Komanso Kulonjeza kwa Dyusautonomi Zina, monga POTS ndi Vasovagal Syncope
Tchimo labwino la tachycardia (IST) ndilo chikhalidwe chodziwika ndi kuthamanga kwa mtima mofulumira (tachycardia), pokhapokha panthawi yopumula ndi panthawi yomwe ikugwira ntchito, zomwe zimakhudza achinyamata omwe ali ndi thanzi labwino. Anthu omwe ali ndi vuto la IST amadwala kwambiri komanso amalephera kupirira, ndipo vutoli likhoza kulepheretsa.
Chithandizo choyenera cha IST, mwatsoka, nthawi zambiri chimakhala chovuta.
Ivabradine ndi mankhwala atsopano ogulitsidwa kuti athetse angina ndi mtima kulephera. Zaka zaposachedwapa ivabradine wasonyeza lonjezo lalikulu pa chithandizo cha IST. Malipoti amasonyeza kuti zingakhalenso zothandiza kwa ma syndromes ena a dysautonom yomwe nthawi zambiri tachycardia imakhala yotchuka.
Kodi Ivabradine Amagwira Ntchito Motani?
Ivabradine imalepheretsa ineyo njira, chingwe mu maselo omwe amalola sodium ndi potaziyamu kuti alowe m'maselo. Ineyo ("f" imatanthauza "zoseketsa," otchulidwapo chifukwa njirayi imachita mosiyana ndi njira zina zambiri), imakhala ndi gawo lalikulu pakuphwanya mfundo za sinus , zomwe zimayendetsa chikhalidwe cha mtima. Poletsa njira yanga, ivabradine amachepetsa chiwerengero cha kuwombera kwa nthenda ya sinus, ndipo motero amachepetsa kuthamanga kwa mtima. Njira imeneyi yochepetsera mtima wa nthenda ya sinus ndi yosiyana kwambiri ndi njira zomwe beta blockers ndi calcium channel blockers zimagwiritsira ntchito , choncho ivabradine nthawi zambiri amachititsa kuchepa kwa mtima ngakhale pamene mankhwala enawa sakulephera.
Ivabradine adayambitsidwa kuti apange angina ndipo adavomerezedwa kuti azigwiritsidwa ntchito padziko lonse lapansi mu 2005. Inavomerezedwa ku US mu April 2015 kuti athetse vuto la mtima , koma osati la IST.
Ivabradine Mu IST
Malipoti angapo ang'onoang'ono - kawirikawiri akufotokoza odwala amodzi kapena awiri - anayamba kuwonekera posachedwa mankhwalawa atalowa ntchito zamagetsi, kutanthauza kuti ivabradine ikhoza kuthandiza pochiza odwala omwe ali ndi IST.
Kenaka, mu 2012, mayesero ogwiritsidwa ntchito mosamala kwambiri, omwe anawongolera malo omwe anagwiritsidwa ntchito ku Italy, adachokera ku Italy, zomwe zanenedwa kuti Ivabradine ingakhale yothandiza kwambiri pa vutoli. Odwala a IST omwe amadziwika kuti ivabradine amasonyeza kuchepa kwa chiwerengero cha 75%, ndipo 50 peresenti ya odwala amavomereza kuti nthawi yomweyo amatha kusintha. Zotsatirapo zinali zochepa. Poyerekeza ndi zomwe zimawoneka ndi mankhwala ena ogwiritsidwa ntchito pa IST, zotsatira zake zimakhala zovuta.
Mayesero atsopano omwe sanagwiritsidwe mwachangu ndi ivabradine odwala 24 omwe ali ndi IST anawonetsa zotsatira zabwino zomwezo. Mu mayeserowa, komabe mankhwalawa anaimitsidwa kwa odwala 10 patatha chaka chimodzi kuti aone zomwe zidzachitike (odwala ena anakana kusiya kumwa mankhwala), ndipo 8 mwa odwala 10 awa analibe kachiwiri kwa IST.
Ivabradine kwa POTS ndi Vasovagal Syncope
Matenda a Post-orthostatic tachycardia (POTS) ndi vasovagal syncope ndi zina ziwiri za dysautonomia syndromes zomwe sinus node tachycardia nthawi zambiri zimakhala ndi mbali yaikulu popanga zizindikiro. Kotero n'zosadabwitsa kuti madokotala angasankhe kuyesa ivabradine muzinthu izi.
Palibe deta yeniyeni yogwiritsira ntchito ivabradine kwa POTS, koma madokotala padziko lonse agwiritsa ntchito mankhwala osankhidwa omwe ali ndi vutoli.
