Ukwelashwa kwe- cardiomyopathy eguqulekile (i-DCM) - ifomu elivame kakhulu lokuhluleka kwenhliziyo - liye lathuthuka kakhulu eminyakeni embalwa eyedlule.
Ngeshwa, ucwaningo lubonisa ukuthi iziguli eziningi ezine-DCM azitholi ukwelashwa okufanele zizitholwe. Ngenxa yalesi sizathu, kubalulekile ukuthi uqaphele izindlela zokwelashwa eziphakanyiselwe i-DCM - uma nje uqinisekisa ukuthi udokotela wakho uhlanganisa zonke izisekelo.
Phatha Isizathu Esisisekelo
Umthetho wokuqala wokuphatha i-DCM ukukhomba nokwelapha imbangela ebalulekile. Ukwelapha imbangela eyinhloko kungase kuphuze, kumise, noma kuguqule ukuqhubekela phambili kwe-DCM. Ungafunda lapha ngezimbangela eziningi ze-DCM .
Ukuphathwa kwezidakamizwa ze-DCM
Abavimba be-Beta. Abavimbela i-Beta banciphisa ukucindezeleka ngokweqile ngenhliziyo ehlulekayo, futhi baye bafakazelwa ekuthuthukiseni okukhulu umsebenzi jikelele wenhliziyo, izimpawu, nokuphila kweziguli ezine-DCM. Abavimbela i-Beta manje babhekwa njengendlela eyinhloko yokwelapha i-DCM. I-Coreg (i-carvedilol), i-Toprol (i-metoprolol), ne-Ziac (i-bisoprolol), yi-blocka blockers evame ukusetshenziswa kakhulu ku-DCM, kodwa ezinye eziningi nazo ziyatholakala.
I-Diuretics. I-Diuretics , noma "amaphilisi amanzi," iyindlela yokwelashwa eqondile kubantu abanesifo senhliziyo. Lezi zidakamizwa zandisa ukonakala kwamanzi ngezinso futhi zinciphise ukugcinwa kwamanzi kanye ne-edema okuvame ukuvela ku-DCM. Ama-diuretics asetshenziswe ngokuvamile ahlanganisa i-Lasix (furosemide) ne-Bumex (i-bumetanide).
Umthelela wabo oyinhloko wukuthi bangabangela amazinga aphansi e-potassium, okungaholela ekusebenzeni kwe- cardiac arrhythmias .
ACE inhibitors. I-ACE inhibitors (izidakamizwa ezivimbela i- angiotensin eguqula i-enzyme ) ziye zafakazela ukuthi ziphumelela kakhulu ekuthuthukiseni kokubili izimpawu nokuphila ezigulini ezinokuhluleka kwenhliziyo. Imiphumela emibi kakhulu ikhwehlela noma i- low blood pressure , kodwa iningi labantu abane-DCM libekezelela i-ACE inhibitors kahle.
Ama-inhibitors ase-ACE avame ukusetshenziswa ahlanganisa i-Vasotec (i-enalapril), i-Altace (ramipril), i-Accupril (i-quinapril), iLotensin (i-benazepril) no-Prinivil (i-lisinopril).
I-Angiotensin II receptor blockers (ARBS). I-ARBS yizidakamizwa ezisebenza ngokufanayo ne-ACE inhibitors. Zingasetshenziswa kubantu abane-DCM abangakwazi ukuthatha i-ACE inhibitors. I-ARBS evunyelwe ukuhluleka kwenhliziyo ihlanganisa i-Atacand (candesartan) ne-Diovan (i-valsartan).
Abaphikisi be-Aldosterone. I-Aldactone (i-spironolactone) no-Inspra (eplerenone) yi-aldosterone, abahlukumezekile, elinye iklasi lezidakamizwa eliboniswa ngokucophelela ekuthuthukiseni ukusinda kwabanye abantu abanokuhluleka kwenhliziyo. Uma zingasetshenziswa ngokuphepha, enye yalezi zidakamizwa ngokuvamile iphakanyisiwe, ngaphezu kwe-ACE inhibitors (noma i-ARB drug) ne-beta blocker, kubantu abane-DCM. Kodwa-ke, uma isiguli sinciphise ukusebenza kwezinso, lezi zidakamizwa zingabangela i- hyperkalemia ebalulekile (amazinga aphezulu e-potassium). Abaphikisi be-Aldosterone kudingeka baqashwe ngokucophelela, uma kunjalo, uma umsebenzi wezinso ungavamile.
