Nūhou

ʻO ka hoʻoweliweli honua o ka Venous Thromboembolism (VTE)

ʻO ka Venous Thromboembolism (VTE), kahi hui make o ka Deep Vein Thrombosis (DVT) a me ka Pulmonary Embolism (PE), e koi ana ma mua o 840,000 mau ola ma ka honua holoʻokoʻa i kēlā me kēia makahiki—e like me hoʻokahi make i kēlā me kēia 37 kekona. ʻOi aku ka hopohopo, 60% o nā hanana VTE e hana ʻia i ka wā o ka haukapila, e lilo ia i kumu nui o nā make i hoʻolālā ʻole ʻia ma ka haukapila. Ma Kina, ke hoʻomau nei ka piʻi ʻana o ka nui o VTE, e hōʻea ana i ka 14.2 no 100,000 heluna kanaka i ka makahiki 2021, me ka ʻoi aku o 200,000 mau hihia maoli. Mai nā poʻe maʻi ʻelemakule postoperative a hiki i nā mea huakaʻi ʻoihana ma nā mokulele lōʻihi, hiki ke peʻe mālie nā pilikia thrombotic—he hoʻomanaʻo koʻikoʻi o ke ʻano kolohe o VTE a me ka laha ākea.

I. ʻO wai ka mea pilikia? Ke kuhikuhi ʻana i nā hui pilikia kiʻekiʻe

Pono ka makaʻala nui ʻia no kēia mau lāhui:

1. Nā "Poʻe i ʻike ʻole ʻia" e noho mau ana
   ʻO ka noho lōʻihi (>4 mau hola) e hoʻolohi nui i ke kahe o ke koko. No ka laʻana, ua loaʻa i kahi mea papahana i kapa ʻia ʻo Zhang ka pehu koke o ka wāwae ma hope o nā hoʻololi keu a ua ʻike ʻia ʻo ia me DVT—he hopena maʻamau o ka stasis venous.

2. Nā Pūʻulu Pōpilikia Iatrogenic

   • Nā Maʻi ʻoki kino: Ke kū nei nā maʻi pani hui i kahi pilikia VTE he 40% me ka ʻole o ka lāʻau anticoagulation prophylactic.
   • Nā Maʻi Kanesa: ʻO nā make e pili ana i ka VTE no 9% o nā make āpau i ka maʻi kanesa. ʻO kahi maʻi kanesa māmā i kapa ʻia ʻo Li, ka mea i loaʻa ʻole ka anticoagulation i ka manawa like i ka wā chemotherapy, ua make ʻo ia i ka PE—he moʻolelo akahele.
   • Nā Wahine Hāpai: ʻO nā loli hormonal a me ke kaomi ʻana o nā kīʻaha koko i loko o ka ʻōpū i alakaʻi i kahi wahine hāpai i kapa ʻia ʻo Liu i loaʻa koke ka dyspnea i kona trimester ʻekolu, a ma hope ua hōʻoia ʻia ʻo PE.

3. Nā maʻi maʻi mau loa me nā pilikia i hoʻohuihui ʻia
   ʻO ke kiʻekiʻe o ka mānoanoa o ke koko i nā poʻe momona a me ka maʻi diabetes, me ka emi ʻana o ka puka o ka naʻau i nā poʻe maʻi puʻuwai hāʻule, e hana i kahi ʻāina momona no ka thrombosis.

Makaʻala Koʻikoʻi: E ʻimi koke i ke kōkua lapaʻau no ka pehu koke ʻana o ka wāwae ʻaoʻao, ka ʻeha o ka umauma me ka hanu ʻana, a i ʻole ka hemoptysis—he heihei kēia me ka manawa.

