Tlhokomelo ea Bobelehisi Maemong a Thrombophlebitis
Pendahuluan
Thrombophlebitis ke ho ruruha ha methapo e tsamaisanang le ho thehoa ha thrombus (maqeba a mali). Tabeng ea pelehi, thrombophlebitis ke bothata bo boholo nakong ea boimana, pelehi, haholo-holo nakong ea kamora ho pepa, kaha liphetoho tsa 'mele tsa boimana li eketsa tšekamelo ea mali ea ho qhoma (hypercoagulability). Boemo bona bo hloka ho tsejoa esale pele hobane bo na le kotsi ea mathata a tebileng a kang pulmonary embolism, e ka bang kotsi bophelong ba 'm'ae.
Karolo ea babelehisi e bohlokoa haholo thibelong, ho lemoha esale pele, le taolong ea pele ea thrombophlebitis, ho kenyeletsoa thuto, ho beha leihlo matšoao a kotsi, le tšebelisano-'moho le litšupiso ka nako. Sengoloa sena se tšohla ka mokhoa o hlophisehileng tlhokomelo ea babelehisi bakeng sa thrombophlebitis, ho kenyeletsoa likhopolo tsa motheo, mabaka a kotsi, matšoao le mehato.
Mehopolo ea Motheo ea Thrombophlebitis ho Obstetrics
Thrombophlebitis e ka aroloa ka mekhahlelo e 'meli e meholo: thrombophlebitis ea holimo le thrombosis ea methapo e tebileng (DVT). Thrombophlebitis ea holimo e hlaha methapong e haufi le bokaholimo ba letlalo, ha DVT e hlaha methapong e tebileng, hangata maotong. DVT e kotsi haholo hobane thrombus e ka robeha 'me ea ea matšoafong, e leng se bakang embolism ea matšoafo.
Nakong ea boimana le ka mor'a ho pepa, ho na le lintlha tse tharo tse ka sehloohong tse tlatsetsang ho thrombosis (Virchow's Triad), e leng:
1. Ho se sebetse hantle ha methapo ya madi: popelo e hodileng e hatella methapo ya madi ya pelvic e le hore ho kgutla ha methapo ya madi maotong ho diehe.
2. Ho ruruha ha mali ka bongata: liphetoho tsa lihormone le lintho tse eketsang ho hoama ha mali e le mokhoa oa ho sireletsa 'mele khahlanong le ho tsoa mali nakong ea pelehi.
3. Tšenyo ea endothelium: e ka hlaha ka lebaka la kotsi ea tsoalo, karolo ea cesarean, kapa ho kenngoa ha IV.
Mabaka a Kotsi
Babelehisi ba lokela ho tseba mabaka a kotsi nakong ea ketelo ea pelehi. Mabaka a kotsi a thrombophlebitis a kenyelletsa:
– Nalane e fetileng ea DVT/thrombophlebitis
– Kaesarean section kapa opereishene e 'ngoe
– Ho sitisa ho sisinyeha nako e telele (phomolo ea bethe)
– Botenya
– Lilemo tsa bo-mme > lilemo tse 35
– Ho tsuba
– Preeclampsia
- Methapo e matla ea varicose
– Ho felloa ke metsi 'meleng
– Tšoaetso ea puerpera
– Mathata a ho etsa madi a thibane (thrombophilia), mohlala, factor V Leiden (le hoja hangata ngaka e hlahloba lefu lena)
Ka ho tseba mabaka a kotsi, babelehisi ba ka nka mehato ea thibelo le ho eketsa temoho ea matšoao a pele.
Matšoao le matšoao
Matšoao a thrombophlebitis a ka fapana ho latela sebaka le boima ba 'mele. Matšoao a mang ao u lokelang ho a ela hloko a kenyelletsa:
– Bohloko ba maoto, ho ikutlwa bo le boima, kapa ho opeloa ke mesifa (hangata manamaneng)
– Ho ruruha leotong le leng (edema e lehlakoreng le le leng)
– Bofubelu le mofuthu sebakeng sa mothapo (se tloaelehileng haholo ho sa bonahaleng)
– Bohloko ba namane kapa mothapong
– Ho ka etsahala keketseho e nyane mochesong oa 'mele
Maemong a lebisang ho embolism ea matšoafo, matšoao a temoso a hlaha a hlokang phetisetso hang-hang:
– Ho hema ka tšohanyetso
- Bohloko ba sefuba bo bakoang ke pleuritic
– Khohlela, e ka tsamaea le mali
- Tachycardia, ho tsekela, kapa ho ferekana ha pelo
Babelehisi ba lokela ho nka matšoao ana e le a tšohanyetso.
