoonekwa kwemazuva mazhinji, panguva iyo D-dimer inogona kunge yadonha
• Chubhu ye citrate isina kuzadzwa zvakakwana ichideredza sampuro
• Kutakurwa kwakanonoka kana kuchengetwa zvisirizvo kwemuenzaniso
• Kuwanda kwakanyanya kwemafuta kana bilirubin kunokanganisa mamwe maekisesaizi emaziso
• Kashoma, "hook effect" inowanikwa zvakanyanya pamimwe miedzo

Njodzi uye kuchengetedzeka kwebvunzo yeD-dimer

Kuongororwa kweD-dimer kunoda chete sampuli yeropa remutsinga. Njodzi dziripo ndedzekunge munhu abhoorwa mutsinga uye kazhinji kacho idiki.

• Zvakajairika nezvidiki: kurwadza kwenguva pfupi, kukuvara kudiki, kurwadziwa kudiki panzvimbo yakaboorwa.
• Zvishoma zvakajairika: kunzwa kupera simba kana kusuruvara, maronda makuru (zvingangoitika kana ukatora mishonga inorwisa ropa kana kuti inorwisa maplatelet), kuedza kwechipiri kunodiwa kana tsinga yacho yakaoma.
• Kazhinji: kuunganidzwa kudiki kweropa pasi peganda, hutachiona hwemunzvimbo, kana kutsamwa kwenguva pfupi kwetsinga zvichikonzera kukwenya.

Udza chiremba wephlebotomist nguva isati yasvika kana wakambofenda panguva yekuongororwa ropa kare, uine chirwere chekubuda ropa, wakatora mishonga yekuderedza ropa, kana uine lymphoedema kana dialysis fistula muruoko rumwe saka rumwe ruoko runoshandiswa.

Mamiriro ezvinhu anokosha

Kubata pamuviri uye nguva yekusununguka

D-dimer inokwira kazhinji muma trimester ese, saka mhedzisiro yakakwira yekuzvitakura inowanzoratidza nhumbu pachayo. PE inofungidzirwa kuti inogona kubatwa nepamuviri inoongororwa uchishandisa nzira dzakagadzirirwa nhumbu, dzingangosanganisira leg Doppler kutanga, wozotanga waongororwa neV/Q scan kana CTPA nekutarisa dose. Sarudzo pano dzinoitwa nechikwata chevanachiremba nevekubereka pamwe chete.

Children

Kubuda kwetsinga mutsinga hakuwanzoitiki muvana uye kunowanzoitika kana paine central line, hutachiona hwakakomba kana chimwe chinhu chiri pasi payo. D-dimer haina kuongororwa muvana sezvakaita muvakuru, saka zvisarudzo zvevana zvinotsamira zvakanyanya pamifananidzo uye kuongororwa kwekiriniki.

Vakuru vakuru

Nekuti chiyero chekutanga cheD-dimer chinokwira nekukura, muganho wakagadzika unoratidza kuti vakwegura vazhinji vane hutano hwakanaka havana kunaka. Muganho wakagadziriswa zera unowanzo shandiswa kune vanofungidzirwa kuti vane PE inopfuura makore makumi mashanu kuderedza kuongororwa kusingakoshi, kana bvunzo ichitsigira.

Vanhu vane chirwere cheshuga

Hapana chinjo pamishonga inoderedza shuga yeropa pakuedzwa kweD-dimer, sezvo kutsanya kusingawanzodiwi. Kana kutorwa kweropa kwakabatana nekuongororwa kwekutsanya, kurukurai nguva yekushandiswa kweinsulin kana sulfonylureas nechiremba kutanga kuti mudzivise hypoglycemia.

Chirwere chisingaperi chepfungwa

D-dimer inowanzova yakakwira muCKD yakakwira isina kana kuumbwa kweropa. Kana zvichidikanwa, kushandisa mifananidzo yeCTPA kunoda kuyera mashandiro eitsvo, izvo zvichaongororwa nechikwata chinorapa.

Heart failure

D-dimer inogona kuwedzerwa kana mwoyo wako wakundikana kushanda zvakanaka uye atrial fibrillation, uye kushaya mweya nekuda kwekushaya simba kwemoyo kunogona kutevedzera PE. Usawedzera huwandu hwemvura yaunonwa usati waongororwa kana uri padanho remvura.

kenza

Gomarara rinoita kuti munhu arware riwedzere D-dimer uye rinowedzera njodzi yekugwamba kweropa, saka bvunzo iyi inorasikirwa nekugona kwayo kusiyanisa. Mifananidzo inowanzo sarudzwa kare kune vanhu vane kenza.

