Daaweynta cudurka Chagas waxay ku xiran tahay marka cudurka la ogaado . Dadka la ogaado inta lagu jiro marxaladda ba'an ee cudurkan ayaa si ka duwan kan loola dhaqmo inta lagu jiro marxaladda daba dheeraatay.
Daweynta Cudurka Dabaysha
Fursada kaliya ee wanaagsan ee lagu daaweyn karo cudurka Chagas-oo ah, gebi ahaanba ciribtirka Trypanosoma cruzi (T.
Kiimikada jirka ka timaada jirka - waa haddii daaweynta la bilaabi karo horaantii cudurka, inta lagu jiro marxaladda ba'an.
Qofkasta oo lagu sheegay infakshanka infakshanka T. Cruzi, ama haddii ilmo yar lagu arko inuu qabo infakshanka ku dhasha, daaweynta waa in lagu siiyaa daawooyinka antitrypanosomal. Labada daroogo ee lagu arkay inay waxtarka ka soo horjeedaan T. cruzi waa benznidazole iyo nifurtimox. Dumarka uurka leh waa inaysan helin daawooyinkan.
Haddii koorsada buuxda ee daaweynta mid ka mid ah daroogooyinkaas la dhameeyo, ciribtirka T. cruzi waxaa lagu dhammeeyaa 85 boqolkiiba waqtiga.
Benznidazole
Benznidazole badanaa waxay leedahay saameyno yar oo yar waxayna badanaa daaweynta doorashada. Daawadan waa in la qaataa 60 maalmood. Waxyeelada ugu badan ee daaweyntu waa finan maqaarka ah.
Nifurtimox
Nifurtimox (oo aan laga aqbalin Mareykanka) waxay u egtahay inay sababto calaamadaha caloosha. Waxay sidoo kale soo saari kartaa hurdo la'aan, xanaaqa , iyo neeropathy ka baxa .
Dhibaatooyinkani waxay xadidaan faa'iidada. Daawadan waa in la qaato ugu yaraan 90 maalmood.
Daweynta Caabuqa Ba'an
Cudurka Chagas ee joogtada ah, ciribtirka sunta T. cruzi leh daaweynta antitrypanosomal waa mid aad u adag marka loo eego marxaladda ba'an, oo laga yaabo in aan macquul ahayn.
Hase yeeshe, khubarada intooda ugu badani waxay kugula talinayaan daaweynta benznidazole ama nifurtimox haddii qofka cudurka qaba uu ku jiro marxaladda aan hubin ee cudur Chagas ah (taas oo ah, aan lahayn calaamadaha wadnaha ama xanuunka caloosha ee Chagas), oo uu ka yar yahay 50 jir.
Dadka da'doodu ka weyn tahay 50 jir waxay ku dhacaan dhacdooyin ka badan daawooyinka antitrypanosal, laakiin daweynta ayaa wali la tixgelin karaa.
Daaweynta Antitrypanosomal laguma talinayo haddii cudurada wadnaha ee Chagas horey ugu jirey, haddii xanuun daran ee xanuunka Chagas uu jiro (sida megacolon ), ama haddii beerka ama kalyaha muhiimka ah uu joogo. Dadkan dhexdooda fursadaha ah in la tirtiro infekshanka T. cruzi aad ayuu u hooseeyaa, khatarta ahna saameyntu waa mid sareeysa.
Daweynta Cudurka Wadnaha ee Chagas
Daaweynta daawooyinka antitrypanosomal ma ahan waxtar u ah cudurka wadnaha ee Chagas. Halkii, daaweyntu waa in si gaar ah loogu talagalay in lagu maareeyo cudurka wadnaha laftiisa.
Cudurka wadnaha ee Chagas waa nooc ka mid ah kiniiniyada wadnaha ee loo yaqaan 'kardiomyopathy' kaasoo badiyaa soo saaro wadnaha oo aan shaqeynin , dadka qaba cudurkan waa in ay helaan dhamaan daaweynta caadiga ah ee loo yaqaan 'kardiomyopathy' .