Tlhahlobo ea Bobelehisi (Tlhahlobo)
Tlhokomelo ea bobelehisi e qala ka tlhahlobo e felletseng e kenyeletsang:
1. Ho hopola lintho
– Litletlebo tse ka sehloohong: bohloko, ho ruruha, bofubelu, ho chesa maotong
– Nako ea ho qala le ho tsoela pele ha matšoao
– Nalane ea pelehi (e tloaelehileng/e buuoang), bolelele ba ho phomola betheng, ho tsoa mali
- Sebelisa thibelo ea bokhachane ea lihormone (nakong ea kamora ho pepa)
- Nalane ea bongaka: methapo ea varicose, khatello e phahameng ea mali, DM, mathata a ho ruruha ha mali
- Nalane ea lelapa ea thrombosis
2. Tlhahlobo ea 'mele
– Matšoao a bohlokoa: khatello ea mali, ho otla ha pelo, mocheso, ho hema
– Tlhahlobo ea maoto: ho ruruha ha lehlakore le le leng, 'mala oa letlalo, methapo e hlahelletseng ea mali
– Ho hlaba ka nko: mofuthu oa sebakeng seo, bonolo, phapang ea bophara ba namane
– Tlhahlobo ea tsamaiso ea ho hema haeba ho na le litletlebo tsa ho hema ka thata
Ela Hloko: Babelehisi ba lokela ho ba hlokolosi ha ba etsa mekhoa e ka bakang ho tsoa ha thrombus. Liteko tse kang letšoao la Homans ha li sa khothaletsoa e le liteko tsa tlhahlobo ka lebaka la ho se totobale ha tsona le kotsi ea tsona.
3. Tlhahlobo ea Tšehetso (Tšebelisano-'moho)
Ho fumana hore na o na le DVT hangata ho hloka:
– Venous Doppler ultrasound (tlhahlobo ea boikhethelo)
– Liteko tse itseng tsa mali joalo ka ha ngaka e boletse
Mosebetsi oa 'melehisi ke ho thusa ho fetisetsa bakuli ho bakuli le ho netefatsa polokeho ea 'm'e.
Tlhahlobo ea Boimana le Mathata a ka Bang Teng
Ho latela tlhahlobo, mobelehisi a ka hlahisa liteko/mathata a 'maloa a pelehi, mohlala:
– Bohloko bo matla bo amanang le ts'ebetso ea ho ruruha methapong
– Ho se tsamaye hantle ha mmele ho amanang le bohloko ba maoto le ho ruruha
– Kotsi ea embolism ea matšoafo e amanang le venous thrombus
– Matšoenyeho a 'm'a mabapi le boemo boo a bo utloang
– Ho hloka tsebo ka matšoao a lemosang a thrombosis le thibelo ea ho khutla ha lefu lena
Moralo oa Tlhokomelo ea Bobelehisi
Ho rera ho shebana le polokeho ea bo-mme, ho thibela mathata le ho potlakisa ho fola.
1. Tsamaiso ea Pele (E ikemetseng ke Mobelehisi)
– Khothalletsa ho phomola ka maoto a phahamisitsoeng ho thusa ho kgutla ha methapo ya madi.
– Qoba ho silila maoto a bohloko/a ruruhileng kaha sena se ka eketsa kotsi ea embolism.
– Metjhini e futhumetseng bakeng sa thrombophlebitis e ka thusa ho fokotsa bohloko (ho latela boemo le leano la setsi).
– Ho beha leihlo matšoao a bohlokoa le matšoao a ho hema khafetsa.
– Phethahatsa litlhoko tsa metsi 'me u khothaletse phepo e leka-lekaneng ho thusa ho hlaphoheloa.
