Futhi uthembisa amanye ama-Dysautonomias, afana ne-POTS ne-Vasovagal Syncope
I-sinus tachycardia engafanele (IST) yisimo esibonakala ngesilinganiso senhliziyo esisheshayo ngokujwayelekile (tachycardia), kokubili kokuphumula nangesikhathi sokuzikhandla, okuvame ukuthinta abantu abasebasha abaphilile ngokuphelele. Labo ababhekene ne-IST bavame ukuzwa amaphupho amaningi kanye nokungahloniphi nokukhathala, futhi isimo singakhubaza ngempela.
Ukwelashwa okuphumelelayo kwe-IST, ngeshwa, kuvame ukuyinselele.
I-Ivabradine yisidakamizwa esisha esithengiswa ukwelashwa kwe- angina ne-heart failure. Eminyakeni yamuva i-ivabradine ibonise isithembiso esibalulekile sokuphathwa kwe-IST. Imibiko ibonisa ukuthi ingase iphumelele nakwezinye izidakamizwa ze-dysautonomia lapho i-tachycardia ngokuvamile iyingxenye evelele.
I-Ivabradine Isebenza Kanjani?
I-Ivabradine ivimbela isiteshi sami, isiteshi esithombeni se-cell evumela ukuthi i-sodium ne-potassium ifake amaseli. Umzila we-I (i-"f" imelela "okuhlekisayo," okuthiwa lesi siteshi siziphatha ngendlela ehlukile kunezinye iziteshi eziningi), idlala indima enkulu ekudubula i- node yesusus , elawula isigqi senhliziyo evamile. Ngokuvimbela isiteshi sami, i-ivabradine iyanciphisa izinga lokudubula kwe-node yesusus, futhi ngaleyo ndlela iyanciphisa izinga lenhliziyo. Le ndlela yokunciphisa izinga lokushaya kwenhliziyo isuke ehluke ngokuphelele ezindleleni ezisetshenziswa yi- beta blockers kanye ne- calcium channel blockers , ngakho i-ivabradine ivame ukunciphisa izinga lokushaya kwenhliziyo ngisho nalapho lezi ezinye izidakamizwa zihluleka ukwenza kanjalo.
I-Ivabradine yasungulwa ekuqaleni kokwelapha i-angina futhi yavunyelwa ukusetshenziswa emhlabeni wonke ngo-2005. Yavunyelwa e-US ngo-Ephreli 2015 yokwelashwa kwenhliziyo , kodwa hhayi ye-IST.
I-Ivabradine Ku-IST
Imibiko eminingana emincane - evame ukuchazela iziguli eyodwa noma ezimbili - yaqala ukuvela ngemuva nje kokuba isidakamizwa sisebenzise emtholampilo, siphakamisa ukuthi i-ivabradine ingase ibe usizo ekuphatheni iziguli nge-IST.
Khona-ke, ngo-2012, isilingo somtholampilo esilawulwa kahle esakhiwe kahle, esabiwe nge-placebo sabikezwa e-Italy, esaphetha ngokuthi i-ivabradine ingaba yimpumelelo ngokukhethekile kule nkinga. Iziguli ze-IST ezingahle zenziwe nge-ivabradine zibonise ukuncipha kwezimpawu ezingu-75%, futhi iziguli ezingu-50% eziphathwayo zabika ukulungiswa okusheshayo nokuphelele kwezimpawu. Imiphumela emibi yayincane. Uma kuqhathaniswa nalokho okuvame ukubonwa nezinye izidakamizwa zokwelashwa ezisetshenziselwa i-IST, umphumela onjalo uyabetha.
Isivivinyo esingasetshenziswanga okwedlule nge-ivabradine ezigulini ezingu-24 ezine-IST sibonise imiphumela emihle efanayo. Kulesi sivivinyo, noma kunjalo, lesi sidakamizwa sagcinwa ezigulini ezingu-10 emva konyaka owodwa ukubona ukuthi kuzokwenzekani (ezinye iziguli zenqaba ukuphuza izidakamizwa), kanti ezingu-8 kulaba abayishumi azikho ukuphindaphinda kwe-IST.
I-Ivabradine ye-POTS ne-Vasovagal Syncope
I-postural orthostatic tachycardia syndrome (i-POTS) ne-syncope ye-vasovagal yilawo amanye ama-syndromia ama-dysautonomia lapho i-sinus node tachycardia ivame ukudlala indima evelele ekukhiqizeni izimpawu. Ngakho akumangalisi ukuthi odokotela bangakhetha ukuzama ivabradine kulezi zimo.
Kukhona idatha engokoqobo ekusetshenzisweni kwe-ivabradine ye-POTS, kodwa odokotela emhlabeni jikelele baye basebenzisa lesi sidakamizwa kubantu abakhethiwe abanalo nalesi simo.
