In ka badan 200 sano, digitalis (walax ka soo jeeda dhirta foxglove), ayaa ahayd mid muhiim u ah daaweynta wadnaha wadnaha-gaar ahaan, wadnaha oo aan shaqeynin iyo fayrasta atrial . Digoxin (illaa fog, qaabka ugu badan ee loo isticmaalo digitalis) ayaa weli si ballaaran loogu qoraa xaaladaha wadnaha labada.
Tobannaankii sano ee la soo dhaafay, si kastaba ha ahaatee, khubarada ayaa si adag u waydiiyay in digoxin wali ay tahay in loo isticmaalo daaweynta cudurka wadnaha.
Waxaa jira laba sababood oo guud ee shaki ku saabsan qarsoodi-yaashii dhowaa ee digoxin. Marka hore, daawooyin cusub oo cusub ayaa la soo saaray, kuwaas oo waxtarkooda lagu xaqiijiyay tijaabooyinka bukaan socod eegtada, halka tijaabooyin kala duwan oo muujinaya faa'iidada digoxin ay aad u yartahay. Sidaas darteed faa'iidooyinka daaweynta ee Digoxin ayaa la is waydiiyay.
Marka labaad, sunta sunta ah waxay noqon kartaa mid aad u adag in laga fogaado, waxayna noqon kartaa mid halis ah. Xaaladaha intooda badan, daroogooyinka kale oo leh awood yar oo sun ah ayaa loo isticmaali karaa halkii digoxin ah.
Iyadoo ay jirto dhibaatooyin, digoxin weli waxay faa'iido u yeelan kartaa dadka qaarkiis ee qaba wadne-la'aanta ama fayriliska atrial.
Sidee Digoxin u Shaqeeyaa?
Digoxin waxay leedahay laba saameyn oo waaweyn oo wadnaha ah.
Marka hore, waxay joojisaa mishiinnada qaarkood ee xuubka unugyada unugyada wadnaha, iyagoo yareynaya dhaqdhaqaaqa sodium gudaha gudaha unugyada ilaa qolalka dibedda. Tallaabadani waxay saameyneysaa kor u qaadista awoodda foosha ee muruqyada wadnaha.
Sidaa daraadeed, muruqyada wadnaha oo daciif ah ayaa waxtar u yeelan kara marka digoxin la maamulo.
Marka labaad, digoxin wuxuu saameeyaa habka autonomic , hoos u dhigidda cilaaqaadka ("dagaalka ama duulimaadka") iyo kordhinta dhawaaqa parasympathetic ( vagal ). Isbeddelada ku yimaada habka autonomic ah waxay hoos u dhigtaa gudbinta dareenka wadnaha ee korontada iyada oo loo marayo AV node sidaas darteedna waxay u muuqataa inay hoos u dhigto heerka garaaca wadnaha ee dadka qaba fibrillada atrial.
Soo koobid, digoxin ayaa hagaajin karta muruqyada wadnaha ee dadka qaba wadnaha oo aan shaqeynin waxayna hoos u dhigi kartaa heerka garaaca wadnaha ee dadka qaba fibrillada atrial.
Digoxin Sun ah
Saamaynta sunta ee digoxin waxay la xiriirtaa heerka dhiigga ee daroogada. Nasiib darro, heerarka daaweynta ee digoxin la'aanta maaha mid ka duwan kan heerka dhiigga sunta ah - sidaas darteed farqiga u dhexeeya qaadashada "ku filan" digoxin iyo qaadashada digoxin aad u badan inta badan waa mid aad u yar. Tani "daaqada daweynta cidhiidhiga ah" waxay ka dhigaysaa isticmaalka nabdoon ee Digoxin inay u adag tahay dad badan.
Digoxinka sunta ayaa aad ugu badan dadka qaba dhibaatooyinka kelyaha ama heerarka potassium -kase labaduba aad ugu badan yihiin dadka qaba wadne-la'aanta iyo kuwa lagu daaweeyo diuretiga .
Saamaynta sunta ee digoxin waxaa ka mid ah qallalka wadnaha oo khatar gelin kara, gaar ahaan tikarshardiikada qallalka ah iyo fibrillada dhiigfuranka leh , garaaca wadnaha oo hooseeya, wadnaha wadnaha , lumitaanka cuntada, lallabbo ama matagid, iyo dhibaatooyinka neerfalka oo ay ku jiraan jahwareer iyo dhibaatooyin muuqaal ah. Waxaa macquul ah, ugu yaraan boqolkiiba 30 dadka qaba sunta digooksida ma laha calaamado. Taas macnaheedu waa in dadkaasi ay ku dhacaan wadno-qabad wadnaha ah oo laga yaabo inay dadkan ku dhacaan digniin la'aan.
