Daaweynta kiniiniga wadnaha ee loo yaqaan 'kardiomyopathy' (DCM) - qaabka ugu badan ee wadnaha oo shaqeyn waaya - ayaa si aad ah u fiicnaaday dhowrkii sano ee la soo dhaafay.
Nasiib daro, daraasado ayaa muujinaya in bukaanno badan oo qaba DCM aysan heleynin daaweynta ay tahay in ay helaan. Sababtan darteed, waxaa muhiim kuu ah inaad ogaatid daaweynta lagu taliyey DCM - haddii kaliya si loo hubiyo in dhakhtarkaaga uu daboolayo dhamaan saldhigyada.
Daawee Sababta Aasaasiga ah
Xeerka ugu horreeya ee daaweynta DCM waa in la aqoonsado laguna daweeyo sababaha hoosta. Daweynta sababaha hoose waxay badanaa gaabin kartaa, joojin kartaa, ama xitaa gaabin kartaa horumarka DCM. Waxaad halkan ka akhrisan kartaa waxyaabo badan oo ah DCM .
Daweynta Dawooyinka DCM
Beta blockers. Beta blockers waxay yareeyaan culeyska badan ee wadnaha qaldan, waxaana loo xaqiijiyay in si weyn loo wanaajiyo guud ahaan wadnaha wadnaha, calaamadaha, iyo badbaadinta bukaanka qaba DCM. Beta-blockers hadda waxaa loo tixgeliyaa inay tahay goob muhiim ah oo lagu daaweynayo DCM. Coreg (carvedilol), Toprol (metoprolol), iyo Ziac (bisoprolol), ayaa ah kuwa ugu badan ee loo isticmaalo DCM, laakiin dhowr kale ayaa la heli karaa.
Diuretics. Diuretics , ama "kaniiniyada biyaha," waa daaweyn muhiim ah oo loogu talagalay dadka qaba wadne-la'aanta. Daroogooyinkaasi waxay kordhi biyaha laga goynayo kelyaha waxayna yareynayaan dheecaanka dareeraha iyo bararka taasoo badanaa ku dhacda DCM. Cudurrada sida caadiga ah loo isticmaalo waxaa ka mid ah Lasix (furosemide) iyo Bumex (bumetanide).
Waxyeelada astaamahooda ah waa inay keenaan heerarka potassium, taas oo keeni karta qalqal wadnaha .
Ka hortagga ACE. Ka-hortagayaasha ACE (daroogooyinka xannibma angiotensin-ka enzyme ) waxay xaqiijiyeen in ay aad waxtar u leeyihiin hagaajinta calaamadaha iyo badbaadada labadaba ee bukaan-socodka wadnaha oo aan shaqayn. Dhibaatooyinka ugu dambeeya ee daawada waa qufac ama dhiig kar , laakiin dadka intooda ugu badan ee qaba DCM waxay u dulqaadanayaan xanuunka ACE si fiican.
Cuncunada ACE ee caadiga ah waxaa ka mid ah Vasotec (enalapril), Altace (ramipril), Accupril (quinapril), Lotensin (benazepril) iyo Prinivil (lisinopil).
Angiotensin II xanuunka dawada (ARBS). ARBS waa daroogo u shaqeynaya sida kuwa ACE xanibay. Waxa loo isticmaali karaa dadka qaba DCM oo aan qaadan karin xanuunka ACE. ARBS oo loo ansixiyay qaliin la'aan wadata waxaa ka mid ah Atacand (candesartan) iyo Diovan (valsartan).
Aldosterone antagonists. Aldactone (spironolactone) iyo Inspra (eplerenone) waa antagonistaha aldosterone, nooc kale oo daawooyin ah oo si cad u muujiyay in kor loo qaado badbaadada dadka qaarkiis ee qaba wadnaha oo aan shaqeynin. Marka loo isticmaali karo si badbaado leh, mid ka mid ah daawooyinkan ayaa guud ahaan lagu taliyaa, marka lagu daro xanuunka ACE (ama daroogada ARB) iyo beta blocker, dadka qaba DCM. Si kastaba ha noqotee, haddii bukaanku hoos u dhigo hawlaha kelyaha, daroogooyinkaasi waxay keeni karaan hyperkalemia (heerarka potassium). Aldosterone antagonists waxay u baahan tahay in loo isticmaalo taxadar weyn, haddii ay dhan, marka hawlgalka kelyaha caadi maaha.