I-Hydralazine ne-nitrate. Kubantu abane-DCM abanezimpawu eziqhubekayo naphezu kwe-beta-blockers, i-ACE inhibitors, nama-diuretics, ukuhlanganisa i-hydralazine kanye ne-nitrate yomlomo (njenge-isosorbide) ingathuthukisa kakhulu imiphumela.
I-Neprilysin inhibitor. I-first of the neprilysin inhibitors (iklasi elisha lezidakamizwa), lavunyelwa ukwelashwa kwenhliziyo ye-FDA ngo-2015. Lesi sidakamizwa, i- Entresto , empeleni inhlanganisela ye-ARB (i-valsartan) ne-neprilysin inhibitor (sacubitril) . Izifundo zakuqala ne-Entresto ziye zithembise kakhulu, kanti ezinye izazi zikholelwa ukuthi kumele zisetshenziswe endaweni ye-ACE inhibitor noma i-ARB. Kodwa-ke, okuhlangenwe nakho nesidakamizwa kuhlala kungapheli futhi imiphumela emibi yesikhathi eside namanje umbuzo wombuzo . Futhi, umuthi uyabiza kakhulu. Ngakho-ke ukusetshenziswa kwayo namuhla kubaluleke kakhulu ezigulini ezingakwazi ukubekezelela noma ukuhluleka ukuphendula ngokwanele ku-ACE inhibitors noma i-ARB.
Njengoba okunye okuhlangenwe nakho ku-Entresto kunqwabelene, ukusetshenziswa kwayo kuzokhula kakhulu.
I-Ivabradine . I-Ivabradine yisidakamizwa esisetshenziselwa ukunciphisa izinga lenhliziyo. Isetshenziswe ezimweni ezifana nesinus tachycardia engalungile , lapho izinga lenhliziyo lingenakuphakanyiswa khona. Abantu abane-DCM nabo bangaba nokuphumula kwamazinga enhliziyo ephakeme kakhulu kunokubhekwa njengokwejwayelekile, futhi kukhona ubufakazi bokuthi ukunciphisa izinga lezinhliziyo eziphakeme nge-ivabradine lingase lithuthukise imiphumela. Iningi lezinzwa ze-cardiologists zicabangela ukusebenzisa i-ivabradine kubantu abanobuchwepheshe obukhulu nezinye izidakamizwa (kufaka phakathi i-bloc beta) futhi ngubani osenalo lokushaya kwenhliziyo ngaphezu kwezingu-70 ngomzuzu.
Digoxin. Ngenkathi emashumini eminyaka adlule i-digoxin ibhekwa njengento eyinhloko ekupheni ukuhluleka kwenhliziyo, izinzuzo zayo zokwelapha i-DCM manje kubonakala sengathi zingezansi. Udokotela abaningi bayayichaza kuphela uma imithi ephumelelayo ingabonakali ngokwanele.
Izidakamizwa ezingenayo i-inotropic. Izidakamizwa ezingenayo i-inotropic imithi ephazamisayo eshukumisa imisipha yenhliziyo ukuba isebenze kanzima, futhi ngaleyondlela iphompo igazi elingaphezulu. Eminyakeni edlule kwakunentshiseko enkulu yalezi zidakamizwa, njengoba cishe njalo ziveza ukuthuthukiswa okusheshayo emsebenzini wenhliziyo. Ngokuyinhloko izidakamizwa ezimbili ze-inotropi (i-milrinone ne-dobutamine) zanda ukusetshenziswa ngokubanzi ekuqiniseni abantu abanezinhliziyo ezihlulekayo, futhi basebenziselwa ukwelashwa kwesikhathi eside kwabanye abantu abanesifo esibi senhliziyo. Kodwa-ke, izifundo ezalandela zabonisa ukuthi abantu baphathwe ngezidakamizwa ze-inotropic - naphezu kokuthuthukiswa okuphawulekayo abavame ukubhekana nakho - kwakwandise kakhulu ukufa. Lezi zidakamizwa manje zisetshenziswe kakhulu, futhi kuphela kubantu abanesifo esibi kakhulu senhliziyo abaye bahluleka ukuphendula kwezinye izindlela eziningi zokwelashwa.
