Kuwonetsetsa zotsatira za mankhwala kungakhale kofunika pamene mukumwa mankhwala ena
Dokotala wanu wa IBD nthawi zambiri amapereka mayesero kuti ayang'ane matenda, komanso kuti aone momwe mankhwala akugwiritsidwira ntchito komanso ngati ali ndi mavuto ena pa ziwalo zina kapena ziwalo zina za thupi. Anthu omwe ali ndi matenda opatsirana (IbD) amachiritsidwa ndi mankhwala osiyanasiyana, omwe ambiri amakhala ndi njira zosiyanasiyana zochitira thupi.
Kawirikawiri, zotsatira zovuta ndizochepa, koma zimatha kugwidwa mofulumira kotero zimakhala zoyenera kupanga mayesero kuti chithandizo chikuyenda bwinobwino.
Malangizo a kuyesa musanayambe mankhwala ena ndi awa: zitsogozo. Dokotala aliyense ndi IBD adzachita zinthu mosiyana. Komabe, ndikofunika kuti anthu omwe amakhala ndi IBD azifotokoza mwachidule zomwe zingachitike ngati atayamba mankhwala ena. Izi ndizowona makamaka ngati sizikuwonekera pa malo a IBD kapena ngati chisamaliro chachikulu chikuyang'aniridwa ndi wina wa gulu (monga internist kapena dokotala wamkulu wa chisamaliro).
Anthu omwe ali ndi matenda a Crohn kapena ulcerative colitis omwe ali ndi mafunso okhudza ntchito ya labu ndi mayesero ena operekedwa poyesa kumwa mankhwala a IBD ayenera kufunsa madokotala awo.
Mukatenga Azulfidine (Sulfasalazine)
Azulfidine ndi mankhwala osakaniza a sulfa omwe ali ndi 5-aminosalicylic acid (5-ASA) ndi sulfapyridine.
Amagwiritsidwa ntchito pochizira matenda a ulcerative komanso matenda ena opweteka monga nyamakazi ya nyamakazi ndi ankylosing spondylitis .
Mankhwalawa ali ndi mbiri yakale yogwiritsira ntchito chitetezo cha zilonda zam'mimba, koma tsopano sagwiritsidwa ntchito mobwerezabwereza ngati mankhwala atsopano omwe ali othandiza kwambiri ndipo amakhala ndi zotsatira zochepa (kumutu ndi kupwetekedwa mtima).
Kawirikawiri, mayesero owonetsetsa kupatulapo kuwerengera kwa CBC sali ovomerezedwa makamaka pamene alandira mankhwalawa.
Magazini Yonse a Blood Cell (CBC)
Mayeso a magazi angapangidwe musanayambitse mankhwala ndi Azulfidine ndipo kenaka sabata iliyonse kapena mwezi uliwonse kwa milungu isanu ndi umodzi yoyamba kufika miyezi itatu. Pambuyo pake, mayeserowo angapangidwe mwezi uliwonse kwa miyezi itatu ndipo patatha miyezi itatu iliyonse yotsatizana ndi Azulfidine.
Izi ndizowona zotsatira zochepa zomwe zimakhala zovuta monga kuchepa kwa maselo oyera a magazi (chikhalidwe chimatchedwa agranulocytosis). Ambiri mwa agranulocytosis amapezeka miyezi itatu yoyambirira ya chithandizo.
Mukatenga Corticosteroids
Kugwiritsira ntchito mankhwala a steroid nthawi yaitali ngati mankhwala a IBD, koma amagwiritsidwa ntchito nthawi zina kapena mankhwala ena. Chimodzi mwa zinthu zofunika kwambiri ndi kugwiritsidwa ntchito nthawi zonse ndi prednisone ndi chiopsezo cha mafupa.
