
shiraparak ghanastrata

shiraparak ghanastrata ack thrombus (rakt kaa thakka) key kaaran honey vaali nus kii rukawat haye. shiraparak ghanastrata kaa ack samanya roop gahari nus ghanastrata (dee. vee. tii.) haye, jaba gahari nason mein rakt kaa thakka banata haye. yadi ack thrombus toot jaataa haye (ambolize) aur vahaan rahane key liye fefadon mein bahata haye, tou yeh ack fuffusiya ambolism (pee. ee.) bunn jaataa haye, joe fefadon mein rakt kaa thakka haye. kewal dee. vee. tii. kii sthitiyaan, pee. ee. key saath dee. vee. tii., aur pee. ee. kewal, sabhi venus thromboembolism (vee. tii. ee.) shabd dwara abhigrahit kii jaati hain.
vee. tii. ee. key liye praarambhik upchaar aamtaur parr yaa tou cumm-aanvik-vajan vaale heprin (ell. aim. doubleu. aich.) yaa unfractionated heprin, yaa teji seey pratyaksh abhinay maukhik anticoagulants (dee. oh. aeye. see.) key saath hotaa haye. jinn logon kaa shuru mein heprin seey ilaaj kiya jaataa haye, unhein anya anticoagulants (warferrin, doek) mein badala jaa sakata haye, halanki garbhavati mahilaaon aur cancer seey peedit kuchh logon koo heprin kaa ilaaj jaari rahata haye. satahi shiraparak ghanastrata yaa flabitis oopari yaa nichale chhor kii satahi nason koo prabhaavit kartaa haye aur kewal vishisht sthitiyon mein anticoagulation kii aavashyakta hoti haye, aur iska ilaaj kewal virodhi-soojan dard raahat key saath kiya jaa sakata haye.
shiraparak ghanastrata key anya cumm samanya roop hain, jinamen seey kuchh fuffusiya antahsraaveeta kaa kaaran bhee bunn sakate hain. shiraparak ghanastrata aur satahi shira ghanastrata lagbhag 90 pratishat shiraparak ghanastrata key liye jimmedaar hain. anya durlabh roopon mein retina nus ghanastrata, macenteric nus ghanastrata (jathrantra angon seey rakt nikaalane vaali nason koo prabhaavit karna), mastishk shiraparak ghanastrata, gurde kii nus ghanastrata aur andashay kii nus ghanastrata shamil hain.
vargeekaran.
samanya roop.
satahi shiraparak ghanastrata asuvidha kaa kaaran banati haye lekin aam taur parr gambhir parinam naheen hoti haye, jaisa kii gahari nus ghanastrata (dee. vee. tii.) joe pairon kii gahari nason mein yaa shroni nason mein banati haye. phir bhee, way chhidrakaari nason key madhyam seey gahari nason mein aage badh sakate hain yaa, way mukhya roop seey fefadon key ambolism key liye jimmedaar hoe sakate hain yadi thakka kaa sir nus kii deewaar seey kharaab tareeke seey judaa huaa haye aur safeno-femoral junction key paas sthit haye.
jaba rakt kaa thakka toot jaataa haye aur rakt mein yatra kartaa haye, tou ise thromboembolism kahaa jaataa haye. dee. vee. tii./pee. ee. kaa sankshipt naam ack vee. tii. ee. koo sandarbhit kartaa haye jahan ack gahari nus ghanastrata (dee. vee. tii.) fefadon (pee. ee. yaa fuffusiya ambolism) mein chully gaee haye.
choonki nasein hriday mein rakt lautaati hain, yadi ack nus mein baney rakt key thakke kaa ack tukada toot jaataa haye tou ise hriday key daahine taraf leey jaaya jaa sakata haye, aur vahaan seey fefadon mein. thrombus kaa ack tukada jise iss tarah seey leey jaaya jaataa haye, ack "ambolus" haih ack thrombus banaane kii prakriya joe ambolic bunn jaati haye, usey "thromboembolism" kahaa jaataa haye. fefadon mein rahane vaalaa ack ambolism ack "pulmonary ambolism" (pee. ee.) haye. fuffusiya ambolism ack bahut hii gambhir sthiti haye joe ambolus key aayamon key aadhar parr ghaatak hoe sakati haye.
durlabh roop.
jabaki pairon kaa shiraparak ghanastrata sabse aam roop haye, shiraparak ghanastrata anya nason mein hoe sakati haye. inmein vishesh jokhim kaarak hoe sakate hainh
paaramparagat ambolism.
