Nitrates ndiyo yakagadziriswa pakurapa angina kwemakore anopfuura zana. Nhasi, nitrate inoshandiswa zvose kuti iite zvikamu zvakanyanya zvema angina (muchimiro chekunyora nitroglycerin kana nitroglycerin oral spray), uye nguva dzose (mumapiritsi kana kuti sechiganda cheganda) kubatsira kudzivirira angina.
Nitrates Inoshanda Sei?
Nitrates inoshanda nekuderedza arteri uye mitsipa, zvose mumoyo uye kune imwe nzvimbo mumuviri.
Uku kuwedzera kwemitsipa yeropa kunoderedza kushungurudzika pamutsipa wemwoyo, uye nokudaro kunoderedza kuwanda kwe okisijeni mwoyo inoda. Kuderedza mwoyo ye oxyjeni zvinotendera mwoyo kuti uite basa rakawanda pasina kuwedzera ischemia , kunyange kana ropa richiyerera mumakironi inonzi coronary rinodziviswa ne atherosclerosis .
Nitrates zvakare inoderedza maronary artery. Sezvo maronary coronary akatozununguka apo hosha ye-atherosclerotic ichidzivisa kubuda kweropa, izvi zvinokonzera kushandiswa zvakakwana kune vanhu vane chirwere chetachiona chetachiona . Zvisinei, kune vanhu vane Prinzmetal angina - iyo inonyanya kukonzerwa nekoniyuta yeropa spasm - nitrate inowanzobatsira zvikuru.
Nitrates Dzinoshandiswa Sei?
Kunyanya kunyoresa (SL) nitroglycerin (nitroglycerin inokurumidza kunyanya kubva pasi pomururimi) ndiyo yekare yakakura ye nitrate therapy. SL nitroglycerin ndiyo nzira inokurumidza yekugadzirisa chikamu chengina chinounzwa kuburikidza nekurovedza kana kushungurudzika, uye kazhinji kunopa zororo mumaminitsi.
Uyezve, kutora SL nitroglycerin nguva isati yatanga kuita zvinhu zvinogona kukonzera zviratidzo (zvakadai sokukwira chikomo kana kufamba mumvura inotonhora) zvinogona kubatsira kudzivirira zvikamu zve angina. SL nitroglycerin inotanga kuderedza midziyo yeropa mukati maminitsi maviri, uye iyo inogona kuguma kusvika pamaminitsi makumi matatu.
Nitroglyerin spray, inopihwa mumuromo nemutambo wemota, inoshanda zvakafanana neS SL nitroglycerin - inongova imwe nzira yekuratidza chiitiko chinokurumidzira che nitroglycerin.
Muchidimbu-acting nitrates (SL kana zvinyorwa zvinyorwa) zvinofanira kutorwa nemumwe munhu ari kurapwa kuti angina.
Iyo yakareba-yakabata nitrates (mapiritsi kana ganda rinogadziriswa) inoonekwa sechipiri mutsara wemishonga yeinina. Zvinorayirwa kana beta blockers (inonzi first line therapy) haigoni kuregererwa, kana kuti haigoni kubvisa zviratidzo.
Nzira inowanzoshandiswa piritsi ye nitrate isosorbide dinitrate (Isordil, Sorbitrate). Ne nitrate yezwi, zvinoitika pamitsipa yeropa zvinotangira mukati maminitsi makumi matatu, uye zvinotora kusvika maawa matanhatu.
Transdermal nitroglycerin patches, iyo inopa nitroglycerin kuburikidza neganda, inopa nitrate therapy inobudirira kwemaawa masere kusvika ku14.
Nitrate Kushivirira
Dambudziko guru nekushandiswa kwenguva refu-nitrate yakave chinhu chinoshamisa che "kushivirira." Kushushikana kwekudzivirira kunoreva kuti zvinobatsira zve nitrate therapy zvinogona kuderedzwa apo nitrate inoshandiswa kupoteredza nguva. Kungotaura chete, kana midziyo yeropa inogara ichitaura kune nitrates, inomira kuwedzera mukupindura kwe nitrate, uye inopesana nemagetsi emushonga inonyangarika.
Kushushikana kwekudzivirira kunogona kudziviswa nekugadzirisa dosing yekusingaperi nitrate therapy kuti ipe nguva dzese dzisina nitrate-pasina.
Saka: oral nitrates kana nitrate ganda rinogadziriswa rinofanira kungoshandiswa kwemaawa 12 kusvika ku16 pazuva, neawa masere kusvika pa12 nguva "nitrate-isina" nguva. Kune varwere vazhinji izvi zvinoreva kuti nitrate inoshandiswa panguva yekukwira, uye kwete panguva yekurara. Mune vamwe varwere vane nocturnal angina, zvisinei, nguva yema nitrate isingada kurongerwa panguva yekukwira.
Zvimwe Kuchengetedzwa Nitrate
Nitrate haifaniri kushandiswa kune varwere vane hypertrophic cardiomyopathy (umo nitrate inogona kukonzera kuvhara kunopisa kuropa mukati memwoyo), kana kune varwere vari kutora Viagra (sildenafil) kana mamwe maitiro akadaro erectile dysfunction.
( Kutora nitrates uye Viagra pamwe chete zvinogona kubvisa zvakanyanya hypotension - kuderera kwemuviri weropa.)
VaAsia vanowanzova nemhinduro shoma kune nitrate, uye havashoma kubatsirwa kuburikidza nekushandiswa kwavo.
Maitiro akawandisa anowanzoitwa nitrate ane maziso uye anoputika, kunyange zvazvo kuchena kwechiedza kubva ku hypotension kunogonawo kuitika. Varwere vane nhoroondo ye migraine misoro inowanzosagona kushivirira nitrate.
Sources:
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF / AHA / ACP / AATS / PCNA / SCAI / STS nhungamiro yehutano uye hutano hwevarwere vane hutano hwakasimba hwechirwere chepfungwa: shanho huru: mushumo weAmerican College of Cardiology Foundation / American Heart Association basa rekuita mitemo, uye American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, uye Society of Thoracic Surgeons. Circulation 2012; 126: 3097.