Absolptiometry Yachiwiri-Mphamvu Yopangira Matenda (DEXA)
Pulogalamu ya DEXA ingalimbikitsidwe musanayambe mankhwala a corticosteroid. Pambuyo pake, zikhoza kuchitanso kachiwiri pakatha zaka ziwiri kapena zitatu, kapena mwamsanga kwa anthu omwe ali ndi matenda otupa mitsempha kapena omwe ali ndi chizindikiro china cha mafupa, monga kupasuka.
Ngati zotsatira za DEXA zikusonyeza kuti pali fupa lakutha, chithandizo chingayambe ndi mayesero ena angathe kuchitidwa.
Mukatenga Cyclosporine
Cyclosporine ndi mtundu wa mankhwala osokoneza bongo omwe amachepetsa chitetezo cha mthupi. Nthawi zina amagwiritsidwa ntchito pozilonda za zilonda zam'mimba ndi matenda a Crohn, komanso kuteteza kukanika kwa thupi pambuyo poika ndi zina zotupa monga lupus, nyamakazi ya nyamakazi, ndi psoriasis. Mayesero angapo angathe kulamulidwa panthawiyi.
Mayeso a Cyclosporine Mlingo
Pofuna kuonetsetsa kuti mankhwalawa ali m'thupi kuti akhale ogwira ntchito, kapena kuti mankhwala osokoneza bongo sakhala okwera kwambiri ndipo amachititsa mavuto, zotsatira za mankhwala zingafunikire kuyeza kupyolera mu kuyesa magazi.
Matupi a anthu amachitanso mosiyana ndi mankhwala ndi magawo m'magazi angakhudzidwe ndi zifukwa zambiri.
Kumayambiriro kwa mankhwala ndi cyclosporine, kuyezetsa kumachitika kawirikawiri tsiku ndi tsiku mpaka mlingo woyenera ukwaniritsidwe. Pambuyo pake, kuyezetsa kumachitika mlungu uliwonse, mwezi uliwonse, kapena kuposa nthawi zambiri. Zingathe kubwereranso ngati pali kusintha, ngati zizindikiro zimakhala zovuta kapena mankhwala ena amafunika ndipo zimakhudza msinkhu wa cyclosporin.
Kuwerengera kwa CBC
Kawirikawiri kafukufuku wamagaziwa amasiyana chifukwa cha dokotala wokonda, koma kawirikawiri, kuchuluka kwa maselo oyera a magazi, maselo ofiira a magazi, hemoglobin, ndi hematocrit adzayesedwa nthawi ndi nthawi.
Kulimbana
Odwala angapemphedwe kuti atenge mkodzo kwa urinalysis . Zotsatira za mayesowa zingathandize kuwunika mavuto a impso ndi chiwindi. Zitha kulamulidwa nthawi zambiri pamene zimatenga cyclosporine kuti zitsimikizireni kuti mankhwalawa sagwiritsa ntchito ziwalozo.
Mayesero Ena a Magazi
Pofuna kutsimikiza kuti cyclosporin sichivulaza, dokotala akhoza kulamula mayeso ena kuti ayang'ane ntchito ya impso ndi chiwindi, kuphatikizapo magazi a urea nitrogen (BUN) , bilirubin, magnesium, potassium uric acid, lipids, ndi michere ya chiwindi .
Kutenga Imuran (Azathioprine)
Imuran (azathioprine) ndi mankhwala osamalidwa bwino a antitimetabolite omwe amauzidwa kuti azichiza IBD ndi zinthu zina zotupa monga nyamakazi ya nyamakazi. Imuran ikhoza kugwiritsidwa ntchito yokha kapena nthawi imodzimodzi monga mankhwala ena (monga corticosteroids) kuti athandize mankhwalawa kugwira bwino ntchito. Pamene akulandira Imuran, odwala adzayang'anitsitsa kwambiri zotsatira zake.
Kuwerengera kwa CBC
Kwa mwezi woyamba, mayeso a magaziwa akhoza kuchitidwa mlungu uliwonse, kutsatiridwa ndi sabata iliyonse m'mwezi wachiwiri ndi wachitatu, ndiyeno patatha mwezi uliwonse. Ngati pali kusintha kwa mlingo, ndondomeko ya sabata iliyonse ndi sabata iliyonse ikhoza kuyambanso.
