I-opioids (okanye i-opiates) yinkalo yeziyobisi ezenziwe kwi-opium poppy, okanye zihlanganiswe ngokufanelekileyo ukuba zisebenze njengalezi "zendalo" ze-opioid. I-opioids isebenza ngokubophelela kwiiprotheyini ezithile zeeprotheyini kwintliziyo kunye nomgudu womgogodla, ngokunciphisa kakhulu impawu zentlungu ezithunyelwa kwingqondo, kwaye zinciphisa ukuqonda kweentlungu.
I-opioids sele idlale indima ebalulekileyo kwiyeza njengendlela enamandla yokulawula intlungu.
Nangona kunjalo, i-opioids inokubangela iingxaki ezinzima. Ezi zi yobisi zilutha kakhulu. Enyanisweni, umlutha wolawulo lwe-opioids kunye ne-opioids engekho mthethweni (ngokuyinhloko, heroin) uye waba yingxaki enkulu yentlalo. Umlutha we-opioid ubangela ubhubhane lokufa kwe-overdose-related related. E-US, abantu abangaphezu kwama-30,000 abafa kwi-opioid overdoses babhalwa ngo-2015 kuphela, ngokutsho kwe-NIH. Ukongeza, ukurhweba kwi-opioids kubangelwa ubumpofu, ubugebengu obundlobongela, ukuphazamisa iintsapho kunye nezinye iintlanzi.
Ukongezelela, i-opioids inokuvelisa imiba enzima nakubantu abayithatha ngokungapheliyo phantsi kolawulo lugqirha. Iingxaki ezinjalo zibandakanya ukutyunjwa , ukugujwa, ukukwazi ukukwazi ukusebenza, izingozi kunye nokulimala, ukugcinwa kwamanzi, kunye neengxaki zeentliziyo.
Iingxaki zentliziyo ezibonwa ngama-opioids aziqhelekanga ngokubanzi phakathi koluntu, okanye ngenxa yolu dokotela abaninzi. Enyanisweni, ezinye zeengxaki zomzimba ezinxulumene ne-opioids ziyabonwa ngoku.
Nangona kunjalo, kubantu abahlakulela iingxaki ze-cardiovascular-related opioid, le micimbi inokuchaphazela enkulu impilo. Abantu abasebenzisa i-opioids ngokungapheliyo ekulawuleni ubuhlungu, kunye noogqirha abayalela, kufuneka baqaphele kakhulu ingozi yomzimba.
Ukusetyenziswa kweepioids kwiMithi
I-opioids inokubaluleka ngokukhethekileyo ekulawuleni iintlungu ezibangelwa zizifo zonyango zisesigxina, njengamathambo aphukileyo okanye intlungu emva kokusebenza, kunye nokulawula intlungu enxulumene neengxaki zezogulane ezigqityiweyo, ngokukodwa umhlaza wesibulali.
Kule meko imeko i-opioid ihlala isebenza kakuhle, kwaye (kuba ukusetyenziswa kwazo kwezi meko kuphelelwe ixesha) izingozi ezichaphazelekayo ekusebenziseni zona zincinci.
Ziyakwazi ukuphumelela ekuphatheni ubuhlungu obungaphantsi kunye nobuhlungu obungapheliyo, kodwa ukusetyenziswa kwabo kule hlobo yentlungu kuxabana kakhulu . Ukusetyenziswa okungapheliyo kwe-opioids kunokukhokelela ekuxhatshazweni nasekugqiliseni. Oku kuhambelana nento yokuba i-opioids ibonisa into eyaziwa ngokuthi "ukunyamezela" -kuthi, ngokugqithiseleyo kwexesha abantu badinga ukunyuka kwamazinga opioid ukufikelela kumgangatho ofanayo wokulawulwa kabuhlungu oye waphumelela okokuqala ngamanani angaphantsi. Ukubhala kunye nokuthatha inani "elungileyo" lee-opioids ixesha elide, ngoko ke, ngumngeni. Iingcaphephe zincoma ukuba xa i- opioids isetyenziselwa ukuphatha ubuhlungu obungapheliyo abuqhathaniswa nomhlaza, ukusebenzisa kwabo kugqithwe oogqirha abanobuchule bokulawula ubuhlungu.
Ama-opioid amaninzi asetyenziswa ngokunyamekela unyango, kuquka ne-buprenorphine, ikhodi, fentanyl, i-Oxycontin, i-methadone, i-morphine, i-Percocet ne-Vicodin.
Iingxaki zezeMpilo zibonwa ngokuqhelekileyo ngama-opioids
Ngaphambi kokuchaza iingxaki zengqondo ezinokubangelwa yi-opioids, kuya kuba luncedo ukuluhlula ubunzima obuqhelekileyo ezi zidalwa ziziyobisi.
