Si mankhwala onsewa omwe amapereka chiwopsezo chomwecho
Mankhwala osagwiritsidwa ntchito poletsa kutupa (NSAIDs) ndi ena mwa mankhwala omwe amagwiritsidwa ntchito kwambiri padziko lonse lapansi. Zimathandiza kuchepetsa kutupa ndi kupweteka ndipo zimapezeka mosavuta ndi mankhwala komanso pamsika.
Komabe, ambiri mwa mankhwalawa tsopano akudziwika kuti amachititsa ngozi ya mavuto a mtima, kuphatikizapo matenda aakulu (ACS) , kufooketsa mtima , komanso mwinamwake kutentha kwa thupi .
Kukula kwa chiopsezo ichi chawonjezeka ndizochepa. Koma chiwopsezo chimawonjezeka ndi mankhwala osagwiritsidwa ntchito komanso ndi mankhwala apamwamba, ndipo ndi apamwamba kwambiri kwa anthu omwe ali ndi matenda odziwika bwino a mtima. Komanso, chiwopsezo n'chokwanira ndi NSAID zina kuposa ena.
(Zindikirani: Aspirin ndi NSAID yakale kwambiri komanso yogwiritsidwa ntchito kwambiri. Komabe, aspirin imachepetsa kuopsa kwa mtima, ndipo sichidzafotokozedwa m'nkhaniyi.
Mitundu ya NSAIDS
NSAIDs zopanda aspirin zimagwira ntchito poletsa chiwalo cha cyclooxygenase (COX) , zotsatira zake zimachepetsa kupanga prostaglandin komwe kumayambitsa kupweteka ndi kutupa.
Pali kwenikweni michere iwiri ya COX - COX-1 ndi COX-2 - yomwe ili ndi zotsatira zosiyana. COX-2 imagwirizanitsidwa ndi ululu ndi kutupa, pamene COX-1 ili ndi ntchito zina, kuphatikizapo kuteteza mimba m'mimba kuchokera ku asidi.
Choncho, NSAIDS imasankhidwa kuti iletse COX-2 ("kusankha" NSAIDS), kapena ngati ikuletsa onse COX-1 ndi COX-2 (NSAIDs "nonselective").
NSAID zapachiyambi, monga ibuprofen (Advil) ndi naproxen (Aleve), zinali zonse zosasamala za NSAIDS. Chifukwa amaletsa COX-1 amakhala ndi chilakolako cha m'mimba.
Makampani oledzera amagwira ntchito mwakhama kuti apange ma NSAID omwe amasankha COX-2 okha, kuti achepetse vuto la m'mimba. Tsono tsopano pali NSAID zingapo, kuphatikizapo celecoxib (Celebrex) ndi meloxicam (Mobic).
Mankhwalawa nthawi zambiri amakhala atsopano, osapezeka mu mawonekedwe achibadwa kapena pamsika.
Matenda a Mtima ndi NSAIDs
Kuwonjezeka kwa chiopsezo cha mtima ndi NSAID kunayambika koyamba ndi NSAID rofecoxib (Vioxx), yomwe inachititsa chidwi kwambiri komanso milandu yotsutsana ndi wopanga, Merck. Vioxx adachotsedwa pamsika.
Kuyambira nthawi imeneyo, maphunziro ambiri a zachipatala asonyeza kuti kuwonjezeka kwa mliri wa mtima kumagwirizanitsidwa ndi NSAID zonse, nSAID zotsatizana komanso nkhanza za COX-2 zatsopano.
Pafupifupi NSAID zonse, ngozi ya mtima imakula ndi kutalika kwa kugwiritsiridwa ntchito kwa mankhwalawa, ndi mlingo wogwiritsidwa ntchito, komanso ndi chiopsezo cha mtima cha munthu amene amamwa mankhwalawa.
Kodi NSAID zina ndizo "zotetezeka" kuposa ena?
Deta yoyerekeza kukula kwa chiwopsezo cha mtima chifukwa cha NSAID zenizeni zikusowa. Chifukwa cha mankhwala ambiri omwe alipo, ndipo kukula kwake kwazing'ono kumachitika, kuchititsa mayesero a chipatala kuti athetsere kusiyana kulikonse kungakhale kotsika mtengo.
Komabe, kufotokozera mndandanda wa maphunziro omwe alipo akufalitsidwa mu 2013. Kufufuza uku kunasonyeza kuti zoopsa za zochitika za mtima zinali zowonjezeka kwambiri poyerekezera ndi placebo ndi mlingo waukulu wa diclofenac (NSAID yopanda nonse), komanso NSAID zonse.
Kuwonjezeka kwa chiopsezo kunawonekeranso ndi ibuprofen yomwe siinali yofunikira kwambiri. Ndipo palibe kuwonjezeka kwowopsa komwe kunawoneka ndi naproxen.
Kusanthula meta uku sikungoganizidwe. Akatswiri ambiri apanga lingaliro lakuti NSAID zonse, za mitundu iwiriyi, ziyenera kuwonjezeka kuti ziwonjezere ngozi ya mtima.
Komabe, ngati NSAID iyenera kugwiritsidwa ntchito kwa munthu amene akukhudzidwa ndi kuwonjezeka kwa chiopsezo cha mtima, akatswiri ambiri angapangire kuti apitirize kukhala ndi vutoli.
Zovuta Zina za Cardiac Zokhudzana ndi NSAIDS
Kuwonjezera pa kuonjezera chiopsezo cha zochitika za mtima, mitundu yonse ya NSAID imayanjananso ndi kuwonjezeka kwa kuthamanga kwa magazi pamene imagwiritsidwa ntchito mosalekeza.
Komanso, ma NSAID ambiri osasamala amalephera kupindula ndi aspirin zomwe zimapezeka pamaplatelet, motero zimatsutsa zotsatira za aspirin. Kusokoneza uku sikuwonekere, komabe, ndi NSAID diclofenac yosasamala, kapena ndi NSAID.
Pansi
Pamene Vioxx adalengeza, zida zonse za NSAID zikuwoneka kuti zowonjezera chiwopsezo cha mtima pamtingo wofanana (ndi zosiyana zomwe zatchulidwa kale).
Kwa anthu amene ali ndi vuto lalikulu la mtima, NSAID ziyenera kugwiritsidwa ntchito pa mlingo wotsika kwambiri kwa nthawi yochepa kwambiri. Ngati chiopsezo chanu cha mtima chikukwera , naproxen mwina ndi NSAID yanu yosankha.
Aliyense amene ali ndi matenda oopsa ayenera kudziwa kuti ma NSAID angathe kuwonjezera mphamvu ya magazi ndi kuchepetsa mphamvu ya mankhwala opatsirana kwambiri .
Aliyense amene atenga aspirin kuti athane ndi matenda a mtima ayenera kupeŵa nSAIDs osasamala ngati kuli kotheka. Ngati NSAID idzagwiritsidwa ntchito, iyenera kutengedwa maola awiri pambuyo pa aspirin.
Zotsatira:
Fosbøl EL, Folke F, Jacobsen S, ndi al. Zowopsa za CV zomwe zimagwirizanitsidwa ndi NSAID pakati pa anthu odwala. Circ Mafilimu Okhudzana ndi Zotsatira za 2010; DOI: 10.1161 / CIRCOUTCOMES.109.861104.
Coxib ndi chikhalidwe cha NSAID Trialists '(CNT), Kulemba N, Emberson J, et al. Zilonda za m'mimba komanso zam'mimba za mankhwala osagwiritsidwa ntchito ndi mankhwala omwe si othandiza. Lancet 2013; 382: 769.