I-Amiodarone (i-Cordarone, i-Pacerone) iyisidakamizwa esisebenzayo kunazo zonke okwamanje isetshenziselwa ukwelashwa kwama- arrhythmias enhliziyo . Ngeshwa, kungase kube yisidakamizwa esinamandla kakhulu esiyingozi, futhi inselele kakhulu ukuyisebenzisa ngokuphepha. Imiphumela emibi evamile ye-amiodarone ihlanganisa izifo ze-thyroid, idiphoal deposits eholela ekuphazamiseni okubukwayo, izinkinga zesibindi, ukukhishwa kwesikhumba kwe-bluish, nokukhanya kwe-photosensitivity (i-sunburning elula).
( Funda ukubuyekezwa okujwayelekile kwe-amiodarone lapha .) Ngenxa yokuthi uma kungenzeka ukukhiqiza izinhlobo eziningana zobuthi obudakamizwa, i-amiodarone kufanele ihlelwe kuphela kubantu ababeka impilo yabo engozini noma abakhubaza kakhulu ama-arrhythmias, futhi abangenayo enye indlela yokwelashwa okuhle.
Umthelela ohlangothini owesaba kakhulu we-amiodarone, ngokude, yi-pulmonary (lung).
Iyini Inyolo Yobuthi Amiodarone?
I-Amiodarone i-lung ye-lung lungaphazamisa cishe ku-5% weziguli ezithatha lesi sidakamizwa. Ayaziwa ukuthi izinkinga zamaphaphu ezibangelwa i-amiodarone zingabangela ukulimala yizidakamizwa ezithombeni zamapayipi, ukubhekana nokuzivikela komzimba kumuthi, noma kwenye indlela. I-Amiodarone ingabangela izinhlobo eziningi zezinkinga zamaphaphu, kodwa ezimweni eziningi inkinga ithatha enye yezinhlobo ezine.
1) Uhlobo oluyingozi kunazo zonke lwe-amiodarone toxicity isifo esiphuthumayo, esasongela ukuphila, esesifo sengqondo samaphaphu esibizwa ngokuthi i- acute respiratory syndrome (ARDS) .
Ngama-ARDS, umonakalo kwenzeka emagqumeni emasaka emoyeni wamapayipi, okwenza ukuba amasaka agcwaliswe ngamanzi, futhi okonakalisa kakhulu ikhono lamapayipi ukudlulisa oksijini okwanele egazini. Abantu abahlakulela i-ARDS bathola i- dyspnea engazelelwe, enamandla (ukuphefumula). Ngokuvamile kufanele zifakwe kuma-ventilators, futhi izinga lokufa kwabo ngisho nangokwelapha okukhulu, lifinyelela ku-50%.
I-ARDS ehlobene ne-amiodarone ibonakala kaningi ngokulandela izinqubo ezinkulu zokuhlinza, ikakhulukazi ukuhlinzeka inhliziyo, kodwa kungabonwa nganoma yisiphi isikhathi futhi ngaphandle kwezimbangela ezibonakalayo ezivelele.
2) Inhlobo evamile kakhulu ye-amiodarone toxicity yinkinga engapheliyo, ebonakalayo yamaphaphu ebizwa ngokuthi i-pneumonitis yangaphakathi (i-IP) . Kule nkinga, amasaka emaphaphu athola kancane kancane amangqamuzana ahlanzekile ahlukahlukeneyo, aphazamisa ukushintshaniswa kwamapayipi. I-IP ivame ukuqala ngokungahambi kahle futhi kancane kancane, ngokuqhubeka kancane kancane kwe- dyspnea , ukukhwehlela nokukhathala ngokushesha. Njengoba abantu abaningi bethatha i-amiodarone banomlando wezinkinga zenhliziyo, izimpawu zabo kulula ukuphutha ngokuhluleka kwenhliziyo (noma ngezinye izikhathi, imiphumela yokuguga). Ngenxa yalesi sizathu, i-IP ivame ukuphuthelwa. Kungenzeka ukuthi kuningi kakhulu kunokucatshangwa njalo.
3) Okungavamile kakhulu ukuthi "i-pattern-pattern" ye-pneumonias (ebizwa nangokuthi i-pneumonia) ihlelwe nge-amiodarone ngezinye izikhathi. Kule nkinga, i-x-ray yesifuba ibonisa indawo ehlanganisiwe yenkimbinkimbi cishe efana nalabo abonwa nge- pneumonia ye-bacteria . Ngenxa yalesi sizathu, leli fomu le-amiodarone toxicity cishe liphutha njalo nge-pneumonia yebhaktheriya futhi liphathwa ngendlela efanele.
Ngokuvamile kuphela uma i-pneumonia ihluleka ukuphucula ngama-antibiotic ukuthi ukuxilongwa kwe-amiodarone toxicity ekugcineni kuyabhekwa.
4 ) Ngokuvamile, i-amiodarone ingaveza umthamo wodwa wamapulmoni otholakala nge-x-ray yesifuba. Ubuningi buvame ukucatshangwa ukuthi yi-tumor noma ukutheleleka, futhi kuphela uma i-biopsy ithathwa yi-amiodarone toxicity yamaphaphu ekugcineni yaqaphela.
I-Amiodarone Lung Toxicity Ithola kanjani?
