Kukho iindlela ezimbini eziqhelekileyo zokuphatha i-fibrillation ye-agriyoti :
- Zama ukuqeda i-fibrillation ye-agriyo ngokupheleleyo kunye nokubuyisela nokugcina isandi sesiqhelo senhliziyo ( Funda malunga nesicwangciso sokulawula isigqi )
- Vumela i-fibrillation ye-agriyo ukuba iqhubeke ngenkathi ilawula izinga lentliziyo ( Funda malunga nesicwangciso sokulawula isantya )
Njengoko ezi zinto zimbini, ngaphandle kokwazi into eninzi, phantse nabani na oya kuqala ukukhetha indlela yokulawula isigqi.
Nangona kunjalo, ngokukodwa, le ndlela ihlala iphela kwaye ikhuseleke ngakumbi kunendlela yokulawula izinga.
Isizathu sokuba isicwangciso sokulawula isigqi sisoloko siyingxaki kukuba izidakamizwa ezichasayo ziyimfuneko ngokubuyiselwa nokugcina intsingiselo yentliziyo evamile. Ezi zi yobisi zivame ukuba zingasebenzi, zinetyhefu, okanye zombini. (Qaphela ukuba kwezinye izigulane, ukukhupha i-fibrillation ye-atrial kunye nenkqubo yokuphulukisa inokwenzeka.)
Into ephambili ngokubhekiselele kwiziyobisi ezichasene nezidakamizwa yizobisi ezikhethekileyo, ezenza ukuba kube nzima kwaye kunzima ukulawula nokuthatha. Kukho iintlobo ezimbini eziqhelekileyo zetyhefu ezibonakalayo ngezidakamizwa ezichasayo:
- Iindidi eziqhelekileyo zemiphumo ebonwayo zibonwa ngamachiza amaninzi, ezinjengeentlungu, ukulala, ukuphazamiseka kwamathumbu, njl njl.
- I-Proarrhythmia, ebangela ingxaki enkulu ngeziyobisi ezichaseneyo.
Proarrhythmia
"I-Proarrhythmia" ithetha nje ukuba kubangele i-cardiac arrhythmias. Oko kukuthi, esikhundleni sokuphelisa i-arrhythmias ezi zidakamizwa zingazivelisa. Izidakamizwa ze-Antiarrhymic zisebenza ngokutshintsha izakhiwo zombane zeethambo zenyama. Kuvela ukuba nanini na xa utshintshe ezo zakhiwo zombane izinto ezinokuthi zenzeke-unokwenza ukuba i-arrhythmias ibe yinto encinci ukuba yenzeke (yinjongo), okanye usenokuthi wenze ukuba i-arrhythmias inokwenzeka ukuba ibe khona.
Okubi kakhulu, iintlobo ze-arrhythmias eziveliswa nge-proarrhymia (ngokungafani ne-fiber fibrillation ngokwayo) ingaba yingozi. Ngoko ke, naziphi na izidakamizwa ezisetyenziswayo, kukho ubuncipheko obunobangela bokusongela ubomi obunokuthi benze oogqirha kunye nezigulane ukuba bangazisebenzisi ngaphandle kokuba ziyimfuneko ngokwenene.
Ezinye iziyobisi zinokuthi zibangele i-proarrhymia kunezinye kwaye ezinye izigulane ziyakwazi ukufumana i-proarrhymia kunezinye. Ubungakanani bentrhythmia kunye nesilwanyana esithile kwisigulane esithile kufuneka kuthathelwe ingqalelo phambi kokuba le miyeza imiselwe.
