I-Amiodarone (i-Cordarone, i-Pacerone) isisisombululo esisebenzayo esaphakanyiswa ukwenzela unyango lwe- arrhythmias yenhliziyo . Ngelishwa, kusenokuba yinto enesifo esiyingozi kakhulu kwisifo se-antiarrhythm , kwaye inzima kakhulu ukuyisebenzisa ngokukhuselekileyo. Iziphumo eziqhelekileyo zemibuzo ye-amiodarone zibandakanya izifo ze-thyroid, idipoal deposits ezikhokelela ekuphazamiseni okubonakalayo, iingxaki zesibindi, ukuguqulwa kwesibindi kwesikhumba, kunye ne-photosensitivity (lula ukukhanya kwelanga).
( Funda ukuhlaziywa ngokubanzi kwe-amiodarone apha .) Ngenxa yokuba ukukwazi ukuvelisa iindidi ezinobungozi, i-amiodarone kufuneka imiselwe kuphela abantu abasongela ubomi okanye abakhubazekanga i-arrhythmias, nabangenayo enye indlela yokwenza unyango olungcono.
Isiphumo esicatshukisiwe kakhulu se-amiodarone, ngokude, yi-pulmonary (lung).
Yintoni i-Amiodarone Lung Toxicity?
I-Amiodarone inetyhefu yesiphunga mhlawumbe ichaphazela ukuya kwi-5% yezigulane ezithatha le mveliso. Ayaziwa ukuba iingxaki zemiphunga ezibangelwa yi-amiodarone zibangelwa umonakalo owenziwe yiziyobisi kumathambo omphunga, ukuya kwisigxina sokuzivikela komzimba kwisilwanyana, okanye kwenye indlela. I-Amiodarone inokubangela iintlobo ezininzi zeengxaki zeemiphunga, kodwa kwiimeko ezininzi iingxaki zithatha enye yeendlela ezine.
1) Uhlobo olunobungozi kakhulu lwe-amiodarone toxicity isifo soxakeka, esongela ubomi, isifo sengqondo se -lungs ebizwa ngokuba yi- acute epiratory syndrome (ARDS) .
Ngama-ARDS, umonakalo uvela kwiimbumba zamaphaphu emoyeni, okwenza ukuba izikhumba zizalise ngamanzi, kwaye ziphazamise kakhulu amandla emiphunga ukuba idlulise i-oxygen eyaneleyo kwigazi. Abantu abahlakulela i-ARDS bafumana i- dyspnea ngokukhawuleza, enamandla kakhulu (ukuphefumula okufutshane). Ngokuqhelekileyo kufuneka zifakwe kuma-ventilator mechanical, kwaye izinga lokufa kwabo nangona unyango olunzulu luphezulu, lufikelela kuma-50%.
I-ARDS ezinxulumene ne-amiodarone ibonakala ngokulandelelaniswa kweenkqubo eziphambili, ngakumbi ukuhlinzwa komzimba, kodwa kunokubonakala nanini na ngaphandle kwanokuba ziphi na izizathu ezibonakalayo ezibangelwayo.
2) Ifomu ye-amiodarone isifo sobisi isifo esiqhekezayo, sisifo esingapheliyo, esasisigxina somphunga esibizwa ngokuba yi- pneumonitis yangaphakathi (IP) . Kule meko, iingxowa zomoya zemiphunga zibuthelela ngokuthe ngcembe iiseli ezixhamlayo kunye nezohlukeneyo, eziphazamisa ukutshintshiselwa kwemida emiphakeni. I-IP isoloko ihamba ngokungahambi kakuhle kwaye ihamba ngokukhawuleza, ihamba ngokukhawuleza i- dyspnea , ukukhwehlela nokukhathala ngokukhawuleza. Ekubeni abantu abaninzi bathatha i-amiodarone banembali yeengxaki zentliziyo, iimpawu zabo kulula ukuphosakela ukuhluleka kwentliziyo (okanye ngamanye amaxesha, iziphumo zokuguga). Ngenxa yesi sizathu, i-IP ilahleka. Mhlawumbi ngokuqhelekileyo kunokuba kudla ngokubanzi.
3) Kuninzi kakhulu okuqhelekileyo "uhlobo oluqhelekileyo" lwepneumonias (olubizwa ngokuba luququzelelo lwe-pneumonia) ngezinye izihlandlo luboniswe nge-amiodarone. Kule meko, i-x-ray yesifuba ibonisa indawo edibeneyo yokudibanisa ngokufanayo nalabo abonwa nge- bacterium pneumonia . Ngesi sizathu, le fom ye-amiodarone inetyxic toxicity ihlala iphosakele nge-pneumonia ye-bacteria kwaye iphathwa ngokufanelekileyo.
Ngokuqhelekileyo kuphela xa i-pneumonia ihluleka ukuphucula iziza-antibiotics ukuba ukuxilongwa kwe-amiodarone i-toxicity yamaphaphu kugqitywa.
4 ) Ngokuqhelekileyo, i-amiodarone inokuvelisa i -mass-pulmonary mass that is founded by x-ray. Ubunzima buvame ukucingwa ukuba yi-tumor okanye intsholongwane, kwaye kuphela xa i-biopsy ithathwa yi-amiodarone inetyxic toxicity ekugqibeleni iyabonwa.
