Pane maitiro maviri maitiro ekurapa utachiona hwehutachiona :
- Kuedza kubvisa uwandu hwehutachiona hwehutachiona zvachose uye kudzorera uye kuchengetedza mwoyo wakakwana rhythm ( Verenga pamusoro pechirongwa chekugadzirisa urongwa )
- Bvumira frill fibrillation kuti irambe ichiramba ichidzora kutarisa mwoyo
Zvichipiwa izvi zviviri zvingasarudzwa, pasina ruzivo rwakawedzerwa, anenge chero munhu aizotanga kusarudza rhythm control approach.
Zvisinei, mumutambo chaiyo, nzira iyi inowanzosvika isina kusimba uye isina yakachengeteka kudarika kutengesa kwekutengesa.
Chikonzero icho rhythm control urongwa inowanzova dambudziko ndechokuti zvinodhaka zvinodhaka zvinowanzodiwa pakudzorera nekuchengetedza chimiro chemoyo chaiwo. Iyi mishonga inowanzove isina kukwana, inosvibisa, kana maviri. (Cherechedza kuti kune vamwe varwere, kubvisa kubvisa fyria inouraya nehutachiona hunoita .)
Chinhu chinonyanya kutaura pamusoro pemishonga inopesana nemishonga inokonzera utsvina, iyo inowanzoita kuti zvive zvakaoma uye zvisingabatsiri kutungamirira uye kutora. Kune marudzi maviri ehuwandu ehutachiona hunowanzoonekwa nemishonga inorwisa mishonga:
- Izvo zvinowanzova nemigumisiro inowanikwa nemishonga yakawanda, yakadai semakemikari, kusuruvara, kuvhiringidzika kwepamuviri, nezvimwewo.
- Proarrhythmia, iyo inokonzera dambudziko guru nemishonga inopesana nemishonga.
Proarrhythmia
"Proarrhythmia" inongoreva kukonzera chimiro chechimiro. Izvi zvinoreva kuti, panzvimbo yekubvisa magaramisi aya madhiragi anogona chaizvo kuaita. Antiarrhythmic zvinodhaka zvinoshandiswa nekushandura magetsi emagetsi emwoyo. Icho chinotarisa kuti pose paunoshandura magetsi aya zvinhu zviviri zvakasiyana-siyana zvinogona kuitika-unogona kuita arrhythmias zvishoma kuti zviitike (iyo ndiyo chinangwa), kana kuti iwe unogona kuita kuti arrhythmias inowanzoitika.
Zvakaipisisa, maitiro e arrhythmias anokonzerwa neproarrhythmia (kusiyana nehutrial fibrillation pachake) inogona kuuraya. Nokudaro, chero nguva iyo zvinodhaka zvinoshandiswa zvinoshandiswa, pane zvimwe njodzi yekukonzera kutyisidzira upenyu hunofanira kuita kuti vanachiremba nevarwere vasaze kuishandisa kunze kwekuti ivo vachida zvechokwadi.
Mimwe mishonga inowanzoita kuti huve nemararamiro kune vamwe uye vamwe varwere vanowanzova nemararthmia kupfuura vamwe. Mikana yeproarrhythmia neimwe chirwere mune mumwe murwere inofanira kuongororwa musati mishonga iyi inorayirwa.
Kurapa Mafiro Atrial
Mishonga mitanhatu inopesana nemishonga inowanzoshandiswa pakurapa fyria inouraya: propafenone (Rhythmol), flecainide (Tambocor), sotalol (Betapace), dofetilide (Tikosyn), amiodarone (Cordarone), uye dronedarone (Multaq). Kune ani naani anotora mishonga iyi, kurapwa kunofanira kunyatsotariswa kuti kuve nehuwandu hwehutachiona, asi zvinotevera zvinogona kuitwa:
- Rhythmol naTambocor vanoregererwa zvakanaka chero bedzi ivo vasingaiti hurumende. Mune varwere vari vaduku uye vane hutano, avo vasina chirwere chepfungwa chepfungwa uye vari pangozi yakanyanya yekutapukira kwechirwere chemwoyo, vanokonzerawo zvishoma kwazvo proarrhythmia. Uye mune izvi varwere, vangave sarudzo yakanaka yekuedza kudzorera rwiyo rwechirwere kune varwere vane fibrillation yeprial. Vanoonekwa sevanonyatsobudirira. Zvisinei, kune varwere vane chirwere chipi nechipi chepfungwa yepfungwa, kana kuti ndiani ane ngozi yakawanda yokuva nechirwere chemwoyo, mishonga iyi inonyanya kukonzera hupenyu hunotyisa proarrhythmia uye inofanira kudziviswa nguva dzose.