shiraparak mool kaa pranaaleegat ambolism ack alind yaa nilay septal dosh vaale rogiyon mein hoe sakata haye, yaa fefadon mein ack dhamani sambandh, jisake madhyam seey ack ambolus dhamani pranali mein jaa sakata haye. aisee ghatana koo virodhabhasi ambolism kahaa jaataa haye. jaba yeh mastishk kii rakt vaahikaon koo prabhaavit kartaa haye tou yeh aghaat kaa kaaran bunn sakata haye.
kaaran.
shiraparak ghanastrata mukhya roop seey shiraparak sthirikaran aur atee-cogulability key sanyojan key kaaran hoti haye-lekin kuchh hudd taka endothelial kshati aur sakriyan. sthirikaran key teen kaarak, atee-cogulability, aur rakt vahika kii deewaar mein parivartan varcho key trayi kaa pratinidhitva karate hain, aur vahika kii deewaar mein parivartan sabse cumm samajhe jaate hain. vibhinn jokhim kaarak kissy ack vyakti key ghanastrata vikasit karane kii sambhavana koo badhaate hainh
jokhim kaarak.
mishrit.
sanyukt maukhik garbh nirodhakon key vartamaan upayog mein prati 100,000 mahila varshon mein shiraparak ghanastrata kaa samagr jokhim lagbhag 60 haye, jabaki gair-upayogkartaon mein 30 haye. thromboembolism kaa jokhim vibhinn prakaar kii janm niyantran goliyon key saath bhinn hotaa haye; levonorgestrail (ell. aine. jee.) yukt sanyukt maukhik garbh nirodhakon kii tulanaa mein, aur astrogen kii samaan khuraak aur upayog kii avadhi key saath, norethisterone key saath sanyukt maukhik garbh nirodhakon key liye gahari nus thrombosis kii darr 0.98 haye, noragestate 1 key saath, disogestrail (dee. aiss. jee.) 1.82 key saath, gastodine 1.86 key saath, drospirone (dee. aar. aiss. pee.) 1.64 key saath, aur cyproterone acetate 1.88 key saath. harr saal prati 100,000 garbhavati mahilaaon mein 100-200 mein shiraparak thromboembolism hotaa haye.
parivarik itihas key sambandh mein, umr kaa kaafee prabhaav parivartan hotaa haye. dou yaa dou seey adhik prabhaavit bhaai-bahanon vaale logon key liye, sabse adhik ghatana darr una 70 varsh kii ayu key logon mein paaee jaati haye (purushon mein 390 prati 100,000 aur mahilaaon mein 370 prati 100,000), jabaki prabhaavit bhaai-bahanon key binaa logon kii tulanaa mein sabse adhik ghatana anupaat bahut cumm umr mein huaa (20 seey 29 varsh kii ayu key purushon mein 4.3 aur 10 seey 19 varsh kii ayu kii mahilaaon mein 5.5 kaa anupaat).
pathophysiology.
dhamani ghanastrata kaise hoti haye, iss baat kii samajh key vipareet, jaise kii dill key daure key saath, shiraparak ghanastrata kaa gathan achchi tarah seey samajha naheen jaataa haye. dhamani ghanastrata key saath, rakt vahika kii deewaar koo nuksan honah aavashyak haye, kyonki yeh jamaavat shuru kartaa haye, lekin adhikansh shiraparak ghanastrata binaa kissy ghayal upkala key roop mein hoti haye.
laal rakt koshikaaen aur fibrin shiraparak thromby key mukhya ghatak hain, aur thromby rakt vahika kii deewaar endothelium seey judataa huaa dikhaai detaa haye, joe aamtaur parr ack gair-thrombogenic satah hoti haye, jisamen fibrin hotaa haye. shiraparak thromby mein platelets downstream fibrin seey judate hain, jabaki dhamani thromby mein, way core kii rachana karate hain. kull milakar, platelets dhamani kii tulanaa mein shiraparak thromby kaa cumm gathan karate hain. maanaa jaataa haye kii yeh prakriya ootak kaarak-prabhaavit thrombin utpaadan dwara shuru kii jaati haye, jisase fibrin jamaa hoe jaataa haye.
