Ithembisa kwakhona ezinye i-Dysautonomias, ezifana ne-POTS kunye neVasovagal Syncope
I-sinus tachycardia engafanelekanga (IST) yimeko ebonakaliswe ngokukhawuleza kwenani lentliziyo (tachycardia), kokubili ekuphumleni nasekuhambeni kwexesha, okuqhelekileyo kuthintela abantu abasebancinci abaphilile ngokupheleleyo. Abo baxhamla kwi-IST bahlala benamava amaninzi kunye nokunyamezela kunye nokukhathala, kwaye loo mqathango inokukhubaza.
Ukunyanga ngempumelelo kwe-IST, ngelanga, kunzima ukufumana umngeni.
I-Ivabradine isilwanyana esitsha esithengiswa ngonyango lwe- angina kunye nokungaphumeleli kwentliziyo. Kwiminyaka yakutshanje i-ivabradine ibonise isithembiso esibalulekileyo sonyango lwe-IST. Iingxelo zibonisa ukuba zinokuthi zisebenze nakwezinye i-dysautonomia syndromes apho i-tachycardia idla ngokuphawulekayo.
I-Ivabradine isebenza njani?
I-Ivabradine ikhusela isiteli sam, ishaneli kwimimbrane yeseli evumela i-sodium ne-potassium ukungena kwiiseli. I-channel (i "f" imele "yinto ehlekisayo," egama lithetha ngokuba eli liza liziphatha ngendlela ehlukileyo kunezinye ezininzi iziteshi), lidlala indima enkulu ekuqhubeni i- node yesusus , elawula isigqi sesimo senhliziyo. Ngokuthintela i-channel, i-ivabradine iyancipha izinga lokushayela kwesodi yesinus, kwaye yanciphise intliziyo. Le ndlela yokunciphisa izinga lenhliziyo yesimo ihluke ngokuthe ngqo kwiindlela ezisetyenziselwa i- beta blockers kunye ne- calcium channel blockers , ngoko ivabradine idla ngokukhawuleza ukuphuculwa kwentlawulo yenhliziyo nangona ezinye iziyobisi zingenzi.
I-Ivabradine yayisungulwa ngokusesikweni ekuphatheni i-angina yaye yavunyelwa ukusetyenziswa kwiindawo ezininzi zehlabathi ngo-2005. Yavunyelwa e-US ngo-Ephreli 2015 ukwenzela unyango lwe- heart failure , kodwa ayiyi-IST.
I-Ivabradine Kwi-IST
Iingxelo ezincinci ezincinane-ngokuqhelekileyo zichaza izigulane esinye okanye ezibini - zaqala ukuvela emva kokuba izilwanyana zisebenzise klinikhi, zibonisa ukuba i-ivabradine inokuba luncedo ekuphatheni izigulane nge-IST.
Emva koko, ngo-2012, isilingo esilungelelaniso esilungelelaniso esilungelelweyo, esilungelelaniswa ne-placebo sasivela kwi-Italy, esaphetha ukuba i-ivabradine inokuba yinkqubela ngokukodwa kule meko. Izigulane ze-IST ezingazange zenze i-ivabradine zibonise ukunciphisa i-75% kwiimpawu, kwaye i-50% yezigulane eziphathwe ngayo zichaze ngokusesikweni nangokugqibeleleyo kweempawu. Imiphumo emibi yayincinci. Xa kuthelekiswa nento ebonakalayo kunye nezinye iindlela zokonyango ezisetyenziselwa i-IST, eso sibonelo siyabetha.
Uvavanyo olusandul 'ulungelo olusandul' ulandelelwano kunye ne-ivabradine kwizigulane ezingama-24 ezine-IST zibonise iziphumo ezifanayo ezilungileyo. Nangona kunjalo, kule lingo, isilwanyana sagcinwa kwizigulane ezili-10 emva komnyaka owodwa ukuba sibone oko kuza kwenzeka (ezinye izigulane zenqabe ukuthabatha inkunkuma), kwaye ezi-8 kwezi zi gulane azizange ziphinde zibuyele kwi-IST.
I-Ivabradine ye-POTS kunye neVasovagal Syncope
I-postural orthostatic tachycardia syndrome (i-POTS) kunye ne-vasovagal syncope zenye i-dysautonomia syndromes apho i-sinus node tachycardia idlala indima ebalulekileyo ekuveliseni iimpawu. Ngoko akumangalisi ukuba oogqirha bayakukhetha ukuzama ivabradine kule miqathango.
Kukho idatha encinci yokusetyenziswa kwe-ivabradine kwi-POTS, kodwa oogqirha behlabathi lonke baye basebenzisa izidakamizwa kubantu abakhethiweyo abaneli meko.
