Rashin kwayar cutar , ko rikici jini , yana da yanayi mai hatsari wanda ya haifar da nau'i biyu na matsalolin kiwon lafiya.
Na farko, thrombosis a cikin maganin zai iya toshe jini, yana haifar da lalacewa ga gabobin da aka kawo ta hanyar caji. Rushewar cututtuka (cututtuka na zuciya) yakan haifar da thrombosis cikin maganin jini , kuma bugun jini na haifar da thrombosis a cikin ɗayan arteries wanda ke samar da kwakwalwa.
Abu na biyu, thrombosis da ke faruwa a cikin wani ɓacin zuciya ko a cikin zuciya na iya hoton . Wato, jinin jini zai iya karya kuma ya yi tafiya ta hanyar kwayoyin halitta, yana yin lalacewa a duk lokacin da ya shiga gida. An yi amfani da alamar kwakwalwa ta hanyar jini wanda ke kunshe da huhu (yawanci, daga jikin da yake cikin kafa). Abun bugun jini na haifar da jini wanda yake tafiya zuwa kwakwalwa, yawanci daga wani ɓacin zuciya a cikin zuciya, mafi yawanci a haɗuwa da fibrillation .
Magungunan da ke Tsarin ko Kula da Gurasar Jiki
Mutanen da suke cikin haɗari masu haɗari don ci gaba da haɗari mai haɗari sukan buƙaci magani ko dai don hana wannan yanayin daga faruwa ko ƙoƙari ya narke jinin jini wanda ya riga ya kafa. Akwai nau'o'i uku na kwayoyi da aka saba amfani dashi don hana ko magance thrombosis - kwayoyi masu tsauraran kwayoyi, kwayoyin fibrinolytic, da magungunan maganin magunguna.
Yayin da waɗannan kwayoyi suna da nasabaccen tasirin tasirin da ya faru, lahani guda ɗaya na kowa ga dukkan su shine zub da jini.
Don haka dukkanin wadannan kwayoyi dole ne a yi amfani da su tare da tsare-tsaren da ya dace.
Magunguna marasa lafiya
Magungunan kwayoyin halitta sun hana daya ko fiye da abubuwan da suka shafi clotting . Hanyoyi masu rarrafe sune rukuni na sunadaran jini waɗanda suke da alhakin jini.
Wadannan kwayoyi sun hada da:
Heparin. Heparin wani magani ne mai dauke da kwayar cutar wanda ke da hanzari (a cikin hutu) sakamako mai hanawa akan abubuwan clotting.
Doctors za su iya daidaita yawan sashi akai-akai, kamar yadda ake buƙata, ta hanyar kula da gwajin jini na jini na zamani (PTT) . PTT yana nuna yadda aka hana kullun abubuwa. (Wato, ya nuna "jinin" jini.) Ana amfani da Heparin kawai a marasa lafiya.
Ƙananan kwayoyin Heparin: enoxaparin (Lovenox), dalteparin (Fragmin). Wadannan magungunan sunadaran tsarkakewa daga heparin. Babban amfani da su a kan heparin shine cewa za'a iya ba su a matsayin fararen fata (wanda kusan kowa zai iya yin karatu a cikin 'yan mintoci kaɗan) a maimakon shiga cikin intravenously, kuma basu buƙata a kula da su tare da gwajin jini. Saboda haka, ba kamar heparin ba, za a iya gudanar da su tare da lafiyar dangi a kan asali.
Sabo mai mahimmanci ko ƙwayoyin cuta-wanda ake gudanarwa. Yawancin magungunan "heparin-like" sun hada da argatroban, bivalirudin (Angiomax), fondaparinux (Arixtra) da kuma lepirudin (Refludan). Mafi kyau lokacin da wuri don yin amfani da dukkan wadannan kwayoyi suna sannu a hankali suna aiki.
Warfarin (Coumadin). Har sai kwanan nan, warfarin shine kawai maganin maganin rigakafi wanda aka samo shi.
Babban matsala tare da warfarin yana daidaitawa da sashi.
A lokacin da aka fara dauka, dole ne a tabbatar da maganin warfarin a tsawon makonni tare da gwaje-gwaje na jini sau da yawa (gwajin INR). Koda bayan karfafawa INR har yanzu ana bukatar kulawa akai-akai, kuma sashin warfarin yana buƙatar gyarawa. Saboda haka, samun shiga da kuma riƙe da "dama" na warfarin ya kasance da wuya kuma maras kyau.
"Sabuwar" Magungunan maganganu na maganganu na kwayoyi - Aiki na NOAC. Saboda kyan magani mafi kyau na warfarin na iya zama da wuya a gudanar, kamfanonin ƙwayoyi sun yi aiki har shekaru masu zuwa don su samo asali da "warfarin-substitutes" - wato, kwayoyin maganin rigakafin da za a iya ɗauka baki daya.
Hudu daga cikin sababbin kwayoyi masu tsauraran kwayoyi (magunguna na NOAC) an amince da su yanzu.
