Opioids (kana maopiates) ikirasi yemishonga inogona kuve yakagadzirwa kubva ku opium poppy, kana kuti yakagadzirirwa kugadzirwa kuti iite se "mahara" epioid. Opioids inoshanda nekusungira kune mapuroteni anokwana mapuropi muuropi uye musana wemagunha, zvinowedzera kuderedza zviratidzo zvinorwadza zvinotumirwa kuuropi, uye zvinoderedza kufungidzira kwekutambudzika.
Opioids yakagara ichiita basa rinokosha mukurapa seipi nzira ine simba yekudzora kurwadziwa.
Zvisinei, opioid inogonawo kukonzera zvinetso zvakakomba. Iyi mishonga inodhaka zvikuru. Zvechokwadi, kuwedzerwa kwemishonga pamwe nemishonga yemakemikari epioids uye maopioid (zvisina kukodzera, heroin) yakava dambudziko guru revanhu. Opioid zvinodhaka zvinokonzera chirwere chekufa kwevakafa-kufanana. MuAmerica, vanopfuura 30 000 vakafa kubva kune opioid overdoses vakanyorwa muna 2015 chete, maererano neNIH. Mukuwedzera, kutengeserana kwemaopioid kuri kukonzera urombo, hutsinye hwemhirizhonga, kukanganisa mhuri, uye mamwe mhirizhonga.
Uyezve, maopioids anogona kuunza nyaya dzinotambudza kunyange kune vanhu vanovatora nguva dzose pasi pechitarisiko chechiremba. Matambudziko akadaro anosanganisira kuvhiringidzika , kusagadzikana, kusakwanisa kuita, njodzi nekukuvadzwa, kuchengetwa kwemakuta, uye zvinetso zvemwoyo.
Matambudziko emwoyo anoonekwa neopioids haawanzozivikanwi pakati pevanhu, kana nokuda kwechocho chiremba navanachiremba vazhinji. Ichokwadi, dzimwe dzenyaya dzomumuviri dzinobatanidza opioid dziri kungoonekwa zvino.
Zvisinei, kune vanhu vanokura matambudziko emagetsi ehupio, zvirwere izvi zvinogona kuchinja zvikuru hutano. Vanhu vanoshandisa maopioids nguva dzose kuti varware kurwadziwa, uye vanachiremba vanovataurira, vanofanira kunge vachiziva zvikuru njodzi dzomwoyo.
Kushandiswa kweOpioids muMedicine
Opioids inonyanya kubatsira mukudzivirira kurwadziwa kwakanyanya kunokonzerwa nekurapa kwenguva pfupi, yakadai sekuputsika kwemapfupa kana kurwadziwa kwemashure, uye mukudzivirira marwadzo anokonzerwa nezvinetso zvekugadzirisa zvekupedzisira, kunyanya chirwere chekupedzisira.
Mune mamiriro ezvinhu aya opioid inowanzove yakabudirira, uye (nokuti kushandiswa kwavo mumamiriro ezvinhu aya nguva-isina kukwana) njodzi dzinobatanidza nekuishandisa hadzina kukwana.
Vanogonawo kuva vanobudirira mukurapa zvishoma uye zvakanyanya kurwadziwa kusingaperi, asi kushandiswa kwavo kwerudzi urwu rwekutambudzika kunopesana zvikuru . Kushandiswa kusingaperi kweipioid kunogona kutungamirira mukushungurudzwa uye kusvuta. Izvi zvinowanzoenderana nechokuti opioid inoratidza chiziviso chinozivikanwa se "kushivirira" -kureva kuti, nokufamba kwenguva vanhu vanoda zvakakwirira uye zvepamusoro mazinga epioid kuti vawane maitiro akafanana ekutambudzika kwepakutanga akawanikwa nemazinga akawanda akaderera. Kunyora uye kutora "kukodzera" kweopioid kwenguva yakareba, saka, inetso. Nyanzvi dzinokurudzira kuti kana opioid inoshandiswa kurapa kurwadziwa kusingaperi kusingabatanidzwi nekenza, kushandiswa kwavo kunotarisirwa navanachiremba vanonyanya kuronga kurwadziwa.
Opioid inoverengeka ikozvino inoshandiswa mukurapa, kusanganisira buprenorphine, codeine, fentanyl, Oxycontin, methadone, morphine, Percocet uye Vicodin.
