Amiodarone (Cordarone, Pacerone) ndiye mishonga inonyanya kushandiswa yakave yakagadzirirwa kurapwa kwemaridythmias . Zvinosuruvarisa, zvinogonawo kunge zvakanyanya kutyisa antiarrhythmic mishonga , uye iyo yakaoma zvikuru kushandisa zvakanaka. Zvinowanzovhiringidza zvemadiodarone zvinosanganisira zvinetso zvehutachiona, mari inokonzerwa nehutachiona, zvinetso zveropa, bluish discoloration yeganda, uye photosensitivity (nyore nyore sunburning).
( Verenga sarudzo yakawanda yeAmododarone pano .) Nokuti kana iyo inogona kukwanisa kubudisa marudzi akasiyana-siyana ekutsvaga, amiodarone inofanira kuongororwa kune vanhu vane hupenyu hwekutya kana kuti vanovhiringidza arrhythmias, uye avo vasina dzimwe nzira dzakanaka dzokurapa.
Icho chinotyisa chinokonzerwa nemasodarone, nechokure, is pulmonary (lung) chepfu.
Chii chinonzi Amiodarone Lung Toxicity?
Amiodarone lung lungisi inogona kuitika kusvika ku5% yevarwere vanotora ichi chirwere. Hazvizivikanwe kana matambudziko emapapu anokonzerwa nemaodarone anokonzerwa kukanganisa kukanganisa nemishonga kusvika kumapupa emapapu, kune maitiro ekudzivirira zvirwere kumishonga, kana kune imwe nzira. Amiodarone inogona kukonzera matambudziko akawanda emapapu, asi mumatambudziko akawanda dambudziko rinotora imwe yemhando ina.
1) Chirwere chinotyisa zvikuru chemayodarone mapepa chekutyisa ndechekurumidza, kutyisa upenyu, chinetso chepapu chinopararira chinonzi acute respiratory distress syndrome (ARDS) .
NeAARD, kukanganisa kunowanikwa kumakumbo emapapu emhepo emapapu, zvichiita kuti zvikwata zvizadze nemvura, uye zvinokanganisa zvikuru kukwanisa kwemapapu kutumira okisijeni akakwana muropa. Vanhu vanovaka ARDS vanoona dyspnea nokukurumidza, yakaoma (kufema kufema). Inowanzofanirwa kuiswa pamashandiro emhepo, uye kufa kwavo kwehutano kunyange nehutachiona hwakanyanya chaizvo, kusvika 50%.
ARDS yakabatana neAmododarone inoonekwa kazhinji kazhinji pakutevera chirwere chikuru, kunyanya chirwere chepfungwa, asi chinogona kuonekwa chero nguva uye pasina zvikonzero zvinoratidzika zvinokonzera.
2) Chimiro chinonyanyozivikanwa chemayodarone mapepa chechivi chinetso chisingaperi, chinopararira chemapapu chinonzi interstitial pneumonitis (IP) . Mumamiriro ezvinhu aya, mabhazi emhepo emapapu zvishoma nezvishoma anowedzera masvikiro uye akasiyana-siyana anosvibisa masero, anokanganisa kushandiswa kwemhepo mumapapu. IP inowanzo ine insidious uye zvishoma nezvishoma inotanga, zvishoma nezvishoma kufambira mberi dyspnea , kukora uye kukurumidza kuneta. Sezvo vanhu vakawanda vachitora amiodarone vane nhoroondo yezvinetso zvemwoyo, zviratidzo zvavo zviri nyore kukanganisa kukanganisa kwemwoyo (kana dzimwe nguva, zvinokonzera kukwegura). Nokuda kwechikonzero ichi, IP inowanzorasikirwa. Zvichida zvinowanzoitika pane zvinowanzofungidzirwa.
3) Zvizhinji zvisinganyanyozivikanwa ndezvokuti "inowanzo-pattern" pneumonias (inonziwo kuronga pneumonia) dzimwe nguva inoonekwa ne amiodarone. Muchiitiko ichi, chikwata x-ray chinoratidza nzvimbo yakagadzikana yekubatana zvakangofanana kune avo vanoonekwa neBacterial pneumonia . Nokuda kwechikonzero ichi, chimiro che amiodarone mapfupa ehupukisi inenge nguva dzose inokanganisa nebhakitiriya pneumonia uye inorapwa zvakakodzera.
Inowanzova iyo apo chirwere chinoshaya kupera nekuvandudza nemishonga inorwisa mabhakitiriya kuti kuongororwa kweAmayodarone kumapukisa chekukonzera kunozoonekwa.
4 ) Kazhinji, amiodarone inogona kubudisa musuru wega wega inowanikwa nebhokisi x-ray. Iyo yakawanda inowanzofungidzirwa kuva chirwere kana utachiona, uye kana bedzi apo bhiopsy inotorwa ndeye amiodarone mapfupa ehupisi pakupedzisira anozivikanwa.
Ndeapi Amiodarone Lung Toxicity Inoonekwa?
Hapana hutachiona hwekuongorora hutachiona hutachiona, kunyange kune mazano ane simba anokwanisa kuwanikwa nokuongorora masero emapapupa akawanikwa kubva kune biopsy kana mapaponic (washing machineways with fluid), kazhinji achishandisa bronchoscopy .
