Intravenous Migraine Mishonga muImergency Room
Dzimwe nguva kurwadziwa kwekurwiswa kwemigraine kwakanyanya zvokuti kunoda nzvimbo yekukurumidzira mushanyi. Kana, mune dzimwe nguva, kushungurudza uye kusuruvara kunosanganisira migraine kurwisa kunokonzerwa nemishonga inonwa mumuromo. Mumakamuri ekukurumidzira kana masangano ekuchengetedza akakurumidza, kurwadza kwakanyanya kwema-migraine kunowanzobatwa nemishonga inopinza. Asi ndeipi iyo yakanakisisa?
Chimwe chekudzidza muNeurology randomized 330 varwere vane acraine achirwadza kurwisa 1g sodium valproate, 10mg Reglan (metoclopramide), kana 30mg Toradol (ketorolac).
Sodium valproate is anti-seizure medication iyo mumuromo wayo dzimwe nguva inoshandiswa kudzivirira migraines. Chaizvoizvo, American Academy of Neurology yakagumisa kuti zvinonzi valproate, divalproex sodium uye sodium valproate, zvinoshanda (Nhamba A zvinodhaka) mukudzivirira migraines. Izvi zvataurwa, zvinokosha kuziva kuti valproate inopesana nemadzimai ane pamuviri.
Reglan (Metoclopramide) inorwisa anti-emetic kana anti-nausea. Iyo inodzivirira dopamine receptors muuropi uye inonyanya kuderedza gastroparesis (apo kubudiswa kwezvokudya zvechingwa kunonoka). Inowanzoshandiswa senhengo imwe chete yekurapa migraines mumakamuri ekukurumidzira. Inogona kukonzera kunzwa kwekusagadzikana.
Toradol (Ketorolac) inonzi NSAID ine kukurumidza kuitika kwechiito. Kufanana Reglan, inowanzoshandiswa mumakamuri ekukurumidzira kuti uite zvirwere. Yeuka, kunyange zvakadaro, NSAIDs dzine zvigaro zvingakanganisa zvinetso uye dzinofanira kudziviswa nevamwe vanhu, kunyanya avo vane nhoroondo yekubuda ropa, chirwere chepfungwa, uye / kana chirwere chemwoyo.
Iyi Migraine Study Show yakaitei?
Muchidzidzo chacho, vose vevarwere vakataura nezvekutanga marwadzo ekurwadza kwechikamu che7 kana kupfuura pane imwe 0 kusvika ku10 murefu, uye vazhinji vakanga vasingatori kudzivirira migraine therapy.
Pashure peawa imwe yekugamuchira imwe yemishonga mitatu inotaurwa pamusoro apa, avo vakagamuchira sodium valproate vakagadziriswa nezvikamu zvinokwana 2.8 asi avo vakagamuchira Reglan naToradol vakavandudzwa nehuwandu hwe 4.7 uye 3.9 mapeji, maererano.
Zvigumisiro zvekudzidza zvakaratidza zvakare kuti avo vakagamuchira valproate sodium vaida mamwe mishonga yokudzivirira migraine (69 muzana) vachienzaniswa nevaya vakagamuchira metoclopramide (33 muzana) uye ketorolac (52 muzana). Kuponesa migraine mishonga
Pakupedzisira, nhamba huru yevakagamuchira Reglan yakasarudza kuwana mishonga imwecheteyo munguva inotevera yekushanyira mukana yekuenzanisa nekuenzaniswa nemamwe mapoka maviri.
Izvi zvose zvinotaurwa, maawa makumi maviri nemaviri mushure mekutanga mishonga yekurapa, kusunungurwa kwepfungwa kwakasimudzika kwaive kwakaderera mumapoka matatu matatu: sodium valproate (4 muzana), Reglan (11 muzana), uye Toradol (16 muzana) -sakanyanya kukura.
Izvi Zvose Zvinorevei?
- Reglan uye Toradol inogona kunge yakasarudzwa pamusoro peyerodium valproate semishonga inopinza yekurwisa migraine muimba yepamhanho.