Matambudziko Ehutano Anowanzoonekwa Neapioids
Vasati vatsanangura zvinetso zvemoyo zvinogona kukonzerwa neopioid, zvingava zvakakosha kunyora zvinetso zvakafanana zvinodhaka izvi zvinogona kukonzera.
Sezvataona, nzira yeopioid inoshanda ndeyokusungira maopioid receptors mukati nepakati pese nherera zvirongwa, uye nokuita saizvozvo vanoderedza maonero ekurwadziwa. Zvisinei, kana kuwedzerwa kwemaopioid kunoshandiswa, zvavanoita pamutemo wenheyo zvinogona kubereka zvimwe zvimwe zvinokonzera, kusanganisira: sedation, euphoria, kufema kuora mwoyo, kugunun'una, kuvhiringidzika, kurutsa, kunongedza vadzidzi, uye kuomesa.
Rufu kubva kune opioid overdose kazhinji inowanzoitika panguva yewapioid-induced stupor, umo motokari yekufema inenge yakanyanyisa kwazvo kuti kufema kunongomira.
Cardiac Matambudziko NaOpioids
Zvichibva kune izvi zvinoshamisa zvisingaiti mwoyo zveopioid, zvingasava kushamisika kuti matambudziko akawanda emwoyo anokonzerwa nezvinhu izvi haana kunyatsofungisisa.
Kunyange zvakadaro, maopioids iko zvino anowanikwa nemhando dzakasiyana dzematambudziko emwoyo, uye dzimwe dzingagona kutyisa upenyu.
Matambudziko emwoyo inobatanidza opioid anosanganisira:
Kushungurudzika basa remuviri wemwoyo. Kunyange zvazvo maopioid neavo pachavo asina kuita zvishoma pamusana pekugona kwemisumbu yepfungwa kukubvumirana nesimba (kureva, pamusoro pekushanda kwemwoyo), kubvumirana kunogona kupedzisirwa apo opioid inosanganiswa ne benzodiazepines (zvinodhaka seValium). Uku kusanganiswa hakusi nyore kune vanhu vanotora maorioid asingagumi. Mune vanhu vane dambudziko remoyo rinokonzera chimwe chiyero chekushaya simba mukati memwoyo unoita basa, zvakadai sechirwere chemoyo , kusanganiswa kweopioid uye benzodiazepine kunogona kukonzera kukundikana kwemoyo .
Bradycardia. Bradycardia, kana inononoka mwoyo, inoratidzika zvakanaka nguva dzose kune vanhu vanotora opioid. Kazhinji iyi bradycardia inokonzerwa nekuderera kwe node ye sinus, sezvinoonekwa muirwere sinus syndrome . Opioid bradycardia haigoni kukonzera zviratidzo zvekuzorora, asi zvinogona kutungamirira kukurasikirwa kwedzidzo yekutsungirira, sezvo kuwedzera kwemwoyo kunogona kusakwanisa kuwedzera kazhinji nekurovedza muviri.
Vasodilation. Kutsika, kana kuputika kwemidziyo yeropa, kunogona kukonzerwa nekushandiswa kweopioid. Izvi zvinogona kukonzera hypotension (kuderera kweropa redu). Nemhaka yokuti opioid inogonawo kubudisa bradycardia pamwe chete nemhepo, kana munhu ane opioid akasimuka nokukurumidza vanogona kuerekana vava kudonha ropa-chiitiko chinonzi orthostatic hypotension . Orthostatic hypotension inogona kutungamirira kumusoro wakakomba apo wakarurama, kana kuti kunyange kuvhura .
Ventricular tachycardia. Maopioid maviri kunyanya (methadone uye buprenorphine) anogona kukonzera chiitiko pane electrocardiogram (ECG) inonzi QT prolongation . Mune vamwe vanhu, QT prolongation inogona kubudisa nzira inotyisa ye tricycardia inonzi tricades de pointses. Icho chimiro chemwoyo chinonzi arrhythmia chinowanzobereka zvikamu zvehutu hutsinye, syncope, kana kunyange kufa kamwe kamwe.