Chinokosha chekuongorora hukama hwemapapu kumapukisi, zvisinei, ndekuve wakangwarira kune zvingaitika. Nokuti chero ani zvake anotora amiodarone, chepukisi yeupfu inofanira kunyatsoongororwa pachiratidzo chekutanga chechinetso. Zvisingatsanangurwi zviratidzo zvemapurmoni izvo zvisingabvumirwe kuti zvimwe zvinokonzera kuonekwa zvinofanirwa kutongerwa sechirevo chinonzi amiodarone lung poison, uye kumira mishonga kunofanira kunyatsoongororwa. (Kana uri kutora amiodarone uye uchifungidzira iwe ungave uchikurira dambudziko remapapu, taura nachiremba wako usati warega mushonga iwe pachako.)
Ndiani Ari Pangozi?
Chero ani zvake anotora amiodarone ari pangozi yehuputi chechipembenene. Vanhu vari pamvura yakakwirira (400 mg pazuva kana kupfuura), kana kuti ndiani aive achitora mishonga kwemwedzi 6 kana kupfuura, kana kuti anopfuura makore makumi matanhatu anoita kunge ane ngozi yakawanda. Humwe humwe humwe hunoratidza kuti vanhu vane matambudziko emapapu asingatauri zvakare vane mikana yekuve nezvinetso zvemapurmoni nema amiodarone.
Kunyange zvazvo nguva dzose kutarisa vanhu vachitora amiodarone nebhokisi x-ray uye pulmonary work test zvinowanzobudisa kuchinja kunokonzerwa nemishonga, vashomanana vevanhu ava vanoenda kukura frank pulmonary toxicity. Kunyange zvazvo chifukidzo chegore negore x-rays inowanzoitwa kuvanhu vanotora mishonga iyi, pane uchapupu hushoma hwokuti kutarisa kwakadaro kunobatsira pakuona avo vanozopedzisira vava nehuwandu hwezvinetso zvemapurmona, kana kuti ndiani anofanira kurega kutora amiodarone nekuda kwe "kuswedera" kumapapu kutyisa.
Ndeapi Amiodarone Lung Toxicity Akabatwa?
Hapana hutachiona chaihwo hwakaratidzwa kuti hunobudirira. Nzira huru yekurapa iri kumisa amiodarone.
Zvinosuruvarisa, zvinotora mwedzi yakawanda kuti ibvise muviri weAmododarone mushure mekuita kwekupedzisira. Kune varwere vakawanda vane miviri isina simba yakanyanya yepapu toxicity (IP, inoshandiswa pneumonia, kana mapulmita mass), zvisinei, mapapu kazhinji anowedzera kugadzirisa kana mushonga wacho wakamira. Amiodarone inofanirawo kumiswa nevarwere vane ARDS, asi munyaya iyi, iyo yekupedzisira kliniki inogadziriswa inenge inogara ichigadziriswa zvakanaka pamberi pemazinga emudiodarone anogona kuderedzwa zvikuru.
Masero akakwirira e-steroid anowanzopiwa varwere vane ARDS inonzi amiodarone-induced, uye apo pane zviitiko zvenyaya dzebatsiro kubva pakadai, kana steroid chaizvoizvo ichiita mutsauko mukuru hazvizivikanwi. Steroid inowanzoshandiswawo kune mamwe maitiro e-amiodarone mapapu ekutyisa, asi zvakare, uchapupu hwokuti hunobatsira mune izvi zvinodarika.
Shoko Rinobva
Pane zvikonzero zvakanaka kuti amiodarone mapupa ehupikisi ndiyo iyo inotya yakaipisisa inokonzerwa nechirwere ichi. Pulmonary toxicity hazvizivikanwi. Inogona kuva yakanyanya uye inouraya. Zvinogona kuva zvakaoma kufungidzira, uye hapana chirongwa chakanyatsorapwa. Kunyange kana chirwere chemapapu chaingova chiitiko chakakosha chakaipa chemadiodarone (icho chisarudzo chisingaiti), ichi choga chinofanira kuva chakakwana kuita kuti vanachiremba vasaze kushandisa mushonga uyu kunze kwekuti kana zvichidikanwa.
> Sources
> Jackevicius CA, Tom A, Essebag V, et al. Nharaunda yehuwandu hwehuwandu hwehuwandu hwehuwandu hwehuwandu hwehuwandu hwehutachiona hunosangana neAmiodarone. Am J Cardiol 2011; 108: 705.
> Hudzik B, Polonski L. Amiodarone-induced Pulmonary Toxicity. CMAJ 2012; 184: E819.
> Papiris SA, Triantafillidou C, Kolilekas L, et al. Amiodarone: Kudzokorora kwePulmonary Effects uye Toxicity. Drug Saf 2010; 33: 539.
> Schwaiblmair M, Berghaus T, Haeckel T, et al. Amiodarone-induced Pulmonary Toxicity: A Inonzwisisika uye Inonyanya Kushata Kwakaita? Clin Res Cardiol 2010; 99: 693.