Kwemakore anopfuura mazana maviri, digitalis (chinhu chinogadzirwa kubva muzvinomera zve foxglove), chave chiri chiitiko chikuru mukurapa kwepfungwa yemwoyo-kunyanya, kusagadzikana kwemoyo nekushaya fayira . Digoxin (nechokure, iyo inowanzoshandiswa ye digitalis) ichiri kunyanya kunyoreswa nekuda kwemamiriro maviri emoyo.
Mumakumi emakore achangopfuura, zvisinei, nyanzvi dzakanyatsopokana mubvunzo kana digoxin ichiripo inofanira kushandiswa mukurapa kwechirwere chemwoyo.
Pane zvikonzero zviviri zvakakosha zvekusava nechokwadi uku kwemazuva ano nezve digoxin. Chokutanga, mishonga mitsva yakawanda yakagadziridzwa iyo kushanda kwayo kwakaratidzwa mumatambudziko emakiriniki, asi miedzo isina maitiro inoratidza kubatsira kwe digoxin yave iri shomanana. Saka chaizvoizvo zvipatara zvinokonzerwa ne digoxin zvakabvunzwa.
Chechipiri, digitalis toxicity inogona kuva yakaoma kudzivisa, uye inogona kuva yakanyanya kuipa. Muzviitiko zvizhinji, mamwe madhiragi ane zvishoma zvingaita zvehutachiona anogona kushandiswa panzvimbo ye digoxin.
Pasinei nezvinetso izvi, digoxin inogona kushandiswa kune vamwe vanhu vane mwoyo kusakundikana kana kuti friction fibrillation.
Ko Digoxin Inoshanda Sei?
Digoxin ine zvinhu zviviri zvakakosha pamwoyo.
Kutanga, inhibits mamwe mapampu mumoyo memakumbo emakumbo, kuderedza kufamba kwe sodium kubva mukati memasero kune kunze kwemasero. Ichi chiito chinokonzerwa nekuvandudza simba rekusimbiswa kwemuviri wemwoyo.
Nokudaro, kuora mwoyo kwemisumbu kunogona kuputira zvinyatsobudirira apo digoxin inoshandiswa.
Chechipiri, digoxin inokanganisa kutenderera kwekutaura , kuderera kunzwira tsitsi ("kurwa kana kutizaira") uye kuwedzera parasympathetic ( vagal ) tone. Izvozvo zvinoshandiswa mumutauro wekutendeseka zvinoderedza kuitisa kwemagetsi emagetsi emagetsi kuburikidza neNV node uye naizvozvo inowanzoita kuti kuderedza mwoyo kuve nehuwandu kune vanhu vane acrial fibrillation.
Mukupfupisa, digoxin inogona kuvandudza mwoyo wepfungwa musimba mukati mevanhu vane mwoyo kusagadzikana uye inogona kuderedza mwoyo wevanhu kune vane inrial fibrillation.
Digoxin Toxicity
Izvozvo zvinosvibisa zve digoxin zvakabatana nehuwandu hweropa remushonga. Zvinosuruvarisa, kurapwa kwemishonga inorapa ne digoxin haisi yakasiyana zvakanyanya kudarika ropa rinokonzera-saka kusiyana pakati pekutora "zvakakwana" digoxin uye kutora zvakawanda zve digoxin kazhinji kazhinji. Iyi "firati inotapurika" inoita kuti kushandiswa kwakachengeteka kwe digoxin kwakaoma kuvanhu vakawanda.
Digoxin toxicity inowanzowanikwa kune vanhu vanokura matambudziko emagunha kana pasi-potassium-zvese izvo zvisinganzwisisiki kune vanhu vane mwoyo wekukundikana uye vari kurapwa ne diuretics .
Izvozvo zvinosvibisa zve digoxin zvinosanganisira upenyu hunopisa moyo wemaridhmia , kunyanya ventricular tachycardia uye ventricular fibrillation , bradycardia yakaoma (slow rate rate), mwoyo block , kurasikirwa nenzara, kushungurudzika kana kurutsa, uye zvinetso zvepfungwa zvinosanganisira kuvhiringidzika uye kuvhiringidzika kwezvinhu. Zvinonzwisisika, zvinenge makumi matatu kubva muzana zvevanhu vane cheksijini digoxin hazviwani zviratidzo. Izvi zvinoreva kuti hupenyu hunotyisa hupenyu hwemarimu hunogona kuitika kuvanhu ava pasina nyevero.
Apo munhu anotora digoxin, mazinga eropa anowanzoongororwa nenguva nenguva kuti aedze kugara mukati mewindo rakamanikana rwekurapa.
Digoxin muThe Treatment of Heart Isingakwanisi
Munguva pfupi yapfuura makore makumi matatu adarika, digoxin (pamwe ne diuretics) ndiyo yainyanya kushandiswa mune vanhu vane mwoyo kusakonzerwa nekuda kwechirwere chemoyo -iko kureva, kukanganisa kwemwoyo kunokonzerwa nekuderera kwemutsipa wemwoyo, unoratidzwa nekacheka ejection fraction .
Asi kubvira panguva iyoyo mishonga mitsva yakawanda yakagadzirirwa kukanganisa kwemoyo uyo kushanda kwakaratidzwa zvakajeka mune dzakawanda zvidzidzo zvemakiriniki. Zvinodhaka izvo zvakaratidzwa kuvandudza zviratidzo uye kuwedzera kukura zvinosanganisira beta blockers , ACE inhibitors , ARB agents , uye (munguva ichangopfuura) kusanganiswa kwechirwere cheArb uye neprilysin inhibitor inotengeswa seIncresto .
