Nkhani

Kuopsa kwa Venous Thromboembolism Padziko Lonse (VTE)

Venous Thromboembolism (VTE), yomwe ndi kuphatikiza koopsa kwa Deep Vein Thrombosis (DVT) ndi Pulmonary Embolism (PE), imapha anthu opitilira 840,000 padziko lonse lapansi chaka chilichonse—chofanana ndi imfa imodzi masekondi 37 aliwonse. Choopsa kwambiri n'chakuti, 60% ya zochitika za VTE zimachitika munthu akagonekedwa m'chipatala, zomwe zimapangitsa kuti ikhale chifukwa chachikulu cha imfa zosayembekezereka m'chipatala. Ku China, kuchuluka kwa VTE kukupitirira kukwera, kufika pa 14.2 pa anthu 100,000 mu 2021, ndipo milandu yoposa 200,000 ndi yotsimikizika. Kuyambira odwala okalamba pambuyo pa opaleshoni mpaka apaulendo abizinesi omwe ali paulendo wautali, zoopsa za thrombosis zitha kubisala mwakachetechete—chikumbutso chodziwikiratu cha mtundu wa VTE wobisika komanso kufalikira kwake kwakukulu.

I. Ndani Ali Pachiwopsezo? Kulemba Mbiri ya Magulu Omwe Ali Pachiwopsezo Chachikulu

Anthu otsatirawa amafunika kusamala kwambiri:

1. "Ozunzidwa Osaoneka" Okhala Pansi
   Kukhala pansi kwa nthawi yayitali (> maola 4) kumachedwetsa kwambiri kuyenda kwa magazi. Mwachitsanzo, katswiri wa mapulogalamu wotchedwa Zhang anayamba kutupa miyendo mwadzidzidzi atasinthana nthawi yochulukirapo ndipo anapezeka ndi DVT—chotsatira chodziwika bwino cha kukhazikika kwa mitsempha yamagazi.

2. Magulu Oopsa a Iatrogenic

   • Odwala Opaleshoni: Odwala omwe alowa m'malo mwa mafupa olumikizana ali ndi chiopsezo cha 40% cha VTE popanda mankhwala oletsa magazi kuundana.
   • Odwala Khansa: Imfa zokhudzana ndi VTE zimayimira 9% ya imfa zonse za khansa. Wodwala khansa ya m'mapapo dzina lake Li, yemwe sanalandire mankhwala oletsa magazi kuundana nthawi imodzi panthawi ya chemotherapy, adadwala PE—nkhani yochenjeza.
   • Azimayi Oyembekezera: Kusintha kwa mahomoni ndi kupsinjika kwa mitsempha yamagazi m'chiberekero kunapangitsa kuti mayi woyembekezera dzina lake Liu akumane ndi vuto la kupuma mwadzidzidzi mu trimester yake yachitatu, yomwe pambuyo pake idatsimikiziridwa kuti ndi PE.

3. Odwala Matenda Osatha Omwe Ali ndi Zoopsa Zowonjezereka
   Kukhuthala kwa magazi mwa anthu onenepa kwambiri komanso odwala matenda a shuga, komanso kuchepa kwa mphamvu ya mtima mwa odwala matenda a mtima, kumabweretsa vuto la thrombosis.

Chenjezo Lofunika Kwambiri: Fufuzani thandizo lachipatala mwamsanga ngati mwendo wanu watupa mwadzidzidzi mbali imodzi, kupweteka pachifuwa chifukwa cha kupuma movutikira, kapena kutaya magazi m'thupi—izi ndi mpikisano wotsutsana ndi nthawi.

II. Dongosolo Loteteza la Tiered: Kuyambira Pachiyambi mpaka Kupewa Molondola

1. Kupewa Koyambira: "Mantra ya Mawu Atatu" Yopewera Thrombosis
   • Kusuntha: Chitani masewera olimbitsa thupi a mphindi 30 tsiku lililonse poyenda kapena kusambira. Kwa ogwira ntchito muofesi, chitani masewera olimbitsa thupi a ankle pump (masekondi 10 a dorsiflexion + masekondi 10 a plantarflexion, mobwerezabwereza kwa mphindi 5) maola awiri aliwonse. Dipatimenti ya anamwino ya Peking Union Medical College Hospital yapeza kuti izi zimawonjezera kuyenda kwa magazi m'miyendo ndi 37%.
   • Madzi: Imwani kapu imodzi ya madzi ofunda mukadzuka, musanagone, komanso usiku mukadzuka (zonse 1,500–2,500 mL/tsiku). Dokotala wa matenda a mtima Dr. Wang nthawi zambiri amalangiza odwala kuti: "Kapu imodzi ya madzi ikhoza kuchepetsa gawo limodzi mwa magawo khumi a chiopsezo chanu cha thrombosis."
   • Idyani: Idyani nsomba ya salmon (yokhala ndi Ω-3 yoletsa kutupa), anyezi (quercetin imaletsa kusonkhana kwa ma platelet), ndi bowa wakuda (polysaccharides amachepetsa kukhuthala kwa magazi).
2. Kupewa kwa Makina: Kuyendetsa Kuyenda kwa Magazi ndi Zipangizo Zakunja
   • Ma Sokisi Okhala ndi Mikwingwirima Yokwera (GCS): Mayi woyembekezera dzina lake Chen ankavala GCS kuyambira sabata la 20 la mimba mpaka atabereka, zomwe zimathandiza kuti mitsempha ya varicose ndi DVT zisamayende bwino.
   • Kupsinjika kwa Pneumatic Intermittent (IPC): Odwala a mafupa omwe amagwiritsa ntchito IPC adawona kuchepa kwa chiopsezo cha DVT ndi 40%.
3. Kupewa Mankhwala: Kuyang'anira Kuletsa Kutsekeka kwa Magazi Ochuluka
   Kutengera ndi Caprini Score:

