Mankhwala a Intravenous Migraine mu Chipinda Chowopsa
Nthawi zina ululu wa ululu wa migraine ndi wolimba kwambiri moti umafuna kupita kuchipatala. Kapena, nthawi zina, kunyoza ndi kusanza komwe kumaphatikizapo kuchepa kwa migraine kuchepetsa kumwa mankhwala. M'zipinda zozunzirako kapena malo ochezera osamalidwa, mankhwala oopsa a migraine amachiritsidwa ndi mankhwala osokoneza bongo. Koma ndi yani yabwino kwambiri?
Kafukufuku wina mu Neurology osapitirira 330 odwala omwe akudwala kwambiri migraine kulandira 1g sodium valproate, 10mg Reglan (metoclopramide), kapena 30mg Toradol (ketorolac).
Valimate ya sodium ndi mankhwala oletsa kupweteka omwe nthawi zina amagwiritsidwa ntchito popewera migraines. Ndipotu, American Academy of Neurology inanenanso kuti mankhwala otchedwa valproate, divalproex sodium ndi sodium valproate, ndi othandiza (Level A mankhwala) poletsa migraines. Izi zikunenedwa, ndizofunikira kuzindikira kuti valproate imatsutsana ndi amayi oyembekezera.
Reglan (Metoclopramide) ndi mankhwala odana ndi mankhwala kapena anti-nausea. Zimapangitsa dopamine receptors mu ubongo ndipo makamaka kuchepetsa gastroparesis (pamene kutaya chapamimba zili kuchedwa). Amagwiritsiridwa ntchito ngati osagwira ntchito yokhala ndi migraines m'zipinda zam'tsogolo. Zingayambitse kudzimva chisoni.
Toradol (Ketorolac) ndi NSAID ndi kuyamba mofulumira. Monga Reglan, imagwiritsidwa ntchito m'magulu opatsirana pofuna kuthandizira migraines. Kumbukirani, NSAIDs ili ndi zotsatira zingapo zovuta ndipo ziyenera kupeĊµedwa ndi anthu ena, makamaka omwe ali ndi mbiri yakupha m'mimba, matenda a impso, ndi / kapena matenda a mtima.
Kodi Phunziro la Migraine Linasonyeza Chiyani?
Phunziroli, odwala onsewa adanena kuti kupweteka kwa migraine koyambirira kwa 7 kapena kuposerapo kumapikisano oposa 0 mpaka 10, ndipo ambiri sanatenge mankhwala othandizira kuti asatengeke.
Pambuyo pa ora limodzi kulandira mankhwala atatu omwe tatchulidwa pamwambapa, omwe analandira sodium valproate amachepetsa ndi maperesenti 2,8 pomwe anthu omwe analandira Reglan ndi Toradol amacheza ndi pafupifupi 4.7 ndi 3.9.
Zotsatira za phunzirolo zinasonyezanso kuti omwe alandira sodium valproate ankafuna mankhwala owonjezera a kupulumuka (69 peresenti) poyerekeza ndi omwe analandira metoclopramide (33 peresenti) ndi ketorolac (52 peresenti). Mankhwala oteteza migraine
Pomalizira, ambiri a Reglan omwe analandira adakondwera kulandira mankhwala omwewa paulendo wa mtsogolo mwadzidzidzi poyerekeza ndi magulu awiriwa.
Zonsezi zikunenedwa, patatha maola makumi awiri ndi awiri mutatha kuchipatala, kupulumutsidwa kwa mutu kumakhala kochepa m'magulu onse atatu: sodium valproate (4 peresenti), Reglan (11 peresenti), ndi Toradol (16 peresenti) - sizinthu zambiri.
Kodi Zonsezi Zimatanthauza Chiyani?
- Reglan ndi Toradol akhoza kukhala opambana pa sodium valproate ngati mankhwala opatsirana omwe amawombera migraine m'chipinda chodzidzimutsa.
