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Kev hem thawj thoob ntiaj teb ntawm Venous Thromboembolism (VTE)

Kab mob Venous Thromboembolism (VTE), uas yog ib qho kev sib xyaw ua ke ntawm Deep Vein Thrombosis (DVT) thiab Pulmonary Embolism (PE), ua rau muaj neeg tuag ntau dua 840,000 tus thoob ntiaj teb txhua xyoo—sib npaug rau ib tus neeg tuag txhua 37 vib nas this. Qhov txaus ntshai tshaj plaws, 60% ntawm cov xwm txheej VTE tshwm sim thaum pw hauv tsev kho mob, ua rau nws yog qhov ua rau muaj kev tuag hauv tsev kho mob uas tsis tau npaj tseg. Hauv Suav teb, qhov tshwm sim ntawm VTE txuas ntxiv nce ntxiv, ncav cuag 14.2 ntawm 100,000 tus pej xeem hauv xyoo 2021, nrog rau ntau dua 200,000 tus neeg mob. Txij li cov neeg mob laus tom qab phais mus rau cov neeg taug kev ua lag luam ntawm cov dav hlau ntev, kev pheej hmoo ntawm thrombotic yuav zais ntsiag to—qhov kev ceeb toom txog VTE qhov xwm txheej tsis zoo thiab kev kis thoob plaws.

I. Leej Twg Muaj Kev Pheej Hmoo? Kev Txheeb Xyuas Cov Pab Pawg Muaj Kev Pheej Hmoo Siab

Cov neeg hauv qab no yuav tsum tau ceev faj ntxiv:

  1. Cov Neeg Raug Tsim Txom Uas Tsis Pom Kev
    Zaum ntev (>4 teev) ua rau cov ntshav ntws qeeb heev. Piv txwv li, ib tug kws sau ntawv hu ua Zhang tau o ntawm ceg sai sai tom qab ua haujlwm dhau sijhawm thiab tau kuaj pom tias muaj DVT - qhov tshwm sim ntawm cov leeg ntshav tsis txav.

  2. Cov Pab Pawg Uas Muaj Kev Pheej Hmoo Iatrogenic

    • Cov Neeg Mob Phais: Cov neeg mob tom qab hloov pob qij txha yuav ntsib kev pheej hmoo ntawm VTE 40% yog tias tsis muaj tshuaj tiv thaiv kev coagulation.
    • Cov Neeg Mob Cancer: Kev tuag ntsig txog VTE yog 9% ntawm tag nrho cov neeg mob cancer tuag. Ib tug neeg mob cancer ntsws uas hu ua Li, uas tsis tau txais tshuaj anticoagulation tib lub sijhawm thaum kho mob chemotherapy, tau tuag vim PE—ib zaj dab neeg ceeb toom.
    • Cov Poj Niam Cev Xeeb Tub: Kev hloov pauv ntawm cov tshuaj hormones thiab kev nias ntawm cov hlab ntsha hauv tsev menyuam ua rau tus poj niam cev xeeb tub lub xeem Liu muaj kev ua pa tsis taus tam sim ntawd hauv nws lub hlis thib peb, thiab tom qab ntawd tau lees paub tias yog PE.

  3. Cov Neeg Mob Kab Mob Ntev Uas Muaj Kev Pheej Hmoo Sib Xyaws
    Cov ntshav viscosity siab dua rau cov neeg rog thiab cov neeg mob ntshav qab zib, ua ke nrog kev txo qis ntawm lub plawv tso zis rau cov neeg mob plawv tsis ua haujlwm, tsim kom muaj av zoo rau thrombosis.

Ceeb Toom Tseem Ceeb: Nrhiav kev kho mob tam sim ntawd yog tias koj ib sab ceg o, mob hauv siab nrog kev tuag tes tuag taw, lossis hemoptysis - qhov no yog kev sib tw nrog lub sijhawm.

