Akuzona zonke lezi zidakamizwa ezifaka ezingeni elifanayo lomngcipheko
Izidakamizwa ezingekho-steroidal anti-inflammatory (NSAIDs) ziphakathi kwemithi evame ukusetshenziswa kakhulu emhlabeni. Zisebenza ngokuphumelelayo ekunciphiseni ukuvuvukala nobuhlungu futhi zitholakala kalula kokubili kanye nomshini.
Kodwa-ke, eziningi zalezi zidakamizwa manje ziyaziwa ukuthi zandisa ingozi yezinkinga zenhliziyo, kuhlanganise ne- acon coronary syndrome (ACS) , ukuhluleka kwenhliziyo , kanye nokufibhala kwe-atrial .
Ubukhulu balo mngcipheko okhulayo ngokuvamile buyingcosana. Kodwa ingozi iyanda ngokusetshenziswa okungapheli futhi ngezinga eliphakeme, futhi liphakeme nakakhulu kubantu abanezifo zenhliziyo. Ngaphezu kwalokho, ingozi iphezulu namanye ama-NSAID kunabanye.
(Qaphela: I-aspirin yi-NSAID endala kunazo zonke futhi esetshenziswa kakhulu. Noma kunjalo, i-aspirin inciphisa ingozi yomzimba, futhi ngeke ixoxwe kule ngqungquthela. Ungafunda ngokusetshenziswa kwe-aspirin lapha mayelana nokusetshenziswa kweprophylactic.)
Izinhlobo ze-NSAIDS
Ama-NSAID angewona ama-aspirin asebenza ngokuvimbela i- cyclooxygenase enzyme (COX) , umphumela ukunciphisa ukukhiqizwa kwama- prostaglandin okudlulisa ubuhlungu nokuvuvukala.
Kukhona empeleni ama-enzyme amabili e-COX - COX-1 ne-COX-2 - enemiphumela ehlukile. I-COX-2 ihlotshaniswa nobuhlungu nokuvuvukala, ngenkathi i-COX-1 ineminye imisebenzi, kuhlanganise nokuvikela uketshezi kwesisu kusuka ku-asidi.
Ngakho-ke, i-NSAIDS ihlukaniswa ngokuthi ivimba kuphela i-COX-2 ("i-NSAIDS" ekhethiwe), noma ngabe ivimba i-COX-1 ne-COX-2 (i-NSAID "ye-nonselective").
I-NSAID yokuqala, njenge-ibuprofen (Advil) ne-naproxen (i-Aleve), yayiyi-NSAIDS engasetshenzisi. Ngoba zivimbela i-COX-1 zihlotshaniswa nokucasula esiswini.
Izinkampani ezidakamizwa zasebenza kanzima ukuthuthukisa ama-NSAID akhethiwe avimbela kuphela i-COX-2, ukuze anciphise izinkinga zesisu. Ngakho manje kukhona ama-NSAID amaningi akhethiwe atholakalayo, kuhlanganise ne-celecoxib (i-Celebrex) ne-meloxicam (i-Mobic).
Lezi zidakamizwa ngokuvamile ziba ezintsha, futhi azitholakali kumafomu ajwayelekile noma ngaphezulu kwekhasi.
Ingozi Yezinhliziyo Nge-NSAID
Ukwanda kwenengozi yomzimba nge-NSAID kuqale kuqashelwe nge-NSAID ekhethayo i-rofecoxib (i-Vioxx), okwakhiqiza ukumemezela okukhulu nezinsolo eziningi zokulwa nomenzi wayo, uMerck. U-Vioxx wabe esekhishwa emakethe.
Kusukela ngaleso sikhathi izifundo eziningi zemitholampilo zibonise ukuthi lokhu kwanda kwengozi yenhliziyo kuhlotshaniswa nakho konke ama-NSAID, kokubili ama-NSAID omdabu wokudoba kanye nemithi ekhethiwe ye-COX-2.
Cishe yonke i-NSAID, ingozi ye-cardiovascular ikhuphuka ngobude bokusetshenziswa kwezidakamizwa, nomthamo osetshenzisiwe, nangomngcipheko wegazi womuntu ophuza izidakamizwa.
Amanye ama-NSAID "Aphephile" Kunabanye?