Atrial fibrillation. Atrial fibrillation , inokurumidza, isina kuchena mwoyo rwiyo rwakakonzerwa nokuvhiringidzika uye kupatsanurwa kwechiratidzo chemagetsi mumoyo weatria ( makamuri makuru epamwoyo ), yakaratidzwa kuva yakanyanya kuwanda kune vanhu vanoshandisa opioid. Vanhu vane fibrionic atrial vane chiitiko chakakura chekurohwa , uye zvichida chekushaya mwoyo .
Kutapukisa endocarditis. Kutapukisa endocarditis chirwere chinopisa upenyu chevheti dzemwoyo, kana zvimwe zvivako mumoyo. Icho chinetso chisingawanzoiti, kazhinji, chinowanzoonekwa kune vanhu vakwegura vane chirwere chepfungwa chepfungwa chepfungwa . Mumakore achangobva kupfuura, zvisinei, kupararira kwekuguma kwehutachiona kwakaonekwa kune vakawanda vakawanda vaduku kudarika kare-uye zvikurukuru mudiki, vakadzi vachena. Izvo zvinowanzoonekwa pakati pevaduku ava vane endocarditis ndeyokuti vakashandisa zvisina kunaka maopioid, zvikurukuru heroin. Kutapukisa endocarditis kune huwandu hwekufa kwevanhu, uye avo vanopukunyuka vanowanzosiyiwa nehosha isingaperi yemafidia.
Opioid kubvisa. Opioid kurega kunogona kukanganisa mwoyo yemavhudhi, asi kwete zviratidzo zvemwoyo zvinowanzove zvakakurumbira (kunyanya kusagadzikana, kuputika zvakanyanya uye kumhanya kwemhepo, marwadzo anorwadza uye majoints, kusuruvara, kurutsa uye kurara). Kushanda kwepfungwa kutsva uye kuwedzerwa kweropa kunokwidzika kunowanzoonekwa neopioid kubvisa, asi zviratidzo izvi hazvirevi zvakakurumbira sezvavari newaini kubvisa chirwere. Zvisinei, kurutsira uye kubuda kwemawere kunokonzerwa nekudzorera opioid kunogona kukonzera kuora mvura, kuderedza ropa, uye kuchena kwemawere kana syncope. Uyezve, kana kukurumidza kubvisa opioid kunokonzerwa nekupa mishonga inodzokorora opioid yakadai saaloxone (Narcan) (iyo inoponesa upenyu kana kudarika kwakaitika), kuwedzera kamwe kamwe muAdrenaline kunogona kuita kuti mwoyo usagadzikane.
Kuora mwoyo kwepfungwa. Chimwe chidzidzo chakabudiswa mu Journal of the American Medical Association muna 2016 chakashamisa uye chakavhiringidza hutano hwehutano nekuzivisa kuti, pakati pevanhu vakagamuchira maawa epioid emarwadzo asingagoneki nekenza, pakanga pane kuwedzera kukuru kwevanhu vakafa mumoyo, uyewo kukura zvakanyanya mune zvisingaiti-kudarika-zvine chokuita nekufa. Chikonzero chekuwedzera kwepfungwa mumapfupa emumwoyo nemagariro asingagumi opioid therapy inofungidzira panguva ino. Imwe nyanzvi ndeyekuti kusingaperi kwemaawa opioid kunogona kukonzera kurara-kunetseka kufema , chiitiko chinosanganiswa nemaridystyrmmias, kurwisa kwemwoyo, uye kamwe-kamwe kufa. Zvisinei, zvimwe zvidzidzo zvinotarisirwa kusimbisa zvitsva zvekudzidza uku, nekunyengedza zvinokonzera zvinokonzera.
Summary
Kufanana nezvinhu zvakawanda zvinobatsira, maopioid-izvo zvakakonzera kurwadziwa kwakanyanya zvinotakura mamiriyoni evanhu-zvakave zvikomborero zvakasanganiswa zvakasarudzwa. Mukuwedzera kune zvinetso zvakawanda zvinonyanyozivikanwa zvinoshandiswa neopioid ndiyo inonyanyozivikanwa chaizvo kuti inokwanisa kubudisa marudzi akasiyana-siyana ezvinetso zvemoyo. Izvo zvinogona kukonzera matambudziko emwoyo ndeimwezve chikonzero icho vanachiremba nevarwere vanofanira kunge vakangwarira kushandisa madhiragi aya nekuda kwekutambudzika kusingaperi.
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