2. Tšebelisano-'moho le Litšupiso
Linyeoe tse belaelloang tsa DVT li lokela ho fetisetsoa kapele bakeng sa netefatso le kalafo. Tsamaiso ea bongaka ka kakaretso e kenyelletsa:
– Di-anticoagulant (mohlala, heparin) ho latela protocol ya ngaka
- Li-analgesics joalo ka ha ho bontšitsoe
– Tšebeliso ea likausi tse hatelletsoeng ha ho khothaletsoa
– Ho bokella butle-butle ho latela litaelo tsa basebetsi ba bongaka
Mosebetsi oa mobelehisi ke ho beha leihlo ho latela melao ea phekolo le ho ruta malapa.
3. Thuto le Boeletsi
Thuto ke karolo ea bohlokoa ea tlhokomelo ea babelehisi, ho kenyeletsoa:
– Hlalosa boemo ba thrombophlebitis le mabaka a ho hloka tlhokomelo e haufi.
– Ruta matšoao a kotsi: ho hema ka potlako, bohloko ba sefuba, ho khohlela mali, ho idibala
– Litlhahiso tsa ho tsamaisa leseli ka mor'a hore le bolokehe, qoba ho lula/ho robala nako e telele haholo
- Boloka metsi 'meleng 'me u qobe ho tsuba
– Ho latela taolo le ho nka meriana ho latela kemiso
– Tlhokomelo ea kamora ho pepa: boikoetliso bo butle-butle ba kamora ho pepa, maemo a phutholohileng a ho anyesa
Ho kenngwa tshebetsong le Tlhahlobo
Ho kenngwa tshebetsong ho etswa ho ya ka moralo ebe ho hlahlojwa ka ho tswelang pele. Ditekanyetso tsa tlhahlobo tse lebelletsweng:
– Bohloko bo fokotsehile, ho ruruha ho fokotsehile, ha ho na ho ata ha bofubelu
– Matšoao a bohlokoa a tsitsitse 'me ha ho na matšoao a ho hema hampe.
– Mme o utloisisa matšoao a kotsi mme o kgona ho hlalosa mehato ya thibelo
– Mme o latela ditaelo tsa phetisetso, ditlhahlobo le kalafo e fanwang
– Ho tsamaea ho eketseha butle-butle ho latela maemo le likhothaletso tse tsoang ho basebetsi ba bophelo bo botle.
Litokomane li lokela ho ba tse felletseng, tse hlophisehileng, 'me li tlalehe tsoelo-pele ea letsatsi le letsatsi le liphetho tsa tšebelisano-'moho.
Thibelo Mokhoeng oa Bobelehisi
Thibelo ea thrombophlebitis e etsoa ho tloha boimaneng ho isa kamora ho pepa, ho kenyeletsoa:
– Ho hlahloba mabaka a kotsi nakong ea ANC le moralo o bolokehileng oa ho pepa
– Khothaletsa ho sisinyeha ha lesea kapele ka mora ho buuoa (haholo-holo ka mor'a opereishene) ho latela maemo a amehang.
– Boikoetliso bo bonolo ba maoto (ho kobeha ha leqaqailana le katoloso) ha mme a lokela ho robala fatshe
- Fumana metsi le phepo e nepahetseng e lekaneng
– Thuto mabapi le tšebeliso ea likausi tsa khatello ha ho khothaletsoa
– Kalafo e potlakileng ea tšoaetso ea puerpera hobane tšoaetso e eketsa kotsi ea thrombosis
Ho koala
Tlhokomelo ea bo-'mè bakeng sa thrombophlebitis e hloka tlhokomelo e kholo, haholo-holo nakong ea pelehi ha kotsi ea thrombosis e eketseha. Babelehisi ba bapala karolo ea bohlokoa tlhahlobong ea pele, thibelo ea mathata, thuto le tšebelisano-'moho bakeng sa phetisetso le phekolo. Ka mokhoa o felletseng—ho tloha ho khetholleng mabaka a kotsi le ho beha leihlo matšoao haufi-ufi ho ea tšehetsong ea kelello—polokeho ea bo-'mè e ka ntlafatsoa 'me kotsi ea mathata a kang pulmonary embolism e ka fokotsoa.
Haeba o lakatsa, nka boela ka ngola mofuta wa sengoloa sena ka sebopeho sa SOAP/Varney (mehato e 7) kapa ka etsa mohlala o felletseng wa nyeoe ka tlhahlobo ya pelehi, diketso le tlhahlobo.
