Sekuyiminyaka engaphezu kwengu-200, i-digitalis (isisetshenziswa esitholakala esitshalweni se-foxglove), siye saba yindlela esemqoka ekwelapheni kwesifo senhliziyo-ikakhulukazi, ukwehluleka kwenhliziyo kanye ne -fibrillation ye-atrial . I-Digoxin (ngokude, ifomu ejwayelekile kunazo zonke ye-digitalis) isacacisiwe kabanzi kulezi zimo ezimbili zenhliziyo.
Nokho, emashumini eminyaka amuva nje, izazi ziye zazibuza ukuthi i-digoxin kufanele isetshenziswe yini ekwelapheni isifo senhliziyo.
Kunezizathu ezimbili ezivamile zalokhu kungabaza okwakamuva mayelana ne-digoxin. Okokuqala, kunezidakamizwa eziningana ezintsha ezenzelwe ukuphumelela kwazo ekuqinisekisweni kwemitholampilo, kanti ukuhlolwa okungahleliwe okubonisa izinzuzo ze-digoxin kuye kwaba mncane kakhulu. Ngakho-ke izinzuzo zomtholampilo zangempela ze-digoxin ziye zabuzwa.
Okwesibili, i-digitalis yobuthi kungaba nzima kakhulu ukugwema, futhi kungaba yingozi kakhulu. Ezimweni eziningi, ezinye izidakamizwa ezincane ezinobuthi obungasetshenziswa zingasetshenziswa esikhundleni se-digoxin.
Naphezu kwalezi zinkinga, i-digoxin isengaba usizo kwabanye abantu abane-heart failure noma fibrillation ye-atrial.
I-Digoxin Isebenza Kanjani?
I-Digoxin inemiphumela emibili enkulu enhliziyweni.
Okokuqala, ivinjelwa amaphampu athile emangqamuzaneni yamangqamuzana enhliziyo, ukunciphisa ukuhamba kwe-sodium kusuka ngaphakathi kwamaseli kuya ngaphandle kwamaseli. Lesi senzo sinomphumela wokwenza ngcono amandla okuchotshozwa kwesisu senhliziyo.
Ngakho-ke, imisipha yenhliziyo ebuthakathaka ingaqhuma kancane uma i-digoxin isetshenziswa.
Okwesibili, i-digoxin ithinta ithoni yokuzimela , ukunciphisa ukuzwelana ("ukulwa noma indiza") nokwanda kwe-parasympathetic ( vagal ). Lezi zinguquko ithoni yokuzimela zinciphisa ukuqhutshwa kwemizwa yombane kagesi ngokusebenzisa i- AV node ngakho-ke ithambekele ekunciphiseni izinga lenhliziyo kubantu abane-fibrillation ye-atrial.
Ngokufingqa, i-digoxin ingathuthukisa ukuhlukunyezwa kwenhliziyo kubantu abanesifo senhliziyo futhi kunganciphisa izinga lokushaya kwenhliziyo kubantu abane-fibrillation ye-atrial.
I-Digoxin Toxicity
Imiphumela emibi ye-digoxin ihlobene namazinga egazi omuthi. Ngeshwa, amazinga omuthi wokwelapha nge-digoxin awahluke kakhulu kunamazinga wegazi enobuthi-ngakho umahluko phakathi kokuthatha "okwanele" i-digoxin nokuthatha i-digoxin kakhulu kaningi kakhulu. Le "festile yokwelapha encane" yenza ukusetshenziswa okuphephile kwe-digoxin kunzima kubantu abaningi.
I-Digoxin yobuthi iningi kubantu abakha izinkinga zezinso noma amazinga aphansi e-potassium-kokubili okuvamile kubantu abanesifo senhliziyo futhi abaphathwa nge- diuretics .
Imiphumela enobuthi ye-digoxin ifaka ama- arrhythmias enhliziyo esongela ukuphila, ikakhulukazi i- tricycardia ye-ventricular kanye ne- fibrication ye-ventricular , i-bradycardia enamandla (izinga lentliziyo elincane), i- heart block , ukulahlekelwa isifiso, isisulu noma ukuhlanza, nezinkinga ze-neurological kuhlanganise ukudideka nokuphazamiseka okubukwayo. Ngokuphawulekayo, okungenani amaphesenti angu-30 abantu abanamazinga e-digoxin anobuthi abatholanga izimpawu. Lokhu kusho ukuthi ama-arrhythmias enhliziyo esongela ukuphila angenzeka kulaba bantu ngaphandle kwesixwayiso.
