Domin fiye da shekaru 200, dijital (wani abu da aka samo daga injin foxglove), ya kasance mafi mahimmanci wajen maganin cututtukan zuciya - musamman, rashin tausayi na zuciyar zuciya da fibrillation . Digoxin (da nisa, mafi yawan amfani da nau'ikan dijital) har yanzu ana ba da izini ga waɗannan yanayin zuciya biyu.
A cikin 'yan shekarun da suka wuce, masana sun yi tambaya sosai game da cewa za a yi amfani da digoxin a maganin cututtukan zuciya.
Akwai dalilai guda biyu na wannan shakku game da digoxin kwanan nan. Na farko, an kafa sababbin magungunan sababbin magungunan sababbin gwaje-gwaje a gwaji, yayin da gwaje-gwajen bazuwar da ke nuna amfani da digoxin sun kasance kaɗan. Saboda haka an tambayi ainihin amfanin asibiti na digoxin.
Abu na biyu, nau'in mahalli na dijital zai iya zama da wuya a guji, kuma zai iya zama mai hatsarin gaske. A mafi yawancin lokuta, wasu kwayoyi da rashin yiwuwar maye gurbi za a iya amfani maimakon digoxin.
Duk da wadannan matsalolin, digoxin zai iya zama da amfani a wasu mutane da rashin ciwo zuciya ko kuma filastillation.
Yaya Yin aikin Digoxin?
Digoxin yana da manyan abubuwa biyu a zuciya.
Na farko, shi ya hana wasu tsinkaye a cikin ƙwayoyin zuciya na zuciya, rage karfin sodium daga cikin kwayoyin halitta zuwa waje na sel. Wannan aikin yana da tasiri na inganta ƙarfin rikici na ƙwayar zuciya.
Saboda haka, tsofaffin zuciya tsoka zai iya zubar da hankali a yayin da ake gudanar da digoxin.
Na biyu, digoxin yana rinjayar sautin jiki , rage rage jin dadi ("yakin ko jirgin") da kuma ƙarar ƙararraki ( vagal ). Wadannan canje-canje a cikin sautin na jiki sun rage karfin motsi na wutar lantarki ta wurin kodin AV kuma saboda haka ya sa jinkirin zuciya a mutanen da ke da fibrillation.
A takaitaccen bayani, digoxin zai iya inganta ƙwayar ƙwayar zuciya na zuciya a cikin mutane da ciwon zuciya kuma zai iya jinkirta zuciya a cikin mutane tare da fibrillation.
Digoxin Raɓa
Hanyoyi masu guba na digoxin suna da alaƙa da yanayin jini na miyagun ƙwayoyi. Abin baƙin ciki, matakan maganin magungunan magani da digoxin ba su da bambanci fiye da matakan jini - saboda haka bambanci tsakanin shan "digiri" da yawa da karɓar digoxin sau da yawa kadan ne. Wannan "rukuni mai karfi" ya sa yin amfani da lafiyar digoxin mai wuya ga mutane da yawa.
Maganin Digoxin ya fi dacewa a cikin mutanen da suka bunkasa matsalolin koda ko rashin matakan potassium - duka biyu sun fi dacewa a cikin mutanen da ke da ciwon zuciya kuma waɗanda ake bi da su tare da diuretics .
Hanyoyi masu guba na digoxin sun hada da kwayar cutar zuciya ta zuciya , musamman tachycardia ventricular da ventricular fibrillation , mai tsanani rage zuciya, raunin zuciya , hasara na ci, tashin zuciya ko vomiting, da matsalolin neurological ciki har da rikice-rikice da damuwa. Hakanan, aƙalla kashi 30 cikin dari na mutane da matakan digoxin mai guba ba su da wata alamar bayyanar. Wannan yana nufin cewa zubar da hankali na zuciya na zuciya na rayuwa zai iya faruwa a cikin wadannan mutane ba tare da gargadi ba.
Lokacin da mutum ya ɗauki digoxin, yawancin jini ana aunawa lokaci-lokaci don ƙoƙari ya zauna a cikin fitilar keɓaɓɓun taga.
Digoxin a Ciki da Cutar Zuciya
Kamar yadda kwanan nan shekaru 30 da suka shude, digoxin (tare da diuretics) shine ainihin magani ga mutanen dake da ciwon zuciya saboda mummunar cututtukan zuciya- wato, rashin tausayi na zuciya wanda ya raunana zuciya, wanda ya rage raunin iskar ejection .
Amma tun daga wannan lokacin an fara sababbin sababbin jiyya don zuciya rashin nasara wanda aka bayyana a fili a yawancin gwajin gwaji. Drugs da aka nuna don inganta bayyanar cututtuka da haɓaka rayuwa sun hada da beta blockers , masu hana ACE , ma'aikatan ARB , da kuma (mafi kwanan nan) haɗuwa da maganin magunguna na ARB da kuma mai hana neprilysin kasuwa a matsayin Entresto .
