Coagulation - yog dab tsi? Txiav suab ntawm cov ntshav coagulation: indicators thiab tus nqi

"Coagulation - yog dab tsi?" - nug nyob rau hauv surprise, cov neeg mob uas yuav xa mus rau noj xws ib tug tsom xam. Nyob rau hauv qhov tseeb, tus neeg zoo tib yuav ntsib nrog ib tug zoo xws li cov kev tshawb ncaw, feem ntau yog nyob rau hauv kev npaj rau ib hoob kev tuamyeem phais. Emblem active lub sij hawm thiab tag nrho cov cev xeeb tub cov poj niam. Analysis ntawm lub coagulation txheej txheem ntawm nqa ib tug me nyuam yog txhua txhua peb lub hlis.

Nyob rau hauv obscure lo lus txoj kev tshawb no dag los ntshav. Teem lub kawm tsis tej zaum yuav txawv nyob ntawm seb cov kev kuaj. Qhov tsom xam yog indicative thiab deployed. Nyob rau hauv thawj rooj plaub no nws yog txiav txim xwb nyob rau hauv uas ncaj qha txuas txhaws txheej txheem yuam cai tshwm sim. Coagulation deployed - hom ntawm kev tshawb fawb, uas, nyob rau hauv tas li ntawd mus tau zoo thiab ntau cov kev tshawb fawb thiab tsis xws luag. Nws yuav siv tau los qhia platelet mob, ntau yam thrombosis, tsis muaj peev xwm ntawm yam txhaws yam thiab cov zoo li. D.

Lub teeb ntawm txoj kev siv kom tau cov kev tshwm sim nyob rau hauv lub soj ntsuam daim duab, tus hom pathology tsom xam. Nws yuav tsum tau muab sau tseg tias tseem ceeb ntawm cov ntshav coagulation - qhov no yog ib tug loj kev sib tw tsis tau tsuas yog rau cov sau, tab sis tej zaum kuj rau tus kws kho mob. Feem ntau, nyob rau hauv thiaj li yuav ua ib tug muaj tseeb mob, nws yuav siv sij hawm ib tug ob peb zoo-xaiv kev ntsuam xyuas.

Tus txheej txheem ntawm cov ntshav coagulation

Cia peb xav txog yuav ua li cas lub txhaws system zog. Nyob rau hauv thawj kauj ruam ib yam tshuaj los yog cov neeg kho tshuab kev puas tsuaj rau ntsha yog faib thromboplastin - tshwj xeeb tshuaj triggering coagulation cov tshuaj tiv thaiv. Ces, kom cov txhaws yam yuav siv sij hawm qhov chaw - ib qho proteins uas feem ntau yeej ib txwm tam sim no nyob rau hauv cov ntshav thiab muab ib qhov chaw ntawm kev raug mob ntawm cov hlab phab ntsa thrombus tsim.

Ntxiv mus, thrombin (ib yam feem ntawm cov coagulation system uas ua los ntawm prothrombin) activates lub tsaug zog protein fibrinogen, converts nws mus rau hauv ib tug active fibrin los khov rau ntawd ntaub ntawv lub hauv paus. Lub ntsiab ntawm cov ntshav, xws li platelets, "entangled" nyob rau hauv lub network ntawm fibrin. Raws li ib tug tshwm sim, ntshav platelets los khov rau ntawd txiav thiab nias rau tsim ib tug paub tab thrombus kaw puas vascular phab ntsa. Rau hauv sib piv, cov ntshav coagulation system nyob rau hauv lub cev kuj tso cai protivosvertyvaniya system. Ua ke lawv tso cai rau koj los tswj kom cov ntshav nyob rau hauv ib tug ib txwm hauv lub xeev.

txhaws kev tshawb fawb nyob rau hauv cev xeeb tub

Raws li twb tau hais, txhua peb lub hlis, thiab nyob rau hauv tej rooj plaub thiab ntau zaus, cev xeeb tub cov poj niam yuav tsum coagulation. Yuav ua li cas yog nws thiab yog vim li cas yog nws tsim nyog, expectant niam paub firsthand. Qhov tseeb yog tias thaum lub sij hawm hnub tus me nyuam ua si ntawm lub coagulation system raws li ib tug tag nrho yog zoo. Qhov no yog ib tug natural txheej txheem txuam nrog dab tsi tshwm uteroplacental ntshav vajvoog kev kho mob. Lub expectant niam kom npaj rau cov ua tau tsis ntawm cov ntshav thaum lub sij hawm yog tau me nyuam.