Daweynta Qalitaanka Wadnaha
Daaweyntu waxay badanaa ku jirtaa daaweynta beta blockers , xanuunka ACE iyo spironolactone. Dawaynta ilayska ee loo yaqaan ' Diuretic therapy' ayaa loo adeegsadaa si loo yareeyo bararka iyo dyspnea.
Daaweynta raajada wadnaha (CRT) waxay u muuqataa inay faa'iido u leedahay cudurka wadnaha ee Chagas sida qaab kasta oo kale ee wadnaha oo aan shaqeynin. Si kastaba ha noqotee, faa'iidada CRT ee lagu daaweynayo wadnaha oo shaqeyn waaya ayaa inta badan ku xadidan dadka ka soo laalay xayawaanka xidhxidhka ah , haddii ay qabaan cudurka Chagas ama nooc kasta oo ka mid ah kiniiniyada wadnaha ee loo yaqaan 'kardiomyopathy'.
Iyo, nasiib daro, cudur Chagas ah oo xiran lakabka lafdhabarta ayaa ka badan inta lakala jarjarayo-sidaas awgeed CRT waxay ku haboon tahay dadka yaryar ee qaba wadnaha ee wadnaha Chagas marka loo eego noocyada kale ee wadnaha oo aan shaqayn.
Dadka qaba cudurka Chagas ayaa u muuqda inay sidoo kale sameeyaan qaliin wadnaha ah iyadoo ah bukaanno leh noocyada kale ee wadnaha oo aan shaqeynin. Mid ka mid ah dareenka qalliinka bedelka ee qalabka wadnaha ee Chagas ayaa ah in tallaalka difaaca jirka ee loo baahan yahay ka dib markii loo yaqaan 'transplantation' uu sababi karo infekshanka T. cruzi si dib loogu soo celiyo. Hase yeeshee, daraasaadka kiliinikada ayaa muujiyey in dib u soo noqoshada infekshanka ka dib markii tallaalku uusan u muuqan inuu dhibaato caadi ah ku yahay cudurka wadnaha ee Chagas.
Khatarta tromboembolism (xaalad inta badan soo saarta dhiig-xinjirowga qulqulka , sambabada sambabada , ama istaroogga ) ayaa lagu kordhiyaa qof kasta oo qaba wadne-la'aanta, laakiin waxay u muuqataa inay khatar gaar ah u tahay dadka qaba cudurka wadnaha ee Chagas. Inta badan dadka qaba cudurada wadnaha ee Chagas waa in lagu dhajiyaa daaweynta daawada xinjirowga lidka ku ah ( Coumadin ama daroogada NOAC ), ama aspirin prophylactic si loo yareeyo khatarta sare ee thromboembolism.
Daweynta Xaaladaha Qalbadhka Wadnaha iyo Ka Hortagga Dhimashada Deg dega ah
Daaweynta si looga hortago ama loo daaweeyo qalabka wadnaha ee daran ayaa badanaa lagama maarmaan u ah dadka qaba cudurada wadnaha ee Chagas sababtoo ah waxay halis dheeraad ah u yihiin labada bradycardia (wadnaha oo gaabiya) iyo tachycardias (garaaca wadnaha oo degdeg ah).
Bradycardias waxay ku dhacdaa qaar badan oo ka mid ah dadka qaba cudurka Chagas. Bradycardias waxaa sababa labadaba cudurka neerfaha iyo qalabka wadnaha . Haddii wadnaha garaaca wadnaha oo hooseeya uu soo saaro calaamadaha, ama haddii ay u muuqato inay u muuqato in ay soo saarto calaamado daran sida syncope , daaweynta qalabka wadnaha ayaa muhiim ah.
Dhibaatada dhabta ah ee ugu weyn ee la xiriirta wadnaha wadnaha ee dadka qaba cudurada wadnaha ee Chagas, si kastaba ha ahaatee, waa dhimasho lama filaan ah oo ay keento qalabka tarbjeerada ama fibrillation-ka . Khatarta haysashada arrimahan nafta halis gelinaya waxay la xiriirtaa darnaanta dhaawaca wadnaha ee uu sameeyay Chagas.
