Coagulation - kuyini? Kulungiswa wegazi coagulation: izinkomba futhi ulinganisele

"Coagulation - kuyini?" - babuza bemangele, ezigulini ithunyelwa ukuthatha azihlole. Eqinisweni, abantu abavamile nakudzingeka socwaningo olufanayo njalo, ngokuvamile belungiselela ukuhlinzwa kobuholi. Emblem eside asebenzayo futhi bonke abesifazane abakhulelwe. Ukuhlaziya inqubo coagulation bephethe ingane zonke senyanga.

Ngaphansi izwi usithe cwaningo namanga ukopha. Setha nemingcele wafunda ingase yehluke kuye ngesistimu elabhorethri. Uhlaziyo kuyinkomba futhi ukhiphe. Esimweni sokuqala kunqunywa kuphela lapho ngqo ukuxhumanisa ekunqandeni inqubo ukwephulwa iphutha. Coagulation efakwe - uhlobo locwaningo, okuyinto, ngaphezu qualitative izifundo ambalwa kanye zamehlo. Ingasetshenziselwa ukuhlonza platelet neziyaluyalu, thrombosis ahlukahlukene, ukuntula yezizathu ezithile ekunqandeni kanye nokunye okufana nalokho. D.

Isethi yezindlela ezisetshenziswa ukuthola umphumela incike isithombe yomtholampilo, uhlobo zokugula ukuhlaziywa. Kufanele kuqashelwe ukuthi yombhalo we coagulation igazi - lokhu kuyinselele enkulu hhayi nje ngobe kutawutfutfukisa ongelutho, kodwa ngezinye izikhathi futhi udokotela. Ngokuvamile, ukuze wenze ukusazi ngokunembile isifo esikuphethe, kuthatha izivivinyo ambalwa akhethwe kahle.

Inqubo igazi coagulation

Ake sicabangele indlela imisebenzi ekunqandeni uhlelo. In the isinyathelo sokuqala umonakalo zamakhemikhali noma mechanical ngezitsha izindonga lwabelwe thromboplastin - esikhethekile nokucupha coagulation ukuphendula. Khona-ke, ukusebenza izakhi ezijiyisayo senzeka - amaprotheni ethize evamile ekhona egazini futhi uhlinzeke indawo yokulimala bomkhumbi odongeni thrombus kumiswa.

Ngaphezu kwalokho, thrombin (isakhi yemvelo kohlelo coagulation okubangelwa prothrombin) oyenza isebenze ngasebenzi amaprotheni fibrinogen iyiguqule ku esebenzayo fibrin ihlule amafomu ngesisekelo. Izakhi igazi, kuhlanganise nama-platelet, "babanjwa" in the inethiwekhi fibrin. Ngenxa yalokho, izinhlayiya zegazi igazi ihlule usike ocindezelwe ukwakha ovuthiwe thrombus lokuvala kulimaze odongeni semithambo. Ngokuphambene, uhlelo igazi coagulation emzimbeni futhi isebenta protivosvertyvaniya uhlelo. Ngokubambisana zikuvumela ukuba silondoloze igazi esimweni esivamile.

izifundo ekunqandeni e abakhulelwe

Njengoba sekushiwo, senyanga ngayinye, futhi kwezinye izimo futhi kaningi, abesifazane abakhulelwe kufanele coagulation. Kuyini futhi kungani kudingeka, omama abakhulelwe wazi ngokuzibonela. Iqiniso liwukuthi ngesikhathi sokukhulelwa ingane umsebenzi kohlelo coagulation sisonke kuyathuthuka. Lokhu kuyinqubo engokwemvelo ezihambisana nalokho livela ukwelashwa umbuthano igazi uteroplacental. Sikamama okhulelwe ukuze ukulungiselela ekulahlekelweni okungenzeka igazi eliningi ngesikhathi sokubeletha.

Ukukhomba izici igazi ekunqandeni kanye nezinkinga ezithile yokukhulelwa ekhiqizwa coagulation. Dlula ukuhlaziywa ngesikhathi unscheduled izikhathi udokotela ungacela uma kukhona ngeziphambeko kuzihlaka evamile hemostatic (izingxenye zegazi kanye nezitsha, okuvumela nokuxhumana silondoloze ubuqotho izindonga semithambo futhi kunqandwe ukopha uma umonakalo). Igazi for the izifundo ezithathwe ekuseni esiswini esingenalutho kusukela emthanjeni.

Kulungiswa wegazi coagulation

Imiphumela cwaningo yokuhlaziya kufanele ibekelwe imingcele kuchwepheshe. Abangenakho ulwazi ekhethekile, abantu ngeke bakwazi wokufunda nemingcele coagulation futhi ukuhlola degree kwabo ukuphambuka kusuka amanani ejwayelekile. Masizame ukuqonda butholakala enqubweni eyinkimbinkimbi inqubo futhi uchaze nemingcele eziyisisekelo cwaningo.

