Imithi yokwelapha ye-Intravenous Migraine kuGumbi Eliphuthumayo
Ngezinye izikhathi ubuhlungu bokuhlasela kwe-migraine bukhulu kangangokuthi kudinga ukuvakashelwa kwamagumbi okuphuthumayo. Noma, kwezinye izimo, isicanucanu nokuhlanza okuhambisana nomkhawulo wokuhlasela we-migraine umuthi wokwelashwa ngomlomo. Emakamelo okuphuthumayo noma izikhungo zokunakekelwa okuphuthumayo, ukuhlaselwa okuphawulekayo kwe-migraine kuvame ukuphathwa ngemishanguzo emithi. Kodwa yiyiphi engcono kakhulu?
Ucwaningo olulodwa ku- Neurology ngeziguli ezingama-330 ezinokuhlasela okunamandla okuthola imithi ye-sodium valproate, i-10mg Reglan (metoclopramide), noma i-30mg Toradol (ketorolac).
I-valproate ye-sodium iyi-anti-seizure imithi ukuthi ngesinye isikhathi ifomu lomlomo isetshenziselwa ukuvimbela imithi. Eqinisweni, i-American Academy of Neurology yaphetha ngokuthi imikhiqizo ye-valproate, i-divalproex sodium ne-valproate ye-sodium, iyasebenza (i-Level A izidakamizwa) ekuvimbeleni i-migraines. Lokhu kushiwo, kubalulekile ukuqaphela ukuthi i-valproate iphikisana nabesifazane abakhulelwe.
I-Reglan (i-Metoclopramide) iyi-anti-emetic noma anti-nausea imithi. Ivimbela i-dopamine receptors ebuchosheni futhi iyancishisa ngokuyinhloko i-gastroparesis (lapho ukudluliswa kokuqukethwe kwesisu kufinyelelwe). Kuvame ukusetshenziswa njenge-agent eyodwa yokuphatha imigraines emakamelweni aphuthumayo. Kungabangela umuzwa wokunganaki.
I-Toradol (Ketorolac) iyi-NSAID enokuqala okusheshayo kwesenzo. Njengo-Reglan, kuvame ukusetshenziselwa amakamelo okuphuthumayo ukuphatha imithi ye-migraines. Kodwa-ke, khumbula ukuthi ama-NSAID anemiphumela eminingana engalungile futhi kufanele agwenywe ngabanye abantu, ikakhulukazi labo abanomlando wesisu lokuphuma kwegazi, isifo sezinso, kanye nesifo senhliziyo.
Ukuboniswa kwalesi sifundo se-Migraine?
Esikhathini sokucwaninga, zonke iziguli zabika izinga lokuqala lobuhlungu be-migraine le-7 noma ngaphezulu esikalini se-0 kuya kwezingu-10, futhi iningi lalingathathi imithi yokuvimbela i-migraine.
Ngemuva kwehora elilodwa lokuthola omunye wemithi emithathu okukhulunywe ngenhla, labo abathola i-valproate ye-sodium bathuthukiswe ngamaphesenti angu-2.8 kanti labo abathola i-Reglan no-Toradol bathuthukiswa ngokulinganiselwa kwamaphuzu angu-4.7 no-3.9, ngokulandelana.
Imiphumela yocwaningo yabuye yabonisa ukuthi abamukeli be-valproate ye-sodium bafuna imithi eminingi yokuphumula yokuphumula (amaphesenti angu-69) uma kuqhathaniswa nalabo abathola i-metoclopramide (amaphesenti angu-33) ne-ketorolac (amaphesenti angu-52). Imithi yokwelapha i-migraine
Ekugcineni, inani elikhulu labamukeli be-Reglan bakhetha ukuthola le mithi efanayo ngesikhathi sokuvakasha kwegumbi eliphuthumayo uma kuqhathaniswa namanye amaqembu amabili.
Konke lokhu kuthiwa, emahoreni angu-24 emva kokulawulwa kwezidakamizwa zokuqala, ukuxilongwa kwekhanda okuqhubekayo kwakuncane kuwo wonke amaqembu amathathu: i-valproate ye-sodium (amaphesenti angu-4), i-Reglan (amaphesenti angu-11), no-Toradol (amaphesenti angu-16) -sinasiphetho esikhulu kakhulu.
Lokho Okushiwo Konke?