Bvunzo yeD-dimer muIndia

• Kuwedzera kwehutachiona kwakajairika. Dengue, fivha yemudumbu, TB, pneumonia yakanyanya uye sepsis zvese zvinokwidza D-dimer. Mumurwere ane fivha, D-dimer yakakwira inowanzo kukonzerwa nehutachiona kwete neganda rakagwamba.
• Maitiro ekuongororwa mushure meCOVID. D-dimer yakawanikwa nevanhu vakawanda panguva yedenda uye dzimwe nguva ichiri kudiwa kune vanhu vasina zviratidzo zvekugwamba kweropa. Kunze kwemubvunzo wekiriniki, D-dimer mumunhu akagwinya inowanzo kukonzera kuzvidya mwoyo uye CT scans dzisina basa pane kujekesa.
• Kubuda kweropa mutsinga hakunyatso zivikanwa. DVT nePE zvaionekwa sezvisingawanzoitiki muSouth Asia, uye fungidziro iyoyo ichiri kunonoka kuongororwa. Kupera kweropa mushure mekuvhiyiwa, mushure mekusununguka uye kusagadzikana kwekufamba kunoitika uye kunofanirwa kufungwa nezvazvo kana zviratidzo zvikaonekwa.
• Chirwere chemwoyo chinonzi rheumatic uye atrial fibrillation Zvinowanzoitika uye zvinogona kusanganiswa nekuwedzera kweD-dimer uye nezviitiko zvemwoyo.
• Kuongororwa kweanemia uye hemolysis. Kudhonza kwakaoma uye kubuda kweropa muropa kunogona kukanganisa mamwe mapuratifomu ekuyedza; sampuli inodzokororwa inogona kukumbirwa.
• Kusiyana kwekuyedza pakati pemarabhoritari. Marabhoritari ekuIndia anoshandisa mapuratifomu akasiyana-siyana uye masisitimu emayuniti. Takura mushumo wekutanga kwete nhamba chete paunoona chiremba mutsva, uye tarisira kudzokorora pane kuenzanisa zvakananga.

Mutengo neinishuwarenzi muIndia

Bvunzo yeD-dimer ibvunzo inowanikwa murabhoritari, ine mutengo uri pakati nepakati wekuongorora kuvharika kweropa. Mari dzinosiyana zvikuru pakati pemaguta, pakati penzvimbo dzekutora ropa dzakazvimiririra nemarabhoritari ezvipatara, uye pakati pekugadzirisa nguva dzose nekukurumidzira. Bvunza rabhoritari kuti ione mwero wayo wemazuva ano usati watorwa sampuli.

Chii chinokanganisa mutengo:

• Puratifomu yekuyedza inoshandiswa, kuyedza kwehuwandu hwepamusoro-soro kunowanzo dhura kupfuura kwemhando yepamusoro
• Kugadziriswa nekukurumidza kana kuti stat zvichienzaniswa nekubatanidzwa kwakajairika
• Kunyangwe bvunzo yacho yakamira yoga kana kuti yakabatanidzwa muchikamu chekudzivirira kana che emergency
• Mitengo yechipatara kana ichienzaniswa neyemarabhoritari yakazvimirira, uye yedunhu reguta
• Mari yekuunganidza mienzaniso yemba
• Mamiriro ekubvumidzwa kwerabhoritari

Inishuwarenzi: kana bvunzo yeD-dimer ikaitwa panguva yekubvumidzwa kupinda muchipatara kana yekuchengeta varwere masikati, inowanzo vharirwa sechikamu chekukumbira kugara muchipatara, zvichienderana nemitemo yeinishuwarenzi. Kuferefetwa kwevarwere vasiri muchipatara kunowanzo vharirwa chete kana inishuwarenzi yacho iine bhenefiti yeOPD kana muripo wekuongorora. Zvikamu zvechirwere zviripo kare uye nguva yekumirira zvinogona kushanda. Simbisa neinishuwarenzi yako kana dhipatimendi reinishuwarenzi rechipatara usati watora muripo.

Ngano nezvokwadi

Mibvunzo inowanzobvunzwa

Chii chinoshandiswa pakuedza D-dimer?

Kuongororwa kweD-dimer kunobatsira vanachiremba kusarudza kana deep vein thrombosis kana pulmonary embolism zvisingaite kuti vadzivise kutorwa mifananidzo, kune varwere vakatoonekwa sevari pangozi yakaderera kana yepakati. Kuongororwa kweD-dimer kunobatsirawo mukuongorora masisitimu ekuti ropa rinopinda muropa rinovharika, pamwe chete nenhamba yemaplatelet, prothrombin time uye fibrinogen.

Kuongororwa kweD-dimer kunotora nguva yakareba sei?

Kutorwa kweropa pachako kunotora maminetsi angangoita mashanu, uye vanhu vazhinji vanopedza maminetsi gumi nemashanu kusvika makumi matatu panzvimbo yekutorwa ropa kusanganisira kunyoresa. Kuongororwa kwerabhoritari kunokurumidza pazviyero zvekuongorora otomatiki, uye madhipatimendi e emergency anowanzo gadzirisa D-dimer nekukurumidza. Nguva yekushuma kwevarwere vasiri muchipatara inotarwa nerabhoritari yega yega, bvunza kuti unopa riini sample.