Haddii hawlgalka wadnaha uu niyad-jebiyo dhibcaha ah in arrimahan khatarta ah ay u badan tahay inay dhacaan, galinta qalab difaaca jirka waa in si weyn loo tixgeliyaa. Si kastaba ha noqotee, gaar ahaan Latin America, halkaas oo daaweynta taranka ee impibrillorer aan badanaa la heli karin, bukaanka qaba cudurka Chagas ayaa aad u badan in lagu daaweeyo daawada loo yaqaan antiarhytmic drug amiodarone halkii ay isku dayi lahaayeen in ay yareeyaan khatarta dhimashada degdegga ah.
Daweynta Cudurka Dhiigga
Daaweynta Antitrypanosomal ma hagaajineyso cudurka caloosha oo ay keento Chagas. Daaweynta waxaa loogu talagalay yareynta calaamadaha iyadoo hoos loo dhigayo celinta mindhicirka iyo xakamaynta lallabbada iyo calool-galinta daawooyinka iyo cuntada. Waxqabadyada qalliinku waxay noqon kartaa mid lagama maarmaan haddii megacolon ama megaesophagus ay joogaan.
Ka hortagga
Sanadihii ugu danbeeyay dhowr waddan oo Latin America ah ayaa dadaal weyn u galay in ay cirib tiraan ama ugu yaraan si yar u yareeyaan cudurka Chagas.
Guud ahaan, dadaaladaasi waxay diiradda saarayaan sidii looga takhalusi lahaa xaddiga cudurka - taas oo ah, "dhunkashada dhiqlaha" ee gudbiya dulinka T. cruzi ee aadanaha ilaa aadanaha. Burburinta dhillaysiga ayaa la isku dayey iyadoo la isticmaalayo sunta cayayaanka ee mudada dheer ee guryaha dadka. Dadaalladahaan ayaa si weyn u caawiyay balse ma aysan tirtirin dhibaatada - iyo cudurrada Chagas ayaa walwal ku ah meelaha miyiga ah ee ku yaalla Latin America.
Imtixaanka dhalmada ee T. cruzi ayaa ka caawiyay in la yareeyo isu-gudbinta cudurada ee loo yaqaan 'congenital transmission'. Dumarka looma daaweyn karo dawooyinka antitrypanomka inta ay uurka leeyihiin, laakiin daaweynta ka hor intaysan uurku badanaaba waxtar ma leh. Haweenka hadda ku dhaca cudurka T. cruzi waxaa sidoo kale lagula talinayaa inayan naasnuujin, inkasta oo gudbinta cudurka uu ka yimid caanaha naaska aan la xaqiijin.
> Ilo:
> Andrade JP, Marin Neto JA, Paola AA, iyo al. Aniga Tilmaamaha Ameerikaanka ah ee loogu talagalay Diagnosis iyo Daaweynta Cudurka Wadnaha ee Chagas: Soo koobista Fulinta. Arq Bras Cardiol 2011; 96: 434.
> Bern C. Chagas 'Cudur. N Engl J Med 2015; 373: 456.
> Martí-Carvajal AJ, Kwong JS. Faragelinta Faragelinta Daaweynta Qalitaanka Wadnaha ee Bukaannada qaba Chagas Cardiomyopathy. Qeybta Database ee Cochrane Rev 2016; 7: Cd009077.
> Pinazo MJ, Cañas E, Elizalde JI, et al. Cudurrada, Maamulida iyo Daaweynta Cudurrada Cudurka Dabaysha ee Chronic Maskaxda ah ee Meelaha Caabuqa Cudurka 'Trypanosoma Cruzi Inflammatory' uusan ahayn mid Xun. Gastroenterol Hepatol 2010; 33: 191.
> Pinazo MJ, Muñoz J, Posada E, iyo al. Dulqaadashada Benznidazole ee Daaweynta Cudurka Chagas ee dadka waaweyn. Agaasiyeyaasha Antimicrob ee Dumarka 2010; 54: 4896.