Amiodarone (Cordarone, Pacerone) ndi mankhwala ogwiritsidwa ntchito kwambiri omwe amapangidwanso kuti azitsatira mtima wamaginthmias . Mwatsoka, imakhalanso mankhwala oopsa kwambiri a antiarrhythmic , ndipo zimakhala zovuta kwambiri kugwiritsa ntchito mosamala. Zotsatira zowonjezereka za amiodarone zimaphatikizapo mavuto a chithokomiro, ndalama zomwe zimayambitsa mavuto osokoneza maso, mavuto a chiwindi, kusinthasintha kwa khungu kwa khungu, ndi photosensitivity (mosavuta dzuwa).
( Werengani ndemanga yowonjezera ya amiodarone kuno .) Chifukwa ngati zingathe kupanga mitundu yosiyanasiyana ya poizoni, amiodarone iyenera kulamulidwa kwa anthu omwe akuika moyo wawo pangozi kapena kulepheretsa kwambiri arrhythmias, komanso omwe alibe njira zina zothandizira.
Mbali yowopsya kwambiri ya amiodarone, pofika kutali, ndi pulmonary (mapapo) poizoni.
Kodi Amiodarone Lung Toxicity ndi chiyani?
Amiodarone poizoni toxicity mwina amatha kufika 5% odwala kumwa mankhwalawa. Sitikudziwika ngati mavuto a m'mapapu amayamba ndi amidodone amatha kuwonongeka ndi mankhwala ku mapapu a mapapo, kuteteza chitetezo cha mthupi kwa mankhwala, kapena njira ina. Amiodarone ingayambitse mavuto ambiri a mapapo, koma nthawi zambiri vuto limatenga njira imodzi.
1) Mtundu woopsa kwambiri wa amiodarone poizoni wa poizoni ndiwodzidzidzimutsa, wowopsa, wowopsa, wowopsa, woopsa wa mapapu wotchedwa acute respiratory distress syndrome (ARDS) .
Pokhala ndi ARDS, kuwonongeka kumachitika kumagulu a mapepala a mpweya, kumapangitsa kuti matumbawo azidzaza ndi madontho, ndipo zimapangitsa kuti mapapu athe kusintha mpweya wokwanira m'magazi. Anthu omwe amapanga ARDS amamva dyspnea mwadzidzidzi (kupuma pang'ono). Kawirikawiri amayenera kuikidwa pamakina opanga mpweya, ndipo chiwerengero cha anthu omwe amafa ali ndi mankhwala aakulu kwambiri, akufikira 50%.
ARDS yokhudzana ndi amiodarone imawonekera kawiri kawiri pakutsata opaleshoni yayikulu, makamaka opaleshoni ya mtima, koma ikhoza kuwonedwa nthawi iliyonse ndipo popanda zifukwa zomveka zowonongeka.
2) Mchitidwe wochuluka wa amiodarone poizoni wa m'mapapo ndi vuto lopanda mapapu lomwe limatchedwa interstitial pneumonitis (IP) . Mu mkhalidwe umenewu, mpweya wa m'mapapu umaphatikizapo kupanga maselo ofiira ndi osiyanasiyana opweteka, omwe amachititsa kuti kusintha kwa mpweya kukhale m'mapapu. IP nthawi zambiri imayamba mofulumira komanso pang'onopang'ono, pang'onopang'ono ikuyenda dyspnea , chifuwa komanso kutopa mwamsanga. Popeza anthu ambiri omwe amatha kukhala ndi amiodarone ali ndi mbiri ya mavuto a mtima, zizindikiro zawo n'zosavuta kulakwitsa mtima (kapena nthawi zina, zotsatira za ukalamba). Pa chifukwa ichi, IP nthawi zambiri imasowa. Zili choncho kawirikawiri kuposa momwe amaganizira.
3) Zochepa kwambiri ndizo "chitsanzo" chotchedwa pneumonia (chomwe chimatchedwanso kukonza chibayo) nthawi zina chimapezeka ndi amiodarone. Mu chikhalidwe ichi, chifuwa cha x-ray chimasonyeza malo omwe mumakhala nawo pafupi ndi omwe amawoneka ndi chibayo cha bakiteriya . Pa chifukwa ichi, mtundu uwu wa amiodarone poizoni wa poizoni nthawi zambiri umakhala wolakwika chifukwa cha chibayo chabakiteriya ndipo amachizidwa moyenera.
Nthawi zambiri zimakhala ngati chibayo chikulephera kusintha ndi ma antibiotic omwe amazindikira kuti mankhwalawa ndi amyodarone.
4 ) Kawirikawiri, amiodarone ikhoza kupanga pululu yodzipatula yomwe imapezeka ndi chifuwa cha x-ray. Unyinji nthawi zambiri umaganizira kuti ndi chotupa kapena matenda, ndipo pokhapokha ngati biopsy imatengedwa ndi amiodarone poizoni poizoni potsiriza anazindikira.
Kodi Amiodarone Lung Toxicity Amadziwika bwanji?
Palibe zovuta zenizeni zomwe zimayambitsa matendawa, ngakhale zili ndi zizindikiro zamphamvu zomwe zingapezeke pofufuza maselo a mapapu omwe amachokera ku chiwopsezo kapena m'mapapo (kuthamanga mpweya ndi madzi), kawirikawiri pogwiritsa ntchito bronchoscopy .