1. fibrinogen

Lokhu namaprotheni kwemiqondo esibindini, ukuvula bedle izici ezithile igazi ukuze fibrin. Lesi sibalo kufanele sifake coagulation kwegazi. Jwayelekile fibrinogen - 2-4 g / l. Uma luyanda, kusho ekunqandeni yanda, futhi kukhona ingozi amahlule. Ngokuvamile, lesi simo kwenzeka ngaphambi kokuzalwa, inyumoniya, ngemuva kokuhlinzwa, nge ukutheleleka kanye ukuvuvukala imvelo acute (isifo sofuba, Umkhuhlane), isilethikusebenza nonhlangothi (ngosuku lokuqala), ukusha, i-hypothyroidism inzalo temlomo na estrogens. fibrinogen encishisiwe kungenzeka kubangelwa ubuthi, sibe sesomile noma isifo sokusha kwesibindi ngo ifomu ezinzima, nokuntuleka vitamin B12 noma C ethola androgens Ama-anabolic steroid, uwoyela inhlanzi, anticoagulants.

2. Kuvulwa thromboplastin ngokwengxenye isikhathi (APTT)

Coagulation uhlola ngesikhathi lapho, emva uxhumano plasma-calcium chloride kanye nezinye izinto ezakhiwe igazi ihlule. Uma okungenani oyedwa coagulation isici ngezansi kuyinsakavukela ngamaphesenti angu 30-40, aPTT ezingeni ushintsho. Izinga Isilinganiso imizuzwana 30-40. Isikhathi kungase kwandise ne vitamin K ukuntula, isifo sesibindi. Isizathu sokuba prolonging aPTT futhi umphumela njengoba, coagulation kancane kungaba hemophilia.

3. Lupus anticoagulant

Lokhu ipharamitha njalo iqukethe coagulation. Kuyini lokhu sibalo? Ngubani oyolandisa. Lokhu IgC omzimba futhi Igm, entailing ukwanda aPTT. Ngokuvamile, abesifazane abakhulelwe, akumele kukhiqizwa. Amasosha Omzimba avele uma izifo sokuhlasela kwamasosha omzimba, gestosis. Ukukhulelwa nale zokugula ngokuvamile ziphune nokuguqulwa, ukufa fetus noma infarction umzanyana.

4. Prothrombin

Kuyinto amaprotheni eziyinkimbinkimbi okungukuthi eyandulela ka thrombin (iprotheni kuvusa kumiswa amahlule). Lena ngenye yama-izinkomba ezibalulekile kakhulu coagulation. Prothrombin, ne iqhaza vitamin K is kuhlelwe umqondo esibindini. Ngemva kokuhlaziya lesi silinganiso, udokotela angase abone zokugula emathunjini ipheshana isibindi.

5. Isikhathi prothrombin

Isikhathi lapho plasma ngokungeza nalokho calcium chloride, thromboplastin futhi fibrin ihlule kwakhiwa. Lesi sibalo lubonakaliswa imizuzwana futhi ngokuvamile elilingana 11-15.

6. Prothrombin Inkomba (pti)

Coagulation ngokuvamile kuhilela ncamashi le ndlela esikhundleni lowo odlule. Lesi isilinganiso yisikhathi ekunqandeni ukopha plasma muntu ovamile plasma isiguli, wezwakalisa njengoba amaphesenti. Ngo evamile prothrombin isilinganiso kufanele ziyahlukahluka phakathi amaphesenti 93-107. Ingabe Zikhona Izimo Ezenza lokhu ipharamitha kuthiwa kwemiqondo kumaseli isibindi, isifo sesibindi inombolo yabo kuyehla, ngakho-IPT ikani ngezinga elithile ukukhonza njengephayona ipharamitha sokunquma sokusebenza zomzimba.

Uma pti lwakhula, ngakho ekunqandeni luyanda, futhi kukhona ingozi thrombosis. Ukukhula kungenzeka uma ethatha izinto zokuvimbela inzalo temlomo na ezinyangeni zokugcina bephethe ingane. Ukuncishiswa index prothrombin libonisa Ukuwohloka igazi coagulation izakhiwo. Ukwakheka prothrombin izici eziyinkimbinkimbi sincike vitamin K, Nokho kusimo yayo, malabsorption emathunjini (dysbacteriosis, enterocolitis) kanti futhi kuhambisana IPT ukunciphisa. Futhi, lokhu kungaholela ukuthatha ebulilini aspirin, isisu.

