Ama-opioids (noma ama-opiates) yiqembu lezidakamizwa ezenziwa opium poppy, noma zihlanganiswe ngokwezifiso ukuze zisebenze njengalezi zithi "zemvelo" ze-opioids. I-opioids isebenza ngokubopha amaprotheni atholakele emcimbini nasezintweni zomgogodla, ngokunciphisa kakhulu izibonakaliso zobuhlungu ezithunyelwa ebuchosheni, nokunciphisa umbono wezinhlungu.
I-opioids sekuyisikhathi eside idlala indima ebalulekile emithi njengendlela enamandla yokulawula ubuhlungu.
Noma kunjalo, i-opioids ingabangela nezinkinga ezinkulu. Lezi zidakamizwa zinomlutha kakhulu. Eqinisweni, umlutha kokubili opioid kadokotela kanye ne-opioids engekho emthethweni (ngokuyinhloko, i-heroin) uye waba yinkinga enkulu yomphakathi. Ukulutha ngokweqile kwe-opioid kubangela isifo sofuzo oluhlobene nokudlula ngokweqile. E-US, ukufa okungaphezu kwama-30,000 kusuka kuma-opioid overdoses kubhalwe ngo-2015 kuphela, ngokusho kwe-NIH. Ngaphezu kwalokho, ukuhweba nge-opioids kubangela ubumpofu, ubugebengu obunobudlova, ukuphazamisa imindeni kanye nezinye izixuku.
Ngaphezu kwalokho, i-opioids ingabangela izinkinga ezinzima nakubantu abazithatha ngokungapheli ngaphansi kokuqondiswa udokotela. Izinkinga ezinjalo zihlanganisa ukuqashwa , ukugujwa, ukukhubazeka ukusebenza, izingozi nokulimala, ukugcinwa kwamanzi, nezinkinga zenhliziyo.
Izinkinga zenhliziyo ezibonwa ngama-opioid azijwayele kakhulu emphakathini, noma ngenxa yodokotela abaningi. Eqinisweni, ezinye zezinkinga zenhliziyo ezihlobene nama-opioids sezivele zibonakala.
Noma kunjalo, kubantu abakha izinkinga ze-cardiovascular-related related opioid, lezi zinkinga zingaba nomthelela omkhulu empilweni. Abantu abasebenzisa i-opioids njalo ngenxa yokulawulwa ubuhlungu, kanye nodokotela ababayala, kufanele bazi kahle izingozi zomzimba.
Ukusetshenziswa kwama-opioids emithi
I-opioids iyasiza kakhulu ekulawuleni ubuhlungu obukhulu obubangelwa izimo zokwelapha zesikhashana, njengamathambo aphukile noma ubuhlungu bokuthunyelwa komzimba, nokulawula ubuhlungu obuhlobene nezinkinga ezinkulu zezokwelapha eziphelile, ikakhulukazi umdlavuza wokugcina.
Kulezi zimo i-opioids ivame ukuphumelela kakhulu, futhi (ngoba ukusetshenziswa kwabo kulezi zimo kukhawulelwe isikhathi) izingozi ezihambisana nokuzisebenzisa ziyingcosana.
Zingaba ngempumelelo ekwelapheni ubuhlungu obunzima obukhulu futhi obungapheliyo, kodwa ukusetshenziswa kwazo kulolu hlobo lobuhlungu buphikisana kakhulu . Ukusetshenziswa okungapheli kwama-opioid kungaholela ekuhlukumezweni nasekubhekaniseni umlutha. Lokhu kuhlobene ngokubambisana nokuthi i-opioids ibonisa isici esaziwa ngokuthi "ukubekezelelana" -kuthi ngokuhamba kwesikhathi abantu badinga ukulinganisa okuphezulu kwama-opioid ukufeza amazinga afanayo wokulawulwa kobuhlungu owakuthola ekuqaleni ngamazinga aphansi kakhulu. Ukubhala nokuthatha inani "elilungile" lama-opioid isikhathi eside, ngakho-ke, kuyinselele. Ochwepheshe batusa ukuthi uma ama-opioids asetshenziselwa ukwelapha ubuhlungu obungapheli obuhlobene nomdlavuza, ukusetshenziswa kwabo kuqondiswe odokotela abasebenza ngokukhethekile ekulawuleni ubuhlungu.
Ama-opioid amaningana okwamanje asetshenziselwa ukunakekelwa kwezokwelapha, kuhlanganise buprenorphine, ikhodiine, fentanyl, i-Oxycontin, i-methadone, i-morphine, i-Percocet ne-Vicodin.
Izinkinga Zempilo Zivame Ukubonwa Ngama-opioids
Ngaphambi kokuchaza izinkinga zenhliziyo ezingabangelwa ama-opioids, kuyoba usizo ukuhlunga izinkinga ezivamile lezi zidakamizwa ezingabangela.