Yuav kom qhia tau tias nta ntawm cov ntshav txhaws thiab tej yam teeb meem uas cev xeeb tub ua coagulation. Dhau tsom xam ntawm unscheduled lub sij hawm tus kws kho mob yuav nug yog hais tias muaj yog hloov los ntawm cov qub hemostatic tsis (Cheebtsam ntawm cov ntshav thiab cov hlab ntsha, uas tso cai rau kev sis raug zoo muaj lub meej mom ntawm lub vascular phab ntsa thiab tsis txhob los ntshav nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj). Ntshav rau cov kev tshawb fawb coj nyob rau hauv thaum sawv ntxov nyob rau ib npliag plab los ntawm cov hlab ntsha.

Txiav suab ntawm cov ntshav coagulation

Txoj kev tshawb no soj ntsuam ntawm txoj kev soj ntsuam yuav tsum tau txwv mus rau ib tug tshwj xeeb. Tsis muaj kev txawj ntse, cov neeg yuav tsis tau decipher lub coagulation tsis thiab ntsuam xyuas lawv cov degree ntawm txawv los ntawm cov txheej txheem qhov tseem ceeb. Cia peb ua kom to taub lub intricacies ntawm tus txheej txheem thiab piav qhia txog qhov yooj yim tsis ntawm txoj kev tshawb.

1. Fibrinogen

Qhov no protein yog tsim nyob rau hauv lub siab, txoj siav nyob rau hauv tus ntawm tej ntshav yam tseem ceeb los fibrin. Qhov no xam yuav tsum muaj xws li cov coagulation ntawm cov ntshav. Tej fibrinogen - 2-4 g / l. Yog hais tias nws yog ntau zog, qhov phem txhaws zog, thiab yog ib tug uas yuav muaj ntshav txhaws. Feem ntau, qhov no qhov teeb meem no tshwm sim ua ntej yug tus me nyuam, mob ntsws, tom qab phais, nrog kab mob thiab o ntawm mob xwm (tuberculosis, kab mob khaub thuas), heart attack myocardial infarction thiab stroke (thawj hnub), nrog rau kev kub nyhiab, hypothyroidism, qhov ncauj contraceptives thiab estrogens. Txo fibrinogen tej zaum yuav vim toxicity, mob npuas paug los yog tus kab mob siab nyob rau hauv lub loj heev daim ntawv no, ib tug tsis muaj peev xwm ntawm vitamin B12 los yog C tau txais androgens anabolic steroids, ntses cov roj, anticoagulants.

2. tshuab txais ib nrab thromboplastin lub sij hawm (APTT)

Coagulation tshuaj xyuas lub sij hawm thaum lub sij hawm uas, tom qab kev twb kev txuas rau ntshav calcium chloride thiab lwm yam tsim ntshav los khov rau ntawd. Yog hais tias tsawg kawg yog ib coagulation zoo tshaj yuav yog hauv qab no lub cai los ntawm 30-40 feem pua, aPTT theem kev hloov. Qhov nruab nrab tus nqi yog 30-40 vib nas this. Lub sij hawm tej zaum yuav ua rau kom nrog vitamin K deficiency, daim siab tus kab mob. Yog vim li cas rau tom lub aPTT thiab raws li ib tug tsim nyog tau, qeeb coagulation yuav ua tau hemophilia.

3. lupus anticoagulant

Qhov no parameter yeej ib txwm muaj cov coagulation. Yuav ua li cas yog no daim duab? Leej twg yuav qhia. Qhov no antibody IgC thiab IgM, entailing ib qho kev nce nyob rau hauv lub aPTT. Feem ntau, cev xeeb tub cov poj niam, lawv yuav tsum tsis txhob ua. Tshuaj tshwm sim nyob rau hauv cov ntaub ntawv ntawm cov kab mob autoimmune, gestosis. Cev xeeb tub nrog no pathology feem ntau ua rau txawj rho menyuam, me nyuam hauv plab tuag los yog infarction ntawm lub tsho me nyuam.

