Kwiminyaka engaphezu kwama-200, i-digitalis (into ephuma kwisityalo se-foxglove), ibe yinto ephambili ekunyanga kwesifo senhliziyo-ngokukodwa, ukungaphumeleli kwintliziyo kunye ne-fibrillation ye-atrial . I-Digoxin (ngokude, ifomu esetyenziswa ngokuqhelekileyo ye-digitalis) isacetywa ngokubanzi kule miqathango yomzimba.
Kodwa-ke, kwiminyaka emva nje, iingcali ziye zabuza ukuba ingaba i-digoxin isasetyenziselwa ukunyangwa kwesifo senhliziyo.
Kukho izizathu ezibini zolu xwebhu lwakutshanje malunga ne-digoxin. Okokuqala, kuye kwaphuhliswa izidakamizwa ezintsha ezenziwe ngempumelelo kwizonyango zesikliniki, kanti izilingo ezingenangqiqo ezibonisa izibonelelo ze-digoxin ziye zincinci. Ngoko ke izibonelelo zeklinikhi zangempela ze-digoxin ziye zabuzwa.
Okwesibini, i-digitalis inetyhefu ingaba nzima ukuyiphepha, kwaye inokuba yingozi kakhulu. Kwiimeko ezininzi, ezinye iziyobisi ezingenako ubuncinane besifo esinobuthi zingasetyenziswa endaweni ye-digoxin.
Naphezu kwezi ngxaki, i-digoxin isenokuba luncedo kwabanye abantu abane-heart failure okanye fibrillation ye-atrial.
I-Digoxin isebenza njani?
I-Digoxin ineempembelelo ezimbini ezibalulekileyo entliziyweni.
Okokuqala, inqanda iipompo ezithile kwiimbilini zeesilini, ukunciphisa ukuhamba kwe-sodium ukusuka ngaphakathi kweeseli ukuya ngaphandle kweeseli. Le nyathelo inefuthe lokuphucula amandla okwephulwa kwesifo senhliziyo.
Ngaloo ndlela, i-heart muscle inobuthakathaka inokupompoza ngakumbi xa i-digoxin ilawulwa.
Okwesibini, i-digoxin ithintela ithoni yokuzimela , iyancipha imfesane ("ukulwa okanye indiza") kunye nokwanda kwe-parasympathetic ( vagal ) ithoni. Ezi zinguqu kwiitoni ezizimelayo zinciphisa ukuqhutywa kweengqondo zombane nge- AV node kwaye ke zithatha ukunciphisa izinga lentliziyo kubantu abane-fibrillation ye-arrivals.
Isishwankathelo, i-digoxin inokuphucula ukunyanyiswa kwemizimba yabantu abaneentliziyo ezingaphumeleli kwaye kunokunciphisa izinga lentliziyo kubantu abane-fibrillation ye-atrial.
I-Digoxin Inetyhefu
Iziphumo eziyingozi ze-digoxin zihambelana namazinga egazi leziyobisi. Ngelishwa, amanqanaba okuchithwa kwezidakamizwa kunye ne-digoxin ayilona ehlukileyo kakhulu kunamaqondo egazini wegazi-ngoko umahluko phakathi kokuthatha "okwaneleyo" i-digoxin kunye nokuthatha kakhulu i-digoxin kaninzi kakhulu kakhulu. Le "festile yokwelapha iminyango" yenza ukuba ukusetyenziswa okukhuselekileyo kwe-digoxin kunzima kubantu abaninzi.
I-Digoxin inetyhefu inokwenzeka kubantu abaphucula iingxaki zeengtso okanye amaqondo aphantsi e-potassium-ezo zombini eziqhelekileyo kubantu abanesifo senhliziyo kunye nabanikwe unyango nge- diuretics .
Iziphumo ezinobungozi be-digoxin ziquka ubomi obungozi bokuphila kweengqondo , ikakhulukazi i- tachycardia ye-ventric and fibrillation ye-ventricular , i-bradycardia enamandla (izinga lentliziyo elincinci), i- heart block , ukuphelelwa kwesidlo, isisulu sokuncwina okanye ukuhlanza, kunye neengxaki ze-neurological kuquka ukudideka nokuphazamiseka okubonakalayo. Ngokucacileyo, ubuncinane ubuncinane iipesenti ezingama-30 zabantu abanamaqondo angcolileyo e-digoxin. Oku kuthetha ukuba i-arrhythmias yengozi yokuphila ubomi inokubakho kula bantu ngaphandle kwesilumkiso.