Azikho izivivinyo eziqondile zokuxilonga ezitholela ukuxilongwa, nakuba kunezici ezinamandla ezingatholakala ngokuhlola amangqamuzana emaphaphu atholakala ku-biopsy noma ukuphazamiseka kwamapulmoni (ukuqhuma umoya womoya ngamanzi), ngokuvamile nge- bronchoscopy .
Isihluthulelo sokuthola i-amioarone toxicity yamaphaphu, noma kunjalo, kufanele uqaphele ukuthi kungenzeka. Ngokuba noma ubani othatha i-amiodarone, ubuthi be-lung lungadinga ukubhekwa ngokujulile ngophawu lokuqala lwenkinga. Izimpawu ezingenakubonakaliswa zamapulmoni okungabikho okunye okungabangela ukuthi zingabonakaliswa kufanele zihlonishwe njenge-amiodarone ingozi ye-lung acid, futhi ukuyeka lesi sidakamizwa kufanele kucatshangwe ngokujulile. (Uma uthatha i-amiodarone futhi usola ukuthi ungase uthuthukise inkinga yamaphaphu, khuluma nodokotela wakho ngaphambi kokumisa lesi sidakamizwa ngokwakho.)
Ubani Osesengozini?
Noma ubani othatha i-amiodarone usemngciphekweni we-lung acid. Abantu abanezilinganiso eziphakeme (400 mg ngosuku noma ngaphezulu), noma obani abaphuza izidakamizwa izinyanga ezingu-6 noma ngaphezulu, noma abangaphezu kweminyaka engama-60 kubonakala benengozi enkulu. Ubufakazi obunye bubonisa ukuthi abantu abanenkinga yokuphuza amaphaphu nabo banamathuba amaningi okuba nezinkinga zamapulmoni ne-amiodarone.
Nakuba ukuqaphelisisa abantu abaphatha i-amiodarone ngesifo se-x-rays kanye nokuhlolwa komsebenzi we-pulmonary kuvame ukuveza izinguquko ezithinta izidakamizwa, bambalwa kulaba bantu bayaqhubeka nokuthuthukisa ubuthi be-pulmonary frank. Nakuba ama-x-rays wesikhwama saminyaka yonke avame ukuthathwa kubantu abathatha lesi sidakamizwa, abukho ubufakazi obuncane bokuthi ukuqapha okunjalo kuyasiza ekutholeni labo ekugcineni abazokhula nezinkinga ezingaphezu kwamapayipi, noma ngubani okufanele ayeke ukuthatha i-amiodarone ngenxa ye-"toxicity" ye-lungs ezayo.
I-Amiodarone Lung Toxicity Yenziwa kanjani?
Ayikho yokwelashwa okuqondile okuye kwaboniswa ukuthi iyasebenza. I-mainstay yokwelapha imisa ama-amiodarone.
Ngeshwa, kuthatha izinyanga eziningi ukuqeda umzimba we-amiodarone ngemuva kwesilinganiso sokugcina. Kulezi ziguli eziningi ezinezinhlobo ezincane kakhulu ezinobuthi be-lung (i-IP, ejwayelekile ye-pneumonia, noma mass mass), noma kunjalo, amaphaphu ngokuvamile ekugcineni athuthuke uma umuthi umiswa. I-Amiodarone kufanele futhi imiswe iziguli ezine-ARDS, kodwa kulokhu, umphumela wokugcina womtholampilo uhlale uzimisele kahle ngaphambi kwamazinga e-amiodarone angancishiswa kakhulu.
Amanothi aphezulu ama-steroids avame ukunikezwa iziguli ezine-ARDS ezibangelwa i-amiodarone, kanti ngenkathi kukhona imibiko yecala yokuzuzwa kulolu hlobo lwezokwelapha, ngabe ngabe i-steroids empeleni yenza umehluko omkhulu akuyaziwa. I-steroids nayo isetshenziselwa kakhulu zonke izinhlobo ze-amiodarone toxicity, kepha futhi, ubufakazi bokuthi bayasiza kulezi zimo bukhulu.
Izwi elivela
Kunezizathu ezinhle zokuthi i-amiodarone i-lung isxicity iyisimo esibi kakhulu esesabekayo salesi sidakamizwa. Ubuthi obunamapulangwe abukwazi ukubikezela. Kungaba nzima futhi kubulawe. Kungaba yinselele ukuxilonga, futhi ayikho yokwelapha okuqondile. Ngisho noma ukuphuza utshwala kwakuwukuphela kwethonya elibi elimangalisayo le-amiodarone (okungenqume ukuthi alikho), lokhu kuphela kufanele kube okwanele ukwenza odokotela benqabe ukusebenzisa le mithi ngaphandle uma kudingekile ngempela.
> Imithombo
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> Hudzik B, Polonski L. Ukwelashwa kwePulmonary-induced by amiodarone. I-CMAJ 2012; 184: E819.
> Papiris SA, Triantafillidou C, Kolilekas L, et al. I-Amiodarone: Ukubuyekezwa kweMiphumela yePulmonary and Toxicity. I-Drug Saf 2010; 33: 539.
> Schwaiblmair M, Berghaus T, Haeckel T, et al. Ukuqothulwa kwe-Pulmonary-induced-induced Pulmonary: I-A-Under-Reconnected Effect Effect Effect? I-Clin Res Cardiol 2010; 99: 693.