Dhamaan dawooyinkaas ma bixiyaan hal isku mid ah halista
Daawooyinka lidka-ka-joojinta ee anti-inflammatory (NSAIDs) ayaa ka mid ah dawooyinka ugu badan ee la isticmaalo adduunka. Waxay waxtar u leeyihiin yaraynta xanuunka iyo xanuunka waxaana si fudud loo heli karaa labadaba warqad dhakhtar qoraya iyo miiska.
Si kastaba ha ahaatee, daawooyinkaas intooda badan waxaa hadda loo yaqaan in ay kordhiyaan khatarta dhibaatooyinka wadnaha, oo ay ku jiraan cilladda korontada (ACS) , wadnaha oo aan shaqeynin , iyo suurta gal ahaan fibrillada atrial .
Baaxadda khatarta korodhkani guud ahaan waa yar tahay. Laakiin khatarta ayaa kordheysa isticmaalka daba dheeraadka ah iyo qiyaaso sarreeya, waxayna aad ugu badan tahay dadka qaba cudurada wadnaha ee loo yaqaan 'cardiovascular'. Dheeraad ah, khatarta ayaa ka sarreysa qaar ka mid ah NSAIDs ka badan kuwa kale.
(Fiiri: Aspirin waa kan ugu da'da badan ee loo isticmaalo NSAID. Hase yeeshee, Aspirin wuxuu yaraynayaa halista wadnaha, lagumana falanqeyn doono maqaalkani waxaad ka akhrisan kartaa isticmaalka daaweynta aspirin halkan .)
Noocyada NSAIDS
NSAID-yada non-aspirin NSAIDs waxay ka shaqeeyaan joojinta siklooxygenase enzyme (COX) , taasoo saameyneysa yareynta wax soo saarka prostaglandins ee dhexdhexaadiya xanuunka iyo bararka.
Waxaa jira runtii laba istiraato oo COX ah - COX-1 iyo COX-2 - kuwaas oo leh saameyn kala duwan. COX-2 wuxuu la xiriiraa xanuunka iyo bararka, halka COX-1 leeyahay hawlo kale, oo ay ku jiraan ilaalinta caloosha caloosha oo ka sameysma acid
Sidaa awgeed, NSAIDS waxaa lagu qeexay haddii ay joojiyaan COX-2 ("selective" NSAIDS), ama haddii ay joojiyaan COX-1 iyo COX-2 ("nonselective" NSAIDs).
NSAID-yada asalka ah, sida Ibuprofen (Advil) iyo naproxen (Aleve), ayaa dhammaantood ahaa mid aan habooneyn NSAIDS. Sababtoo ah waxay joojiyaan COX-1 waxay la xiriiraan xanuunka murqaha.
Shirkadaha maan-dooriyaha ayaa xoog u shaqeeyay si ay u sameeyaan NSAID-yada xulashada ah ee joojiya COX-2, si loo yareeyo dhibaatooyinka gastric. Hadda waxaa jira dhowr farsamo oo NSAID ah oo la kala dooran karo, oo ay ku jiraan celecoxib (Celebrex) iyo meloxicam (Mobic).
Daroogooyinkaasi guud ahaan waa kuwo cusub, oo aan laga helin foomamka caamka ah ama kuwa miiska lagu soo saaro.
Halista wadnaha iyo xididada NSAIDs
Kororka khatarta wadnaha ee NSAIDs ayaa markii ugu horreysay lagu xusay xulashada NSAID rofecoxib (Vioxx), kaas oo soo bandhigay bandhig weyn iyo dacwado badan oo ka dhan ah soo saaraha, Merck. Vioxx ayaa markii dambe laga saaray suuqa.
Tan iyo wakhtigaas daraasaddaha badan ee kiliinikada ayaa muujiyay in kororka khatarta wadnaha iyo xididada ay dhab ahaantii la xiriirta dhammaan NSAIDs, labadaba NSAID-yada iyo daawooyinka cusub ee COX-2.
Iyada oo dhammaanba NSAIDs, khatarta wadnaha waxay kordhinaysaa dhererka isticmaalka daroogooyinka, iyada oo qiyaasta loo isticmaalo, iyo khatarta wadnaha ee hoose ee qofka qaadanaya daawooyinka.