- Betapace naTikosyn vakanyatsorambidzwawo chero bedzi ivo vasingaiti chirwere chemararamiro. Zvisinei, mishonga iyi inogona kubudisa sarudzo mumunhu uye kunyatsochenjerera kunofanira kutorwa navanachiremba kuti vaderedze ngozi. Zvechokwadi, munyaya yeTikosyn, FDA yakatsanangura kuti vanachiremba vanofanira kutora kurairirwa kwakanyanya vasati vabvumirwa kutungamirira ichi chirwere. Iyi mishonga inonyatsobudirira mukudzora friction fibrillation.
- Cordarone inoshamisa yakasiyana-siyana inorwisa mishonga inodhaka. Kunyange zvazvo iri yakakosha kupfuura chero mimwe mishonga mukurapa inrial fibrillation, uye iyo iyo inokonzera zvishoma zvishoma proarrhythmia, inonyanya kukanganisa kukonzera mamwe mimwe migumisiro inogona kuva yakakosha uye kunyange kutyisa upenyu. Somugumisiro, Cordarone inofanira kudziviswa pose pose zvichibvira. Apo inoshandiswa, kutarisa kwakanyatsofanirwa kunofanira kuitwa nokuda kwehutu chero bedzi murwere achitora mishonga uye kwemwedzi inoverengeka mushure mekunge mishonga inomiswa. Iwe unogona kuverenga pamusoro pezvinhu zvakasiyana-siyana zveCordarone pano .
- Multaq ihanzvadzi yeCordarone uye yakasimbiswa netariro iyo inogona kunge yakaita seCordarone isina chepfu. Asi, kunyange zvazvo Multaq inenge iri shoma shoma kudarika Cordarone, haisi iyo inoshanda mukudzivirira hutachiona hwehutachiona. Uyewo, Multaq haigone kushandiswa kune vanhu vane mwoyo wakakundikana . Heano humwe ruzivo pamusoro pekushandiswa kweMutaq pakurapa friction friction.
The Bottom Line
Zvinofanira kuva zvakajeka kuti kurapwa kweAriric fibrillation nemishonga inorwisa-iyo ndiyo nzira yekuedza kudzorera nekuchengetedza rwiyo rwemaitiro-inogona kuva yakaoma zvikuru. Nokuda kwechikonzero ichi, kuwedzerwa kune chokwadi chokuti zvipatara zvinoratidzira hazvina kuratidza kubatsirwa zvachose kurongwa huno hwekurapa, zviri nani kuti varwere vadzivirire mishonga inopesana nemishonga zvachose uye vasarudza panzvimbo yekutengesa-chirongwa chekurapa chirongwa.
Sources:
Fogoros, RN. Mushonga we Supraventricular Arrhythmias. Mu: Fogoros, RN. Dambudziko reAnarrhythmic - A Practical Guide. Blackwell Publishing, Malden, MA: 2007.
American College of Cardiology Foundation, American Heart Association, European Society of Cardiology, et al. Kutarirwa Kwevarwere Nehutano Hwenyama (Compilation ya 2006 ACCF / AHA / ESC uye 2011 ACCF / AHA / HRS Zvinyorwa): Mharidzo yeAmerican College of Cardiology / American Heart Association Task Force pamitungamiri yekuita maitiro . Circulation 2013; 127: 1916.