I-Amiodarone Lung Toxicity yafunyanwa njani?
Azikho iimvavanyo ezithile zokuxilonga ezithintela ukuxilongwa, nangona kukho izikhombisi ezinamandla ezinokufunyanwa ngokuhlola amangqamuzana emiphunga afunyenwe kwi-biopsy okanye i-pulmonary washing (ngokuchukumisa i-airways nge-fluid), ngokuqhelekileyo nge- bronchoscopy .
Isisitshixo sokufumanisa i-amioarone isifo sobisi, nangona kunjalo, kufuneka uqaphele ukuba kungenzeka. Kuba umntu othabatha i-amiodarone, inetyhefu yomphunga kufuneka ithathelwe ingqalelo ngokuqinileyo kwindawo yokuqala yeengxaki. Izimpawu ezingabonakaliyo zamapulmoni ezingabonakali naziphi na izizathu ezinokubangela ukuba zichongwe zifanele zigwetywe njenge-amiodarone inetyhefu yengxube, kwaye ukuyeka isicirisi kufuneka kuqwalaselwe. (Ukuba uthatha i-amiodarone kwaye uyakrokrela ukuba unokuhlakulela ingxaki yemiphunga, xela ugqirha ngaphambi kokuyeka isilwanyana ngokwakho.)
Ngubani Osemngciphekweni?
Nabani na othabatha i-amiodarone usemngciphekweni wesifo sotywala. Abantu abanamazinga aphezulu (400 mg ngosuku okanye ngaphezulu), okanye ngubani othabatha izilwanyana kwiinyanga ezili-6 okanye ngaphezulu, okanye obani abangaphezu kweminyaka engama-60 kubonakala benomngcipheko ophezulu. Olunye u bungqina lubonisa ukuba abantu abaneengxaki zamaphaphu ezingapheliyo banakho amathuba okuba neengxaki zepommon kunye ne-amiodarone.
Nangona ukubeka iliso ngokuqhelekileyo abantu abathatha i-amiodarone ngesifo se-x-rays kunye nemisebenzi ye-pulmonary imvavanyo kaninzi ibonakalisa utshintsho olubangelwa kwisiyobisi, bambalwa bala bantu baqhubela phambili ukuphucula isifo se-pulmonary toxicity. Nangona i-x-rays yonyaka isenziwa rhoqo kubantu abasebenzisa le myeza, akukho ubungqina obuncinane bokuthi ukubeka iliso kuncedo ekufumaneni abo ekugqibeleni baya kuba neengxaki ze-pulmonary, okanye ngubani na omele ayeke ukuthatha i-amiodarone ngenxa ye-"toxicity".
I-Amiodarone Lung Toxicity yenziwa njani?
Akukho nonyango oluthile oluye lwaboniswa ukuba lunempumelelo. Ingundoqo yonyango imisa ama-amiodarone.
Ngelishwa, kuthatha iinyanga ezininzi ukukrazula umzimba we-amiodarone emva kwesazi yokugqibela. Kwizigulane ezininzi ezineentlobo ezingaphantsi kobutyhefu (i-IP, efana ne-pneumonia, okanye i-pulmonary mass), nangona kunjalo, imiphunga ivame ukugqitywa ekugqibeleni ukuba i-drug is stopped. I-Amiodarone nayo kufuneka ivalwe izigulane nge-ARDS, kodwa kulo mzekelo, isiphumo sokugqibela seklinikhi sisoloko sigqitywe kakuhle phambi kwamanqanaba ama-amiodarone angancitshiswa kakhulu.
Amanqanaba aphezulu ase-steroids amaninzi anikezelwa kwizigulane ezine-ARDS ezibangelwa i-amiodarone, kwaye nangona kukho iingxelo zecandelo loxhamla kwilolu hlobo lonyango, nokuba ngaba i-steroids ngokwenene yenza umda omkhulu awunakwazi. I-Steroids nayo isetyenziswa rhoqo kuzo zonke iindidi ze-amiodarone toxicity, kodwa kwakhona, ubungqina bokuba luncedo kule miqathango banzi.
ILizwi
Kukho izizathu ezintle zokuthi i-amiodarone isetyysi yesohlwayo yinkembelelo eyingozi kakhulu yile mveliso. Inetyhefu yepulmonary ayilungiseki. Inokuba nzima kwaye ibulawe. Kungaba ngumngeni ukufumanisa, kwaye akukho nonyango oluthile. Nangona ukuba inetyhefu yimiphunga yinto echaphazelekayo eyona miphumo ebalulekileyo ye-amiodarone (leyo leyo ayiyiyo isigqibo), le nto yodwa kufuneka ibe ngokwaneleyo ukwenzela ukuba oogqirha bangafuni ukusebenzisa le mveliso ngaphandle kokuba kuyimfuneko ngokwenene.
> Imithombo
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> Papiris SA, Triantafillidou C, Kolilekas L, et al. I-Amiodarone: Ukuhlaziywa kweempembelelo zePulmonary kunye noTyhefu. LweDrug 2010; 33: 539.
> Schwaiblmair M, Berghaus T, Haeckel T, et al. Utywala lwe-Amiodarone-Induced Pulmonary Toxicity: Impembelelo engapheliyo kunye nefuthe elibi? Iiklinikhi Res Cardiol 2010; 99: 693.