Marka qofku qaato digoxin, heerarka dhiigga waxaa sida caadiga ah lagu qiyaasi karaa si wakhti ah si uu isugu-dayo inuu ku jiro daaqada daaweynta dhuuban.
Digoxin ee Daaweynta Qalitaanka Wadnaha
Sida ugu dhakhsaha badan 30 sano ka hor, digoxin (oo ay weheliso dheecaan) waxa ay ahayd daaweynta dadka qaba wadne-la'aanta wadnaha ee loo yaqaan 'cardiomyopathy' -tat waa, wadnaha oo aan sabab u ahayn daciifinta muruqa wadnaha, oo lagu gooyo jajabsanaanta hoos loo dhigo .
Laga soo bilaabo waqtigaa dhowr daaweyn oo cusub ayaa loo sameeyay qaliin wadnaha kaas oo waxtarkiisa si cad loogu muujiyey tijaabooyin badan oo la kala soocay. Mukhaadaraadka la muujiyay inay kor u qaadeen calaamadaha iyo kordhinta calaamadaha waxa ka mid ah beta blockers , ACE inhibitor , wakiilada ARB , iyo (ugu dambeyn) isku-dar ah daawada ARB iyo neprilysin inhibitor oo laga iibsado Entresto .
Waxaa intaa dheer, dad badan oo qaba wadnaha wadnaha ee wadnaha ku jira ayaa ah musharaxiin loogu talagalay daawaynta qalabka is-galka ah ee daaweynta wadnaha , daaweyn taas oo si weyn u yareyn karta calaamadaha iyo hagaajinta badbaadada.
Dhibaatooyinka kiniiniga ayaa muujiyay, in dadka qaba wadne-la'aanta wadnaha ee loo yaqaan 'kardiomyopathy, digoxin' ay u muuqato inay hagaajinayso calaamadaha wadnaha oo aan shaqeynin ayna yareynayso baahida loo qabo isbitaalka. Si kastaba ha noqotee, marka laga soo tago daawooyinka kale ee hadda loo isticmaalo wadnaha oo aan shaqeynin, digoxin uma muuqato inuu sii wanaajinayo badbaadada.
Khabiirada intooda badan waxay kugula talinayaan isticmaalka digoxin dadka dadka qaba wadnaha oo aan shaqeynin kaliya sida daaweynta labaad ama sadexaad ee daaweynta, haddii dhammaantood. Taasi waxay tahay, digoxin guud ahaan waxaa lagula taliyaa kaliya haddii qofka wadnaha qabsashadu wadnuhu uu sii socdo calaamado muhiim ah inkastoo daaweyn aan fiicnayn oo ay ku jiraan beta blocker, ACE inhibitor ama daawada ARB, diuretics, iyo / ama Entresto.
Digoxin ma bixiso wax faa'iido leh oo lagu daaweynayo dadka qaba wadnaha oo aan ku fashilmayn jajabyada loo yaqaan 'Ejection fraction' - taasi waa, dadka qaba wadno-qabka wadnaha oo aan shaqayn . Digoxin sidoo kale maaha wax faa'iido leh oo lagu xasilinayo dadka qaba wadnaha oo qalala Isticmaalka waa in ay ku kooban tahay maaraynta kuwa leh calaamadaha daba-dheer ee wadnaha wadnaha ee wadnaha ee wadnaha.
Digoxin-ka Daaweynta Qalabka Dabaysha
Sida hore loo xusay, digoxin ayaa hoos u dhigaysa kor u qaadista koronto-qabadka iyada oo loo marayo AV node, natiijadaasina, waxay hoos u dhigi kartaa heerka garaaca wadnaha ee dadka qaba fibrillada atrial. Sababtoo ah garaaca wadnaha oo degdeg ah ayaa ah sababta ugu weyn ee calaamadaha ah ee dadka qaba hurgunka atrial , daawada digoxin waxay faa'iido u yeelan kartaa bixinta cilladaha qaarkood.