Deta yomwe ilipo, komabe, ikusonyeza kuti, mwa anthu ena, kuyang'anira tachycardia ndi ivabradine kungachepetse kapena kuthetsa zizindikiro zina zogwirizana ndi POTS. Kuyesedwa kwachidziwitso kwa ivabradine kwa POTS tsopano kukuchitika mu Israeli.
Ngakhale vasovagal syncope ikugwirizanitsa ndi kuchepa kwakukulu m'magazi a magazi ndipo (kawirikawiri) muyezo wa mtima, zimadziwika bwino kuti asanatayike (ndiko kuti, panthawi ya "zizindikilo" zomwe anthu amavutika nazo), Kawirikawiri kuthamanga kwa mtima mofulumira kumakhalapo. Mu kafukufuku woyendetsa wa odwala 25 omwe ali ndi vasovagal syncope omwe adawonetsa tachycardia yotereyo isanakwane, oposa 70% anali ndi zotsatira zabwino ndi ivabradine - mwina kuchepetsa kapena kuthetsa zizindikiro.
Kotero, ivabradine imasonyeza lonjezo lenileni la ma dysautonomias omwe sinus tachycardia ndi mbali yaikulu.
Zotsatira Zotsatira za Ivabradine
Chokhacho chowoneka bwino chotchedwa side effects chimaimbidwa ndi ivabradine, chomwe chimapezeka pafupifupi 15% mwa odwala, ndi maonekedwe omwe amatchedwa "chowala." Chodabwitsa ichi chikufotokozedwa kuti chiri ndi "kuwala" kosaoneka bwino m'masomphenya, popanda kusintha kwawonekedwe . Zikuganiza kuti zimachokera mwa kutseka kanjira m'maselo a retina omwe ali ofanana ndi ine mu mtima. Mwamwayi, mbali iyi imakhala yofatsa ndipo nthawi zambiri imathetsa ndekha. Lipoti lina laposachedwapa limasonyeza kuti odwala omwe ali ndi mankhwalawa akhoza kukhala ndi chiopsezo chowonjezereka cha matenda opatsirana pogonana . Zovuta zina zochepa zomwe zimakhalapo zimaphatikizapo kupweteka mutu komanso chizungulire. Chiwerengero chonse cha mankhwalawa ndi bwino kulekerera.
Ivabradine ku US
Ngakhale kuti mankhwalawa akhala akugwiritsidwa ntchito kwa zaka zoposa khumi ku Ulaya, ku Asia, ku Russia, Australia, ndi ku Canada, adavomerezedwa ku USA mu April 2015. Komanso, chovomerezeka chokha chovomerezeka ndi ivabradine ku US pofuna kuchiza mtima kulephera. (Ivabradine imagulitsidwa ndi Amgen, pansi pa dzina la malonda Corlentor.)
Ngati mumakhala ku US ndipo muli ndi IST (kapena imodzi mwa ma dysautonomias omwe angayankhe mankhwalawa), ndipo ngati dokotala wanu akukhulupirira kuti ivabradine ingakhale yopindulitsa kwa inu, iye akutha kuilemba. Komabe, popeza ivabradine imangotchulidwa kuti mtima ukulephera ku US, dokotala wanu ayenera kukhala wokonzeka kuupereka kwa ntchito "yolemba". Mulimonsemo, ivabradine tsopano ndi njira yabwino ngakhale kwa Amwenye omwe ali ndi IST.
> Zotsatira:
> Cappato R., Castelvecchio S., Ricci C., Kachipatala ka Ivabradine Pakati pa Odwala Amene Ali ndi Tchimo Losafunika Tachycardia: Cholinga, Chokhazikika, Chachidindo, Chokhazikika, Kudzala Mtengo. J Am Coll Cardiol. 2012; 60: 1323-1329.
> Benezet-Mazuecos J1, Rubio JM, Farré J, et al. Zotsatira Zakale za Ivabradine mu Sinus Yosafunika Tachycardia Odwala: Ogwira bwino kapena Odwala Osafunika. Pacing Clin Electrophysiol. 2013 Jul; 36 (7): 830-6. onetsani: 10.1111 / kuyenda 12118. Epub 2013 Mar 19.
> McDonald C, Frith j, Newton JL. Chidziwitso Chokhazikika cha Ivabradine mu Postural Orthostatic Tachycardia Syndrome. Europace (2011) 13 (3): 427-430. do: 10.1093 / europace / euq390.
> Sutton R1, Salukhe TV, Franzen-McManus AC, et al. Ivabradine mu Chithandizo cha Sinus Tachycardia Mediated Vasovagal Syncope.Europace. 2014 Feb; 16 (2): 284-8. lembani: 10.1093 / europace / eut226. Epub 2013 Sep 26.