Chinthu chothandizira kupeza mankhwala a ammonoarone m'mapapo, komabe, tiyenera kukhala tcheru kuti zitheke. Kwa aliyense kutenga amidodarone, poizoni wa m'mapapo ayenera kuganiziridwa mozama pa chizindikiro choyamba cha vuto. Zizindikiro zosadziwika za pulmonary zomwe palibe chifukwa china chingadziwike ziyenera kuonedwa ngati mankhwala omwe amachititsa kuti mankhwala a lungodarone awonongeke, ndipo kuimitsa mankhwalawa kuyenera kuganiziridwa mozama. (Ngati mukutenga amiodarone ndikuganiza kuti mwina mukukula vuto la mapapo, lankhulani ndi dokotala musanayambe mankhwala anu nokha.)
Ndani Ali Pangozi?
Aliyense amene amatenga amiodarone ali pachiopsezo cha poizoni poizoni. Anthu omwe ali ndi mlingo waukulu (400 mg pa tsiku kapena kuposa), kapena amene akhala akumwa mankhwalawa kwa miyezi 6 kapena kuposerapo, kapena omwe ali ndi zaka zoposa 60 akuwoneka kuti ali ndi chiopsezo chachikulu. Umboni wina umasonyeza kuti anthu omwe ali ndi vuto la mapapu osakanikirana amakhalanso ndi vuto la pulmonary ndi amiodarone.
Ngakhale nthawi zambiri kuyang'anira anthu kutenga amidodarone ndi chifuwa cha x-rays ndi pulmonary ntchito zowonetsera nthawi zambiri zimasonyeza kusintha komwe kumachitika chifukwa cha mankhwalawa, ochepa chabe a anthuwa amapitiriza kukhala ndi poizoni wowonongeka. Ngakhale kuti nthawi zambiri chifuwachi chimagwiritsidwa ntchito kwa anthu omwe amamwa mankhwalawa, palibe umboni wosonyeza kuti kuwunika koteroko kumathandiza pakuzindikira omwe potsiriza adzakula mavuto ambiri, kapena omwe ayenera kusiya kumwadiododone chifukwa cha "pofika" poizoni poizoni.
Kodi Amiodarone Lung Toxicity Amachitidwa Bwanji?
Palibe mankhwala enieni omwe asonyezedwa kukhala othandiza. Chofunika kwambiri cha mankhwala ndi kusiya amiodarone.
Mwatsoka, zimatengera miyezi yambiri kuchotsa thupi la amiodarone pambuyo pa mlingo womaliza. Kwa odwala ambiri omwe ali ndi mitundu yochepa ya ma poizoni (IP, omwe amachititsa chibayo, kapena mapulisa), komabe mapapo nthawi zambiri amatha kusintha ngati mankhwala atayimitsidwa. Amiodarone iyeneranso kuimitsidwa odwala omwe ali ndi ARDS, koma pakadali pano, zotsatira zowonjezereka zamagetsi nthawi zonse zimatsimikiziridwa bwino pamaso pa mayodarone.
Mankhwala apamwamba a steroid nthawi zambiri amaperekedwa kwa odwala omwe ali ndi ARDS, omwe ali ndi adidarone, ndipo pamene pali zochitika zina zomwe zimapindula ndi mankhwalawa, kaya steroids kwenikweni amapanga kusiyana kwakukulu sichidziwika. Steroids imagwiritsidwanso ntchito pa mitundu yonse ya mankhwala a ammonodarone poizoni, koma kachiwiri, umboni wakuti iwo ndi othandiza mu zinthu izi ndi ochepa.
Mawu Ochokera
Pali zifukwa zomveka kuti amiodarone poizoni poizoni ndizowopsezedwa kwambiri ndi mankhwalawa. Ukhondo wamadzimadzi sungadziŵikire. Zingakhale zoopsa komanso zakupha. Zingakhale zovuta kudziwa, ndipo palibe chithandizo chapadera kwa icho. Ngakhalenso poizoni wamapapu ndilo chokhacho choopsa kwambiri cha amidodarone (chomwe sichiri chomwecho), ichi chokha chiyenera kukhala chokwanira kuti madokotala asafune kugwiritsa ntchito mankhwalawa pokhapokha ngati n'kofunikiradi.
> Zosowa
> Jackevicius CA, Tom A, Essebag V, et al. Kuwonjezeka kwa chiwerengero cha anthu ndi ziopsezo za chiopsezo chotchedwa pulmonary Toxicity Associated with Amiodarone. Am J Cardiol 2011; 108: 705.
> Hudzik B, Polonski L. Amiodarone-inachititsa kuti Pulmonary Toxicity. CMAJ 2012; 184: E819.
> Papiris SA, Triantafillidou C, Kolilekas L, et al. Amiodarone: Ndemanga za Zotsatira za Uzirombo ndi Zoopsa. Mankhwala osokoneza bongo 2010; 33: 539.
> Schwaiblmair M, Berghaus T, Haeckel T, et al. Kuchokera kwa poizoni wochititsa chidwi ndi Amiodarone: Kodi Mvula Yodziwika Ndi Yovuta Kwambiri? Chipatala cha Car Resol 2010; 99: 693.