Si kastaba ha noqotee, digoxinku wuxuu u eg yahay mid aan waxtar u lahayn cilladaha ka yareeya labada nooc ee daroogooyinka kale ee hadda loo isticmaalo in lagu yareeyo xaddiga garaaca wadnaha ee faafidda atrial atrial fibrillation, kuwaas oo ah beta blockers, iyo xakamaynta calcium . Labadan nooc ee daroogada waxay soo saaraan gaabis ah heerka garaaca wadnaha inta labadaba nasasho iyo inta lagu jiro jimicsiga, halka Digoxin uu hoos u dhigo heerka garaaca wadnaha oo kaliya. Sababtoo ah dad badan oo qaba fibrillada atrial ayaa badanaa ka cabanaya dulqaad darro oo liita, oo ay sababto korodhka degdegga ah ee garaaca wadnaha oo leh xitaa jimicsi sahlan, digoxinku wuxuu muujiyaa calaamadaha yar yar.
Waxaa intaa dheer, hadda waxaa jira caddayn ah in isticmaalka digoxin loogu talagalay xakamaynta sicirka ee dadka qaba fibrillada atrial-ka la xiriirta kororka dhimashada. Gaar ahaan, tijaabada baaritaanka 2017 ayaa soo jeedinaysa in kororka dhimashada ay si toos ah u saameyn karto heerarka dhiigga ee digoxin-taasi waa heerka sare ee dhiigga, khatarta sareeya. Iyadoo ay sabab u tahay khatarta sare u kacda ee dhimashada digoxin maaha mid la hubo, waxay u badan tahay inay sabab u tahay khatarta sare ee dhimashada degdega ah ee ka timaadda qalabka wadnaha.
Khabiirada intooda ugu badani waxay ugu yaraan diidaan inay kugula taliyaan isticmaalka digoxin si loogu xakameeyo garaaca wadnaha ee dadka qaba fibrillada atrial. Si kastaba ha noqotee, digoxinku wali waa ikhtiyaari macquul ah haddii qof qaba fibrillada atrials uu leeyahay calaamado joogto ah oo muhiim ah nasasho, taas oo aan lagu yareynin isku-dar ah beta blockers iyo blockers calcium.
Ereyga
Dhowr ka hor, Digoxin wuxuu ahaa daaweyn loogu talagalay daaweynta wadnaha iyo qalaldhaca wadnaha. Hase yeeshee, tobankii sano ee ugu dambeeyay ayaa daroogooyinka cusubi la sameeyay kuwaas oo ah kuwo wax ku ool ah, oo ammaan ah inay isticmaalaan. Khubarada intooda badani waxay kugula talinayaan isticmaalka digoxin kaliya ee shakhsiyaadka daawadani ay u badan tahay inay bixiso faa'iido gaar ah iyo faa'iido badan. Marka la isticmaalo, waa in si taxadar leh loo isticmaalo.
> Ilo:
> Ambrosy AP, Butler J, Ahmed A, et al. Isticmaalka Digoxin ee Bukaan-jiifka Iyadoo Maqnaanshaha Wadnaha Wadnaha Dulleeya: Dib-u-eegida Maan-dooriye Diiwaan-galin ah si loo yareeyo Is-qoritaanka Isbitaalka. J Am Coll Cardiol 2014; 63: 1823.
> Lopes R, Gibson CM. ARITOTLE: Digoxin iyo Dhimashada Bukaannada qaba Qalliinka Isticmaalka Burburka ee Qalalaasaha Dabaysha Iyo Iyadoo aan Wadnaha Wadnaha lagu Jirin: Miyuu Xumad Dareemo Ah Ku Dhicin? Barnaamijka iyo qoraallada Kuliyada Kaliya ee Kuliyada Caafimaadka Wadnuhu 66-Sanadood ee Sayniska & Cunnada; Maarso 17-19, 2017; Washington, DC. Maxkamadeynta kiliinikada ee goos goos ah.
> Ponikowski P, Voors AA, Anker SD, iyo al. 2016 Tilmaamaha ESC ee loogu talagalay Diagnoska iyo Daaweynta Wadnaha iyo Xanuunka Wadnaha Xanuunka ah: Xoogga Shaqo ee Daaweynta iyo Daaweynta Cudurka Wadnaha iyo Xannuunta Dumarka ee Cudurrada Wadnaha ee Yurub (ESC) Lagu horumariyay qaybta gaarka ah ee Ururka Hawlgabka Wadnaha (HFA) ) ee ESC. Eur Heart J 2016; 37: 2129.