Chithandizo cha kuchepa kwa mtima (DCM) - njira yowopsya ya mtima - yakula bwino kwambiri pazaka zingapo zapitazo.
Mwatsoka, kafukufuku amasonyeza kuti odwala ambiri omwe ali ndi DCM sakulandira chithandizo chimene ayenera kulandira. Pa chifukwa ichi, nkofunika kuti muzindikire za mankhwala operekedwa kwa DCM - ngati mutatsimikizira kuti dokotala wanu akuphimba zonse.
Tengerani Chifukwa Chachikulu
Lamulo loyamba pochiza DCM ndikutulukira ndikukhazikitsa chifukwa choyambitsa. Kukhazikitsa chomwe chimayambitsa kawirikawiri kawirikawiri kumachepetsa, kuimitsa, kapenanso kubwezeretsa kusintha kwa DCM. Mutha kuwerenga pano za zifukwa zambiri za DCM .
Kuchiza Mankhwala a DCM
Ophwanya Beta. Olemba Beta amachepetsa nkhawa yowonjezera pamtima, ndipo atsimikiziridwa kuti amasintha kwambiri mtima, mphamvu, komanso moyo wa odwala omwe ali ndi DCM. Ogwira ntchito ya Beta tsopano akuwoneka ngati ofunika kwambiri pochiza DCM. Coreg (carvedilol), Toprol (metoprolol), ndi Ziac (bisoprolol), ndi mabotala omwe amagwiritsidwa ntchito kwambiri ku DCM, koma ena ambiri amapezeka.
Diuretics. Diuretics , kapena "mapiritsi a madzi," ndizofunikira kwambiri kwa anthu omwe ali ndi vuto la mtima. Mankhwalawa amachititsa kuwonongeka kwa madzi kudzera impso ndi kuchepetsa kusungunuka kwa madzi ndi edema komwe kawirikawiri kumachitika ku DCM. Mankhwala ogwiritsidwa ntchito kawirikawiri amatchedwa Lasix (furosemide) ndi Bumex (bumetanide).
Mbali yawo yaikulu ndi yakuti akhoza kuyambitsa ma potaziyamu otsika, omwe angapangitse mtima wamaganizo .
ACE inhibitors. ACE inhibitors (mankhwala omwe amachititsa kuti angiotensin asinthe mavitamini ) atsimikiziridwa kuti ali othandiza kwambiri kusintha zizindikiro zonse ndi kupulumuka kwa odwala omwe ali ndi vuto la mtima. Zotsatira zake zimakhala chifuwa kapena kuthamanga kwa magazi , koma anthu ambiri omwe ali ndi DCM amalekerera ACE.
Zomwe amagwiritsidwa ntchito pogwiritsa ntchito ACE ziwalo ndi Vasotec (enalapril), Altace (ramipril), Accupril (quinapril), Lotensin (benazepril) ndi Prinivil (lisinopril).
Angiotensin II receptor blockers (ARBS). ARBS ndi mankhwala omwe amagwira ntchito mofanana ndi ACE inhibitors. Zitha kugwiritsidwa ntchito kwa anthu omwe ali ndi DCM omwe sangathe kutenga ACE inhibitors. ARBS yomwe yavomerezedwa kuti iwonongeke mtima ikuphatikizapo Atacand (candesartan) ndi Diovan (valsartan).
Aldosterone antagonists. Wachirombo (spironolactone) ndi Inspra (eplerenone) ndi aldosterone otsutsa, gulu lina la mankhwala osokoneza bongo likuwonetseratu bwino kuti apulumutse moyo mwa anthu ena omwe ali ndi vuto la mtima. Pamene angagwiritsidwe ntchito mosamala, imodzi mwa mankhwalawa imalangizidwa, kuphatikizapo ACE inhibitors (kapena mankhwala a ARB) ndi beta blocker, mwa anthu okhala ndi DCM. Komabe, ngati wodwala atha kugwira ntchito, mankhwalawa angayambitse matenda oopsa a potaziyamu. Aldosterone antagonists ayenera kugwiritsidwa ntchito mosamala kwambiri, ngati nkomwe, ntchito ya impso si yachibadwa.
