Chithandizo cha matenda a Chagas chimadalira nthawi yomwe matendawa amapezeka . Anthu amene amapezeka kuti akudwala matendawa amachiritsidwa mosiyana ndi omwe amapezeka pa nthawi yochepa.
Kuchiza Matenda Aakulu-Phase
Mpata wabwino wokhawokha kuchiza matenda a Chagas, ndiko kuti, kuthetseratu Trypanosoma cruzi (T.
cruzi) majeremusi a thupi - ngati mankhwala angayambe msanga kudwala, panthawi yovuta.
Mu munthu aliyense amene amapezeka ndi matenda oopsa a T. cruzi, kapena ngati mwanayo akupezeka kuti ali ndi kachilombo ka HIV, chithandizocho chiyenera kuperekedwa ndi mankhwala osokoneza bongo. Mankhwala awiri omwe asonyezedwa kuti ali othandizira T. cruzi ndi benznidazole ndi nifurtimox. Azimayi omwe ali ndi mimba sayenera kulandira mankhwala awa.
Ngati mankhwala amodzi mwa mankhwalawa amatha, kuthetsa T. cruzi kukwaniritsidwa kwa 85 peresenti ya nthawiyo.
Benznidazole
Benznidazole kawirikawiri imakhala ndi zotsatira zochepa ndipo nthawi zambiri amachiza kusankha. Mankhwalawa ayenera kutengedwa kwa masiku 60. Zomwe zimawathandiza kwambiri ndi kutupa khungu.
Nifurtimox
Nifurtimox (yomwe sivomerezedwa ku United States) imayambitsa zizindikiro za m'mimba. Zingathenso kuchititsa kusowa tulo, kusokonezeka maganizo, ndi kupweteka kwa m'mimba .
Zotsatira zake zimachepetsa ubwino wake. Mankhwalawa ayenera kutengedwa kwa masiku osachepera 90.
Kuchiza Matenda Osapitirira
Ndi matenda a Chagas osatha, kuthetsa tizilombo T. cruzi ndi mankhwala oteteza antitrypanosomal ndizovuta kwambiri kuposa nthawi yapakati, ndipo zingakhale zosatheka.
Komabe, akatswiri ambiri amalimbikitsa kuti azichiza ndi benznidazole kapena nifurtimox ngati munthu amene ali ndi kachilomboka ali m'kati mwa matenda aakulu a Chagas (kutanthauza kuti alibe matenda a mtima kapena a m'mimba a Chagas matenda), ndipo ali ndi zaka zoposa 50.
Anthu opitirira zaka 50 ali ndi zotsatira zoopsa kwambiri kuchokera kwa mankhwala a antitrypanosomal, koma mankhwala omwe angakhalepo angaganizidwe.
Mankhwala a Antitrypanosomal si othandizidwa ngati matenda a mtima wa Chagas ali kale, ngati matenda aakulu a Chagas amapezeka (monga megacolon ), kapena ngati chiwindi chachikulu kapena matenda a impso alipo. Mwa anthu awa mwayi wochotsa matenda a T. cruzi ndi otsika kwambiri, ndipo chiopsezo cha zotsatirapo ndi chokwanira.
Kuchiza Matenda a Mtima wa Chagas
Kuchiza ndi mankhwala oletsa antitrypanosomal sizothandiza pa matenda a mtima wa Chagas. M'malo mwake, chithandizochi chiyenera kukhazikitsidwa makamaka pakuyang'anira matenda a mtima.
Matenda a mtima wa Chagas ndi mawonekedwe a mtima wodzichepetsa omwe nthawi zambiri amachititsa mtima kusagonjetsedwa , ndipo anthu omwe ali ndi matendawa ayenera kulandira mankhwala onse omwe amawathandiza kuti azidwala matenda oopsa .
Kuchiza Kulephera kwa Mtima
Thandizo lachipatala nthawi zambiri limaphatikizapo mankhwala ndi beta blockers , ACE inhibitors , ndi spironolactone. Thandizo la Diuretic limagwiritsidwa ntchito kuthandiza kuchepetsa edema ndi dyspnea.
Thandizo lachilendo la mtima (CRT) likuwoneka ngati lothandiza ku matenda a mtima wa Chagas monga mwa mtundu uliwonse wa mtima wosalimba. Komabe, ubwino wa CRT wokhala ndi mtima wolephera kwambiri makamaka kwa anthu omwe asiya nthambi yamagulu , kaya ali ndi matenda a Chagas kapena mtundu uliwonse wa mtima wokhudzidwa mtima.
Ndipo, mwatsoka, ku Chagas matenda ogulitsira nthambi yowonjezera yowonjezera kusiyana ndi kusungidwa kwa nthambi yachitsulo-CRT ili yabwino kwa anthu ochepa omwe ali ndi vuto la mtima wa Chagas kusiyana ndi mtundu wina wa mtima wosalimba.
Anthu omwe ali ndi matenda a Chagas akuwoneka ngati akuchitanso bwino ndi kusintha kwa mtima monga odwala omwe ali ndi vuto linalake la mtima. Chodetsa nkhaŵa pakuchita opaleshoni yopangira matenda m'thupi la Chagas ndi chakuti chithandizo cha immunosuppressive chofunika pambuyo pa kusamalidwa chingayambitse matenda a T. cruzi. Komabe, maphunziro a zachipatala asonyeza kuti kubwezeretsedwa kwa kachilomboka pambuyo pa kusamalidwa sikuwoneka ngati vuto lalikulu mu matenda a mtima wa Chagas.