Mbali ya Thiopurine Methyltransferase (TPMT)
Mayesowa angapangidwe musanalandire mankhwala alionse a thiopurine omwe akuphatikizapo Imuran, mercaptopurine (6-MP) , ndi thioguanine. Mbidzi ya TPMT imayang'aniridwa kupyolera mwa kuyesedwa kwa magazi, koma ngati kuyesedwa kwa chibadwa kumayesedwa kungathe kukwanilitsidwa mwa kuswa maselo ena mkati mwa tsaya.
Ndikofunika kuti mayesowa athetsedwe musanayambe kumwa mankhwala kuti mupeze chithunzi chenicheni cha enzyme ya TPMT. Mayesowa amachitika chifukwa TPMT ndi enzyme m'thupi lomwe limaphwanya Imuran ndi mankhwala ena ofanana. Ngati mlingo wa TPMT mu thupi ndi wochepa kwambiri (umene umapezeka pafupifupi 10 peresenti ya anthu) kapena otsika kwambiri (omwe amapezeka pafupifupi 0,3 peresenti ya anthu), kutenga mankhwala a thiopurine ngati Imuran kungabweretse mavuto aakulu.
Mukatenga Mankhwala ndi Zina 5-ASA Mankhwala Osokoneza Bongo
Pali mitundu yambiri yokonzekera ya mesamiine yogwiritsira ntchito matenda a zilonda zam'mimba, ndipo mankhwalawa angaperekedwe pamlomo kapena mu enema. Mesalamine ndi mankhwala osokoneza bongo 5 omwe ali ndi zotsatira zochepa kuposa Azulfidine chifukwa mulibe gawo la sulfa.
Chiwerengero cha CBC ndi chiyeso cha ntchito ya chiwindi chingathe kumaliza musanayambe mankhwalawa kuti mupeze msinkhu woyamba. Komabe, palibe malangizo oti apitirize kuyesedwa pa mankhwala. Mayeso amodzi omwe angapangidwe kawirikawiri ndi mlingo wa creatinine.
Creatinine Level
Mesalamine ndi mankhwala othandizira omwe amatengedwa nthawi yaitali. Mlingo wa creatinine ukhoza kulamulidwa musanayambe kumwa mankhwala, pa masabata sikisi, pa miyezi isanu ndi umodzi, chaka chimodzi, ndi chaka chimodzi.
Mlingo wa creatinine umagwiritsidwa ntchito kuthandizira kuwunika kwa zotsatira zosavuta zomwe mphuno zimatuluka, zomwe zimatchedwa interstitial nephritis. Ngati mankhwala osokoneza bongo akuphatikizidwa, mankhwala omwe ali ndi mesalamine amaletsedwa.
Pogwiritsa Ntchito Methotrexate
Methotrexate ndi mankhwala osokoneza bongo omwe amagwiritsidwa ntchito pochiza matenda a Crohn, matenda a anthlosing, nyamakazi, ndi psoriasis. Awonetseredwa kuti amachititsa kuti mwana asamwalire choncho samayenera kutengedwa ndi amayi omwe ali ndi mimba kapena amene akufuna kutenga pakati. Ndikofunika kukambirana njira zothandizira kubereka musanayambe kumwa mankhwalawa.
Chiyeso cha Mimba
Musanayambe methotrexate, yesero la mimba likhoza kulamulidwa kuti liwonetsetse kuti ndibwino kutenga mankhwalawa. Mankhwalawa angayambitse kuperewera kwa amayi komanso zolepheretsa kubadwa. Methotrexate imadutsanso mkaka wa m'mawere, motero sizowonjezedwa kuti ugwiritsidwe ntchito ndi amayi oyamwitsa. Kuyezetsa mimba kungapangidwenso panthawi yonse yogwiritsira ntchito mankhwala ngati n'kofunikira.