Hydralazine komanso nitrates. Kwa anthu omwe ali ndi DCM omwe ali ndi zizindikiro zosavuta ngakhale kuti beta-blockers, ACE inhibitors, ndi diuretics, kuphatikiza hydralazine komanso nitrate yomlomo (monga isosorbide) akhoza kusintha kwambiri zotsatira.
Neprilysin inhibitor. Choyamba cha neprilysin inhibitors (mankhwala atsopano a mankhwala), adavomerezedwa kuti athetse vuto la mtima la FDA mu 2015. Mankhwalawa, Entresto , kwenikweni akuphatikizapo ARB (valsartan) ndi neprilysin inhibitor (sacubitril) . Maphunziro oyambirira ndi Entresto akhala akudalira kwambiri, ndipo akatswiri ena amakhulupirira kuti ayenera kugwiritsidwa ntchito m'malo mwa ACE inhibitor kapena ARB. Komabe, chidziwitso ndi mankhwalawa sichikhalapo ndipo zotsatira zake za nthawi yayitali zimakhalabe chizindikiro . Komanso mankhwalawa ndi okwera mtengo kwambiri. Choncho, masiku onse amagwiritsidwa ntchito makamaka odwala omwe sangathe kulekerera kapena kulephera kuyankha mokwanira kwa ACE inhibitors kapena ARB.
Monga momwe chidziwitso china ndi Entresto chatsopano, ntchito yake idzawonjezeka ndithu.
Ivabradine . Ivabradine ndi mankhwala omwe amagwiritsidwa ntchito kuchepetsa kuthamanga kwa mtima. Amagwiritsidwa ntchito pazikhalidwe monga sinus tachycardia , komwe mtima wamakono uli wosakwanira. Anthu omwe ali ndi DCM amakhalanso ndi mpweya wabwino kwambiri kuposa momwe amawonera kuti ndi oyenera, ndipo pali umboni wakuti kuchepetsa kuchuluka kwa mtima ndi ivabradine kungapangitse zotsatira. Akatswiri ambiri a zamoyo amalingalira kugwiritsa ntchito ivabradine mwa anthu omwe ali ndi mankhwala opatsirana ndi mankhwala ena (kuphatikizapo beta blocker) komanso amene ali ndi vuto la mtima wopuma pamwamba pa 70 kugunda pa mphindi.
Digoxin. Ngakhale kuti zaka makumi anayi zapitazi digoxin imatengedwa kuti ndiyoyi yaikulu pochiza mtima, zotsatira zake zothandizira DCM tsopano zikuwoneka kuti ndizochepa. Madokotala ambiri amapereka mankhwala okha ngati mankhwala osagwira ntchito sakuwoneka okwanira.
Inotropic mankhwala. Mankhwala osokoneza bongo ndi mankhwala osokoneza bongo omwe amachititsa kuti minofu ya mtima ikhale yogwira ntchito mwamphamvu, motero kupopera magazi ambiri. Zaka zapitazo kunali kukhudzidwa kwakukulu kwa mankhwalawa, chifukwa iwo nthawi zonse amawunikira mwamsanga ntchito ya mtima. Makina awiri a inotropic makamaka (milrinone ndi dobutamine) adagwiritsidwa ntchito kwambiri polimbitsa anthu omwe ali ndi vuto lalikulu la mtima, ndipo amagwiritsidwanso ntchito pakuthandizira kwa nthawi yaitali kwa anthu ena omwe ali ndi mtima wolephera. Komabe, kufufuza kumeneku kunasonyeza kuti anthu ankachiritsidwa ndi mankhwala osokoneza bongo - ngakhale kuti kusintha kwakukulu komwe iwo ankakumana nawo - kunali kochulukira kwambiri kufa. Mankhwalawa tsopano akugwiritsidwa ntchito kwambiri, ndipo ndi anthu omwe ali ndi mtima wolephera kwambiri omwe alephera kulabadira mankhwala ena ambiri.