Ukuphathwa kweFibrillation yeArivri
Izidakamizwa ezithandathu zokusetyenziswa kwamanzi zivame ukusetyenziswa ekuphatheni i-fibrillation ye-agriyo: i-propafenone (iRhythmol), i-flecainide (i-Tambocor), i-sotalol (i-Betapace), i-dofethilide (i-Tikosyn), i-amiodarone (iCordarone) kunye ne-dronedarone (i-Multaq). Kuba nawuphi na othabatha la mayeza, unyango kufuneka lugcinwe ngokuzimeleyo ukuze unciphise umngcipheko wesifo esinobuthi, kodwa oku kulandelayo kungenziwa:
- I-Rhythmol neTambocor zixhomekeke kakuhle xa nje zingabangeli i-proarrhymia. Kwizigulane ezisemncinci kwaye ziphilile, ezingenayo isifo senhliziyo kwaye zisengozini kakhulu yokuphuhliswa kwesifo senhliziyo, nazo zibangele i-proarrhymia encinci. Kwaye kwezi zigulane, zinokuba lukhethi olufanelekileyo lokuzama ukubuyisela isigqi esivamile kwizigulane ezinefayibrillation. Zijongwa njengendlela efanelekileyo. Nangona kunjalo, kwizigulane ezinaluphi na uhlobo lwesifo senhliziyo, okanye ngubani osengozini enkulu yokuphuhliswa kwesifo senhliziyo, ezi ziyobisi ziyakubangela ukuba kubekho ubomi obungozi bokusongela i-proarrhythmia kwaye kufuneka kuhlale kugwenywa.
- I-Betapace kunye neTikosyn nazo zixhomekeke kakuhle xa nje zingabangeli i-proarrhymia. Nangona kunjalo, ezi ziyobisi zingenza i-proarrhymia kunoma ubani kunye nokulumkela okufanelekileyo kufuneka kuthathelwe oogqirha ukunciphisa umngcipheko. Enyanisweni, kwimeko kaTikosyn, i-FDA ivakalise ukuba oogqirha kufuneka bathathe uqeqesho olukhethekileyo ngaphambi kokuba bavunyelwe ukulawula le nkunkuma. La machiza asebenza ngokufanelekileyo ekulawuleni i-fibrillation ye-atrial.
- I-Cordarone isicatshulwa esinqabileyo ngokwenene. Nangona iphumelele ngakumbi kunezinye iziyobisi ekuphatheni i-fibrillation ye-agriyoti, kwaye ngelixa kubangela ukuba i-proarrhymia encinci, kubaluleke kakhulu ukuba kubangele ezinye iziphumo zempembelelo ezinokubaluleka kunye nokuba zisongela ubomi. Ngenxa yoko, iCordarone kufuneka igwenywe xa kunokwenzeka. Xa isetyenziswe, kufuneka kubekwe iliso ngokunyamekela ukutywala ixesha elide isigulane sithatha isibisi kunye neenyanga eziliqela emva kokuba isigxina sinqanyuliwe. Unokufunda malunga neenkalo ezikhethekileyo zeCordarone apha .
- I-Multaq ngumzala waseCordarone kwaye yaveliswa ngethemba lokuba yayiya kusebenza njengeCordarone ngaphandle kobutyhefu. Kodwa, ngoxa i-Multaq incinci kakhulu kuneCordarone, ayinakusebenza ekulawuleni i-fibrillation ye-atrial. Kwakhona, i-Multaq ayikwazi ukusetyenziswa kubantu abanesifo senhliziyo . Nantsi ulwazi oluthe xaxa malunga nokusetyenziswa kwe-Multaq ekuphatheni i-fibrillation ye-atrial.
Ngaphantsi
Kufuneka kucace ukuba unyango lwe-fibrillation ye-agriyo kunye neziyobisi ezinqamlekileyo-oko kukuthi, isicwangciso sokuzama ukubuyisela nokugcina isigqi-siqhelo-sinokuba yingxaki enkulu. Ngenxa yesi sizathu, wongezwa kwimeko yokuba izilingo zekliniki azibonanga nzuzo enkulu kulolu cwangciso lwezokwelapha, kungcono izigulane ukuphepha zonke iziyobisi ezichanekileyo kwaye ukhethe endaweni yesicwangciso solawulo lwezinga.
Imithombo:
Fogoros, RN. Unyango lwe-Supraventricular Arrhythmias. Ku: Fogoros, RN. Izidakamizwa zeAnarrhythmic - Isikhokelo esiSebenzayo. Blackwell Publishing, Malden, MA: 2007.
Ikholeji yaseMelika yaseCardiology Foundation, i-American Heart Association, i-European Society of Cardiology, et al. Ukulawulwa kwezigulane ezine-Fibrillation ye-Atrial (Ukuhlanganiswa kuka-2006 ACCF / AHA / ESC kunye ne-2011 ACCF / AHA / HRS Iziphakamiso): Ingxelo ye-American College of Cardiology / American Heart Association Task Force on Practice Guidelines . Uhambo luka-2013; 127: 1916.