Xa umntu ethatha i-digoxin, amanqanaba egazi ayenziwa ngokuphindaphindiweyo ukuze azame ukuhlala kwinqanaba elincinci lonyango.
I-Digoxin kwiNyango yeNtliziyo yokusilela
Ngoku kutshanje nje kwiminyaka engama-30 eyadlulayo, i-digoxin (kunye ne-diuretics) yayiyintloko yokunyanga kubantu abanesifo senhliziyo ngenxa ye- cardiomyopathy (dilation cardiomyopathy) -ukuthi, ukungaphumeleli kwintliziyo kubangelwa kukuncipha kweentliziyo zentliziyo, ezibonakala ngeqhekeza elincinci elincinci .
Kodwa ukususela ngaloo xesha kukho unyango olutsha olwenziweyo olwenzelwe ukukhubazeka kwentliziyo. Izidakamizwa eziye zaboniswa ukuphucula iimpawu kunye nokwandisa ukusinda kubandakanya i- beta blockers , i- ACE inhibitors , i- Agent agents , kwaye (ngoku kutshanje) ukudibaniswa kwezilwanyana ze-ARB kunye ne-neprilysin inhibitor ezithengiswa njenge- Entresto .
Ukongezelela, abaninzi abantu abanokukhubazeka kwentliziyo yesibindi abaviwa be- cervicing remynchronization , unyango olunokunciphisa kakhulu iimpawu kunye nokuphucula ubomi.
Uvavanyo lwezonyango lubonise ukuba, kubantu abanesifo senhliziyo ngenxa ye-cardiovascular dilation, i-digoxin ibonakala kuphucula iimpawu zeentliziyo ezingaphumeleli kwaye zinciphise imfuno yokubhedlelelwa esibhedlele. Nangona kunjalo, ngokungafani nezinye iindlela zokwelapha eziqhelekileyo ezisetyenziswa ngokusweleka kwentliziyo, i-digoxin ayibonakali ukuphucula ubomi.
Uninzi lweengcali zincoma ukusebenzisa i-digoxin kubantu abaneentliziyo ezingaphumeleli nje njengendlela yomgca wesibini okanye unyango lwangowesithathu, ukuba kunjalo. Oko kukuthi, i-digoxin ikhuthazwa kuphela ukuba umntu onentliziyo engaphumeleli uyaqhubeka eneempawu ezibalulekileyo nangona unyango olufanelekileyo olubandakanya i-beta blocker, i-ACE inhibitor okanye i-ARB, i-diuretics, kunye ne-Entresto.
I-Digoxin ayinikeli inzuzo ekuphatheni abantu abanesifo senhliziyo kunye neqhekeza elondoloziweyo-oko kukuthi, abantu abane- diastolic ye-heart failure . I-Digoxin ayinakunceda ekuqiniseni abantu abanokukhubazeka kwentliziyo. Ukusetyenziswa kwayo kufuneka kupheleliswe ekulawuleni abo abaneempawu ezingapheliyo zokuphelelwa yintliziyo yokunciphisa umzimba.
I-Digoxin kwiNyango yeFibrillation ye-Atrial
Njengoko kuphawuliwe kwangaphambili, i-digoxin iyancipha ukuqhutyelwa kwempembelelo yombane ngokusebenzisa i-AV node, kwaye ngenxa yoko, inokunciphisa izinga lentliziyo kubantu abane-fibrillation ye-arrivri. Ekubeni ixabiso lentliziyo elikhawulezileyo liyintloko ebangela impawu kubantu abane- fibrillation ye-agrix , i-digoxin inokunceda ekunikezeni ukukhululeka kweempawu.