Mankhwala Otsitsimutsa Maganizo a Cardiac
Thandizo lachilombo la cardiac (CRT) ndi mawonekedwe a mtima wamtima omwe amachititsa kuti onse awiri azitsulo (kumanja ndi kumanzere) panthawi yomweyo. ( Omwe amachititsa kuti ziphuphu zitsitsimutse bwino zimangoyambitsa chithunzithunzi choyenera.) Cholinga cha CRT ndi kukonza kusinthasintha kwa mitsempha, kuti lipititse patsogolo mtima. Zofukufuku ndi CRT kuti mankhwalawa, mwa odwala omwe asankhidwa bwino, amachititsa kusintha kwakukulu mu ntchito ya mtima ndi zizindikiro, amachepetsa kuchipatala, ndikulitsa moyo. Wodwala ali yense ndi DCM ndi bwalo lalikulu lachithupi ayenera kuganiziridwa kuti ali CRT.
Thandizo lokhazikitsidwa
Mwamwayi, anthu okhala ndi DCM ovuta kwambiri amakhala ndi chiopsezo chochuluka cha imfa ya modzidzimutsa kuchokera ku ventricular arrhythmias . Magetsi otchedwa cardioverter defibrillator (ICD) awonetsedwa kuti amachepetsa kwambiri imfa mwa anthu ena omwe ali ndi DCM omwe adachepetsa kwambiri magawo a ejection a ventricular ejection . Ngati muli ndi DCM, muyenera kukambirana ndi adokotala ngati ICD ndiyomwe muyenera kuiganizira.
Kusakaniza kwa mtima
Kupambana ndi kusintha kwa mtima kwapambana kwazaka makumi angapo zapitazo. Komabe, chifukwa cha chithandizo chachikulu cha mankhwalawa, komanso kuti mitima ya opereka imakhala yochepa, kusintha kwa mtima kumakhala kwa odwala kwambiri omwe ali ndi vuto la mtima. Komabe, ndizodabwitsa kuti malo ambiri opatsirana mtima apeza kuti odwala ambiri amatchulidwa ndi "mapeto a mtima wosagwira ntchito" sadayambe kulandira chithandizo chamtima chosowa mtima - ndipo pamene mankhwala oopsa akuyambitsidwa amayamba bwino kwambiri ndipo palibe amatenga nthawi yaitali kuika mtima.
Thandizo Labwino
Kafufuzidwe zambiri zikuchitika kuti mudziwe ngati mankhwala a jeni kapena mankhwala opatsirana pogwiritsa ntchito maselo angakhale opindulitsa kwa anthu omwe ali ndi DCM. Ngakhale kuti mankhwalawa akuwonetsa lonjezo, iwo ali oyambirira mu kafukufuku, ndipo sapezeka kwa odwala omwe ali ndi DCM.
Mawu Ochokera
Zofukufuku zikupitiriza kusonyeza kuti anthu ambiri omwe ali ndi vuto la mtima chifukwa cha DCM sakulandira mankhwala onse omwe ayenera kulandira. Pa chifukwa chimenechi, ngati inu kapena wokondedwa wanu muli ndi vutoli muyenera kutsimikiza kuti mumadziŵa bwino chithandizo chonse cholimbikitsidwa, ndi kuti mukambirane ndi dokotala wanu.
> Zotsatira:
> Gulu la Ntchito Yophunzira ndi Kuchiza Kulephera kwa Mtima ndi Wopanda Mtima 2008 a European Society of Cardiology, Dickstein K, Cohen-Solal A, et al. Malingaliro a ESC Ofufuza ndi Kuchiza Kulephera kwa Mtima ndi Wopanda Moyo 2008: Gulu la Ntchito Yowunikira ndi Chithandizo cha Kulephera kwa Mtima Wosatha ndi Wokhazikika 2008 ya European Society ya Cardiology. Anakhazikitsidwa mogwirizana ndi Heart Failure Association ya ESC (HFA) ndi Kuvomerezedwa ndi European Society of Intensive Care Medicine (ESICM). Mtima; 29: 2388.
> Yambani CW, Jessup M, Bozkurt B, et al. 2013 ACCF / AHA Malangizo othandizira kulamulira kwa mtima: Chidule Chachidule: Lipoti la American College Association of Cardiology Foundation / American Heart Association Task Force pa ndondomeko zoyendetsera ntchito. Circulation 2013; 128: 1810.