Njengoba sibonile, indlela i-opioid isebenza ngayo ngokubopha ama-opioid receptors ohlelweni lwe-central central ne-peripheral, futhi ngokwenza kanjalo banciphisa umbono wezinhlungu. Kodwa-ke, uma kusetshenziswe ama-opioid ngokweqile, isenzo sabo kwisimiso sezinzwa singakhipha imiphumela eminingana embalwa, kuhlanganise: ukuguquka, ukuphefumula, ukuphefumula, ukudideka, ukuhlanza, ukukhomba abafundi, nokugxila.
Ukushona kwama-opioid overdose ngokuvamile kwenzeka ngesikhathi se-opioid-induced-stimulated, lapho umshini wokuphefumula ucindezeleke ngokuphelele ukuthi ukuphefumula kumane.
Izinkinga zezinhliziyo ezinama-opioid
Njengoba kunikezwe lezi zinkinga ezingezinhle zomzimba ze-opioids, kungase kungamangazi ukuthi izinkinga eziningi zenhliziyo ezibangelwa lezi zinto zitholile kancane kancane.
Noma kunjalo, i-opioids manje ihlotshaniswa nezinkinga eziningana zenhliziyo, kanti ezinye zazo zingasongela ukuphila.
Izinkinga zenhliziyo ezihlobene nama-opioids zihlanganisa:
Umsebenzi ocindezelekile we-muscle wenhliziyo. Nakuba ama-opioid ngokwawo angenalo ithonya elincane ekwenzeni ikhanda lezinhliziyo zisebenze ngokuqinile (okungukuthi, enkonzweni yesifo senhliziyo), ukuvumelanisa isivumelwano kungabanjelwa lapho ama-opioids ehlanganiswa ne-benzodiazepines (izidakamizwa ezifana neValium). Le nhlanganisela ayiyona into engavamile kubantu abathatha i-opioids engapheli. Kubantu abanenkinga yenhliziyo eyinkimbinkimbi eveza izinga elithile lobuthakathaka ekusebenzeni kwenhliziyo, njenge- cardiomyopathy , ukuhlanganiswa kwe-opioid kanye ne-benzodiazepine kunganciphisa ukwehluleka kwenhliziyo .
I-Bradycardia. I-Bradycardia, noma izinga lentliziyo elincane, libonakala njalo njalo kubantu abathatha ama-opioid. Ngokuvamile le brascardia ingenxa yokunciphisa i-node yesusus, njengoba kubonakala kwisifo se-sinus syndrome . I-opioid bradycardia ayikhombisi neze izimpawu zokuphumula, kodwa kungaholela ekutheni ukubekezeleleka kokuzivocavoca umzimba, ngoba izinga lokushaya kwenhliziyo lingenakukwazi ukukhula ngokujwayelekile ngokuzivocavoca.
Vasodilation. I-Vasodilation, noma ukujula kwemithwalo yegazi, ingabangelwa ukusetshenziswa kwe-opioid. Lokhu kuhlasela kungabangela hypotension (low blood pressure). Ngenxa yokuthi ama-opioid nawo angakhipha i-bradycardia kanye ne-vasodilation, lapho umuntu e-opioid evuka masinyane angase ahlasele ngokuzumayo ukucindezelwa kwegazi-isimo esibizwa nge- orthostatic hypotension . I-Orthostatic hypotension ingabangela ubukhulu obunzima ngenkathi ilungile, noma ngisho nokuvumelanisa .
I-tachycardia ye-Ventricular. Ngokukhethekile i-opioids amabili (i-methadone ne-buprenorphine) ingenza isenzo ku- electrocardiogram (ECG) esibizwa ngokuthi i- QT extension . Kwamanye abantu, i-QT prolongation ingaveza uhlobo oluyingozi lwe- tricycardia ye- ventricular ebizwa ngokuthi i-torsades de pointses. Loluhlobo lwe- arrhythmia yenhliziyo luvame ukukhiqiza iziqephu zezinwele ezinzima, i-syncope, noma ngisho nokufa okungazelelwe.
I-fibrillation ye-Atrial. I-fibrillation ye-atrial , isimiso senhliziyo esisheshayo esisheshayo esingazange senzeke , esibangelwa isignali kagesi ephazanyiswayo kanye nengxenyana emagumbini enhliziyo (amakamelo aphezulu enhliziyo ), iboniswe ukuthi iyanda kakhulu kubantu abasebenzisa i-opioids. Abantu abane-fibrillation ye-atrial bane- stroke ephakeme kakhulu, kanti mhlawumbe nokuhlaselwa kwenhliziyo .