7. Thrombin isikhathi

Lesi yisikhathi lapho fibrinogen uguqulwe fibrin. Inani layo normative - 15-18 imizuzwana. Ukwanda kule Inkomba siyenzeka ngesikhathi ukuntuleka azalwa naso we fibrinogen noma umonakalo ezinzima isibindi. Ukuncishiswa ipharamitha, ie nokwehlisa thrombin isikhathi, kubonisa khona paraprotein (immunoglobulin amaprotheni) noma ngokweqile fibrinogen. Ngokuvamile, ukulawula inkomba value ngesikhatsi ukwelashwa fibrinolytics noma heparin.

8. Antithrombin III

Kuyinto inhibitor ka thrombin, uhlelo amaprotheni anticoagulation. Anakho umphumela ezicindezelayo ezikuyi-inqubo coagulation. Level Inkomba kunqunywa yokubopha thrombin ekuhlolweni isampula (okusithiyayo). Inani lesilinganiso antithrombin III - amaphesenti 71-115. Ukuncishiswa kulungiselelwa amaphesenti angu-50 ezivamile kufaka ingozi thrombosis.

Incazelo le nkomba kubalulekile ikakhulukazi kwabesifazane abakhulelwe ukuthatha anticoagulants. Le mithi asetshenziswa ingane esindayo, lapho igazi ekunqandeni luyanda, futhi kukhona ingozi kumiswa esingamahlalakhona esinomhlapho, ukukhulelwa ukunqanyulwa.

9. D-dimer

Lena inkomba kubalulekile sitholakele thrombosis, okubandakanya coagulation. Lokhu ipharamitha libonisa? He phendla izinqubo thrombosis futhi fibrinolysis. Ngokuvamile, D-dimer lingaphansi kuka 248 ng / ml. Izinga inkomba iyaqala sikhula ngezigaba zokuqala zokukhulelwa. Ukushiya ukubaluleka ipharamitha lingadlula izikhathi sokuqala emithathu kuya kwemine. Kuthathwa kuyinsakavukela. A izinga ephakeme e abesifazane nge Yiqiniso kuyinkimbinkimbi yokukhulelwa (preeclampsia), kanye labo abaphethwe isifo sezinso, isifo sikashukela.

10. Ama-platelet I

It ehilelekile ekunikezeni hemostasis platelet. Basuke kwakheka umnkantsha. Inani normative - 150-400 eziyinkulungwane / ml. Kwezinye izimo, abantu besifazane enempilo bangezwa ukwehla platelet ukubala izinkulungwane 130. / L. ukwehla okukhulu izakhi idatha igazi ngokuthi "thrombocytopenia" futhi kwenzeka ngenxa ukunciphisa ukwakheka zegazi, okwandisa ukusetshenziswa yabo noma ekubhujisweni. Nge umsoco enganele encishisiwe platelet kumiswa. Ngezinye DIC, okuzoxoxwa enzansi, kuchazwa egazi okwenyanga iyakhula.

11. DIC

Ukuxhumana ka-platelet, ezijiyisa igazi futhi inqubo fibrinolysis inikeza ukulinganisela phakathi coagulation futhi anticoagulation izinhlelo. Uma noma iyiphi yalezi izixhumanisi uzohanjiswa iziyaluyalu e sokukhulelwa kungabangela ukukhubazeka okukhulu yezinkinga esithile esingathí sina. I esiyingozi iningi labo eqonda coagulation intravascular. Kutfutfukisa ngenxa ukusebenza kwawo ohlelweni fibrinolytic futhi uhlelo coagulation. Kwabesifazane abakhulelwe, izimbangela zezinkumbulo DIC kungenzeka amniotic fluid embolism, lamabutho kwanoma yi-placenta, endometritis.

12. Lesi sifo antiphospholipid (APS)

Kuyinto eyinkimbinkimbi izimpawu agcwele thrombosis (pooling eyeqile lwemithambo). Abesifazane kanye APS abe ingozi eliphezulu kwesisu kanye okuvela isisu nokuguqulwa, ngoba kulesi simo ukwanda inani lemikhumbi umzanyana kuyaphazamiseka nokuthuthukisa esingamahlalakhona fetoplacental. Ukuxilonga anti-phospholipid syndrome, kukhuphuke thrombogenesis ngaphezu, futhi ukuthola amasosha elingaphandle igobolondo ulwelwesi (phospholipids).

Ekuphetheni

coagulation kubhekwe zinkomba alupheli. Njengoba kuphawulwe ngenhla, ukukhethwa nemingcele ethize isifundo kuxhomeke ezicini eziningana. Imiphumela yokuhlaziya kuyoba ngosuku olulandelayo ngemva kokunikeza igazi etholakalayo.