Kunezindlela ezimbili ezijwayelekile zokwelapha i-fibrillation ye-atrial :
- Ukuzama ukuqeda ukucubungula kwama-atrial ngokuphelele futhi ubuyisele futhi ugcine isigqi senhliziyo evamile ( Funda mayelana nesimiso sokulawula isigqi )
- Vumela i-fibrillation ye-atrial ukuba iqhubeke ngenkathi ilawula izinga lenhliziyo ( Funda mayelana nesu lokulawula isilinganiso )
Njengoba kunikezwe lezi zinto ezimbili, ngaphandle kokwazi okwengeziwe, cishe noma ubani ozoqala ukukhetha indlela yokulawula isigqi.
Kodwa-ke, ekusebenzeni kwangempela, le nqubo ivame ukuphumelela kangcono futhi iphephile kancane kunendlela yokulawula izinga.
Isizathu sokuthi isu lokulawula isigqi ngokuvamile siyinkinga ukuthi izidakamizwa ezithintekayo zivame ukudingwa ukubuyisela nokugcina isigqi senhliziyo evamile. Lezi zidakamizwa zivame ukungasebenzi, ezinobuthi, noma kokubili. (Qaphela ukuthi kwezinye iziguli, ukuqeda ukufucula kwe-atrial nge- ablation inqubo kungenzeka.)
Into ekhuluma ikakhulukazi mayelana nezidakamizwa ezithintekayo yizoyingozi zabo eziyingqayizivele, okuvame ukwenza kube nzima futhi kube yingozi ukuphatha nokuthatha. Kunezinhlobo ezimbili ezijwayelekile zokushukela ezivame ukubonwa ngezidakamizwa eziphikisanayo:
- Izinhlobo ezivamile zemiphumela emibi ebonwayo ngezidakamizwa eziningi, ezinjengama-allergies, ukuleleka, ukuphazamiseka kwamathumbu, njll.
- I-proarrhythmia, okuyinto eyenza inkinga enkulu ngezidakamizwa ezithathelwanayo.
I-proarrhythmia
"I-proarrhythmia" isho ukuthi kubangele ukuhoxisa amakhemikhali enhliziyo. Okusho ukuthi, esikhundleni sokuqeda ama-arrhythmias lezi zidakamizwa zingabakhipha ngempela. Izidakamizwa ze-antiarrhythm zisebenza ngokushintsha izakhiwo zikagesi zezicubu zenhliziyo. Kuvela ukuthi noma nini lapho ushintsha lezo zakhiwo kagesi izinto ezimbili ezingahle zenzeke-ungase wenze ama-arrhythmias amathuba okuba kwenzeke (okuyinto inhloso), noma kunalokho ungase wenze amakhemikhali amaningi akwenzeke.
Okubi nakakhulu, izinhlobo ze-arrhythmias ezikhiqizwa nge-proarrhythmia (ngokungafani ne-fibrillation ye-atrial ngokwayo) ingaba yingozi. Ngakho-ke, noma nini lapho kusetshenziselwa izidakamizwa zokulwa nezidakamizwa, okungenani kukhona engozini yokubangela izifo ezisongela ukuphila okumele zenze odokotela neziguli behluke ukuzisebenzisa ngaphandle uma zidingeka ngempela.
Ezinye izidakamizwa zingase zidale ukwedlula ezinye futhi ezinye iziguli zikwazi ukuzwa ubukhulu kunezinye. Amathuba okuba ne-proarrhythmia ngesidakamizwa esithile kwesiguli esithile kufanele ahlolwe ngaphambi kokuba lezi zidakamizwa zibekiwe.