Idatha ekhona, noma kunjalo, ikhombisa ukuthi, okungenani kwabanye abantu, ukulawula i-tachycardia ne-ivabradine kunganciphisa noma kuqede ezinye izimpawu ezihlobene ne-POTS. Isivivinyo somtholampilo esingahleliwe esisebenzisa i-ivabradine ye-POTS manje senziwa ku-Israyeli.
Ngenkathi i-syncope ye-vasovagal ihlotshaniswa nokudonsa okunamandla ekucindezelweni kwegazi futhi (ngokuvamile) ngenani lezinhliziyo, kuyaziwa ukuthi ngaphambi kokulahlekelwa kokwazi (okungukuthi, ngesikhathi "izimpawu zokuxwayisa" abantu bavame ukubhekana nalesi simo), Ngokuvamile isilinganiso senhliziyo esisheshayo ngokuvamile sikhona. Esikhathini sokutadisha umshayeli wezilwane ezingama-25 ezine-syncope ye-vasovagal abonise i-tachycardia enjalo nje ngaphambi kokudlulela, ngaphezulu kuka-70% kwaba nemiphumela emihle nge-ivabradine-kungaba ukunciphisa okukhulu noma ukuqedwa kwezimpawu.
Ngakho, i-ivabradine ibonisa isithembiso sangempela kubo bonke ama-dysautonomi lapho isinus tachycardia isici esikhulu.
Imiphumela emibi ye-Ivabradine
Okuwukuphela kwethonya elivelele elibi elibikwe nge-ivabradine, elibonwa ezigulini ezizungeze ezingu-15%, isimo esibukwayo esibizwa ngokuthi "into ekhanyayo." Lesi simo sibonakala sibhekene "nokukhanya" okungavamile emasimini abukwayo, ngaphandle kokuguquka kokubonakala okubonakalayo . Kucatshangwa ukuthi kubangelwa ukuvimbela isiteshi kumaseli we-retinal afana nesiteshi sami enhliziyweni. Ngenhlanhla, lo mphumela ohlangothini uvame ukuba mncane futhi uvame ukuzixazulula wedwa. Omunye umbiko wamanje ubonisa ukuthi iziguli ezikulesi sidakamizwa zingase zibe nengozi eyengeziwe ye-fibrillation ye-atrial . Eminye imiphumela emibi engavamile kakhulu ihlanganisa ikhanda lokukhwabanisa kanye nosizi. Ngokuvamile isidakamizwa esibikiwe sibekezeleleke kahle.
I-Ivabradine e-US
Nakuba le mithi isetshenziswe iminyaka engaphezu kweyishumi eYurophu, emazweni amaningi ase-Asia, naseRussia, e-Australia naseCanada, yamukelwa e-US kuphela ngo-Ephreli 2015. Ngaphezu kwalokho, ukukhombisa kuphela imvume e-ivabradine e-US ukuphathwa kokwehluleka kwenhliziyo. (I-Ivabradine idayiswa ngu-Amgen, ngaphansi kwegama lohwebo uCorlentor.)
Uma uhlala e-US futhi ube ne-IST (noma enye ye-dysautonomias engaphendula kulo muthi), futhi uma udokotela wakho ekholelwa ukuthi i-ivabradine ingaba nenzuzo kuwe, manje uyakwazi ukuyibeka. Kodwa-ke, njengoba i-ivabradine ibhalwe kuphela ngokuhluleka kwenhliziyo e-US, udokotela wakho kumele azimisele ukuwubeka "ukusetshenziswa kwelebula" ukusetshenziswa. Kunoma yikuphi, i-ivabradine manje iyindlela engokoqobo nakwabaseMelika abane-IST.
> Imithombo:
> Cappato R., Castelvecchio S., Ricci C., Ukusebenza Kwemitholampilo ye-Ivabradine Ezilwelweni Nge-Sinus Tachycardia engafanele: i-Prospective, Randomized, i-Placebo-Controlled, i-Double-Blind, i-Crossover Evaluation. J Am Coll Cardiol. 2012; 60: 1323-1329.
> Benezet-Mazuecos J1, Rubio JM, Farré J, et al. Imiphumela Yesikhathi Eside I-Ivabradine Ezingalungile I-Sinus Tachycardia Iziguli: I-Efficacy efanele noma iziguli ezingafanelekile. I-Pacing Clin Electrophysiol. 2013 Jul; 36 (7): 830-6. i-doi: 10.1111 / ijubane.12118. Epub 2013 Mar 19.
> McDonald C, Frith j, Newton JL. Okuhlangenwe nakho Kwesikhungo Sodwa se-Ivabradine ku-Postural Orthostatic Tachycardia Syndrome. I-Europace (2011) 13 (3): 427-430. doi: 10.1093 / europace / euq390.
> Sutton R1, uSalukhe TV, Franzen-McManus AC, et al. I-Ivabradine ekwelapheni kweSinus Tachycardia Mediated Vasovagal Syncope.Europace. 2014 Feb; 16 (2): 284-8. doi: 10.1093 / europace / eut226. I-Epub 2013 Septhemba 26.