Opioids (kapena opiates) ndi kalasi ya mankhwala omwe amapangidwa kuchokera ku opium poppy, kapena amapangidwa kuti apangidwe monga opioid "zachilengedwe". Opioids amagwira ntchito pomangirira mapuloteni enieni a ubongo m'mphuno ndi msana, zomwe zimachepa kwambiri kupweteka kwa ubongo, ndipo zimachepetsanso malingaliro a ululu.
Opioids akhala atagwira ntchito yofunika kwambiri pa mankhwala monga njira yamphamvu yothetsera ululu.
Komabe, opioids angayambitsenso mavuto aakulu. Mankhwalawa amamwa kwambiri. Ndipotu, kumwa mowa mankhwala opioids ndi opioids osayenera (makamaka, heroin) wakhala vuto lalikulu la anthu. Chizoloŵezi cha opioid chikuyambitsa mliri wa imfa yowonjezereka. Ku US, anthu opitirira 30,000 ophedwa ndi opioid overdoses analembedwa mu 2015 okha, malinga ndi NIH. Kuonjezera apo, malonda a opioid akubweretsa umphawi, chiwawa, kusokoneza mabanja, ndi chisokonezo china.
Kuwonjezera apo, opioids ikhoza kubweretsa mavuto ngakhale kwa anthu omwe amawatenga mosalekeza akuyang'aniridwa ndi dokotala. Mavuto oterewa akuphatikizapo kudzimbidwa , kusokonezeka, kusowa mphamvu, kugwira ntchito, ngozi ndi kuvulala, kusungidwa kwa mkodzo, ndi mavuto a mtima.
Matenda a mtima omwe amawoneka ndi opioids sadziwika bwino pakati pa anthu, kapena chifukwa cha madokotala ambiri. Ndipotu, mavuto ena a mtima omwe amagwiritsidwa ntchito ndi opioid amangozindikira tsopano.
Komabe, kwa anthu omwe ali ndi mavuto okhudzana ndi mtima wa opioid, nkhanizi zingakhudze kwambiri thanzi. Anthu omwe amagwiritsira ntchito opioids nthawi zambiri pofuna kupweteka kupweteka, ndipo madokotala omwe amawalembera, ayenera kudziwa kwambiri ngozi za mtima.
Kugwiritsa Ntchito Opioids mu Medicine
Opioids ndi othandiza makamaka poyambitsa ululu wowawa chifukwa cha matenda otha msinkhu, monga mafupa osweka kapena kupweteka kwapambuyo, komanso poletsa ululu wokhudzana ndi matenda aakulu, makamaka khansa yomaliza.
Pazifukwazi ma opioid amayamba kukhala othandiza kwambiri, ndipo (chifukwa ntchito zawo muzochitikazi ndizochepa) zoopsa zogwiritsidwa ntchito ndizochepa.
Zitha kuthandizanso pochiza zowawa zochepa komanso zopweteka kwambiri, koma kugwiritsidwa ntchito kwa mtundu uwu wa ululu ndizovuta kwambiri . Kugwiritsidwa ntchito kosatha kwa opioids kungayambitse kuchitiridwa nkhanza ndi kuledzeretsa. Izi zimagwirizana ndi mfundo yakuti opioids imaonetsa mbali yomwe imadziwika kuti "kulekerera" -ndipo, patapita nthawi anthu amafunika kuchuluka kwa ma opioids kuti akwaniritse maulendo omwe amatha kupweteka omwe poyamba anali ochepa. Kulemba ndi kutenga "zoyenera" kuchuluka kwa opioids kwa nthawi yaitali, choncho, ndizovuta. Akatswiri amavomereza kuti ngati opioids amagwiritsidwa ntchito pochiza ululu wosagwirizana ndi khansa, ntchito yawo imayang'aniridwa ndi madokotala omwe amadziwika bwino ndi kupweteka.
Ma opioids angapo amagwiritsidwa ntchito pakamwa, kuphatikizapo buprenorphine, codeine, fentanyl, Oxycontin, methadone, morphine, Percocet ndi Vicodin.
Mavuto Ambiri Amawoneka Ndi Opioid
Musanafotokoze mavuto a mtima omwe angayambitsidwe ndi opioid, zidzakhala zothandiza kulemba mavuto omwe anthu ambiri amawagwiritsa ntchito.