nason key valve vee. tii. deeksha kaa ack maanyata praapt sthal hain. rakt pravaah pattern key kaaran, valve sinus kaa aadhar vishesh roop seey oxygen (hypoxic) seey vanchit haye. staces hypoxia koo badhaata haye, aur yeh sthiti shwet rakt koshikaon (leukocytes) aur endothelium key sakriyan seey judee hui haye. vishesh roop seey, hypoxia-inducible factor-1 (aich. aaee. aff.-1) aur praarambhik vikas pratikriya 1 (ee. jee. aar.-1) key dou maarg hypoxia dwara sakriya hotey hain, aur way monocyte aur endothelial sakriyan mein yogdan karate hain. hypoxia pratikriyaasheel oxygen prajaati (aar. oh. aiss.) utpaadan kaa bhee kaaran banata haye joe aich. aaee. aff.-1, ee. jee. aar.-1, aur paramanu kaarak-κb (aine. aff.-κb) koo sakriya curr sakata haye, joe aich. aaee. aff.-1 pratilekhan koo niyantrit kartaa haye.
aich. aaee. aff.-1 aur ee. jee. aar.-1 maarg endothelial protein key saath monocyte sambandh kaa kaaran banate hain, jaise kii pee-selectin, monocytes koo ootak kaarak seey bharey microvasicals koo chhodane key liye prerit kartaa haye, joe sambhavatah endothelial satah koo baandhane key baad fibrin jamaav (thrombin key madhyam seey) shuru karate hain.
roktham.
kaee davaaon koo ack vyakti key vee. tii. ee. honey key jokhim koo cumm karane key liye dikhaaya gayaa haye, halanki yeh taya karane key liye saavdhaanipoorvak nirnay lene kii aavashyakta haye kii kyaa ack vyakti key vee. tii. ee. honey kaa jokhim adhikansh thrombophrophaxis upchaar drishtikon (venus thrombosis koo rokane key liye davaaen) seey judey jokhimon seey adhik haye. yeh anushansa kii jaati haye kii logon koo shiraparak ghanastrata key lagaatar uchch jokhim key liye unake aspatal seey chhutti parr mulyankan kiya jaanaa chaahiye aur joe loga hriday-swasth jeevan shally apanaate hain, way shiraparak ghanastrata key apane jokhim koo cumm curr sakate hain. american college off physician kii naidaanik neeti mein kissy bhee pradarshan upaayon key liye samarthan kii kamee kaa ullekh kiya gayaa haye joe doctors koo jokhimon koo dhyaan mein rakhe binaa saarvbhaumik prophylaxis lagu karane key liye protsaahit karate hain.
shalya chikitsa.
sakshya shalya chikitsa key baad una logon mein heprin key upayog kaa samarthan karate hain jinhen dee. vee. tii. key jokhim koo cumm karane key liye ghanastrata kaa uchch jokhim hotaa haye; haalaanki, paces yaa samagr mrityu darr parr prabhaav gyaat naheen haye. aspatal mein bharti gair-shalya chikitsa rogiyon mein, mrityu darr mein koee badalaav naheen dikhaai detaa haye. haalaanki, yeh lakshanaatmak dee. vee. tii. kii darr koo cumm karane key liye dikhaai naheen detaa haye. heprin aur sampeedan stocking donon kaa upayog karna dee. vee. tii. kii darr koo cumm karane mein akele ack seey behtar prateet hotaa haye.
gair-shalya chikitsa sthitiyaan.
aspatal mein bharti logon mein jinhen aghaat huaa haye aur jinaki shalya chikitsa naheen hui haye, yaantrik upaayon (sampeedan stocking) key parinamswarup twacha koo nuksan huaa haye aur koee naidaanik sudhaar naheen huaa haye. binaa aghaat key aspatal mein bharti gair-shalya chikitsa rogiyon key beach sampeedan stocking kii prabhavsheelta parr detta durlabh haye.
american college off physician (aeye. see. pee.) ney gair-shalya chikitsa rogiyon mein vee. tii. ee. kii roktham parr madhyam gunavatta vaale sakshya key saath teen majboot sifaarishen deenh
vayaskon mein jinake nichale pair koo ack saptah seey adhik samay taka dhaala gayaa, braced yaa anyatha sthir kiya gayaa haye, ell. aim. doubleu. aich. gahari nus ghanastrata key jokhim aur gambhirta koo cumm curr sakata haye, lekin fuffusiya ambolism kii ghatnaaon parr koee prabhaav naheen padata haye.
pahale seey.
poorv vee. tii. ee. vaale logon mein warfarin key puuraa honey key baad, deerghakaalik aspirin kaa upayog fayademand saabit huaa haye.
cancer.