Njengoko sibonile, indlela yokusebenza i-opioids isebenza ngokubophelela kwi-opioid receptors kwiinkqubo ezisisiseko kunye nendawo yokutya, kwaye ngokwenza njalo banciphisa ukuqonda kweentlungu. Nangona kunjalo, xa kusetshenziselwa i-opioid ngokweqile, isenzo sabo kwinkqubo yeentlanzi sinokuvelisa ezinye iziphumo, kubandakanya: i-sedation, i-euphoria, ukuphefumula, ukuxakeka, ukudideka, ukuhlanza, ukugxotha abafundi, nokunyuka.
Ukufa ngokugqithiseleyo kwama-opioid ngokuqhelekileyo kwenzeka rhoqo ngexesha lokukhupha i-opioid, apho umoya wokuphefumula usuxineke gqitha ukuba ukuphefumula kuyayeka.
Iingxaki zeCardia nge-opioids
Ngenxa yokuba le miphumo ephawulekayo yegazi ye-opioids, akunakukumangalisa ukuba ezininzi iingxaki zentliziyo ezibangelwa zizinto ziye zanyanzeliswa.
Nangona kunjalo, i-opioids ngoku idibene neentlobo ezininzi zeengxaki zeentliziyo, kwaye ezinye zazo zingasongela ubomi.
Iingxaki zeenhliziyo ezinxulumene nama-opioid ziquka:
Umsebenzi ogxininisekile wesifo senhliziyo. Nangona i-opioids ngokwabo ayinakuchaphazela kangangoko amandla okwenza imisipha yenhliziyo ibe yintsebenziswano (oko kukuthi, kwintsebenzo yesifo senhliziyo), inkontileka ingakwazi ukucinywa xa i-opioids idibene ne-benzodiazepines (iziyobisi ezifana neValium). Le ntsebenziswano ayinqabile kubantu abenza i-opioids engapheliyo. Kubantu abanengxaki yentliziyo eyenza ubunzima obunobuthathaka kumsebenzi wenhliziyo, njenge- cardiomyopathy , ukudibanisa i-opioid kunye ne-benzodiazepine kunokunciphisa ukungaphumeleli kwenhliziyo .
Bradycardia. I-Bradycardia, okanye iqondo lentliziyo elincinci, ibonakala ngokukhawuleza kubantu abathwala i-opioids. Ngokuqhelekileyo le bradycardia ingenxa yokunciphisa i-node yesusus, njengoko ibonakala kwisifo se-sinus syndrome . I-opioid bradycardia ayikho nto ibangela iimpawu zokuphumla, kodwa ingakhokelela ekunyamezelweni kokunyamezela, kuba inqanaba lentliziyo lingenakukwazi ukukhula ngokuqhelekileyo ngokuzivocavoca.
Vasodilation. Ukuhlambuluka, okanye ukuhluthwa kwemithambo yegazi, kunokubangelwa yi-opioid. Le vasodilation ingabangela i-hypotension (uxinzelelo lwegazi oluphantsi). Ngenxa yokuba i-opioids nayo inokuvelisa i-bradycardia kunye ne-vasodilation, xa umntu e-opioid ephakame ngokukhawuleza, unokuhlaselwa ngokukhawuleza kwegazi-imeko ebizwa ngokuba yi- orthostatic hypotension . I-Orthostatic hypotension ingakhokelela ekubuneni okukhawulezayo xa kulungile, okanye ku- syncope .
Tachycardia. Ngakumbi i-opioids (i-methadone kunye ne-buprenorphine) inokwenza i-phenomenon kwi- electrocardiogram (ECG) ebizwa ngokuba yi- QT prolongation . Kwamanye abantu, i-QT prolongation ingavelisa uhlobo oluyingozi lwe- tachycardia ye- ventricular ebizwa ngokuba yi-torsades de pointes. Olu hlobo lwe- cardiac arrhythmia luvame ukuvelisa iziqulatho ezinobunzima obukhulu, i-syncope, okanye nokufa ngokukhawuleza.
I-fibrillation ye-Atrial. I-fibrillation ye-Atrial, isantya esiphuthumayo nesingenangqondo esabangelwa ngumqondiso ophazamisayo kunye nombane oqhekezayo kwi-atria yenhliziyo ( amagumbi aphezulu e- cardiac ), iboniswe ukuba iyanda kakhulu kubantu abasebenzisa i-opioids. Abantu abane-fibrillation ye-atrial banesigxina esiphambanweni sengozi , kwaye mhlawumbi sisifo senhliziyo .