Chifuwa cha X-ray ndi / kapena Mphungu Zoyesayesa Ntchito
Methotrexate ingakhudze mapapo ndipo kotero musanayambe kumwa mankhwala, mayesero kuti ayang'ane mapapu angathe kulamulidwa. Izi zingaphatikizepo kampani ya carbon monoxide ndikuyesa kuyesa kuti palibe vuto la mapapu lomwe silinayang'ane, makamaka kwa anthu omwe amasuta kapena omwe amasuta fodya kale.
Kuwerengera kwa CBC
Kuchuluka kwa magazi kudzachitidwa musanayambe mankhwala othandizira, ndikuthetsanso kachiwiri pambuyo pa sabata limodzi ndi pakati pa masabata asanu ndi atatu ndi masabata 12 pambuyo pake. Khungu lachizungu loyera limawerengera pamene limatenga methotrexate silinasonyezedwe kwa odwala omwe ali ndi IBD, koma chachitika kwa odwala ali ndi nyamakazi.
Pulogalamu Yamakono Yambiri
Mayesowa angaphatikizepo BUN, carbon dioxide (CO2), creatinine, shuga, cholesterol, albumin, electrolyte, michere ya chiwindi, ndi mahomoni a chithokomiro. Izi ndizowona zotsatira zake zomwe zimayambitsa chiwindi ndi impso. Mayesowa akhoza kuchitika miyezi itatu iliyonse pamene methotrexate ikutengedwa.
Chiopsezo cha Chiwindi
Ngati chiwindi cha nkhuku chikuwoneka kuti chikukhudzidwa kuchokera ku zotsatira za mawonekedwe oyambirira a zamagetsi kapena zizindikiro zina, chiwindi cha chiwindi chikhoza kuchitidwa. Kwa anthu omwe ali ndi matenda a nyamakazi kapena psoriasis, chiwindi cha chiwindi chikhoza kuchitika kamodzi kokha ngati mlingo wa methotrexate ukufikira, koma pakalipano, chiwerengero cha chiwindi chomwe chimapangidwira ngati ichi kwa anthu omwe ali ndi IBD sichivomerezedwa.
Mawu Ochokera
Monga nthawi zonse, gastroenterologist ndi njira yabwino yokambirana za mtundu wanji wa kufufuza womwe ukufunikira pamene mukugwiritsa ntchito mankhwala a IBD. Kawirikawiri, ntchito yabu lachizoloŵezi ndi mayeso ena amachitidwa pofuna kuthana ndi mavuto aliwonse oyambirira ndi kuwachitira nthawi yomweyo.
Nthawi zambiri mavutowa ndi osowa koma amatha kupewa ndi mayesero ophweka, chifukwa chake zimawoneka ngati ntchito ya magazi ikuchitika nthawi zambiri. Malangizo alipo kuti athandize madokotala kudziwa momwe angasamalire odwala, koma wodwala aliyense yemwe ali ndi IBD ndi wosiyana ndipo motero mankhwala sali okhawokha, koma momwemonso kuyesedwa kwachitika nthawi zonse.
> Zotsatira:
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> [Palibe omwe analembapo] "Kuyeza kwa TPMT pamaso pa mankhwala a azathioprine?" Drug Ther Bull . 2009 Jan; 47 (1): 9-12. Do: 10.1136 / dtb.2008.12.0033.
> Cunliffe RN, Scott BB. Kuwunika kwa zotsatira za mankhwala m'thupi lamatumbo. Mankhwala Osokoneza Bwino ndi Opaleshoni. 2002; 16: 647-662. lembani: 10.1046 / j.1365-2036.2002.01216.x
> Jacobson IM, Kelsey PB, Blyden GT, Demirjian ZN, Isselbacher KJ. Sulfasalazine-inachititsa agranulocytosis. Am J Gastroenterol. 1985; 80: 118-121.
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