Kuopsa kwa thromboembolism (vuto limene limapangitsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda , tizilombo toyambitsa matenda , kapena tizilombo toyambitsa matenda ) tiwonjezeke kwa aliyense amene ali ndi vuto la mtima, koma zikuoneka kuti ndizoopsa kwa anthu omwe ali ndi matenda a mtima wa Chagas. Anthu ambiri omwe ali ndi matenda a mtima wa Chagas ayenera kuikidwa pa anticoagulantrapy (ndi Coumadin kapena NOAC mankhwala ), kapena aspirin ya prophylactic kuchepetsa chiopsezo chachikulu cha thromboembolism.
Kuchiza Arrhythmias Cardiac ndi Kupewa Imfa Yodzidzimutsa
Mankhwala othandizira kupewa matenda oopsa a mtima ndi ofunika kwambiri kwa anthu omwe ali ndi matenda a mtima wa Chagas chifukwa ali ndi chiopsezo chowonjezeka kwa onse a bradycardias (amtima ochepa) ndi tachycardias (miyendo yolimba ya mtima).
Bradycardias imachitika nthawi zambiri mwa anthu omwe ali ndi matenda a Chagas. The bradycardias amachititsa zonse ndi matenda a nthenda ya sinus ndi mtima block . Ngati pang'onopang'ono mtima umakhala ndi zizindikiro, kapena ngati zikuwoneka kuti zikhoza kukhala ndi zizindikiro zoopsa monga syncope , mankhwala opatsirana ndi pacemaker ndi ofunikira.
Chodetsa nkhaŵa chachikulu chokhudzana ndi ziwalo za mtima m'maganizo mwa anthu omwe ali ndi matenda a Chagas, komabe, ndi imfa yadzidzidzi yomwe imabwera chifukwa cha ventricular tachycardia kapena ventricular fibrillation . Kuopsa kokhala ndi ziopsezo za moyowu kumagwirizana ndi kuopsa kwa kuwonongeka kwa mtima kwa Chagas.
Ngati ntchito ya mtima yayimilira mpaka kufika poopsa kuti arrhythmias izi zitha kuchitika, kulembedwa kwa mankhwala osokoneza bongo akuyenera kuganiziridwa mozama. Komabe, makamaka ku Latin America, kumene mankhwala osokoneza bongo amatha kupezeka mosavuta, odwala matenda a Chagas amatha kuchiritsidwa ndi amiodarone ya mankhwala osokoneza bongo m'malo moyesera kuchepetsa kufala kwadzidzidzi.
Kuchiza Matenda a M'mimba
Thandizo la Antitrypanosomal silikuwonjezera matenda a m'mimba omwe amachititsidwa ndi Chagas. Kuchiza kumafuna kuchepetsa zizindikiro pochepetsa kuchepa kwa m'mimba komanso kuchepetsa kunyoza ndi kudzimbidwa ndi mankhwala ndi zakudya. Kuchita opaleshoni kungakhale kofunikira ngati megacolon kapena megaesophagus alipo.
Kupewa
M'zaka makumi angapo zapitazi mayiko ambiri a Latin America adayesetsa kuyesetsa kuthetsa kapena kuchepetsa matenda a Chagas.
Kawirikawiri, zoyesayesazi zakhala zikuthandizira kuchotsa vector ya matenda-ndiko "kupsompsona" komwe kumatulutsa tizilombo T. cruzi kuchokera kwa anthu kupita kwa anthu. Kuthetsa mimbulu ya kupsyopsyona kwayesedwa pogwiritsa ntchito tizilombo toyambitsa matenda m'mizinda ya anthu. Khama limeneli lathandiza kwambiri koma silinathetse vutoli-ndipo matenda a Chagas amakhalabe ochuluka m'madera ambiri akumidzi ku Latin America.
Matenda a T. cruzi akuyamwitsa asanawathandize kuchepetsa kufala kwa matendawa. Azimayi sangathe kuchiritsidwa ndi mankhwala osokoneza bongo pamene ali ndi pakati, koma chithandizo chisanayambe mimba nthawi zambiri zimakhala zothandiza. Azimayi omwe ali ndi kachilombo ka T. cruzi akulangizidwanso kuti asamayamwitsa, ngakhale kutumiza kwa matendawa kudzera mkaka wa m'mawere sikunatsimikizidwe.
> Zotsatira:
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> Matendawo a C. C. Chagas '. N Engl J Med 2015; 373: 456.
> Martí-Carvajal AJ, Kwong JS. Mapulogalamu Achipatala Pochiza Kulephera kwa Mtima Kwa Odwala Amene Ali ndi Chagas Cardiomyopathy. Cochrane Database Rev Rev 2016; 7: Cd009077.
> Pinazo MJ, Cañas E, Elizalde JI, et al. Kuzindikira, Kutsogoleredwa ndi Chithandizo Cha Matenda Odwala Matenda a Chagas 'M'madera Amene Kumayesa Kachilombo ka Trypanosoma Cruzi Sali Wofooka. Gastroenterol Hepatol 2010; 33: 191.
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