Ndinofanira kutsanya ndisati ndaitwa bvunzo yeD-dimer here?

Kutsanya hakuwanzodiwi pakuongororwa kweD-dimer, saka unogona kudya nekunwa zvakajairika. Kana kushanya kumwe cheteko kuchisanganisira bvunzo dzekutsanya dzakadai semafuta kana shuga yekutsanya, tevera mirairo iyoyo panzvimbo pezvo. Kana ukatora mapiritsi e insulin kana chirwere cheshuga uye ukakumbirwa kutsanya, tanga wakurukura nezvenguva nechiremba wako.

D-dimer yangu yakwira asi scan yangu yaive yakajairika. Ko zvino chii?

Uyu musanganiswa unowanzo shandiswa uye unowanzo nyaradza. Kuongororwa kweD-dimer yakakwira ine mifananidzo yakajairika inowanzo ratidza hutachiona, kuzvimba, kuvhiyiwa kuchangobva kuitwa, pamuviri, zera kana chimwe chikonzero chisina kuumbwa kweganda. Chiremba wako achatsvaga tsananguro iyoyo. Dzokera nekukurumidza kana kufema kusina simba, kurwadziwa pachipfuva kana kuzvimba kwemakumbo kukawedzera kana kuipa.

Kuongororwa kweD-dimer kungave kusina kunaka here?

Bvunzo yeD-dimer inonzwisisika asi haina kunyatsojeka, saka mhedzisiro yakakwira inowanzoitika pasina kuumbwa kweropa. Mhedzisiro yakaderera inogona kuitika kana ropa risingapindi ropa, kuumbwa kweropa kudiki kana kure, zviratidzo zvinogara kwemazuva mazhinji, kana kuti chubhu yemuenzaniso isina kuzadzwa zvakakwana. Dudziro inogara ichienderana nemhedzisiro yekiriniki inoongororwa nachiremba wako.

D-dimer yakafanana here ne coagulation profile kana PT/INR?

Kwete. PT/INR ne aPTT zvinoyera kuti ropa rinoumba sei gwamba uye zvinobatsira kuongorora njodzi yekubuda ropa kana kuyera warfarin. Kuongororwa kweD-dimer kunoyera zvidimbu zvinosara mushure mekunge gwamba rapwanyika. Zvinopindura mibvunzo yakasiyana uye hazvichinjiki, kunyangwe zvese zvingakumbirwa pamwe chete.

Ndofanira kuongororwa D-dimer here kana ndichinzwa zvakanaka asi ndichinetseka nezvekugwamba kweropa?

Kazhinji kwete. Bvunzo yeD-dimer haibvumidzwe sebvunzo yekuongorora vanhu vasina zviratidzo. Muvanhu vane hutano inowanzo dzosera kukosha kwakakwira zvishoma, kusingatsananguriki kunotungamira mukuzvidya mwoyo uye CT scanning isingadzivisike. Pane kudaro, kurukurai nachiremba zvinhu zvamunogona kuisa panjodzi.

Kunwa mishonga inodzikisa ropa kunokanganisa here mhedzisiro yeD-dimer?

Ehe. Mishonga inorwisa ropa kuvhara ropa yakaita seheparin, warfarin, apixaban, rivaroxaban uye dabigatran inoderedza huwandu hweD-dimer uye inogona kuunza mhedzisiro inokurudzira. Udza rabhoritari nachiremba ari kukumbira zvaunotora. Usamira kana kugadzirisa chero mushonga unorwisa ropa kuvhara ropa usati wataura nechiremba.

Sei D-dimer yangu yakakwira panguva yekuzvitakura?

Kubata pamuviri kunowedzera mashandiro e "clotting factor" uye "fibrin turnover", saka D-dimer inokwira kuburikidza ne trimester uye inoramba ichikwira mushure mekusununguka. Saka miganhu yakajairika inoita zvisina kunaka mukuzvitakura. Kuvharika kweropa kunofungidzirwa mukuzvitakura kunoongororwa uchishandisa nzira dzakatarwa nekuzvitakura, kazhinji kutanga ne "leg Doppler ultrasound".

Sources

• National Institute for Health and Care Excellence (NICE), gwara rekuongorora zvirwere zve venous thromboembolic: kuongororwa, kutarisirwa uye kuongororwa kwe thrombophilia (NG158).
• Nhungamiro dzeEuropean Society of Cardiology pamusoro pekuongororwa uye kurapa acute pulmonary embolism.
• Nhungamiro dzeAmerican Society of Hematology pamusoro pe venous thromboembolism: kuongororwa kwe venous thromboembolism.
• Nhungamiro yeInternational Society on Thrombosis and Haemostasis pamusoro pekuongorora uye kutarisira kupararira kweropa muropa.
• Gwaro reClinical and Laboratory Standards Institute pamusoro pekuongororwa kweropa, kuunganidzwa kwesampuli uye kuzadza machubhu ecitrate.