Bugu da ƙari, mutane da yawa tare da cikewar zuciya ta rugujewa su ne 'yan takarar don maganin ciwon zuciya na zuciya , magani wanda zai iya rage yawan bayyanar cututtuka kuma inganta rayuwar.
Gwajen gwaje-gwaje sun nuna cewa, a cikin mutane da rashin tausayi na zuciya saboda mummunar cardiomyopathy, digoxin yana nuna inganta yanayin bayyanar cututtuka na zuciya da rage yawan buƙata don asibiti. Duk da haka, da bambanci da sauran hanyoyin kwantar da hankalin da aka saba amfani dashi don rashin zuciya, digoxin ba ze neman inganta rayuwar ba.
Yawancin masana sun bayar da shawarar yin amfani da digoxin a cikin mutane da nakasa zuciya kamar yadda na biyu ko layi na uku, idan komai. Wato, ana bada shawara kawai a cikin kwayar cutar kawai idan mutum da ciwon zuciya ya ci gaba da samun alamun bayyanar cututtuka duk da farfadowa mafi kyau wanda ya hada da beta blocker, mai hana ACE ko ARB magani, diuretics, da / ko Entresto.
Digoxin ba ta da amfani wajen zalunta mutanen da suke da ciwon zuciya tare da ragowar maganin da aka kiyaye su-wato, mutanen da ke da haɗin zuciya na diastolic . Digoxin kuma ba ma amfani a wajen karfafa mutane tare da mummunan rauni na zuciya. Amfani da shi ya kamata a iyakance ga sarrafawa da wadanda ke da alamun bayyanar cututtukan cututtuka na cardiomyopathy.
Digoxin a cikin Jiyya na Fibrillation Atrial
Kamar yadda muka gani a baya, digoxin yana jinkirin kwantar da hanyoyi na lantarki ta hanyar kodin AV, kuma a sakamakon haka, zai iya jinkirta zuciya cikin mutanen da ke da fibrillation. Tun lokacin da zuciyar zuciya ta kasance babbar hanyar bayyanar cututtuka a cikin mutanen da ke da launi , digoxin zai iya zama da amfani wajen samar da wani taimako na bayyanar cututtuka.
Duk da haka, digoxin yana da mahimmanci wajen kawar da bayyanar cututtuka fiye da sauran nau'o'i biyu na kwayoyi yanzu ana amfani dasu don jinkirta zuciya a cikin filastillation, watau beta blockers, da kuma masu caji mai kwakwalwa . Wadannan nau'o'i biyu na kwayoyi suna haifar da jinkirin zuciyar zuciya duk lokacin hutawa da kuma lokacin motsa jiki, yayin da digoxin yana jinkirin zuciya kawai kawai. Saboda mutane da yawa da ke da alamar dabarar da ke tattare da korafi suna kokawar yawancin rashin haƙuri na motsa jiki, wanda ya haifar da karuwa a cikin zuciya har ma da motsa jiki, digoxin yana ba da taimako kadan a cikin alamun su.
Bugu da ƙari kuma, akwai shaida a yanzu cewa yin amfani da digoxin don kulawa da kwayoyi a cikin mutanen da ke da fibrillation mai haɗari yana haɗuwa da karuwa a cikin mace-mace. Musamman, jarrabawar gwaji ta 2017 ta nuna cewa wannan karuwa a cikin mace-mace yana dacewa da matakan jinin jini-wato, mafi girma da matakan jini, mafi girman haɗarin. Duk da yake dalilin hadarin haɗari da mutuwa tare da digoxin ba tabbas ba ne, yana yiwuwa ne saboda mummunan mutuwa na mutuwa daga kwakwalwar zuciya.
Mafi yawan masana yanzu a kalla kadan ba su bayar da shawarar ta yin amfani da digoxin domin sarrafawa cikin zuciya a cikin mutane tare da fibrillation. Duk da haka, digoxin na iya zama wani zaɓi mai kyau idan mutumin da ke da fibrillation yana da ciwon mahimmanci bayyanar cututtuka a hutawa, wanda ba'a sauke shi ta hanyar haɗakar beta blockers da mashiyoyin mai launi na calcium.
Kalma Daga
Ba da daɗewa ba, digoxin ya kasance mahimmancin farfadowa don rashin tausayi na zuciya biyu da fibrillation. Duk da haka, a cikin shekarun da suka wuce, an bunkasa sababbin kwayoyi wanda yafi tasiri, kuma mafi aminci ga amfani. Yawancin masana sun bayar da shawarar yin amfani da digoxin kawai a cikin mutanen da wannan magungunan zai iya ba da wani amfani mai mahimmanci. Kuma idan aka yi amfani da shi, dole ne a yi amfani dashi da hankali.
> Sources:
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> Lopes R, Gibson CM. HALITTA: Digoxin da rashin mutuwa a cikin marasa lafiya tare da jita-jita ta shari'a tare da ba tare da ciwon zuciya ba: Shin Serum Digoxin Concentration Matter? Shirye-shiryen da abstracts of the American College of Cardiology 66th Annual Scientific Session & Expo; Maris 17-19, 2017; Washington, DC. Late-watse gwaji na asibiti.
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