II. ʻŌnaehana Palekana Pae: Mai ke Kumu a i ka Palekana Kūpono

1. Kāohi Kumu: ʻO ka "Mantra ʻEkolu Huaʻōlelo" no ka Kāohi ʻana i ka Thrombosis
   • Neʻe: E hele wāwae wikiwiki a ʻauʻau paha i 30 mau minuke i kēlā me kēia lā. No nā limahana keʻena, e hana i nā hoʻomaʻamaʻa puʻupuʻu kuʻekuʻe wāwae (10 kekona o ka dorsiflexion + 10 kekona o ka plantarflexion, hana hou ʻia no 5 mau minuke) i kēlā me kēia 2 hola. Ua ʻike ka ʻoihana kahu maʻi o ka Halemai ʻo Peking Union Medical College e hoʻonui kēia i ke kahe koko o nā lālā haʻahaʻa ma 37%.
   • Hoʻomaʻū: E inu i hoʻokahi kīʻaha wai mehana i ke ala ʻana, ma mua o ka moe ʻana, a i ka wā e ala ana i ka pō (ka huina o 1,500–2,500 mL/lā). ʻŌlelo pinepine ka kauka puʻuwai ʻo Kauka Wang i nā maʻi: "Hiki i hoʻokahi kīʻaha wai ke hoʻoheheʻe i hoʻokahi hapaʻumi o kou pilikia thrombosis."
   • ʻAi: E ʻai i ka iʻa sālemona (waiwai i ka anti-inflammatory Ω-3), nā ʻakaʻakai (kāohi ka quercetin i ka platelet aggregation), a me ka fungus ʻeleʻele (hoʻēmi ka polysaccharides i ka viscosity o ke koko).
2. Kāohi ʻana i ka mīkini: Ke hoʻokele nei i ke kahe koko me nā mea hana o waho
   • Nā Kānana Paʻa Hoʻopaʻa Puka (GCS): Ua komo kahi wahine hāpai i kapa ʻia ʻo Chen i ka GCS mai ka pule 20 o ka hāpai ʻana a hiki i ka postpartum, e pale pono ana i nā aʻa varicose a me DVT.
   • ʻO ka hoʻopili ʻana o ka Pneumatic Intermittent (IPC): Ua ʻike nā poʻe maʻi Orthopedic postoperative e hoʻohana ana i ka IPC i ka emi ʻana o 40% i ka pilikia DVT.
3. Kāohi ʻana i ka lāʻau lapaʻau: Hoʻokele Anticoagulation Stratified
   Ma muli o ka helu Caprini:

   Pae Pōpilikia	Helu Kanaka Maʻamau	Palapala Hoʻomalu Palekana
   Haʻahaʻa (0–2)	Nā maʻi ʻoki kino minimally invasive ʻōpio	Hoʻoulu mua + IPC
   Kaulike (3–4)	Nā mea maʻi ʻoki kino nui Laparoscopic	ʻEnoxaparin 40 mg/lā + IPC
   Kiʻekiʻe (≥5)	Nā maʻi hoʻololi hip/maʻi kanesa holomua	ʻO Rivaroxaban 10 mg/lā + IPC (hoʻolōʻihi 4-pule no nā maʻi kanesa)

ʻŌlelo Aʻo no ke Kūʻē: ʻAʻole i kūʻē ʻia nā anticoagulants i ke kahe koko ʻana a i ʻole ka helu platelet ma lalo o 50 × 10⁹ / L. ʻOi aku ka palekana o ka pale ʻana i ka mīkini i ia mau hihia.

III. Nā Helu Kanaka Kūikawā: Nā Hoʻolālā Palekana i Hoʻopilikino ʻia

1. Nā maʻi kanesa
   E loiloi i ka pilikia me ka hoʻohana ʻana i ke kumu hoʻohālike Khomana: ʻO kahi maʻi maʻi kanesa māmā i kapa ʻia ʻo Wang me ka helu ≥4 e koi ana i ka heparin kaumaha haʻahaʻa-molecular i kēlā me kēia lā. ʻO ka hoʻāʻo barcode PEVB hou (96.8% sensitivity) e hiki ai ke ʻike mua i nā maʻi pilikia kiʻekiʻe.

2. Nā Wahine Hāpai
   ʻAʻole kūpono ʻo Warfarin (pilikia teratogenic)! E hoʻololi i ka enoxaparin, e like me ka mea i hōʻike ʻia e kahi wahine hāpai i kapa ʻia ʻo Liu nāna i hānau palekana ma hope o ka anticoagulation a hiki i 6 mau pule postpartum. ʻO ka hānau ʻana ma Cesarean a i ʻole ka momona comorbid / makahiki makuahine kiʻekiʻe e pono ai ka anticoagulation koke.