II. Kev Tiv Thaiv Qib: Los ntawm Lub Hauv Paus mus rau Kev Tiv Thaiv Kom Tseeb

  1. Kev Tiv Thaiv Kab Mob Thrombosis: Cov Lus Qhia Txog Peb Lo Lus
    • Kev Txav Mus Los: Ua 30 feeb ntawm kev taug kev ceev ceev lossis ua luam dej txhua hnub. Rau cov neeg ua haujlwm hauv chaw ua haujlwm, ua cov kev tawm dag zog ntawm lub pob taws (10 vib nas this ntawm dorsiflexion + 10 vib nas this ntawm plantarflexion, rov ua dua rau 5 feeb) txhua 2 teev. Peking Union Medical College Tsev Kho Mob lub chaw saib xyuas neeg mob pom tias qhov no ua rau cov ntshav ntws ntawm ceg qis nce 37%.
    • Haus dej kom txaus: Haus ib khob dej sov thaum sawv ntxov, ua ntej yuav mus pw, thiab thaum hmo ntuj sawv ntxov (tag nrho 1,500–2,500 mL/hnub). Kws kho mob plawv Dr. Wang feem ntau qhia cov neeg mob tias: "Ib khob dej yuav ua rau koj txo tau ib feem kaum ntawm koj qhov kev pheej hmoo ntawm kev mob ntshav txhaws."
    • Noj: Noj ntses salmon (nplua nuj nyob rau hauv anti-inflammatory Ω-3), dos (quercetin inhibits platelet aggregation), thiab dub fungus (polysaccharides txo cov ntshav viscosity).
  2. Kev Tiv Thaiv Mechanical: Tsav Cov Ntshav Ntws Nrog Cov Khoom Siv Sab Nraud
    • Cov thom khwm nruj (GCS): Ib tug poj niam cev xeeb tub uas muaj lub xeem hu ua Chen tau hnav GCS txij lub lim tiam 20 ntawm kev cev xeeb tub mus txog tom qab yug menyuam, ua kom tiv thaiv tau cov leeg ntshav thiab DVT.
    • Kev Siv Lub Tshuab Nqus Pa Sib Nqus (IPC): Cov neeg mob tom qab phais mob pob txha uas siv IPC pom tias muaj kev pheej hmoo ntawm DVT txo qis 40%.
  3. Kev Tiv Thaiv Tshuaj: Kev Tswj Xyuas Kev Ntshav Ntshav Uas Muaj Qib Sib Txawv
    Raws li Caprini Score:

    Qib Kev Pheej Hmoo Cov pejxeem ib txwm muaj Cov Txheej Txheem Tiv Thaiv
    Qis (0–2) Cov neeg mob hluas uas phais mob tsawg kawg nkaus Kev tawm tsam thaum ntxov + IPC
    Nruab Nrab (3–4) Cov neeg mob phais loj Laparoscopic Enoxaparin 40 mg/hnub + IPC
    Siab (≥5) Kev hloov lub duav/cov neeg mob qog noj ntshav theem siab Rivaroxaban 10 mg/hnub + IPC (txuas ntxiv 4 lub lis piam rau cov neeg mob qog noj ntshav)

Ceeb Toom Txog Kev Tsis Txaus Siab: Cov tshuaj Anticoagulants tsis haum rau cov neeg uas muaj ntshav ntws ntau lossis cov ntshav platelet tsawg dua 50 × 10⁹/L. Kev tiv thaiv kab mob muaj kev nyab xeeb dua rau cov xwm txheej zoo li no.

III. Cov Neeg Tshwj Xeeb: Cov Tswv Yim Tiv Thaiv Uas Tsim Los Rau Koj

  1. Cov Neeg Mob Cancer
    Siv tus qauv Khomana los ntsuas qhov kev pheej hmoo: Ib tug neeg mob qog noj ntshav hauv lub ntsws uas muaj lub xeem Wang nrog qhov qhab nia ≥4 uas xav tau heparin uas muaj qhov hnyav tsawg txhua hnub. Qhov kev ntsuas barcode PEVB tshiab (96.8% rhiab heev) ua rau pom tau cov neeg mob uas muaj kev pheej hmoo siab thaum ntxov.

  2. Cov Poj Niam Cev Xeeb Tub
    Warfarin tsis pom zoo (muaj feem ua rau menyuam tsis taus)! Hloov mus siv enoxaparin, raws li tau ua pov thawj los ntawm ib tug poj niam cev xeeb tub uas hu ua Liu uas tau yug menyuam tau zoo tom qab siv tshuaj anticoagulation txog 6 lub lis piam tom qab yug menyuam. Yog tias koj raug phais cesarean lossis rog dhau heev/yog tias koj niam muaj hnub nyoog ntau dhau, koj yuav tsum siv tshuaj anticoagulation tam sim ntawd.