Waɗannan su ne dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), da kuma edoxaban (Savaysa). Babban amfani da dukkan wadannan kwayoyi ita ce za'a iya ba su a cikin jinsin yau da kullum, kuma baya buƙatar gwaje-gwajen jini ko gyarawa. Duk da haka, kamar yadda lamarin yake tare da dukkan kwayoyi, akwai ƙwayoyi marasa ƙarfi na NOAC .
Fibrinolytic Drugs
Streptokinase, urokinase, alteplase, refeplase, tenecteplase. Wadannan magungunan sunadaran suna ba da yardar rai don su wanke jinin jini wanda suke aiwatarwa. A mafi yawancin, aikinsu yana iyakance ga marasa lafiya waɗanda ke cikin cikin 'yan kwanakin farko na wani rauni na zuciya ko bugun jini, kuma an ba su a cikin ƙoƙari don sake buɗe maɗaukakin kariya da kuma hana lalacewa na har abada.
Kwayoyin fibrinolytic (wanda ake kira "clotting busters" sau da yawa), zai iya yin amfani dasu. kuma suna dauke da hadarin ƙwayar jini. Duk da haka, a yanayin da ya dace, yin amfani da waɗannan kwayoyi zai iya hana mutuwa ko rashin lafiya daga ciwon zuciya ko bugun jini. Daga cikin kwayoyi masu fibrinolytic, ana amfani da streptokinase mafi yawancin duniya, saboda yana da daraja. A Amurka, halin yanzu yana da magani na zabi saboda yana ganin ya haifar da mummunan sakamako na jini, kuma ya fi sauƙin sarrafawa fiye da sauran magungunan wannan rukuni.
Anti-Platelet Drugs
Ana amfani da wasu rukuni uku don rage "sandar hannu" na plalets , da kananan kwayoyin halittar da ke haifar da tsakiya daga jini. Ta hanyar hana yin amfani da takalma don kwance tare, kwayoyin anti-platelets sun hana jini jini. Wadannan kwayoyi sun fi tasiri a hana rigakafin jini daga haɗuwa a cikin arteries kuma basu da tasiri sosai wajen hana thrombosis a cikin veins.
Aspirin da dipyridamole (Aggrenox). Wadannan kwayoyi suna da tasiri mai kyau a kan "sandar" plalet "amma suna haifar da mummunar illa mai cutar jini kamar sauran kwayoyi masu magunguna. An yi amfani dasu sau da yawa a ƙoƙari don rage haɗarin ciwon zuciya ko bugun jini a cikin mutanen da ake haɓaka haɗarsu.
Ticlopidine (Ticlid), clopidogrel (Plavix) da prasugrel (M). Wadannan kwayoyi sun fi ƙarfin (sabili da haka mai haɗari) fiye da aspirin da dipyridamole. Ana amfani da su ne a yayin da haɗarin clotting arterial ya fi girma. Mafi yawan aikace-aikacen da suke yi shi ne a cikin mutanen da suka karbi suturar ƙwayoyin jini . Amfani da su game da stents - musamman, yanke shawara game da lokaci da kuma tsawon lokacin amfani da su - sunyi rikici .
IIb / IIIa Masu hanawa: abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat). Magunguna na IIb / IIIa sune mafi karfi rukuni na masu cin abincin plalet. Suna hana mai karɓar mai karbi a farfajiya na plalets (wanda ake kira IIb / IIIa receptor) wanda yake da mahimmanci don tsayawa ga platelet. Yin amfani da su shi ne ya hana ketare mai tsanani bayan hanyoyin shiga (irin su angioplasty da jigilar sutura ), kuma a cikin marasa lafiya da ciwo mai cututtuka . Wadannan kwayoyi suna da tsada sosai kuma (a gaba ɗaya) dole ne a ba su cikin intravenously.
Kalma Daga
Yawancin magungunan suna cikin amfani na asibiti don taimakawa wajen hana ko yaduwa da jini. Suna da hanyoyi daban-daban na aiki, hadari daban-daban, kuma ana amfani dashi a wasu yanayi daban-daban. Yin amfani da duk waɗannan kwayoyi ko da yaushe yana ɗauke da haɗarin zubar da jini marar haɗari, kuma ya kamata a yi amfani da su kawai idan amfanin su zai iya wuce wadannan hadarin. Yayin da ake sarrafa thrombosis, yana da mahimmanci ga likita don zabi miyagun ƙwayoyi masu kyau, a halin da ake ciki.
> Sources:
> Franchini M, Mannucci PM. Sabbin Sabbin Magunguna a Magungunan Intanit: Ɗaukakawa. Eur J Intern Med 2010; 21: 466.
> Kearon C, Akl E, Omelas J, et al. Antithrombotic Far for VTE cuta. Jagoran CHEST da Takaddun Sakamako. Chest 2016; 149: 315.
> Weitz JI, Hirsh J, Samama MM, Cibiyar Kwalejin Kwalejin Kwalejin Kwanan Amirka. Sabbin Magunguna na Antithrombotic: Kwalejin Kwalejin Kwalejin Kwalejin Kwayoyin Yammacin Amirka Kwararrun Sharuɗɗan Harkokin Kasuwanci (8th Edition). Chest 2008; 133: 234S.