Endocarditis ezithathelwanayo. Endocarditis ezithathelwanayo yisifo esisongela impilo ye-valves yenhliziyo, noma ezinye izakhiwo enhliziyweni. Kuyinto inkinga engavamile, ngokuvamile, evame ukubonakala kubantu asebekhulile abanesifo senhliziyo senhliziyo . Eminyakeni yamuva, i-endocarditis ezithathelwanayo iye yabonakala kubantu abaningi abasha kunanini ngaphambili-ikakhulukazi kwabasikati abamhlophe. Okuvamile phakathi kwalaba bantu abasha abane-endocarditis ukuthi bahlukumeze ama-opioid angaphakathi, ikakhulukazi i-heroin. I-endocarditis ezithathelwanayo inezinga eliphezulu lokufa kwabantu, kanti abasindile bavame ukushiywa isifo esingenasifo senhliziyo.
Ukuhoxiswa kwe-opioid. Ukuhoxiswa kwe-opioid kungathinta isifo senhliziyo, kodwa izimpawu ezingezona izinhliziyo zivame ukuvelela kakhulu (ikakhulukazi ukuphumula, ukuphuza ngokweqile kanye nekhala eligijimayo, imisipha ebuhlungu kanye namalunga, isicanucanu, ukuhlanza nokuhuda). Isilinganiso senhliziyo esisheshayo kanye nokuphakama kwengcindezi yegazi kuvamile ukuhoxiswa kwe-opioid, kodwa lezi zibonakaliso ngokuvamile azivezi njengoba zikhona ne-alcohol withdrawal syndrome. Noma kunjalo, ukuhlanza nokuhuda okubangelwa ukuhoxiswa kwe-opioid kungaholela ekudambiseni amanzi, ukucindezela kwegazi okuphansi, nokuphefumula noma i-syncope. Ngaphezu kwalokho, uma ukuhoxiswa okusheshayo kwe-opioid kukhishwa ngokunikeza isidakamizwa sokuguqula i-opioid njenge-naloxone (i-Narcan) (okuyiyona inqubo yokulondoloza impilo uma kwenzeka ukudlula ngokweqile), ukuqhuma okungazelelwe ku-adrenaline kungabangela ukungaqiniseki kwenhliziyo.
Ukufa kwenhliziyo. Ucwaningo olwanyatheliswa eNcwadini ye-American Medical Association ngo-2016 lwamangaza futhi luphazamisa umphakathi wezokwelapha ngokubika ukuthi phakathi kwabantu abathola ama-opioids odokotela abanomdlavuza ongapheli, babe nokwanda okukhulu kwezifo zenhliziyo, kanye nokwanda okukhulu ekufeni okuhlobene nokungekho ngokweqile. Isizathu salokhu okweqile ekufeni kwabantu abanesifo senhliziyo nesifo esingelapheki sokwelashwa kwe-opioid siyicabangela ngalesi sikhathi. Enye inkolelo yokuthi ukusetshenziswa okungapheli kwe-opioid kungabangela ukuphefumula okuphazamisekile ukulala , isimo esithinta izifo zokuphefumula inhliziyo, ukuhlasela kwenhliziyo, nokufa okungazelelwe. Kodwa-ke, kudingekile izifundo eziningi ukuqinisekisa ukutholakala kwalolu cwaningo, nokukhipha izizathu ezikhona.
Isifingqo
Njengento ewusizo kakhulu, ama-opioid-awenze ubuhlungu obunzima obuthwalwe izigidi zabantu-abe yisibusiso esihlanganisiwe esinqunyiwe. Ngaphezu kwezinkinga eziningi ezaziwayo ezihlobene nokusetshenziswa kwe-opioid yiqiniso elingaziwa kangako ukuthi lingakhipha izinhlobo eziningana zezifo zenhliziyo. Ikhono lezinkinga zenhliziyo isisinye isizathu sokuthi odokotela neziguli kufanele baqaphele ukusebenzisa lezi zidakamizwa ukulawula ubuhlungu obungapheli.
> Imithombo:
> Ama-opioids: Isifo Sezidakamizwa Sezidakamizwa Sezidakamizwa. UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. https://www.hhs.gov/opioids/.
> Ray WA. I-Cjung CP, u-Murray KT, et al. Imithi ye-opioids edala isikhathi eside nokufa kwabantu ezigulini ezinezinhlungu ezingapheli. I-JAMA. 2016; 315 (22): 2415-2423. i-doi: 10.1001 / jama.2016.7789.
> I-American Pain Society ngokubambisana ne-American Academy of Pain Medicine. Umhlahlandlela Wokusetshenziswa Kwe-Opioid Therapial Treatment In Chronic Uncancercer Pain: Ukubukeza Ubufakazi. http://americanpainsociety.org/uploads/education/guidelines/chronic-opioid-therapy-cncp.pdf.
> Wurcel AG, Anderson JE, Chul KH, et al. Ukwandisa Izifo Ezithathelwanayo Ngezifo Eziphuthumayo Phakathi Kwabasha Abasebenzisa Izidakamizwa. Vula i-Forum Infect Dis (2016) 3 (3): ye-157. I-DOI: https://doi.org/10.1093/ofid/ofw157