Uma umuntu ethatha i-digoxin, amazinga egazi ngokuvamile alinganiswa ngezikhathi ezithile ukuze azame ukuhlala ngaphakathi kwewindi elincane lokwelapha.
I-Digoxin ku-Treatment of Heart Failure
Ngokushesha nje eminyakeni engama-30 eyedlule, i-digoxin (kanye ne-diuretics) yiyona ndlela eyinhloko yokwelapha kubantu abanesifo senhliziyo ngenxa ye- cardiomyopathy ehlanjululwe- okungukuthi, ukwehluleka kwenhliziyo kubangelwa ukukhubazeka kwenhliziyo yesisu, ebonakala ngencishwana encane ye-ejection .
Kodwa kusukela ngaleso sikhathi izinyathelo eziningana zokwelashwa zenzelwe ukuhluleka kwenhliziyo okusebenza kahle kuye kwabonakaliswa ngokucacile ezinhlolweni eziningi zokwelapha. Izidakamizwa eziye zaboniswa ukuthi zithuthukise izimpawu futhi zanda ukwanda zibandakanya izibhamu ze-beta , i- ACE inhibitors , ama-ARB agents (futhi kamuva) inhlanganisela ye-ARB izidakamizwa kanye ne-neprilysin inhibitor emakethe njenge- Entresto .
Ngaphezu kwalokho, abantu abaningi abanezinkinga ze-heart congestive bafuna ukwelashwa kabusha komzimba , ukwelashwa okunganciphisa kakhulu izimpawu nokuthuthukisa ukusinda.
Ukuvivinywa kwemitholampilo kubonise ukuthi, kubantu abanesifo senhliziyo ngenxa ye-cardiomyopathy ehlanjululwe, i-digoxin ibonakala ithuthukisa izimpawu zenhliziyo futhi iyanciphisa isidingo sokubhedlela. Noma kunjalo, ngokungafani nezinye izindlela zokwelashwa manje ezivame ukusetshenziselwa ukuhluleka kwenhliziyo, i-digoxin ayibonakali ukuthuthukisa ukusinda.
Iningi lezazi manje zincoma ukusebenzisa i-digoxin kubantu abanokuhluleka kwenhliziyo kuphela njengomzila wesibili noma ukwelashwa kwemigqa yesithathu, uma kunjalo. Okokuthi, ngokuvamile i-digoxin inconywa kuphela uma umuntu enesifo senhliziyo eqhubeka nokuthola izimpawu ezibalulekile naphezu kokwelashwa okuhle okuhlanganisa i-beta blocker, i-ACE inhibitor noma i-ARB, izidakamizwa, kanye / noma i-Entresto.
I-Digoxin ayinikeli inzuzo ekwelapheni abantu abanokuhluleka kwenhliziyo ngengqamuzana egcinwe e-ejection-okungukuthi, abantu abane- diastolic yehluleka inhliziyo . I-Digoxin ayinakusizo ekuqiniseni abantu abanokuhluleka kwenhliziyo. Ukusetshenziswa kwalo kufanele kube nomkhawulo ekulawuleni labo abanezimpawu ezingapheli zokuhluleka kwenhliziyo ehlukumezekile.
I-Digoxin ekuPhileni kweFibrillation ye-Atrial
Njengoba kuphawuliwe ekuqaleni, i-digoxin iyancipha ukuqhutshwa kwezimpawu zikagesi ngokusebenzisa i-AV node, futhi ngenxa yalokho, inganciphisa izinga lokushaya kwenhliziyo kubantu abane-fibrillation ye-atrial. Njengoba isilinganiso senhliziyo esiphuthumayo yisisusa esiyinhloko sezimpawu kubantu abane -fibrillation ye-atrial , i-digoxin ingasiza ekuhlinzekeni okunye ukukhululeka kwezimpawu.
