Kwa zaka zoposa 200, digitalis (chinthu chochokera ku chomera cha foxglove), chakhala chofunika kwambiri pakulandila matenda a mtima-makamaka mtima, kulephereka kwa thupi komanso matenda opatsirana pogonana . Digoxin (mwapafupi, mawonekedwe ogwiritsiridwa ntchito kwambiri a digitalis) akadali olembedwa kwambiri chifukwa cha zinthu ziwiri za mtima.
Komabe, m'zaka zaposachedwapa, akatswiri akhala akukayikirabe ngati digoxin iyenera kugwiritsidwabe ntchito pochiza matenda a mtima.
Pali zifukwa zikuluzikulu zotsutsa zaposachedwa zokhudza digoxin. Choyamba, mankhwala angapo atsopano apangidwa omwe mphamvu zawo zatsimikiziridwa mu mayesero a zamankhwala, pomwe mayesero osaneneka omwe amasonyeza ubwino wa digoxin akhala ochepa. Kotero zothandiza zachipatala za digoxin zafunsidwa.
Chachiwiri, digito ya digito ingakhale yovuta kupeŵa, ndipo ikhoza kukhala yoopsa kwambiri. Nthaŵi zambiri, mankhwala ena omwe sangakhale ndi poizoni angagwiritsidwe ntchito m'malo mwa digoxin.
Ngakhale mavutowa, digoxin amatha kukhala othandiza kwa anthu ena omwe ali ndi vuto la mtima kapena matenda opatsirana pogonana.
Kodi Digoxin Amagwira Ntchito Bwanji?
Digoxin ili ndi zotsatira ziwiri pa mtima.
Choyamba, imaletsa mapampu ena m'maselo a mtima, kuchepetsa kayendetsedwe ka sodium kuchokera mkati mwa maselo mpaka kunja kwa maselo. Izi zimakhala ndi zotsatira zowonjezera mphamvu ya kusweka kwa minofu ya mtima.
Choncho, minofu ya mtima yofooka imatha kupopera bwino kwambiri pamene digoxin ikuperekedwa.
Chachiwiri, digoxin imakhudza kudzimvera , kudzichepetsa ("kumenyana kapena kuthawa") ndi kukula kwa vesi ( vagal ). Kusintha kumeneku mu mawu ovomerezeka kumachepetsa kuchititsa mtima kwa magetsi pogwiritsa ntchito kachilombo ka AV kotero kuti zimachepetsa kuchepa kwa mtima kwa anthu omwe ali ndi matenda oopsa.
Mwachidule, digoxin ikhoza kusintha mtima wa mitsempha ya mtima mkati mwa anthu omwe ali ndi vuto la mtima ndipo ikhoza kuchepetsa kuthamanga mtima kwa anthu omwe ali ndi matenda oopsa.
Digoxin Toxicity
Zotsatira zoopsa za digoxin zimagwirizana ndi magulu a mankhwala. Mwamwayi, mankhwala ochizira omwe ali ndi digoxin sali osiyana kwambiri ndi magazi oopsya-kotero kusiyana pakati pa kutenga "mokwanira" digoxin ndi kumwa kwambiri digoxin nthawi zambiri ndi kochepa. "Njira yochepetsera" imeneyi imapangitsa kuti anthu ambiri azivutika kwambiri ndi digoxin.
Digoxin poizoni ndizovuta kwambiri kwa anthu omwe ali ndi vuto la impso kapena potaziyamu - zomwe zimakhala zofala pakati pa anthu omwe ali ndi mtima wosalimba komanso amene akuchiritsidwa ndi mankhwala ozunguza bongo .
Zotsatira za poizoni za digoxin zimaphatikizapo moyo wowopsya mtima wa arrhythmias , makamaka ventricular tachycardia ndi ventricular fibrillation , bradycardia yoopsa (mtima wautali wa mtima), kutaya mtima , kusowa mtima, kusanza, ndi mavuto a ubongo kuphatikizapo chisokonezo ndi kusokonezeka kwa maso. N'zochititsa chidwi kuti pafupifupi 30 peresenti ya anthu omwe ali ndi digoxin yoopsa sakhala ndi zizindikiro. Izi zikutanthawuza kuti ziwalo zoopsa za moyo zakuda zikhoza kuchitika mwa anthuwa popanda chenjezo.