- U-Reglan no-Toradol bangase bakhethwe phezu kwe-valproate ye-sodium njengemithi yokwelapha yokuhlasela kwe-migraine ekamelweni eliphuthumayo.
- I-Reglan ingaba yimithi ekhethwayo phakathi kweziguli eziya ku-ER ze-migraine-nakuba lokhu akuwona umthetho onzima futhi okusheshayo.
- Ukukhathazeka okuvezwe lapha ukuthi iningi lezihloko azizange zithole ukukhululeka kwezinhlungu zekhanda. Lokhu kusho ukuthi sidinga ukwelashwa okungcono ukuhlinzeka ukuphumula kobuhlungu be-migraineurs ngesikhathi sokuhlaselwa okunzima, okunzima.
I-caveat yocwaningo okufanele kukhulunywe ngayo ukuthi iningi labahlanganyeli ababengathathi imithi yokwelapha ye-migraine.
Lokhu kwenza kube nzima ukukhiqiza imiphumela kulabo abane- migraine eyingozi kakhulu / / engapheli (okungenzeka bathatha imithi yokuvimbela).
Enye iphuzu lokukhuphula ukuthi lezi zidakamizwa ezintathu ezingezona zodwa akuzona ezisebenzisayo zokwelapha okukhulu, nokuhlasela okunamandla ekamelweni eliphuthumayo.
Enye indlela yokwelashwa kwe-migraine ku-ER isifo se-sumatriptan esincane (i- triptan enikezwa njengomjovo emaqenjini akho amafutha). Ezinye izinhlobo ze-antiemetics ezifana neCompazine (prochlorperazine) zinganikezwa, kaningi kanye neBenadryl (diphenhydramine) ukuvimbela imiphumela emibi ye-antiemetics, njengokungabi nokuphumula kanye ne- dystonia .
I-Dihydroergotamine (i- DHE ) nayo inganikezwa ekamelweni eliphuthumayo futhi ingalawulwa njengesiphampu esisodwa, ngokungahambisani, noma nge-intramuscularly. I-DHE ingabangela i-nausea, ngakho-ke i-antiemetic ivame ukunikezwa kusengaphambili ukuvimbela lokhu.
Okokugcina, odokotela abathile be-ER banikeza futhi i-steroid ebizwa ngokuthi i-dexamethasone ngenye yezinto ezibalwe ngenhla ye-migraine-inkolelo yokuthi ingasiza ekunciphiseni ithuba lokuthi ikhanda lomuntu lizobuya ekuseni. Ukushisa nge-IV fluids kuyisici esikhulu sokuphatha i-migraines egumbini lokuphuthumayo, ikakhulukazi uma umuntu enesisulu sokuhlanza nokuhlanza.
Izwi elivela
Uma uqeda ukuya ku-ER ngokuhlasela okunamandla, ungase uthole imithi emithanjeni (noma umjovo, uma udokotela wakho ekunika i-sumatriptan). Ekugcineni, lokho udokotela akunika khona isinqumo esenziwe ngabanye, ngokusekelwe kumlando wakho wezempilo ohlukile.
> Imithombo:
> Bajwa ZH, Smith JH. (February 2017). Ukwelashwa okunamandla kwe-migraine kubantu abadala. Ku: UpToDate, Swanson JW (Ed), UpToDate, Waltham, MA.
> Gilmore B, Michael M. > Ukwelashwa kwe-Acute U-Headache. > Am Fam Physician. 2011 Feb 1; 83 (3): 271-280.
> Friedman BW et al. Ukuhlolwa okungahleliwe kwe-IV valproate vs metoclopramide vs ketorolac ukuthola ukuguquka okunamandla. I-Neurology. 2014 Mar 18; 82 (11): 976-83.
> Kostic MA, Gutierrez FJ, Rieg TS, Moore TS, Gendron RT. Ukuhlolwa okungahleliwe, okuhloswe ngokulandelana kwe-proklorperazine versus subcutaneous sumatriptan ekwelashweni okulukhuni kumnyango ophuthumayo. U-Ann Emerg Med . 2010 Jul; 56 (1): 1-6.
> Silberstein SD et al. Ukubuyekezwa okusekelwe ebukhosini: Ukuphathwa kwe-pharmacologic yokuvimbela i-episodic migraine kubantu abadala: umbiko we-Quality Standards Subcommittee ye-American Academy of Neurology kanye ne-American Headache Society. I-Neurology 2012; 78: 1337.