Kodwa-ke, i-digoxin ijwayele ukuphumelela kakhulu ekunciphiseni izimpawu kunezinye izigaba ezimbili zezidakamizwa manje ezivame ukusetshenziselwa ukunciphisa izinga lenhliziyo ekufubeni kwe-atrial, okungukuthi, i-beta blockers ne- calcium channel blockers . Lezi zigaba ezimbili zezidakamizwa zenza ukunciphisa izinga lokushaya kwenhliziyo kokubili futhi ngesikhathi sokuzivocavoca, kanti i-digoxin yenza ijubane lenhliziyo liphumule ngokuphumula kuphela. Ngenxa yokuthi abantu abaningi abane-fibrillation ye-atrial bayakhononda ikakhulukazi ngokuzivocavoca okungekho emthethweni, okubangelwa ukunyuka okusheshayo kwenani lenhliziyo ngisho nokuzivocavoca okuncane, i-digoxin ayiniki amandla kakhulu ezimpawu zabo.
Ngaphezu kwalokho, kukhona manje ubufakazi bokuthi ukusebenzisa i-digoxin yokulawulwa kwamazinga kubantu abane-fibrillation ye-atrial kuhlotshaniswa nokwanda kokufa. Ngokuyinhloko, ukuhlolwa komtholampilo ngo-2017 kubonisa ukuthi lokhu kwanda ekufeni kufana ngokulingana namazinga egazini e-digoxin-okungukuthi, amazinga egazi aphezulu, aphezulu kakhulu engozini. Nakuba imbangela yengozini ebonakalayo ephezulu yokufa ne-digoxin ayiqinisekile, kungenzeka ukuthi ingenxa yokuthi ingozi ephezulu yokufa okungazelelwe kusuka ekuqedeni kwe-cardiac.
Iningi ochwepheshe manje okungenani liyanqikaza ukutusa ukusebenzisa i-digoxin yokulawula izinga lenhliziyo kubantu abane-fibrillation ye-atrial. Kodwa-ke, i-digoxin isengaba yindlela enengqondo uma umuntu one-fibrillation ye-atrial engenazo izimpawu eziqhubekayo neziphawulekayo ekuphumuleni, ezingaxoshwa yinhlanganisela ye-beta blockers ne-block block ye-calcium.
Izwi elivela
Esikhathini eside esedlule, i-digoxin yayiyindlela yokwelashwa okuyisisekelo kokubili ukwehluleka kwenhliziyo nokuphefumula kwe-atrial. Kodwa-ke, emashumini eminyaka amuva nje izidakamizwa ezintsha zakhiwe eziphumelela kakhulu, futhi ziphephile ukusebenzisa. Iningi lezazi manje zincoma ukusebenzisa i-digoxin kuphela kubantu abathile lesi sidakamizwa singase sinikeze inzuzo ethile futhi enkulu. Futhi uma isetshenziswe, kufanele isetshenziswe ngokuqapha.
> Imithombo:
> Ambrosy AP, Butler J, Ahmed A, et al. Ukusetshenziswa kwe-Digoxin Ezilwelweni Ezihluleka Ukwehluleka Kwezinhliziyo Eziphuthumayo: Ukucabangela Ukudakwa Kwezidakamizwa Esidala Ukunciphisa Izibhedlela Zokuvuma. J Am Coll Cardiol 2014; 63: 1823.
> Lopes R, Gibson CM. I-ARISTOTLE: I-Digoxin Nokufa Kweziguli Ezinezifo Ezibhekene Ne-Atrial Fibrillation Nengaphandle Kwenhliziyo Ukungaphumeleli: Ingabe I-Serum Digoxin Yokugxilisa Okubalulekile? Uhlelo kanye nezinhlamvu ze-American College of Cardiology 66th Scientific Session & Expo; NgoMashi 17-19, 2017; Washington, DC. Ukuvivinywa kokuvivinya isikhathi eside emtholampilo.
> Ponikowski P, I-Voors AA, i-Anker SD, et al. Izinkombandlela ze-ESC 2016 ze-Diagnosis and Treatment Of Ukuhluleka Kwenhliziyo Ephuthumayo Nokuphefumula: I-Task Force For The Diagnosis And Treatment Of Ukuhluleka Kwenhliziyo Ephuthumayo Ne-Chronicle Ye-European Society of Cardiology (ESC) Yakhelwe ngegalelo elikhethekile le-Heart Failure Association (HFA) ) we-ESC. I-Eur Heart J 2016; 37: 2129.