Idatha ngokuqhathanisa ubukhulu benengozi yomzimba ebangelwa ama-NSAID athile ahluleka. Ngenxa yenani elikhulu lalezi zidakamizwa ezitholakalayo, futhi ubukhulu obuncane besengozini obubandakanyekile, ukuqhuba izivivinyo zomtholampilo ezidingekayo ukuze kukhishwe noma yikuphi ukungafani kuzoba kubiza ngokweqile.
Kodwa-ke, ukuhlaziywa kwe-meta-uphando lwezifo ezitholakalayo kwanyatheliswa ngo-2013. Lokhu kuhlaziywa kubonisa ukuthi ingozi yemicimbi ye-cardiovascular yanda kakhulu uma kuqhathaniswa ne-placebo ene-dose ephakeme ye-diclofenac (i-NSAID ye-Nonse), nayo yonke i-NSAID ekhethiwe.
Ukwanda kwengozi kwaphinde kwabonakala nge-ibuprofen eyayingeyona into ephawulekayo. Futhi akukho ukukhuphuka engcupheni kubonwe nge naproxen.
Lokhu kuhlaziywa kwe-meta akubhekwa njengokuqedile. Iningi lezazi zenze umbono wokuthi yonke i-NSAID, yezo zombili izigaba, kufanele ikhulise ingozi yempilo.
Kodwa-ke, uma i-NSAID idinga ukusetshenziswa kumuntu othintekayo mayelana nokwandisa ingozi yomzimba, ochwepheshe abaningi bangancoma i-naproxen.
Ezinye izinkathazo ze-Cardiac ezihlobene ne-NSAIDS
Ngaphandle kokwandisa ingozi yemicimbi yezinhliziyo, zombili izigaba zama-NSAID nazo zihlotshaniswa nokwanda kwe-blood pressure uma zisetshenziswe ngezikhathi ezithile.
Ngaphezu kwalokho, eziningi ze-NSAID ezingenayo iphazamisa imiphumela ezuzisayo eyenziwa yi-aspirin kumaplatelet, ngaleyo ndlela iphikisana nemiphumela ye-aspirin ye-prophylactic. Lokhu kuphazamiseka akubonwanga, noma kunjalo, nge-NSAID diclofenac, noma nge-NSAID ekhethiwe.
Ngaphansi
Ngesikhathi i-Vioxx ithola lonke ulwazi, kuvela ukuthi yonke i-NSAID ibonakala ingeza ingozi yomzimba cishe ngesilinganiso esifanayo (ngaphandle kwalokho okuveziwe kakade).
Kubantu abasengozini enkulu yenhliziyo, ama-NSAID kufanele asetshenziswe ngomthamo ophansi kunazo zonke isikhathi esifushane kakhulu. Uma ingozi yakho yomzimba iphakanyisiwe , i-naproxen cishe i-NSAID yakho yokuzikhethela.
Noma ubani onomfutho wegazi ophakeme kufanele aqaphele ukuthi ama-NSAID angakhuphula ukucindezelwa kwegazi futhi anciphise ukusebenza kwe- antihypertensive therapy .
Noma ubani othatha i-aspirin ye-prophylaxis ngokumelene nezifo zenhliziyo kufanele agweme ama-NSAID angenayo yonke indawo uma kungenzeka. Uma ama-NSAID azosetshenziswa, kufanele athathwe okungenani amahora amabili ngemva kwe-aspirin.
Imithombo:
Fosbøl EL, Folke F, Jacobsen S, et al. Inhlekelele ethize ye-CV ehlobene ne-NSAID phakathi kwabantu abaphilile. Imibala ye-Circ Cardiovasc Qual 2010; I-DOI: 10.1161 / IZINDLELA ZOKUQALA 109.861104.
I-Coxib kanye ne-NSAID Trialists '(CNT) Ukusebenzisana, Bhala N, Ubuntu J, et al. Imiphumela ye-Vascular kanye engenhla yamathumbu wezidakamizwa ezingezona izifo ezivuvukalayo: ukuhlaziywa kwe-meta-idatha yomuntu ngamunye ohlanganyele kusuka ekuhlolweni okungahleliwe. Lancet 2013; 382: 769.