Ma qaar qaar ka mid ah NSAID-ka "Safer" oo ka Horeeya kuwa kale?
Xogta la barbar dhigo baaxadda wadarta halista wadnaha ee ay sababeen NSAID-ga gaarka ah ayaa ka maqan. Sababtoo ah tiro badan oo ka mid ah daawooyinkan oo la heli karo, iyo baaxadda yar ee khatarta ku lug leh, samaynta tijaabooyinka bukaan-socodka ee lagama-maarmaanka u ah in la gooyo wixii khilaafaad ah waa mid aad u qaali ah.
Si kastaba ha ahaatee, falanqaynta miisaaniyada ee daraasaddaha caafimaad ee la heli karo ayaa la daabacay sanadka 2013. Falanqayntan ayaa waxay muujisay in khatarta xaaladaha wadnaha iyo xididada ay aad u korodhay marka la barbardhigo cirbadda loo yaqaan 'diclofenac dose' (oo aan aheyn NSAID), iyo dhammaan xulashooyinka NSAID-ka.
Khatarta korodhka waxaa sidoo kale lagu arkay Ibuprofen oo aan ahayn mid muhiim ah. Wax khatar ahna laguma arag naproxen.
Falanqaynta noocan ah looma tixgelin. Khubarada intooda badani waxay sameeyeen fikradda ah in dhammaan NSAID-yada, labada qayboodba, ay tahay in la filayo inay kordhiso halista wadnaha.
Si kastaba ha noqotee, haddii NSAID u baahan tahay in loo isticmaalo qof ku walaacsan sidii loo kordhin lahaa khatarta wadnaha, khabiirada badankood waxay kugula talinayaan naproxen.
Welwelyada kale ee Wadnaha ee la xiriira NSAIDS
Marka laga soo tago kordhinta khatarta munaasabadaha wadnaha, labada qaybood ee NSAIDs waxay sidoo kale la xiriiraan kororka cadaadiska dhiigga marka loo isticmaalo si joogto ah.
Dheeraad ah, badankooda NSAID-yada aan waxba galabsanin waxay farageliyaan saameynta faa'idada leh ee aspirin ay ku leedahay tarbiyada, sidaas darteedna ka hortageysa saamaynta aspirin-ka-kor-u-qaadista. Ficilkan aan la arag, hase yeeshee, nasiib darrada ah NSAID diclofenac, ama xulashada NSAID-yada xulashada.
Khadka hoose
Inkasta oo Vioxx ay heshay dhammaan bandhigyada, waxay soo baxday in dhammaan NSAIDs ay u muuqdaan inay kordhinayaan khatarta wadnaha ee qiyaastii isku mid ah (marka laga reebo wixii hore loo sheegay).
Dadka qaba khatarta wadnaha iyo xididada, NSAID waa in loo isticmaalo qiyaasta ugu hooseysa ee mudada ugu macquulsan. Haddii khatarta wadnahaaga sare u kacdo , naproxen waxay u badan tahay inaad doorato NSAID.
Qof kasta oo qaba hypertension waa inuu ogaadaa in NSAIDs ay kordhin karaan cadaadiska dhiigga waxayna yareyn karaan waxtarka daaweynta antihypertensive .
Qof kasta oo asal u ah daawada loo yaqaan 'aspirin' ee ka hortaga cudurada wadnaha waa inuu iska ilaaliyaa naceelective NSAIDs mar kasta oo ay suurtagal tahay. Haddii loo isticmaalo NSAIDs, waa in la qaato ugu yaraan laba saacadood ka dib umusha.
Ilaha:
Fosbøl EL, Folke F, Jacobsen S, iyo al. Khatarta gaarka ah ee khatarta CV ee la xidhiidha NSAIDs ka mid ah dadka caafimaadka qaba. Natiijooyinka Shaybaarka Cardiovasc 2010; DOI: 10.1161 / CIRCOUTCOMES.109.861104.
Coxib iyo dhaqdhaqaaqa NSAID Trialists '' (CNT) 'Collaboration, Bhala N, Emberson J, iyo al. Vascular iyo saameynta dheefshiidka sare ee daawooyinka non-steroid anti-inflammatory: falanqaynta macaamiisha xogta shakhsiyaadka ka soo jimicsiga la kala saaray. Lancet 2013; 382: 769.