3. Nā maʻi Orthopedic
   Pono e hoʻomau ʻia ka anticoagulation ma mua o 14 mau lā ma hope o ke pani ʻana o ka ʻūhā a me 35 mau lā no nā haki ʻūhā. Ua loaʻa i kahi maʻi i kapa ʻia ʻo Zhang ka PE ma hope o ka hoʻōki mua ʻana—he haʻawina i ka hoʻokō ʻana.

IV. Nā Hoʻohou Alakaʻi Kina 2025: Nā Holomua Holomua

1. ʻenehana nānā wikiwiki
   Loaʻa i ka Fast-DetectGPT o ke Kulanui ʻo Westlake ka pololei o 90% i ka ʻike ʻana i nā kikokikona i hana ʻia e AI, e hana ana he 340 mau manawa wikiwiki—e kōkua ana i nā puke pai i ka kānana ʻana i nā hoʻouna AI haʻahaʻa.

2. Nā Kaʻina Hana i Hoʻonui ʻia

   • ʻO ka hoʻolauna ʻana o ka "catastrophic PTE" (systolic BP <90 mmHg + SpO₂ <90%), e hoʻoulu ai i ke komo ʻana o ka hui PERT multidisciplinary.
   • Ua hōʻemi ʻia ka nui o ka apixaban i ʻōlelo ʻia no ka hōʻino ʻana o ka renal (eGFR 15–29 mL/min).

V. Hana Hui: Hoʻopau ʻana i ka Thrombosis ma o ke komo ʻana o ke ao holoʻokoʻa

1. Nā ʻOihana Ola Kino
   Hoʻopau i ka helu ʻana o Caprini i loko o 24 mau hola o ke komo ʻana no nā maʻi āpau. Ua hoʻemi ka Halemai ʻo Peking Union Medical College i ka nui o VTE ma 52% ma hope o ka hoʻokō ʻana i kēia protocol.

2. Hoʻokele ponoʻī o ka lehulehu
   ʻO ka hōʻemi ʻana o ke kaumaha he 5% i nā kānaka me BMI >30 e hoʻohaʻahaʻa i ka pilikia thrombosis ma 20%! He mea koʻikoʻi ka hoʻōki ʻana i ka puhipaka a me ka kaohi ʻana i ka glycemic (HbA1c <7%).

3. Ka Loaʻa ʻana o ka ʻenehana
   E nānā i nā code no nā kumu aʻo hoʻoikaika kino pamu kuʻekuʻe wāwae. Uhi nā lawelawe hoʻolimalima hāmeʻa IPC i 200 mau kūlanakauhale i kēia manawa.

ʻŌlelo Koʻikoʻi: He "mea pepehi kanaka leo ʻole" hiki ke pale ʻia a kāohi ʻia ʻo VTE. E hoʻomaka me kāu hoʻomaʻamaʻa puʻupuʻu kuʻekuʻe wāwae aʻe. E hoʻomaka me kāu kīʻaha wai aʻe. E hoʻomau i ke kahe ʻana o ke koko me ka manuahi

Nā Kuhikuhi

1. Ke Aupuni Kalana ʻo Yantai. (2024).Hoʻonaʻauao Ola ma ka Venous Thromboembolism.
2. Nā Alakaʻi Kina no ka Kāohi ʻana a me ka Lāʻau ʻana i nā maʻi Thrombotic. (2025).
3. Ke Kula ʻEpekema Kina o ka ʻAhahui ʻEpekema o ke Kino a me ke Kemika. (2025).Nā Holomua Hou i ka Wānana ʻana i ka Pōpilikia VTE no nā Maʻi Kanesa.
4. Hoʻonaʻauao Ola Kino Lehulehu. (2024).Ka Palekana Kumu no nā Helu Kanaka Kiʻekiʻe o ka VTE.
5. Ke Kulanui ʻo Westlake. (2025).Hōʻike ʻenehana GPT ʻIke wikiwiki.