jinn logon koo cancer haye, unamen vee. tii. ee. kaa khatra adhik hotaa haye aur way anticoagulant nivaarak upchaar aur roktham upaayon key prati alag-alag pratikriya dey sakate hain. american society off hematology dridhata seey sujhaav detee haye kii cancer key liye chemotherapy seey gujarane vaale loga jinhen thrombosis (thrombophrophylaxis) koo rokane key liye davaaon seey bachane kaa cumm jokhim haye. cancer key liye chemotherapy seey gujarane vaale logon key liye jinhen aspatal mein rahane kii aavashyakta naheen hoti haye (joe ambulatory dekhbhal seey gujar rahey hain), yeh sujhaav dene key liye cumm nishchit pramaan hain kii pratyaksh kaarak xa avrodhakon key saath upchaar seey rogsoochak rogon koo rokane mein madad mill sakati haye, haalaanki iss upchaar drishtikon seey placebo dawa kii tulanaa mein ack badey raktasraav key jokhim mein vriddhi bhee hoe sakati haye. yeh sujhaav dene key liye majboot saboot hain kii ell. aim. doubleu. aich. rogsoochak vee. tii. ee. koo rokane mein madad kartaa haye, haalaanki yeh upchaar drishtikon placebo dawa kii tulanaa mein ack badey raktasraav key uchch jokhim key saath bhee aataa haye yaa vee. tii. ee. koo rokane key liye koee upchaar naheen haye.
joe loga cancer kii shalya chikitsa karaa rahey hain, unake liye yeh anushansa kii jaati haye kii way ack vee. tii. ee. koo rokane key liye anticoagulation therapy (adhimaantah ell. aim. doubleu. aich.) praapt karein. ell. aim. doubleu. aich. kii sifarish cancer sergery key baad cumm seey cumm 7-10 dinon key liye kii jaati haye, aur sergery key baad ack maheene key liye una logon key liye kii jaati haye jinhen vee. tii. ee. aiss. kaa uchch jokhim hotaa haye.
upchaar.
americi sakshya-adharit naidaanik dishanirdesh 2016 mein vee. tii. ee. key upchaar key liye prakaashit kiye gaye they. britten mein, rashtriya swaasthya aur dekhbhal utkrishtata sansthaan (achchha) dwara dishanirdesh 2012 mein prakaashit kiye gaye they, 2020 mein adyatan kiye gaye they. inn dishaanirdeshon mein ghanastrata key durlabh roop shamil naheen hain, jisake liye aksar ack vyaktigat drishtikon kii aavashyakta hoti haye. kendriya aur shakha retina nus avrodh seey anticoagulation seey laabh naheen hotaa haye jaisa kii anya shiraparak ghanastrata kartaa haye.
anticoagulation.
yadi naidaanik pareekshan teji seey naheen kiya jaa sakata haye, tou kaee anubhavjanya upchaar parr shuru kiye jaate hain. paaramparik roop seey yeh heprin thaa, lekin kaee doek koo praarambhik heprin upayog key binaa upchaar key liye licenses praapt haye.
yadi heprin kaa upayog vee. tii. ee. key praarambhik upchaar key liye kiya jaataa haye, tou cumm aanvik-vajan vaale heprin (ell. aim. doubleu. aich.) key saath nishchit khuraak rakt key thakkon koo cumm karane mein unfractionated heprin (yuu. aff. aich.) kii samaayojit khuraak kii tulanaa mein adhik prabhaavi hoe sakati haye. mrityu darr mein koee antar, pramukh raktasraav kii roktham, yaa ell. aim. doubleu. aich. aur yuu. aff. aich. key beach aavarti seey vee. tii. aiss. koo rokane mein koee antar naheen dekhaa gayaa. yuu. aff. aich. (twachiya yaa antahshira) key prashaasan key maarg mein koee antar naheen paaya gayaa haye. ell. aim. doubleu. aich. koo aamtaur parr ack upcharm injection dwara prashaasit kiya jaataa haye, aur ack vyakti key rakt key thakke key karakon kii yuu. aff. aich. key saath utani bariki seey nigrani naheen kii jaani chaahiye.
ack baar nidan kii pushti hoe jaane key baad, chala rahey upchaar kii prakriti aur isaki avadhi key baare mein nirnay lene kii aavashyakta hoti haye. cancer key binaa logon key liye sanyukt raajya america kii sifaarishon mein warferrin yaa cumm aanvik vajan vaale heprin (ell. aim. doubleu. aich.) key bajaay doacus dabigatron, rivaroxaban, epixaban, yaa adoxaban key saath anticoagulation (dawa joe aage rakt key thakkon koo banane seey rokti haye) shamil haye.