4. Prothrombin

Nws yog ib tug complex protein uas yog ib tug precursor ntawm thrombin (a protein uas nkoos tsim ntawm cov ntshav txhaws). Qhov no yog ib tug ntawm cov tseem ceeb tshaj plaws kev ntsuas ntawm coagulation. Prothrombin, nrog kev koom tes ntawm vitamin K yog tsim nyob rau hauv lub siab. Tom qab cais cov nqi no, ib tug kws kho mob tej zaum yuav qhia pathology mob huam thiab siab.

5. Lub prothrombin lub sij hawm

Lub sij hawm thaum lub sij hawm uas cov ntshav los ntawm kev ntxiv thereto calcium chloride, thromboplastin thiab fibrin los khov rau ntawd tsim. Qhov no xam yog qhia nyob rau hauv vib nas this thiab yog feem ntau sib npaug zos rau 11-15.

6. Prothrombin index (PTI)

Coagulation feem ntau yuav raws nraim qhov kev xaiv no es tsis txhob ntawm yav tas los ib. Qhov no piv yog lub txhaws lub sij hawm ntawm ib txwm tib neeg ntshav thiab ntshav ntawm tus neeg mob, qhia raws li ib feem pua. Nyob rau hauv ib txwm prothrombin piv yuav tsum sib txawv ntawm 93-107 feem pua. Yam tseem ceeb ntawm no parameter yog tsim nyob rau hauv lub siab lub hlwb, daim siab tus kab mob lawv tus xov tooj yog txo, yog li IPT can rau ib co degree pab raws li parameter rau kev txiav txim tej lub xeev ntawm lub cev.

Yog hais tias PTI nce, yog li txhaws yog nce, thiab yog ib tug uas yuav muaj thrombosis. Kev loj hlob muaj peev xwm tshwm sim thaum noj qhov ncauj contraceptives thiab nyob rau hauv lub kawg lub hlis ntawm nqa ib tug me nyuam. Yuav txo tau ntawm lub prothrombin index qhia ib tug deterioration ntawm cov ntshav coagulation zog. Cov tsim ntawm prothrombin complex yam nyob rau vitamin K, txawm li cas los nws disadvantage, malabsorption nyob rau hauv cov hnyuv (dysbacteriosis, enterocolitis) thiab tej zaum yuav entail yuav txo tau IPT. Tsis tas li ntawd, qhov no tej zaum yuav raug nyob rau hauv kev noj siab koob tshuaj aspirin, diuretics.

7. Thrombin lub sij hawm

Qhov no yog lub sij hawm thaum lub sij hawm uas tus fibrinogen yog hloov mus rau hauv fibrin. Nws normative nqi - 15-18 vib nas this. Qhov nce nyob rau hauv no Performance index yog cai nyob ib congenital tsis muaj fibrinogen los yog nyob rau hauv mob loj heev rau lub siab puas. Yuav txo tau ntawm parameter, piv txwv li lub yuav txo tau ntawm thrombin lub sij hawm, qhia lub xub ntiag ntawm paraprotein (immunoglobulin protein) los yog ib tug dhau heev lawm ntawm fibrinogen. Feem ntau, qhov taw qhia tus nqi tswj thaum lub sij hawm kev kho mob fibrinolytics los yog heparin.

8. Antithrombin III

Nws yog ib qho inhibitor ntawm thrombin, ib tug protein anticoagulation system. Nws muaj ib tug depressing ntxim rau cov coagulation txheej txheem. Theem qhia txiav txim los ntawm thwj toob ntawm thrombin nyob rau hauv lub xeem qauv (inhibition). Nruab nrab nqi ntawm antithrombin III - 71-115 feem pua. Yuav txo tau qhov chaw kawm rau 50 feem pua ntawm cov qub entails txoj kev pheej hmoo ntawm thrombosis.