Ukwelapha Ukuvuselela I-Cardiac
Ukwelashwa kabusha kwe-cardiac (CRT) uhlobo lwe-pacing caring that stimulates both ventricles (kwesokudla nangesobunxele) kanyekanye. (Ama- pacemakers ajwayelekile avuselela kuphela i-ventricle efanele.) Inhloso ye-CRT ukuxhumanisa ukukhishwa kwamagciwane, ukuze kuthuthukiswe ukusebenza kwenhliziyo. Ukuhlola nge-CRT ukubonisa ukuthi le mithi yokwelapha, ezigulini ezikhethiwe kahle, ibangela ukuthuthukiswa okukhulu komsebenzi wezinhliziyo kanye nezimpawu, kunciphisa izibhedlela, futhi kwandise ukuphila. Noma yisiphi isiguli esine-DCM nesibalo esikhulu segatsha esibalulekile kufanele sicatshangelwe ku-CRT.
Ukwelapha okusetshenziselwa i-Defibrillator Therapy
Ngeshwa, abantu abanomthamo olinganiselwe kuya kwi-DCM enamandla banengozi eyengeziwe yokufa kwe-cardiac okungazelelwe kusukela eziqhingini ze-ventricular arrhythmias . I- cardioverter defibrillator (i-ICD) ekhonjisiwe iboniswe ngokunciphisa kakhulu ukushona kubantu abathile abane-DCM abaye banciphisa kakhulu izingxenyana ze-ejection ze-ventricular ejection . Uma unayo i-DCM, kufanele uxoxe nodokotela wakho ukuthi i-ICD yinto okufanele icatshangelwe kuwe.
Ukufakelwa kwe-Cardiac
Ukuphumelela nge-transplantation ye-cardiac kuye kwaba ngcono kakhulu emashumini eminyaka edlule. Noma kunjalo, ngenxa yemvelo enkulu yokwelashwa, futhi iqiniso lokuthi izinhliziyo zabaxhasi zisezincane kakhulu, ukuguqulwa kwenhliziyo kugcinwe iziguli ezigula kakhulu ezinokwehluleka kwenhliziyo. Kodwa-ke, kuyaphawuleka ukuthi izikhungo eziningi zokufakelwa kwenhliziyo ziye zathola ukuthi iziguli eziningi ezibhekiswe kuzo ngokuthi "ukuphelelwa yinhliziyo ekugcineni" empeleni azizange zithole ukwelashwa kwekhanda lokuhlukumezeka kwenhliziyo abayidingayo - futhi lapho ukwelashwa okunamandla kuthuthukiswa kakhulu futhi akukho isikhathi eside sidinga ukufakelwa kwenhliziyo.
Ukwelashwa kokuhlola
Ucwaningo olwenziwe luyenziwa ukunquma ukuthi ukuphathwa kwegciwane noma ukwelashwa kwe-stem cell kungase kuzuze kubantu abane-DCM. Nakuba zombili lezi zindlela zokwelapha zibonisa isithembiso esithile, zisanda kuhlelo lokuhlola, futhi azivamile ukuthola iziguli ezine-DCM.
Izwi elivela
Ucwaningo luqhubeka lubonisa ukuthi iningi labantu abanesifo senhliziyo ngenxa ye-DCM abatholi yonke imithi okufanele bayithole. Ngenxa yalesi sizathu, uma wena noma othandekayo enesi simo kufanele uqiniseke ukuthi uyazi zonke izindlela zokwelashwa, nokuthi uyazixoxa nodokotela wakho.
> Imithombo:
> Umsebenti Wezinhlelo Zokuthola Ukuxilongwa Nokunakekelwa Kwehluleka Inhliziyo Ephuthumayo Neyengapheli 2008 ye-European Society of Cardiology, uDickstein K, Cohen-Solal A, et al. Imihlahlandlela ye-ESC yokuHlola kanye nokwelashwa kokuhluleka kwenhliziyo ephuthumayo neyiguli 2008: Umsebenzi wokuHlola nokuPhathwa kweKuhluleka Kwenhliziyo Ephuthumayo Neyiguli 2008 we-European Society of Cardiology. Kuthuthukiswe ngokubambisana ne-Heart Failure Association ye-ESC (HFA) futhi Yamukelwa yi-European Society of Intensive Care Medicine (ESICM). I-Eur Heart J 2008; 29: 2388.
> Yancy CW, Jessup M, Bozkurt B, et al. Umhlahlandlela we-ACCF / AHA ka-2013 we-Management of Heart Failure: Summary Executive: Umbiko we-American College Association of Cardiology Foundation / American Heart Association Task Force emithethweni yokuziphatha. Ukujikeleza 2013; 128: 1810.