Endocarditis. I-endocarditis echaphazelekayo yintsholongwane esongela ubomi kwiintsimbi zentliziyo, okanye ezinye izakhiwo entliziyweni. Ingxaki engavamile, ngokuqhelekileyo, iya kubonakala kubantu asebekhulile abanesifo se- valve senhliziyo . Kwiminyaka yakutshanje, nangona kunjalo, i-endocarditis echaphazelayo ibonakaliswe kubantu abatsha abaninzi kunanini ngaphambili- kwaye ngakumbi kubasetyhini abamhlophe. I-common denominator phakathi kwala bantu abaselula abane-endocarditis kukuba baxhaphaze i-opioid, i-heroin. I-endocarditis echaphazelekayo inezinga eliphezulu lokufa kwabantu, kwaye abasindileyo bayasala ngokugula kwesifo esingapheliyo.
Ukuhoxisa i-opioid. Ukuhoxiswa kwe-opioid kunokuchaphazela inkqubo ye-cardiovascular system, kodwa iimpawu ezingenayo i-cardiac zivame ukuba zibalaseleyo (ngokukodwa ukuzithiba, ukuphuza ngokweqile kunye neempumlo ezixakekileyo, izihlunu ezibuhlungu kunye namalungu, isisonguluko, ukuhlanza kunye nesifo sohudo). Isantya senhliziyo esheshayo kunye nokunyuswa kwengcinezelo yegazi ziqhelekile ukuhoxisa i-opioid, kodwa le miqondiso kaninzi ayifumani njengotshanje njengoko banesifo sokuphuza utshwala. Nangona kunjalo, ukuhlanza kunye nesifo sohudo esibangelwa ukuhoxiswa kwe-opioid kungakhokelela ekudambiseni amanzi, uxinzelelo lwegazi oluphantsi kunye nokukhanya okulula okanye syncope. Ukongezelela, ukuba ukukhutshwa kwe-opioid ngokukhawuleza kubangelwa ukunikezela kwezilwanyana eziguqula i-opioid ezifana ne-naloxone (Narcan) (leyo yinkqubo yokulondoloza ubomi xa kunokugqithisa okwenzekayo), ukunyuka ngokukhawuleza kwi-adrenaline kunokuvelisa ukungazinzi kwenhliziyo.
Ukufa kwenhliziyo. Uphando olupapashwe kwi- Journal ye-American Medical Association ngo-2016 lwamangaliswa kwaye luphazamise uluntu lwengonyango ngokunika ingxelo yokuba, phakathi kwabantu abafumana i-opioids yesigulo esingenasifo somhlaza, kwakukho ukwanda okwenyukayo ekufeni kwabantu, kunye nokunyuka okukhulu ekufeni okungahambisani nokugqithisa. Isizathu saloo mfuneko kwiintsholongwane zomzimba kunye neyeza ezingapheliyo zonyango lwe-opioid lucacisa ngeli xesha. Enye imfundiso yokuba ukusetyenziswa kwe-opioid okungapheliyo kunokubangela ukuphefumula okuphazamiseka ukulala , imeko ehambelana neemeyimu zentliziyo, ukuhlaselwa kwentliziyo, nokufa ngokukhawuleza. Nangona kunjalo, kukho uphando olongezelelweyo olufunekayo ukuqinisekisa ubungqina beli pho nonongo, nokukhupha izizathu ezikhoyo.
Isishwankathelo
Njengolunye luncedo lwezinto, i-opioids-eyabangela intlungu enzima ethwalwe izigidi zabantu-ibe yintsikelelo edibeneyo. Ukongeza kwiinkalo ezininzi eziyaziwayo ezinxulumene nokusebenzisa i-opioid yinto eyaziwayo encinane ukuba inokuvelisa iintlobo ezininzi zeengxaki zentliziyo. Ingxaki yeengxaki zentliziyo yeso sizathu esinye isizathu sokuba oogqirha kunye nezigulane kufuneka baqaphele ukusebenzisa le mithi yokulawula ubuhlungu obungapheliyo.
> Imithombo:
> I-opioids: Ulwabiwo lweMithi yokuLawulwa kweMithi kunye neHerin Overdose Epidemic. ISebe lezeMpilo kunye neNkonzo zoLuntu. https://www.hhs.gov/opioids/.
> Ray WA. Cjung CP, u Murray KT, et al. Ubhalo lwe-Opioids edala ixesha elide kunye nokufa kwabantu abanezigulane ezine-Pain Noncancer Pain. JAMA. 2016; 315 (22): 2415-2423. i-doi: 10.1001 / jama.2016.7789.
> I-American Pain Society ngokubambisana ne-American Academy of Medicine Pain. Isikhokelo sokusetyenziswa kweNyango yama-Opioid eqhubekayo kwi-Pain Noncancer Pain: Ubufakazi boBungqina. http://americanpainsociety.org/uploads/education/guidelines/chronic-opioid-therapy-cncp.pdf.
> Wurcel AG, Anderson JE, Chul KH, et al. Ukunyuka kwe-Endocarditis yokuXhatshazwa kwabantwana abaselula. I-Forum ye-Open Disfer Dis (2016) 3 (3): ye-157. INGXELO: https://doi.org/10.1093/ofid/ofw157