Munthu akatenga digoxin, magazi amadziwika nthawi ndi nthawi kuti ayese kukhala pawindo lochepetsetsa.
Digoxin mu Treatment of Heart Imalephera
Posachedwapa zaka 30 zapitazo, digoxin (pamodzi ndi diuretics) inali njira yothandizira kwambiri anthu omwe ali ndi vuto la mtima chifukwa cha kuchepa kwa mtima -ndiko kuti, kulephera kwa mtima chifukwa cha kufooka kwa minofu ya mtima, yomwe imadziwika ndi kachigawo kakang'ono kochepa .
Koma kuyambira nthawi imeneyo mankhwala angapo atsopano apangidwa chifukwa cha kulephera kwa mtima komwe mphamvu zawo zakhala zikuwonetseredwa bwino mu mayesero ambirimbiri omwe amachititsa kuti pakhale matenda. Mankhwala omwe asonyezedwa kuti apangitse zizindikiro ndi kuwonjezeka ndi monga beta blockers , ACE inhibitors , ARB agents , ndi (posachedwa) kuphatikiza mankhwala a ARB ndi neprilysin inhibitor ogulitsidwa monga Entresto .
Kuonjezera apo, anthu ambiri omwe ali ndi mtima wokhudzidwa mtima amatha kupatsidwa mankhwala a mtima , mankhwala omwe angathe kuchepetsa kwambiri zizindikiro ndikupulumuka.
Zochitika zachipatala zasonyeza kuti, mwa anthu omwe ali ndi vuto la mtima chifukwa cha kuchepa kwa mtima, digoxin ikuwoneka kuti imapangitsa kuti zizindikiro za mtima zilephereke komanso kuchepetsa kufunika kokhala kuchipatala. Komabe, mosiyana ndi njira zina zothandizira zomwe tsopano zimagwiritsidwa ntchito mobwerezabwereza kwa mtima, digoxin sawoneka kuti ikupulumuka.
Ambiri mwa akatswiri tsopano amalimbikitsa kugwiritsa ntchito digoxin mwa anthu omwe ali ndi vuto la mtima monga mzere wachiwiri kapena mankhwala achitatu, ngati nkomwe. Izi zikutanthauza kuti digoxin imangotchulidwa kokha ngati munthu amene ali ndi vuto la mtima akupitirizabe kukhala ndi zizindikiro zazikulu ngakhale kuti ali ndi beta blocker, ACE inhibitor kapena ARB mankhwala, diuretics, ndi / kapena Entresto.
Digoxin sapereka phindu pochitira anthu omwe ali ndi mtima wolephera ndi kachigawo kakang'ono kamene kalikonse kamene kamasungidwa-ndiko kuti, anthu omwe ali ndi mtima wolephera wa diastolic . Digoxin imathandizanso kukhazikitsa anthu omwe ali ndi vuto lalikulu la mtima. Kugwiritsiridwa ntchito kwake kuyenera kukhala kokha pa kuyang'anira awo omwe ali ndi zizindikiro zosatha za kuchepa kwa mtima mtima kulephera.
Digoxin mu Chithandizo cha Matenda a M'thupi
Monga tanenera kale, digoxin imachepetsa kupangitsa magetsi kupyolera mwa nthenda ya AV, ndipo chifukwa chake, ikhoza kuchepetsa chiŵerengero cha mtima kwa anthu omwe ali ndi matenda oopsa. Popeza kuthamanga kwa mtima mofulumira ndi chifukwa chachikulu cha zizindikiro za anthu omwe ali ndi matenda a atrial , digoxin ikhoza kukhala yothandiza kuthetsa zizindikiro.