- Mutemo unogona kunge uri mushonga unofanirwa pakati pevarwere vanoenda kuE ER nokuda kwemigraine-kunyange iyi haisi mutemo wakaoma uye unokurumidza.
- Izvo zvakaderera zvakaratidzwa apa ndezvokuti vazhinji venyaya idzi havana kubatsiridza kusunungurwa kwemusoro wavo kurwadza. Izvi zvinoreva kuti tinoda kurapa kwakanakisisa kuti tibatsire kurwadziwa kwemigraineurs panguva yakaoma, kurwisa kwakanyanya.
Bhokisi rekudzidza rinofanira kutaurwa nderokuti vazhinji vevatori vechikamu vakanga vasingatori chirwere chekudzivirira chinonzi migraine.
Izvi zvinoita kuti zvive zvakaoma kuisa zvibereko kune avo vane zvakanyanya uye zvakanyanya uye vasingagumi migraine (avo vari kutora mishonga yekudzivirira).
Chimwe chikonzero chekurera ndechekuti idzi nhatu dzokurapa mishonga haisi yega inoshandiswa kurapa zvakanyanya, zvakanyanya migraine kurwisa muimba yepamhanho.
Imwe nzira yekugadzirisa migraine muEER is subcutaneous sumatriptan ( triptan inopiwa sejisi muzvipfuva zvako). Dzimwe mhando dze antiemetics dzakadai seCompazine (prochlorperazine) dzinogona kupiwa, kazhinji pamwe neBenadryl (diphenhydramine) kudzivirira migumisiro ye antiemetics, sekusazorora uye dystonia .
Dihydroergotamine ( DHE ) inogonawo kupiwa muimba yepamhanho uye inogona kutarisirwa sepine spray, intravenously, kana intramuscularly. DHE inogona kukonzera kushungurudza, naizvozvo antiemetic inowanzopiwa kare kuti idzivise izvi.
Pakupedzisira, vamwe ER vanonzi vanopawo steroid inonzi dexamethasone neimwe yezvataurwa pamusoro apa migraine remitambo-iyo pfungwa iyo inogona kubatsira kuderedza mukana wokuti musoro wemunhu uchadzoka mangwanani. Kudyidzana nemvura inowanzoitawo chikamu chakakura chokurapa migraines muimba yekukurumidzira, kunyanya kana munhu ane tsvina uye kurutsa.
Shoko Rinobva
Kana ukazoguma uchienda kuE ER nokuda kwekurwadza kwechirwere ichi, unogona kugamuchira mushonga wemushonga (kana mujoyi, kana chiremba wako achikupa sumatriptan). Pakupedzisira, izvo chiremba anokupa iwe sarudzo yakasiyana-siyana, yakabva pane imwe nhoroondo yehutano yakasiyana.
> Sources:
> Bajwa ZH, Smith JH. (February 2017). Kunyatsorapwa kwemigraine kune vanhu vakuru. Mu: UpToDate, Swanson JW (Ed), UpToDate, Waltham, MA.
> Gilmore B, Michael M. > Kurapa kweAigute Migraine Headache. > Am Phys Physician. 2011 Feb 1; 83 (3): 271-280.
> Friedman BW et al. Randomized muedzo weVV valproate vs metoclopramide vs ketorolac pamusana pemigraine. Neurology. 2014 Mar 18; 82 (11): 976-83.
> Kostic MA, Gutierrez FJ, Rieg TS, Moore TS, Gendron RT. Chiitiko chinotaridzika, chinonzi randomed protractous prochlorperazine versus subcutaneous sumatriptan mumukana wakaoma wemigraine muchipatara. Ann Emerg Med . 2010 Jul; 56 (1): 1-6.
> Silberstein SD et al. Evidence-based based guideline update: pharmacologic kurapa episodic migraine kudzivirira kune vanhu vakuru: mushumo weChristian Standards of Neurology uye American Headache Society. Neurology 2012; 78: 1337.