Idatha ekhoyo, nangona kunjalo, ibonisa ukuba, ubuncinane kwabanye abantu, ukulawula i-tachycardia ne-ivabradine kunokunciphisa okanye kuphelise ezinye iimpawu ezihambelana ne-POTS. Uvavanyo olulungelelaniso lweklinikhi olusebenzisa i-ivabradine kwi-POTS ngoku luqhutyelwa kwaSirayeli.
Ngelixa i-vasovagal syncope idibene ne-drop precipit inxinzelelo yegazi kwaye (ngokuqhelekileyo) kwisantya senhliziyo, yaziwa kakuhle ukuba ngaphambi kokulahlekelwa kwengqondo (oko kukuthi, ngexesha "lezimpawu zokulumkisa" abantu bahlala befumana le meko), Ngokuqhelekileyo isantya senhliziyo sihlala sikhona. Kuhlolisiso lwamagqirha angama-25 kunye ne-vasovagal syncope abonise i-tachycardia enjalo ngaphambi kokudlulela, ngaphezulu kwe-70% ibe nemiphumo emihle nge-ivabradine-nokuba kukunciphisa okanye kupheliswe impawu.
Ngoko, i-ivabradine ibonisa isithembiso sangempela kuzo zonke i-dysautonomias apho isusus tachycardia yinto ebalulekileyo.
Iimpawu eziphambili ze-Ivabradine
Impembelelo yecala elibalaseleyo elibikwe nge-ivabradine, elibonwe kwi-15% yezigulane, imeko ebonakalayo ebizwa ngokuba "yinto ekhanyayo." Le nto ichazwa njengento ebonakalayo "ukukhanya" okungavamile kwiindawo ezibonakalayo, kungekho naluphi utshintsho kwizinto ezibonakalayo . Kucatshangelwa ukuba kubangelwe ukuvimbela ishaneli kwiiseli zokubuyisela ezifana neyeshaneli entliziyweni. Ngethamsanqa, le mpembelelo yecala ngokuqhelekileyo ilula yaye ihlala isombulula. Enye ingxelo ya kutshanje ibonisa ukuba izigulane kule nkunkuma zingenokuba yingozi enkulu ye-fibrillation ye-atrial . Ezinye iziphumo eziqhelekileyo eziqhelekileyo ziquka intloko yesisu kunye nesondlo. Ngokubanzi isicatshulwa esichaziweyo siyakunyamezela kakuhle.
I-Ivabradine e-US
Nangona le nkunkuma isetyenzisiwe iminyaka engaphezu kwelishumi eYurophu, kwiindawo ezininzi zase-Asiya, naseRashiya, e-Australia kunye neCanada, yavunywa kwi-US kuphela ngo-Ephreli 2015. Ngaphezu koko, uphawu oluvunyelwe kuphela lwe-ivabradine e-US Ngaba ukwenzela unyango lwenkohlakalo. (I-Ivabradine ithengiswa ngu-Amgen, phantsi kwegama lezorhwebo Corlentor.)
Ukuba uhlala e-US kwaye ube ne-IST (okanye enye yamanye ama-dysautonomiya angaphendula kule nkunkuma), kwaye ukuba ugqirha wakho ukholelwa ukuba i-ivabradine inokukunceda kuwe, ngoku uyakwazi ukuyibeka. Nangona kunjalo, ekubeni i-ivabradine ibhalwe kuphela ngenxa yokuhluleka kwentliziyo e-US, ugqirha wakho kufuneka azimisele ukuwubeka "kwileyile". Kwimeko nayiphi na into, i-ivabradine ngoku inokuyinyaniso nakwii-Americans ezine-IST.
> Imithombo:
> I-Cappato R., i-Castelvecchio S., iCicci C., i-Clinical Efficiency ye-Ivabradine kwizigulane ezingenasifanele isinus Tachycardia: i-Prospective, i-Randomized, i-Placebo-Controlled, i-Double-Blind, i-Crossover Evaluation. J Am Coll Cardiol. 2012; 60: 1323-1329.
> Benezet-Mazuecos J1, uRubio JM, Farré J, et al. Iziphumo zexesha elide ze-Ivabradine kwi-Sinus Tachycardia engafanelekanga Izigulane: Ukuchaneka ngokufanelekileyo okanye izigulane ezingafanelekanga. I-Pacing Clin Electrophysiol. 2013 Jul; 36 (7): 830-6. i-doi: 10.1111 / ijubane.12118. Epub 2013 ngoMatshi 19.
> McDonald C, Frith j, uNewton JL. I-Centre Centre ye-Ivabradine kwi-Postural Orthostatic Tachycardia Syndrome. I-Europace (2011) 13 (3): 427-430. i-doi: 10.1093 / i-europace / euq390.
> Sutton R1, Salukhe TV, Franzen-McManus AC, et al. I-Ivabradine kwonyango yeSinus Tachycardia Mediated Vasovagal Syncope.Europace. 2014 Feb; 16 (2): 284-8. i-doi: 10.1093 / i-europace / eut226. Epub 2013 Septemba 26.