Ukwelapha I-Fibrillation Ye-Atrial
Izidakamizwa eziyisithupha zokulwa nezidakamizwa zivame ukusetshenziselwa ukwelapha i-fibrillation ye-atrial: i-propafenone (i-Rhythmol), i-flecainide (i-Tambocor), i-sotalol (i-Betapace), i-dofethilide (i-Tikosyn), i-amodarone (iCordarone) ne-dronedarone (i-Multaq). Kulawo muntu othatha lezi zidakamizwa, ukwelashwa kufanele kube ngabanye ngokucophelela ukuze kuncishiswe ingozi yobuthi, kepha ukukhiqizwa okulandelayo kungenziwa:
- I-Rhythmol ne-Tambocor zibekezelelwe kahle uma nje zingabangeli i-proarrhythmia. Ezigulini ezisencane futhi ezinempilo, ezingenayo isifo senhliziyo futhi zisengozini enkulu yokuthuthukisa isifo senhliziyo, nazo zibangelwa ukuhamba kancane kwe-proarrhythmia. Futhi kulezi ziguli, zingase zibe yisinqumo esihle sokuzama ukubuyisela isigqi esivamile kwiziguli ezine-fibrillation ye-atrial. Zibhekwa njengeziphumelelayo ngokuphumelelayo. Kodwa-ke, ezigulini ezinezinhlobo zesifo senhliziyo, noma obungozi bokukhula kwesifo senhliziyo, lezi zidakamizwa kungenzeka ukuthi zibangele ukubulawa kwesandulela ngculazi futhi kufanele zigweme njalo.
- I-Betapace ne-Tikosyn nayo ibekezelela kahle uma nje ingabangeli i-proarrhythmia. Kodwa-ke, lezi zidakamizwa zingaveza u-proarrhythmia kunoma ubani futhi ukuqapha kufanele kuqashwe odokotela ukunciphisa ingozi. Ngempela, esimweni sikaTikosyn, i-FDA imemezele ukuthi odokotela kumele bathathe ukuqeqeshwa okukhethekile ngaphambi kokuba bavunyelwe ukuphatha lesi sidakamizwa. Lezi zidakamizwa zisebenza kahle ngokulawula i-fibrillation ye-atrial.
- I-Cordarone yisidakamizwa esiyingqayizivele elwa nomzimba . Nakuba iphumelela kunanoma imuphi omunye umuthi ekwelapheni i-fibrillation ye-atrial, futhi ngenkathi ibangela ukuvama okuncane kakhulu, kungenzeka kakhulu ukuthi kubangele ezinye izimo ezimbi ezingabonakala ziphawulekayo ngisho nokusongela ukuphila. Ngenxa yalokho, i-Cordarone kufanele igwenywe noma kunini lapho kungenzeka khona. Uma isetshenziselwa, ukuqapha okucophelelayo kufanele kwenziwe ngenxa yobuthi uma nje isiguli sithatha lesi sidakamizwa kanye nezinyanga ezimbalwa ngemuva kokuba umuthi umisiwe. Ungafunda ngezici ezihlukile zeCordarone lapha .
- U-Multaq ungumzala weCordarone futhi wakhiwa ngethemba lokuthi kuzoba ngempumelelo njengeCordarone ngaphandle kobuhlungu. Kodwa, kuyilapho i-Multaq impela ingcolile kakhulu kuneCordarone, ayikho ephumelelayo ekulawuleni i-fibrillation ye-atrial. Futhi, i-Multaq ayikwazi ukusetshenziswa kubantu abaye bahluleka inhliziyo . Nansi ulwazi oluthe xaxa mayelana nokusetshenziswa kwe-Multaq ekwelapheni i-fibrillation ye-atrial.
Okubalulekile
Kumele kucacile ukuthi ukwelapha izidakamizwa ze-atrial nge-drug antiarrhythmic-okungukuthi, isu lokuzama ukubuyisela nokugcina isigqi esivamile-singaba inkinga enkulu. Ngenxa yalesi sizathu, wanezela ukuthi izilingo zemitholampilo azange zibonise inzuzo enkulu kulolu cwaningo lwezokwelapha, kungcono iziguli zigweme izidakamizwa ezingezansi kanye nokukhetha isu lokulawula izinga lokulawula.
Imithombo:
I-Fogoros, i-RN. Ukwelashwa kwama-Arrhythmias aphezulu. Ku: Fogoros, RN. Izidakamizwa Zama-Antiarrhythmic - Isiqondiso Esiwusizo. I-Blackwell Publishing, i-Malden, MA: 2007.
I-American College of Cardiology Foundation, i-American Heart Association, i-European Society of Cardiology, et al. Ukuphathwa kweziguli ezine-Fibrillation ye-Atrial (Ukuhlanganiswa kuka-2006 ACCF / AHA / ESC no-2011 ACCF / AHA / HRS Izincomo) Umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice . Ukujikeleza 2013; 127: 1916.