cancer seey peedit logon key liye, ell. aim. doubleu. aich. kii sifarish kii jaati haye, halanki adhikansh sthitiyon mein doek surakshit dikhaai dete hain. cancer vaale logon mein deerghakaalik upchaar key liye, vitamin key virodhi kii tulanaa mein ell. aim. doubleu. aich. shayed vee. tii. ee. aiss. koo cumm karane mein adhik prabhaavi haye. cancer vaale logon koo nivaarak anticoagulation dawa lete samay bhee, vee. tii. ee. episode ("aavarti vee. tii. ee.") kaa anubhav karane kaa adhik jokhim hotaa haye. inn logon koo ell. aim. doubleu. aich. dawa kii chikitsiya khuraak dee jaani chaahiye, yaa tou kissy anya anticoagulant seey switch karke yaa ell. aim. doubleu. aich. kii adhik khuraak laker.
garbhavastha mein, warferrin aur doek koo upayukt naheen maanaa jaataa haye aur ell. aim. doubleu. aich. kii sifarish kii jaati haye.
ack chhote seey fuffusiya ambolism aur kuchh jokhim karakon vaale logon key liye, kissy anticoagulation kii aavashyakta naheen haye. haalaanki, jinn logon mein jokhim kaarak hain, unamen anticoagulation kii sifarish kii jaati haye.
thrombolysis.
thrombolysis dawa (ack punarsanyoji enzyme) kaa prashaasan haye joe shareer key mukhya enzyme plasmin koo sakriya kartaa haye joe rakt key thakkon koo todata haye. isamen raktasraav kaa khatra hotaa haye aur isaliye yeh una logon key liye aarakshit haye jinake paas thrombosis kaa ack roop haye joe badee jatilataon kaa kaaran bunn sakata haye. fuffusiya ambolism mein, yeh una sthitiyon mein lagu hotaa haye jahaan fefadon key madhyam seey rakt pravaah kii kamee ("badey paimaane parr" yaa "uchch jokhim" fuffusiya ambolism) key kaaran hriday kaary seey samjhauta kiya jaataa haye, jisase nimn raktchaap hotaa haye. yadi post-thrombotic syndrome kaa mahatvapurna jokhim haye tou gahari nus thrombosis key liye thrombolysis kii aavashyakta hoe sakati haye. thrombolysis koo antahshira catheter dwara seedhe thakke mein prashaasit kiya jaa sakata haye ("catheter-nirdeshit thrombolysis"); isake liye dawa kii cumm khuraak kii aavashyakta hoti haye aur isamen cumm raktasraav kaa jokhim hoe sakata haye lekin isake laabh key liye sakshya seemit haye.
nimnatar vena kaava filter.
joe anticoagulant parr hain, unamen nimnatar vena kaava filter (ivcfs) kii sifarish naheen kii jaati haye. aaee. vee. see. aff. aiss. kaa upayog naidaanik sthitiyon mein kiya jaa sakata haye jahaan ack vyakti koo fuffusiya ambolism kaa anubhav karane kaa uchch jokhim hotaa haye, lekin raktasraav key uchch jokhim key kaaran anticoagulants parr naheen hoe sakata haye, yaa unamen sakriya raktasraav hotaa haye. yadi aaee. vee. see. aff. kaa upayog kiya jaanaa chaahiye tou punah praapt karane yogya aaee. vee. see. aff. kii sifarish kii jaati haye, aur jaba filter kii aavashyakta naheen hoti haye tou usey hataane key liye ack yojana banaai jaani chaahiye.
satahi shiraparak ghanastrata.
jabaki satahi shiraparak ghanastrata key liye saamyik upchaar vyaapak roop seey upayog kiye jaate hain, heprin jaisi dawa fondaparinax (ack kaarak xa avarodhak) key liye saboot sabse majboot haye, joe satahi shiraparak ghanastrata key vistaar aur punaravritti koo cumm kartaa haye aur saath hii saath rogsoochak ambolism kii pragati koo bhee cumm kartaa haye.
purvanuman.
binaa ukasaave key ack prakaran key baad, upchaar puuraa karane key baad aage key prakarnon kaa jokhim badh jaataa haye, halanki yeh jokhim samay key saath cumm hoe jaataa haye. duss varshon mein, 41 pratishat purush aur 29 pratishat mahilaaen aage key prakaran kaa anubhav karane kii ummeed curr sakate hain. pratyek prakaran key liye, mrityu kaa jokhim 4 pratishat haye.