Komabe, digoxin imakhala yosafunikira kwenikweni pakuthana ndi zizindikiro kusiyana ndi magulu ena awiri a mankhwala omwe tsopano amagwiritsidwa ntchito kuchepetsa kutentha kwa mtima m'thupi, monga beta blockers, ndi calcium channel blockers . Maphunziro awiriwa amachititsa kuti mtima ukhale wochepa panthawi yopuma komanso nthawi yochita masewera olimbitsa thupi, pamene digoxin imachepetsa kupuma kwa mtima pokhapokha. Chifukwa chakuti anthu ambiri omwe ali ndi matenda a atrial akudandaula makamaka chifukwa cholephera kuchita masewera olimbitsa thupi, chifukwa cha kuwonjezeka kwa mtima wa mtima ndi maseŵera olimbitsa thupi ngakhale pang'ono, digoxin imathandiza kuti zizindikiro zawo zisamakhale bwino.
Komanso, palinso umboni wakuti kugwiritsira ntchito digoxin pofuna kuchepetsa mphamvu kwa anthu omwe ali ndi matenda oopsa a chiwindi akugwirizana ndi kuwonjezeka kwa kufa. Makamaka, mayesero a chithandizo cha 2017 akusonyeza kuti kuwonjezeka kwa kufa kumeneku ndiko kufanana ndi digoxin m'magazi-ndiko kuti, kuchuluka kwa magazi, kumakhala koopsa. Ngakhale kuti vuto lalikulu la kufa ndi digoxin sichidziwikiratu, ndilo chifukwa cha chiopsezo chachikulu cha imfa ya mwadzidzidzi kuchokera kumagido a mtima.
Akatswiri ambiri tsopano akukayikira kuti agwiritse ntchito digoxin pofuna kuchepetsa mtima wa anthu omwe ali ndi matenda a atrial. Komabe, digoxin ikhoza kukhala yodalirika ngati munthu amene ali ndi matenda a atrial akukhala ndi zizindikiro zowonjezereka zotsalira, zomwe sizimasulidwa ndi kuphatikiza kwa beta blockers ndi calcium channel blockers.
Mawu Ochokera
Posachedwa kale, digoxin inali njira yothandizira kwambiri ya mtima kusalimba komanso kupha tizilombo toyambitsa matenda. Komabe, m'zaka zaposachedwa zatsopano zakhala zikukonzedwa bwino, komanso zotetezeka kuzigwiritsa ntchito. Akatswiri ambiri akulimbikitsanso kugwiritsa ntchito digoxin okha mwa anthu omwe mankhwalawa angaperekeko phindu lapadera. Ndipo ikagwiritsidwa ntchito, iyenera kugwiritsidwa ntchito mosamala.
> Zotsatira:
> Ambrosy AP, Butler J, Ahmed A, et al. Kugwiritsira Ntchito Digoxin Kwa Odwala Amene Amapweteka Mtima Wopweteka Kulephera: Kusinkhasinkha Dokotala Wakale Kuti Apepetse Kuvomerezeka kwa Chipatala. J Am Coll Cardiol 2014; 63: 1823.
> Lopes R, Gibson CM. ARISTOTLE: Digoxin Ndipo Kufa Kwa Odwala Ndi Matenda Aakulu Amphamvu Ndi Opanda Mtima Kulephera: Kodi Serum Digoxin Imayesedwa? Mapulogalamu ndi zolemba za American College of Cardiology 66th Annual Scientific Session & Expo; March 17-19, 2017; Washington, DC. Kuyesedwa kwa kachipatala kochedwa.
> Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Malangizo Othandizira Kuzindikira ndi Chithandizo Chakumva Kwachilendo Ndiponso Kulimbana ndi Mtima Wopanda Moyo: Ntchito Yogwira Ntchito Yodziwika ndi Yopweteka Yopweteka Kwambiri Yopanda Pakati pa Mtima wa European Society wa Cardiology (ESC) Yapangidwa ndi zopereka zapadera za Heart Failure Association (HFA) ) a ESC. Mtima; 37: 2129.