  3. Cov Neeg Mob Pob Qij Txha
    Yuav tsum tau siv tshuaj Anticoagulation ntxiv ≥14 hnub tom qab hloov lub duav thiab 35 hnub rau pob txha tawg. Ib tug neeg mob uas hu ua Zhang tau mob PE tom qab tsum tsis txhob siv tshuaj sai sai—ib zaj lus qhia txog kev ua raws li txoj cai.

IV. Xyoo 2025 Cov Lus Qhia Tshiab Txog Tuam Tshoj: Kev Nce Qib Tshiab

  1. Kev Siv Tshuab Tshawb Xyuas Sai
    Westlake University's Fast-DetectGPT ua tiav qhov tseeb 90% hauv kev txheeb xyuas cov ntawv sau los ntawm AI, ua haujlwm sai dua 340 npaug—pab cov ntawv xov xwm hauv kev lim cov ntawv xa tawm AI tsis zoo.

  2. Cov Txheej Txheem Kev Kho Mob Zoo Dua

    • Kev Taw Qhia Txog "catastrophic PTE" (systolic BP <90 mmHg + SpO₂ <90%), ua rau muaj kev cuam tshuam ntawm pab pawg PERT ntau yam.
    • Txo cov koob tshuaj apixaban kom tsawg dua rau kev puas tsuaj rau lub raum (eGFR 15–29 mL/min).

V. Kev Ua Haujlwm Ua Ke: Tshem Tawm Kev Mob Thrombosis Los Ntawm Kev Koom Tes Thoob Ntiaj Teb

  1. Cov Tsev Kho Mob
    Ua kom tiav qhov kev ntsuas Caprini hauv 24 teev tom qab nkag mus rau hauv tsev kho mob rau txhua tus neeg mob. Peking Union Medical College Hospital tau txo qhov tshwm sim ntawm VTE los ntawm 52% tom qab siv cov txheej txheem no.

  2. Kev Tswj Tus Kheej ntawm Pej Xeem
    Kev txo qhov hnyav 5% rau cov neeg uas muaj BMI ntau dua 30 txo qhov kev pheej hmoo ntawm kev mob ntshav txhaws los ntawm 20%! Kev tso kev haus luam yeeb thiab kev tswj cov piam thaj hauv cov ntshav (HbA1c <7%) yog qhov tseem ceeb heev.

  3. Kev Nkag Tau Siv Tshuab
    Luam theej cov lej rau cov lus qhia txog kev tawm dag zog ntawm lub pob luj taws. Cov kev pabcuam xauj khoom siv IPC tam sim no npog 200 lub nroog.

Cov Lus Tseem Ceeb: VTE yog ib yam kab mob uas tiv thaiv tau, tswj tau thiab "tus neeg tua neeg ntsiag to." Pib nrog koj qhov kev tawm dag zog tom ntej ntawm lub pob luj taws. Pib nrog koj khob dej tom ntej. Ua kom cov ntshav ntws tau yooj yim.

Cov ntaub ntawv siv los ua piv txwv

  1. Tsoom Fwv Teb Chaws Yantai. (2024).Kev Kawm Txog Kev Noj Qab Haus Huv Txog Kev Mob Thromboembolism Hauv Venous.
  2. Cov Lus Qhia Suav rau Kev Tiv Thaiv thiab Kho Mob Thrombotic. (2025).
  3. Lub Tsev Kawm Ntawv Qib Siab Suav ntawm Kev Tshawb Fawb Lub Koom Haum ntawm Physics thiab Chemistry. (2025).Kev Txhim Kho Tshiab hauv Kev Kwv Yees Kev Pheej Hmoo VTE rau Cov Neeg Mob Cancer.
  4. Kev Kawm Txog Kev Noj Qab Haus Huv Rau Peb Pej Xeem. (2024).Kev Tiv Thaiv Kab Mob VTE Rau Cov Neeg Muaj Kev Pheej Hmoo Ntau.
  5. Tsev Kawm Ntawv Qib Siab Westlake. (2025).Daim Ntawv Qhia Txog Kev Tshawb Fawb Sai Sai ntawm GPT.
Lub sijhawm tshaj tawm: Lub Xya Hli-04-2025