Monga momwe taonera, njira yomwe opioid imagwirira ntchito ndikumangiriza opioid receptors pakatikati ndi mchitidwe wamanjenje, ndipo potero amachepetsa kulingalira kwa ululu. Komabe, ngati ma opioid akugwiritsidwa ntchito, zochita zawo pamatope amatha kupanga zotsatira zina zambiri, kuphatikizapo: kuchepa, kupweteka, kupuma, kupweteka, kusokonezeka, kusanza, kubwereza ana, ndi kusokoneza.
Imfa yochokera ku opioid overdose kawirikawiri imapezeka phokoso la opioid, yomwe imapangitsa kuti kupuma kupweteke kwambiri kuti kupuma kumangoima.
Matenda a Mtima Ndi Opioid
Chifukwa cha zotsatirazi zosautsa mtima za opioids, sizingakhale zodabwitsa kuti mavuto ambiri a mtima chifukwa cha zinthu zimenezi sakuyang'anitsitsa.
Komabe, ma opioids tsopano akugwirizana ndi mitundu ingapo ya mavuto a mtima, ndipo ena mwa iwo akhoza kuopseza moyo.
Matenda a mtima okhudzana ndi opioids ndi awa:
Ntchito yovutika maganizo ya minofu ya mtima. Ngakhale ma opioids okhawo sagwira ntchito pamtundu wa minofu ya mtima kuti ikhale yogwirizana kwambiri (kutanthauza kugonana kwa mtima), zogonana zingathetsedwe pamene opioids ikuphatikizidwa ndi benzodiazepines (mankhwala monga Valium). Kuphatikizana kumeneku sikofala kwa anthu omwe amatenga opioids osatha. Kwa anthu omwe ali ndi vuto la mtima lomwe limapangitsa kuti thupi lawo lifooke, monga matenda a mtima , kuphatikiza kwa opioid ndi benzodiazepine amatha kuchepetsa kuperewera kwa mtima .
Bradycardia. Bradycardia, kapena kuchepa kwa mtima, amawoneka mwachilungamo mwa anthu omwe amatenga opioids. Kawirikawiri izi zimapangitsa kuti pang'onopang'ono pang'onopang'ono, pang'onopang'ono zimakhala zovuta kwambiri. Opioid bradycardia sizimayambitsa zizindikiro zowonongeka, koma zimapangitsa kuti thupi likhale losalekerera, popeza kuti kutentha kwa mtima sikungatheke kuwonjezera pa masewera olimbitsa thupi.
Vasodilation. Kuwongolera, kapena kuchepa kwa mitsempha ya magazi, kungayambitsidwe ndi ntchito ya opioid. Kuwongolera kumeneku kungayambitse kutaya magazi (kutsika kwa magazi). Chifukwa chakuti opioids imatha kubweretsa bradycardia pamodzi ndi vasodilation, pamene munthu pa opioids akuimirira mwamsanga angadwale mwadzidzidzi kuthamanga kwa magazi-chikhalidwe chotchedwa orthostatic hypotension . Orthostatic hypotension ingayambitse kuunika kosalala pang'onopang'ono, ngakhale ku syncope .
Ventricular tachcarcardia. Makamaka opioids awiri (methadone ndi buprenorphine) angapangitse chodabwitsa pa electrocardiogram (ECG) yotchedwa QT prolongation . Kwa anthu ena, kuwonjezereka kwa QT kungawononge mtundu woopsa wa tricycardia wotchedwa torsades de pointes. Mtundu wa mtima wamtunduwu umatulutsa mitu yambiri yamoto, syncope, kapena imfa yadzidzidzi.
Matenda a atrial. Matenda a atrial , mwamsanga, osasinthasintha mtima wamtima chifukwa cha kusokonezeka ndi chizindikiro chochepa cha magetsi mu mtima wa atria ( zipinda zam'mwamba za mtima ), wasonyezedwa kukhala mwachangu kwambiri mwa anthu ogwiritsa ntchito opioids. Anthu omwe ali ndi matenda a atrial akudwala kwambiri , ndipo mwina amavutika ndi mtima .
Matenda opatsirana. Matenda opatsirana pogonana ndi matenda owopsya a valves, kapena zinthu zina mu mtima. Ndilo vuto losazolowereka lomwe, kawirikawiri, limakhala likuwonekera kwa anthu achikulire omwe ali ndi matenda a mtima wamagetsi . M'zaka zaposachedwapa, matenda opatsirana opatsirana amatha kuwonetsedwa kwa achinyamata ambiri kusiyana ndi kale lonse-makamaka makamaka azimayi oyera. Zowonongeka pakati pa achinyamata awa omwe ali ndi matenda a endocarditis ndikuti agwiritsa ntchito opioid intravenous, makamaka heroin. Matenda opatsirana opatsirana amatha kufa kwambiri, ndipo opulumuka amasiyidwa ndi matenda aakulu a mtima.