Lub ntsiab txhais ntawm qhov ntsuas no yog tshwj xeeb tshaj yog ib qho tseem ceeb rau cev xeeb tub cov poj niam noj anticoagulants. Cov tshuaj siv nyob rau hauv tus me nyuam-tau cov kabmob, thaum cov ntshav txhaws yog nce, thiab yog ib tug txaus ntshai ntawm tsim ntawm placental insufficiency, cev xeeb tub txiav.

9. D-dimer

Qhov no yog ib qho tseem ceeb qhia rau cov mob ntawm thrombosis, uas muaj xws li coagulation. Qhov no qhia tau hais tias parameter? Nws qhia cov txheej txheem ntawm thrombosis thiab fibrinolysis. Feem ntau, D-dimer yog tsawg tshaj li 248 ng / ml. Cov theem qhia tau yog pib loj hlob nyob rau hauv thaum ntxov ua sawv ntawm cev xeeb tub. Yuav kom tawm hauv lub parameter nqi tej zaum yuav ntau tshaj thawj zaug peb mus rau plaub lub sij hawm. Nws yog suav hais tias yog cai. Ib tug ntau dua tus nqi nyob rau hauv cov poj niam uas nyuab kawg ntawm cev xeeb tub (preeclampsia), raws li zoo raws li cov neeg uas raug kev txom nyem los ntawm tus kab mob raum, mob ntshav qab zib.

10. platelets

Nws yog kev koom tes nyob rau hauv muab hemostasis platelets. Lawv tsim nyob rau hauv lub hlwb pob txha. Normative nqi - 150-400 txhiab / ml. Nyob rau hauv tej rooj plaub, nyob rau hauv kev noj qab nyob cov poj niam tej zaum yuav muaj ib tug txo nyob rau hauv platelet suav rau 130 txhiab. / L. Tseem Ceeb txo nyob rau hauv cov ntshav cov ntaub ntawv ntsiab hu ua "thrombocytopenia" thiab tshwm sim raws li ib tug tshwm sim ntawm kev txo lub tsim los ntawm cov qe ua ntshav khov, kom lawv noj los yog kev puas tsuaj. Nrog txaus noj haus txo platelet tsim. Thaum DIC, uas yuav tsum tau los sib tham li hauv qab no, nws yog piav zoo li tus ntshav nce.

11. DIC

Sis ntawm platelets, coagulation yam thiab fibrinolysis txheej txheem muab ib tug nqi koj tshuav ntawm coagulation thiab anticoagulation systems. Yog hais tias ib yam ntawm cov kev mus yuav undergo mob nyob rau hauv cev xeeb tub yuav ua rau tej yam teeb meem. Cov feem ntau txaus ntshai ntawm lawv yog disseminated intravascular coagulation. Nws muaj raws li ib tug tshwm sim ntawm qhov ua kom ntawm fibrinolytic system thiab lub coagulation system. Nyob rau hauv cev xeeb tub cov poj niam, cov ua DIC tej zaum yuav amniotic kua embolism, ntxov ntxov detachment ntawm lub tsho me nyuam, endometritis.

12. Lub antiphospholipid syndrome (APS)

Nws yog ib tug complex ntawm cov tsos mob uas tuab thrombosis (venous thiab arterial). Cov poj niam uas APS muaj ib tug yuav muaj nchuav menyuam thiab qhov tshwm sim ntawm txawj rho menyuam, vim hais tias nyob rau hauv cov ntaub ntawv no qhov kev nce rau hauv lub xov tooj ntawm cov hlab ntsha ntawm lub tsho me nyuam yog ntxhov thiab tsim fetoplacental insufficiency. Yuav kom kuaj anti-phospholipid syndrome, nce thrombogenesis nyob rau hauv tas li ntawd, kuj ntes tshuaj mus rau lub plhaub week (phospholipids).

Nyob rau hauv xaus

coagulation xam tau tias yog ntsuas yog tsis exhaustive. Raws li sau tseg saum toj no, cov kev xaiv ntawm kev tsis rau txoj kev tshawb no yog nyob ntawm ntau yam. Tau ntawm tus tsom xam yuav muaj ib hnub tom ntej tom qab muab cov ntshav.