Hydralazine iyo sidoo kale Nitrates. Dadka qaba DCM ee leh calaamado joogto ah inkastoo ay beta-blockers, ACE xannibaadayaasha, iyo diuretics, oo isku darsamaya hydralazine iyo sidoo kale kiimiko afka ah (sida isosorbide) ayaa si weyn u horumarin kara natiijooyinka.
Neprilysin inhibitor. Markii ugu horeysay ee neprilysin inhibitor (daroogo cusub oo daroogo ah), ayaa loo ansixiyey daaweynta qaliin wadnaha ee FDA ee sannadka 2015. Daawadan, Entresto , dhab ahaantii waa isku-dar ah ARB (valsartan) oo leh neprilysin inhibitor (sacubitril) . Barashada hore ee Entresto ayaa ah mid aad u ballan qaadaya, khubarada qaarkood waxay aaminsan yihiin in loo baahan yahay in loo isticmaalo habka loo yaqaan ACE inhibitor ama ARB. Si kastaba ha noqotee, waayo-aragnimada daroogada ayaa xaddidan iyo saameynaha muddada-dheer waxay weli yihiin calaamad su'aal . Sidoo kale, daroogadu waa qaali. Sidaa awgeed guud ahaan adeegsigeeda maanta waxaa badanaa ku jira bukaanada aan u dulqaadan karin ama aysan ku fashilmin inay si wax ku ool ah uga jawaabaan celiyayaasha ACE ama ARB.
Sida waayo-aragnimo dheeraad ah ee Entresto ayaa la ururshay, isticmaalka ayaa si aad ah u kordhi doona.
Ivabradine . Ivabradine waa daawo loo isticmaalo in lagu yareeyo heerka wadnaha. Waxaa loo isticmaalaa xaaladaha sida qalabka daawada ee aan habooneyn , oo ah heerka garaaca wadnaha si aan haboonayn. Dadka qaba DCM sidoo kale waxay yeelan karaan heerarka wadnaha ee lagu nasto oo aad u sarreeya marka loo eego sida caadiga ah, waxaana jira caddayn ah in hoos u dhaca heerka garaaca wadnaha ee sare leh ivabradine uu horumarin karo natiijada. Inta badan khabiirada wadnaha waxay tixgeliyaan isticmaalka ivabradine ee dadka ku jira daweynta ugu badan ee daawooyinka kale (oo ay ku jiraan beta-blocker) oo weli leh qiyaas wadnaha lagu nasto oo ka sareeya 70 garaac daqiiqadii.
Digoxin. Inkastoo tobankii sano ee la soo dhaafay digoxin loo tixgeliyey in ay tahay daaweyn wadnaha oo shaqeynaya, faa'iidooyinkeeda dhabta ah ee daaweynta DCM waxay u muuqataa in ay tahay mid cakiran. Dhakhaatiirta intooda badani waxay u qoraan kaliya haddii daawooyinka wax ku oolka ah aysan u muuqan inay ufiican yihiin.
Daawooyinka aan laf dhabarta ahayn. Daawooyinka aan laf dhabarta ahayn waa daawooyinka xididada oo riixaya muruqa wadnaha si ay u shaqeeyaan si ka adag, sidaas darteedna loo dhiibi karo dhiig badan. Sannado ka hor waxaa jiray waxyaabo badan oo xiiso leh daawooyinkan, maaddaama ay had iyo jeer soo saaraan isbeddel degdeg ah oo ku yimaada hawlaha wadnaha. Laba daawo oo aan daweyn (gaar ahaan milrinone iyo dobutamine) ayaa u adeegsaday si caddaalad ah baahsan oo loogu talagalay dadka deggan xasiloonida wadnaha, waxaana sidoo kale loo isticmaalay daaweynta muddada-dheer ee dadka qaba wadne-la'aanta wadnaha. Hase yeeshee, daraasado ku xiga ayaa muujiyay in dadka lagu daaweeyo daawooyinka aan dawooyinka lahayn - inkastoo ay badanaaba soo roonaanayaan calaamadaha muuqda - waxay si weyn u kordhiyeen geerida. Daawooyinkaan waxaa hadda loo isticmaalaa si aad u qarsoon, oo keliya dadka qaba qalalaan wadnaha oo aad u xun oo ku fashilmay in ay ka jawaabaan daaweynyo badan oo kale.