- Reglan ikhoza kukhala mankhwala ochiritsira pakati pa odwala omwe amapita ku ER kwa migraine-ngakhale kuti si lamulo lovuta komanso lokhazikika.
- Chokhumudwitsa chanenedwa apa ndikuti zambiri mwazinthuzi sizinawathandize kupweteka kwa mutu wawo. Izi zikutanthauza kuti tikusowa mankhwala abwino kuti tipeze kupweteka kwa migraineurs panthawi yovuta kwambiri.
Chophimba cha phunziro lomwe chiyenera kutchulidwa ndikuti ambiri mwa ophunzirawo sanatenge mankhwala othandiza kuti asatengeke.
Izi zimapangitsa kuti zikhale zovuta kufotokozera zotsatira kwa omwe ali ndi vuto loopsa komanso / kapena achilendo a migraine (omwe amamwa mankhwala ochizira).
Chinthu china chotsatira ndi chakuti mankhwala atatuwa ndi omwe sagwiritsidwa ntchito pochiza matenda oopsa a migraine m'chipinda chodzidzimutsa.
Njira ina yothandizira migraine mu ER ndi subcutaneous sumatriptan ( triptan yoperekedwa monga jekeseni mumatupi anu a mafuta). Mitundu ina ya antiemetic monga Compazine (prochlorperazine) ingaperekedwe, nthawi zambiri pamodzi ndi Benadryl (diphenhydramine) kuteteza zotsatira za antiemetics, monga kupuma ndi dystonia .
Dihydroergotamine ( DHE ) ingaperekedwe mu chipinda chodzidzimutsa ndipo imatha kuperekedwa ngati mankhwala amphongo, mwachangu, kapena mwachangu. DHE ikhoza kuyambitsa chisokonezo, choncho antiemetic nthawi zambiri amaperekedwa kale kuti asateteze izi.
Potsirizira pake, madokotala ena ER amaperekanso steroid yotchedwa dexamethasone ndi imodzi mwa mankhwala otchulidwa pamwambapa omwe amatha kuwathandiza kuti athe kuchepetsa kupweteka kwa mutu wake. Kutentha ndi mavitamini achinayi ndi mbali yaikulu yothandizira migraine m'chipinda chodzidzimutsa, makamaka ngati munthu ali ndi nseru ndi kusanza.
Mawu Ochokera
Ngati mutha kupita ku ER chifukwa cha mankhwala oopsa a migraine, mungalandire mankhwala opatsirana (kapena jekeseni, ngati dokotala wanu akupatsani sumatriptan). Pamapeto pake, zomwe adokotala akukupatsa ndi chisankho chodziwika payekha, pogwiritsa ntchito mbiri yako yapadera ya umoyo.
> Zotsatira:
> Bajwa ZH, Smith JH. (February 2017). Kuchepetsa mankhwala a migraine kwa akuluakulu. Mu: UpToDate, Swanson JW (Ed), UpToDate, Waltham, MA.
> Gilmore B, Michael M. > Chithandizo cha Mutu Wopweteka wa Migraine. > Am Phys Physician. 2011 Feb 1; 83 (3): 271-280.
> Friedman BW ndi al. Kuyesedwa kwapadera kwa IV valproate vs metoclopramide vs ketorolac kwachidule. Neurology. 2014 Mar 18; 82 (11): 976-83.
> Kostic MA, Gutierrez FJ, Rieg TS, Moore TS, Gendron RT. Chiyeso chotsatira, choyesedwa chokhazikika cha intravenous prochlorperazine versus subcutaneous sumatriptan mu mankhwala ovuta a migraine mu dipatimenti yosautsa. Ann Emerg Med . 2010 Jul; 56 (1): 1-6.
> Silberstein SD ndi al. Zolemba zowonjezera zowonjezera: mankhwala osokoneza bongo omwe amachititsa kuti anthu achikulire azipewa matendawa: lipoti la Quality Standards Subcommittee ya American Academy of Neurology ndi American Society Headache. Neurology 2012; 78: 1337.