Nangona kunjalo, i-digoxin iyancipha ukuba iphumelele kakhulu ekunciphiseni iimpawu kunezinye iindidi ezimbini zamachiza ngoku eziqhelekileyo ezisetyenziselwa ukunciphisa izinga lentliziyo kwi-fibrillation ye-atrial, okuthi, i-beta blockers kunye ne- calcium channel blockers . Ezi zididi zamachiza zivelisa ukuphuculwa kwentlawulo yenhliziyo kokubili kwaye ngexesha lokuzivocavoca, kanti i-digoxin iyancipha inqanaba lentliziyo kuphela. Ngenxa yokuba abantu abaninzi abane-fibrillation ye-atrial bayakhalaza ngokunyamezela ukunyamezela kokunyamezela, okubangelwa ukwanda ngokukhawuleza kwentlawulo yenhliziyo kunye nokuzivocavoca komzimba, i-digoxin inika imiphumo encinane kwimpawu zabo.
Ngaphezu koko, kukho ubungqina bokusebenzisa i-digoxin ngokulawulwa kwamazinga kubantu abane-fibrillation ye-atrial kuhambelana nokunyuka kokufa. Ngokukodwa, uvavanyo lwezonyango lwango-2017 lubonisa ukuba lo kunyusa ekufeni kufana ngokulinganayo namanqanaba egazi e-digoxin-oko kukuthi, amazinga aphezulu egazi, aphakamileyo umngcipheko. Nangona imbangela yengozi ebonakalayo ephezulu yokufa ne digoxin ayiqinisekanga, mhlawumbi kukuba ngenxa yengozi ephezulu yokufa ngokukhawuleza kwi-arrhythmias yenhliziyo.
Uninzi lweengcali ngoku zincinci ukucebisa ukusebenzisa i-digoxin yokulawula izinga lentliziyo kubantu abane-fibrillation ye-atrial. Nangona kunjalo, i-digoxin isenokuba yinto efanelekileyo ukuba umntu ophethe i-fibrillation ye-arrivri ephethe iimpawu eziqhubekayo kunye nezibonakaliso eziphambili, ezingenakuxhaswa ngumxube we-beta blockers kunye ne-block block ye-calcium.
ILizwi
Kungekudala, i-digoxin yayisisiseko sonyango kokubili ukungaphumeleli kwintliziyo kunye ne-fibrillation ye-atrial. Nangona kunjalo, kwiminyaka emva kutshitshiswa izidakamizwa ezitsha ezisebenzayo, kwaye zikhuselekile ukusebenzisa. Uninzi lweengcali zincoma ngoku ukusebenzisa i-digoxin kuphela kubantu abathile isilwanyana sinokunikela ngenzuzo ethile. Yaye xa isetyenziswe, kufuneka isetyenziswe.
> Imithombo:
> Ambrosy AP, Butler J, Ahmed A, et al. Ukusetyenziswa kwe-Digoxin Kwizigulane ezinezifo ezingapheliyo zentliziyo Ukungaphumeleli: Ukuqwalasela kwakhona i-Drug Old ukuze kuncitshiswe izibhedlele zeZibhedlele. J Am Coll Cardiol 2014; 63: 1823.
> Lopes R, iGomson CM. I-ARISTOTLE: I-Digoxin nokufa kwabantu Kwizigulane ezinezibilini ze-Atrial kunye nangaphandle kokusilela kwintliziyo: Ngaba i-Serum Digoxin Ingxaki Yokuxininisa? Inkqubo kunye neendlela zokusebenza ze-American College of Cardiology 66 I-Scientific Session & Expo; Matshi 17-19, 2017; EWashington, DC. Ukuvavanywa kwexesha elizayo.
> I-Ponikowski P, i-Voors AA, i-Anker SD, kunye ne-al. 2016 Izikhokelo ze-ESC zoLwazi kunye noNyango lweCandelo eliPhezulu kunye nokuPhelelwa kweNtsholongwane engapheliyo: IQela leMisebenzi yokuHlola kunye nokuPhatyalaliswa kweNtsholongwane yeNtliziyo kunye nokuPhelelwa kweNtsholongwane ye-European Society of Cardiology (ESC) Iphuhliswe ngegalelo elikhethekileyo loMbutho we-Heart Failure Association (HFA). ) ye ESC. I-Eur Heart J 2016; 37: 2129.