Kuchokera kwa opioid. Kuchokera kwa opioid kungakhudze mtima, koma zizindikiro zosagwirizana ndi mtima zimakhala zolemekezeka makamaka makamaka kupuma, kupweteka kwambiri, mphuno, kupweteka, kutsekula m'mimba. Kuthamanga kwa mtima mofulumira komanso kuthamanga kwa magazi kumakhala kofala ndi kuchotsa opioid, koma zizindikirozi sizowoneka ngati zovuta monga momwe zilili ndi matenda oledzeretsa mowa. Komabe, kusanza ndi kutsekula m'mimba komwe kumayambitsa kuchotsa opioid kungayambitse kutaya thupi, kuthamanga kwa magazi, ndi kutsika kwa thupi kapena syncope. Kuwonjezera pamenepo, ngati kuthamanga kwa opioid mofulumira kumachitika mwa kupereka mankhwala odzoza opioid monga naloxone (Narcan) (omwe ndi njira yopulumutsa moyo ngati kuwonjezereka kwachitika), kuwonjezeka mwadzidzidzi mu adrenaline kungapangitse mtima kukhala wosasinthasintha.
Imfa ya mtima. Kafukufuku wofalitsidwa mu Journal of the American Medical Association mu 2016 adadodometsa ndi kudodometsa madokotala powauza kuti, pakati pa anthu omwe alandira mankhwala opioid odwala matenda osapweteka a khansa, pamakhala kuwonjezeka kwakukulu kwa imfa ya mtima, komanso kuwonjezeka kwakukulu mu zakufa zosiyana-siyana. Chifukwa cha kuchuluka kwa matenda a mtima ndi matenda osaphatikizapo opioid therapy ndizopangidwira panthawiyi. Chinthu chimodzi chokha ndichoti ntchito yaikulu ya opioid ingayambitse kupuma-kusokonezeka kupuma , matenda omwe amayamba ndi mtima wamaganizo, matenda a mtima, ndi imfa mwadzidzidzi. Komabe, kafukufuku wambiri amafunika kuti atsimikizire zomwe zapezeka pa phunziro lino, ndi kuti asokoneze zomwe zingayambitse.
Chidule
Monga zinthu zothandiza kwambiri, ma opioids-omwe amachititsa ululu wopweteka opirira mamiliyoni a anthu-akhala akudalitsidwa mwadongosolo. Kuwonjezera pa mavuto ambiri odziwika bwino omwe amagwiritsidwa ntchito ndi opioid ndizodziwika bwino kuti akhoza kupanga mitundu yambiri ya matenda a mtima. Kukhoza kwa mavuto a mtima ndi chifukwa china chomwe madokotala ndi odwala ayenera kusamala kuti azigwiritsa ntchito mankhwalawa kuti azipweteka kwambiri.
> Zotsatira:
> Opioids: Mliri wa Mankhwala Osokoneza Bongo ndi Kugonjetsedwa kwa Heroin. Dipatimenti ya zaumoyo ndi zithandizo zaumunthu. https://www.hhs.gov/opioids/.
> Ray WA. Cjung CP, Murray KT, et al. Kulemba kwa Opioid Zakale Zochita ndi Kufa kwa Odwala Amene Ali ndi Chisoni Chosawonongeka. JAMA. 2016; 315 (22): 2415-2423. lembani: 10.1001 / jama.2016.7789.
> American Pain Society mogwirizana ndi American Academy of Pain Medicine. Malangizo Othandizira Kugwiritsa Ntchito Matenda Opioid Osakaniza Osautsa Osautsa: Umboni Umboni. http://americanpainsociety.org/uploads/education/guidelines/chronic-opioid-therapy-cncp.pdf.
> Wurcel AG, Anderson JE, Chul KH, ndi al. Kukula kwa Odwala Matenda Ochepetsa Matenda Opatsirana Pakati pa Achinyamata Amene Amamwa Mankhwala Osokoneza Bongo. Tsegulani Forum Infect Dis (2016) 3 (3): ya 157. DOI: https://doi.org/10.1093/ofid/ofw157