   Gawo la Chiwopsezo	Anthu Ambiri	Ndondomeko Yopewera
   Zochepa (0–2)	Odwala achichepere omwe sachita opaleshoni yoopsa kwambiri	Kuyambitsa koyambirira + IPC
   Pakati (3–4)	Odwala opaleshoni yayikulu ya Laparoscopic	Enoxaparin 40 mg/tsiku + IPC
   Wapamwamba (≥5)	Odwala khansa yolowa m'chiuno/odwala khansa yapamwamba	Rivaroxaban 10 mg/tsiku + IPC (kuwonjezera kwa milungu 4 kwa odwala khansa)

Chenjezo la Kuletsa Kutsekeka kwa Magazi: Mankhwala oletsa magazi kutuluka magazi amaletsedwa ngati magazi akutuluka kapena ngati magazi akutuluka m'magazi ali pansi pa 50×10⁹/L. Kupewa kwa makina ndikotetezeka kwambiri ngati zinthu zotere zikuchitika.

III. Magulu Apadera: Njira Zopewera Zoyenera

1. Odwala Khansa
   Yesani chiopsezo pogwiritsa ntchito chitsanzo cha Khomana: Wodwala khansa ya m'mapapo dzina lake Wang ali ndi chigoli cha ≥4 chomwe chimafunika tsiku lililonse cha heparin yolemera pang'ono ya mamolekyulu. Kuyesa kwatsopano kwa PEVB barcode (96.8% sensitivity) kumathandiza kuzindikira msanga odwala omwe ali pachiwopsezo chachikulu.

2. Azimayi Oyembekezera
   Warfarin ndi yoletsedwa (chiopsezo cha teratogenic)! Sinthani kugwiritsa ntchito enoxaparin, monga momwe zasonyezedwera ndi mayi wapakati dzina lake Liu yemwe anabereka bwino atatha kuletsa magazi kuundana mpaka milungu 6 atabereka. Kubereka mwana kwa opaleshoni kapena kunenepa kwambiri/zaka zokulirapo za amayi kumafuna kuletsa magazi kuundana nthawi yomweyo.

3. Odwala a Mafupa
   Mankhwala oletsa magazi kuundana ayenera kupitilira masiku ≥14 pambuyo pobwezeretsa chiuno ndi masiku 35 kuti munthu asweke chiuno. Wodwala dzina lake Zhang adadwala PE atasiya msanga—phunziro loti azitsatira malangizo.

IV. Zosintha za Malangizo a ku China a 2025: Kupita Patsogolo kwa Chitukuko

1. Ukadaulo Wowunikira Mwachangu
   Pulogalamu ya Westlake University ya Fast-DetectGPT imapeza kulondola kwa 90% pozindikira zolemba zopangidwa ndi AI, ikugwira ntchito mwachangu nthawi 340—kuthandiza magazini kusefa zolemba za AI zosagwira ntchito bwino.

2. Ndondomeko Zothandizira Kuchiza

   • Kuyambitsa "catastrophic PTE" (systolic BP <90 mmHg + SpO₂ <90%), zomwe zimayambitsa kulowererapo kwa gulu la PERT m'magulu osiyanasiyana.
   • Kuchepetsa mlingo wa apixaban komwe kumalimbikitsidwa pa vuto la impso (eGFR 15-29 mL/min).

V. Ntchito Yogwirizana: Kuthetsa Matenda a Thrombosis Kudzera mu Kugwirizana kwa Onse

1. Mabungwe Osamalira Zaumoyo
   Kumaliza Caprini kupeza zigoli mkati mwa maola 24 kuchokera pamene analowa m'chipatala kwa odwala onse omwe ali m'chipatala. Chipatala cha Peking Union Medical College Hospital chinachepetsa kuchuluka kwa VTE ndi 52% atagwiritsa ntchito njira imeneyi.

2. Kudzisamalira Pagulu
   Kuchepetsa thupi ndi 5% mwa anthu omwe ali ndi BMI yoposa 30 kumachepetsa chiopsezo cha thrombosis ndi 20%! Kusiya kusuta fodya ndi kuwongolera shuga m'magazi (HbA1c <7%) ndikofunikira kwambiri.

3. Kupezeka kwa Ukadaulo
   Sikani ma code kuti mupeze maphunziro olimbitsa thupi a pampu ya akakolo. Ntchito zobwereka zipangizo za IPC tsopano zikukhudza mizinda 200.

Uthenga Waukulu: VTE ndi "wakupha chete" wopewedwa komanso wowongoleredwa. Yambani ndi masewera olimbitsa thupi otsatira a bondo. Yambani ndi kapu yanu yotsatira yamadzi. Pitirizani kuyenda kwa magazi momasuka

Zolemba

1. Boma la Municipal la Yantai. (2024).Maphunziro a Zaumoyo pa Venous Thromboembolism.
2. Malangizo aku China okhudza kupewa ndi kuchiza matenda a thrombotic(2025).
3. Bungwe la Chinese Academy of Sciences Institute of Physics and Chemistry. (2025).Kupita Patsogolo Kwatsopano mu Kuneneratu Zoopsa za VTE kwa Odwala Khansa.
4. Maphunziro a Zaumoyo wa Anthu Onse. (2024).Kupewa Koyambira kwa Anthu Omwe Ali Pachiwopsezo Cha VTE.
5. Yunivesite ya Westlake. (2025).Lipoti la Ukadaulo la GPT Lozindikira Mwachangu.