Mukuwedzera, vanhu vazhinji vane congestive heart failure vanotsvaga kubata resynchronization therapy , kurapa kunogonawo kuderedza zviratidzo uye kunatsiridza kupona.
Mishonga yemakiriniki yakaratidza kuti, kune vanhu vane mwoyo wekukundikana nekuda kwechirwere chema cardiomyopathy, digoxin inoratidzika kuvandudza zviratidzo zvemoyo kusakundikana uye kuderedza kudiwa kwekuchengetwa mumba. Zvisinei, kusiyana nemamwe marapirwo iye zvino anowanzoshandiswa pamwoyo kusakundikana, digoxin haifaniri kunge ichivandudza kupona.
Kazhinji nyanzvi zvino dzinokurudzira kushandisa digoxin kune vanhu vane mwoyo kukundikana seyetsero yechipiri kana yechitatu-mutsara, kana zvachose. Izvozvo zvinoreva kuti digoxin inowanzotaurirwa chete kana munhu ane mwoyo wekukundikana anoenderera mberi ane zviratidzo zvinoshamisa pasinei nehutano hwakanaka hunosanganisira beta blocker, ACE inhibitor kana ARB drug, diuretics, uye / kana Entresto.
Digoxin haina kupa ruzivo pakubata vanhu vane mwoyo wekukundikana nechachengetedzwa chikamu chiduku-kureva, vanhu vane diastolic mwoyo kukundikana . Digoxin hainawo kubatsira mukugadzirisa vanhu vane urombo hwekushaya mwoyo. Kushandiswa kwaro kunofanira kunge kwakagadzirirwa kutarisira avo vane zvirwere zvisingaperi zvechirwere che cardiomyopathy moyo kusakona.
Digoxin muAradication of Atrial Fibrillation
Sezvambotaurwa, digoxin inononoka kutengesa magetsi kuburikidza neAV node, uye somugumisiro, inogona kuderedza mwoyo wevanhu kune vane chirwere chekushaya ropa. Sezvo kukurumidza kwepfungwa yemwoyo ndicho chikonzero chikuru chezviratidzo kune vanhu vane atrial fibrillation , digoxin inogona kubatsira mukupa humwe hurombo hwezviratidzo.
Zvisinei, digoxin inowanzove isina kunyanya kushanda mukuderedza zviratidzo kupfuura mamwe makirasi maviri emishonga iye zvino inowanzoshandiswa kuderedza mwoyo yehutachiona muutrial fibrillation, kureva, beta blockers, uye calcium channel blockers . Iyi mapoka maviri emishonga inoita kuti kuderedza mwoyo kuve kwekuzorora uye panguva yekurovedza, asi digoxin inononoka kutengesa mwoyo pane zororo. Nemhaka yokuti vanhu vazhinji vane chirwere chinonzi atrial fibrillation vanonyunyuta zvikuru nezvekusava nekushanda kwemaitiro ekutsungirira, zvichikonzerwa nekuwedzera nokukurumidza kwepfungwa yemwoyo kunyange kunyorovedza muviri, digoxin inopa zvishoma zvishoma muzviratidzo zvavo.
Uyezve, kune humwe uchapupu hwokuti kushandisa digoxin kwehuwandu hwekutonga muvanhu vane hutachiona hwehutano hunobatanidza nekuwedzera kwekufa. Kunyanya, chirongwa chekurapa kwegore ra2017 chinoratidza kuti kuwedzera uku mukufa kunonyatsoenderana nema digoxin yeropa-kureva kuti, kukwirira kweropa, kunowedzera ngozi. Kunyange zvazvo chinokonzera njodzi yakakosha yekufa ne digoxin isingazivi, zvinenge zvichida nekuda kwehuwandu hwekufa kamwe-kamwe kubva pamaridythmias emwoyo.
Nyanzvi dzakawanda nyanzvi ikozvino zvingangove dzisingadi kukurudzira kushandisa digoxin yekudzora kushaya kwemwoyo kune vanhu vane atrial fibrillation. Zvisinei, digoxin inogona kunge ichinge iine chisarudzo chakanaka kana munhu ane atrial fibrillation ari kuramba achiita uye zviratidzo zvinoshamisa pazororo, izvo hazvisunungurwi nekubatanidzwa kwe beta blockers uye calcium channel blockers.
Shoko Rinobva
Pasina nguva refu, digoxin yaiva yepamusoro yekurapa kwemwoyo wose kusakatika uye inrial fibrillation. Zvisinei, mumakumi emakore achangopfuura mishonga mitsva yakagadzirwa inobudirira, uye yakachengeteka kushandisa. Nyanzvi nyanzvi zvino dzinokurudzira kushandisa digoxin chete kune vanhu vanoita kuti mishonga iyi inogona kupa chimwe chinhu chakakosha uye chikuru. Uye kana inoshandiswa, inofanira kushandiswa nekuchenjerera.
> Sources:
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> Lopes R, Gibson CM. ARISTOTLE: Digoxin Uye Kufa Muzvirwere Nehutano Hwenyama Nekusina Mwoyo Kusakundikana: Ko Serum Digoxin Inogadzirisa Matter? Purogiramu uye zvinyorwa zveAmerican College of Cardiology 66th Annual Scientific Session & Expo; March 17-19, 2017; Washington, DC. Kutevera-kupera kliniki yekuedzwa.
> Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Zvinyorwa Zvokurapa uye Kurapa Kwekugadzikana Kwemwoyo uye Kusingaperi Mwoyo Usingaiti: Mushandi Wekugadzirira Kuziva uye Kurapa Kwepfungwa Nemazuva Akasingaperi Kusagadzikana kweEuropean Society of Cardiology (ESC) Yakagadzirirwa nemupiro unokosha we Heart Failure Association (HFA ) yeEC. Eur Moyo J 2016; 37: 2129.