Daaweynta Khatarta Daaweynta Wadnaha
Daaweynta raajada wadnaha (CRT) waa nooc ka mid ah isdul-galka wadnaha oo kicinaysa labada jeermis (labadaba midig iyo bidix) isku mar. (Standard pacemakers waxay kicinayaan oo kaliya halbeegga saxda ah.) Ujeedada CRT waa in ay isku-duwo foosha hawo-mareenada, si loo hagaajiyo waxtarka wadnaha. Cilmi-baarista CRT-da waxay muujinaysaa in daaweyntan, ee bukaanku si habboon loo soo doorto, waxay keenaysaa horumarin wax ku ool ah oo ku yimaada hawlaha wadnaha iyo calaamadaha, yaraynaya isbitaalada, iyo sii dheereynaya nolosha. Bukaan kasta oo leh DCM iyo xayeysiin muhiim ah oo looxyo ah waa in loo tixgeliyaa CRT.
Qalabka Daaweynta Defibrillator ee Implantable
Nasiib darro, dadka qaba dhexdhexaad ilaa DCA waxay halis dheeraad ah ugu jiraan dhimashada wadnaha oo degdeg ah oo ka yimaada qallafsanaanta quman . Dhiirrigeliyaha 'defibrillator' (ICD) ayaa lagu muujiyey inuu si weyn u yareeyo dhimashada dadka qaarkiis ee qaba DCM kuwaas oo si weyn hoos u dhigay jajabka istiraatiijiga ah ee dhinacyada xuubka ah . Haddii aad heysato DCM, waa inaad kala hadashaa takhtarkaaga haddii ay ICD tahay wax ay tahay in laguu tixgeliyo kiiskaaga.
Qalitaanka Wadnaha
Ku guuleysiga wadno-qabashada wadnaha ayaa si fiican u fiicnaaday tobankii sano ee la soo dhaafay. Si kastaba ha ahaatee, sababtoo ah dabeecadda adag ee daaweynta, iyo xaqiiqda ah in wadnaha deeq-bixiyuhu uu aad u yaryahay, wadnaha wadnaha ayaa loogu talagalay bukaanka aadka u xanuunsan ee qaba wadnaha oo aan shaqeynin. Waxaa xusid mudan, in xarumaha wadnaha ee badankood ay ogaadeen in bukaanno badan oo loo yaqaan "heart end failure" aysan dhab ahaantii helin daaweyn qalafsan oo qalafsan wadnaha oo ay ubaahanyihiin - iyo marka daweynta gardarrada ah la hirgeliyo si ay u horumariyaan si weyn iyo muddo dheer waxay ubaahan tahay isugeynta wadnaha.
Daaweynta Dabiiciga ah
Daraasado fara badan ayaa la sameeyaa si loo ogaado haddii daaweynta hiddesidaha ama daaweynta stem therapy ay faa'iido u leedahay dadka qaba DCM. In kasta oo labada daaweyn ee tijaabada ah ay muujinayaan ballanqaadyo, waxay aad u yartahay nidaamka qiimeynta, oo guud ahaan ma heli karaan bukaanka qaba DCM.
Ereyga
Daraasaduhu waxay sii wadaan inay muujiyaan in dadka intooda ugu badan ee wadnaha qaba ay sabab u yihiin DCM aysan helin dhammaan daaweynta ay tahay in ay helaan. Sababtaa darteed, haddii adiga ama qof aad jeceshahay uu leeyahay xaaladdan waa inaad hubisaa inaad taqaanay dhammaan daaweynta la soo jeediyey, iyo inaad kala hadasho dhakhtarkaaga.
> Ilo:
> Ciidanka Xoogga ee Baaritaanka iyo Daaweynta Cudurka Wadnaha iyo Xanuunka Wadnaha Diseembar 2008 ee Bulshada Bariga Yurub, Dickstein K, Cohen-Solal A, et al. Tilmaamaha ESC ee loogu talagalay Ciladda iyo Daaweynta Qalitaanka Wadnaha iyo Xanuunka Wadnaha Diseembar 2008: Ciidanka Hawlaha ee Daaweynta iyo Daaweynta Qalitaanka Wadnaha iyo Xanuunka Wadnaha ee 2008 oo ka tirsan Jaaliyadda Yurub ee Wadnaha. Waxaa lagu horumariyey wadashaqeyn lala yeeshay Iskaashiga Qalitaanka Wadnaha ee ESC (HFA) oo uu ansixiyay Bulshada Yurub ee Daaweynta Khasabka ah (ESICM). Eur Heart J 2008; 29: 2388.
> Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF / AHA Xidhiidhka Maamulka Maareynta Wadnaha Wadnaha: Soo-koobidda Fulinta: Warbixinta Kuliyada Aasaasiga ah ee American College of Cardiology / Qalabka American Heart Association Force ee ku saabsan tilmaamaha tababarka. Wareegga dhiigga 2013; 128: 1810.