Ndizachibadwa kukhala ndi mantha komanso nkhawa kwambiri dokotala akakuuzani kuti mtima wanu ndi wofooka, kapena monga momwe timatchulira, muli ndi vuto la mtima. Mukudziwa momwe zimakhalira zovuta kukhala ndi mavuto monga kutopa, kutupa miyendo, komanso kusagona bwino usiku ngakhale mutayesetsa pang'ono. Nthawi zina zotsatirapo zake monga chifuwa chomwe chimabwera ndi mankhwala ena akale omwe amaperekedwa pa vutoli zingakhale zokhumudwitsa kwambiri. Komabe, ndi kupita patsogolo kwa sayansi ya zamankhwala, mankhwala opambana kwambiri komanso atsopano tsopano aonekera pamavuto otere. Gulu limodzi latsopano la mankhwala lomwe lathandiza anthu ambiri ndi ARNI. Tiyeni tikambirane za izi lero.
Mwachidule, kodi ARNI ndi chiyani?
Ngakhale dzina lakuti ARNI lingamveke ngati lovuta pang'ono, tanthauzo lake ndi losavuta. ARNI (Angiotensin Receptor/Neprilysin Inhibitor) ndi mankhwala apadera omwe amapangidwa pophatikiza mitundu iwiri ya mankhwala kuti athetse matenda a mtima. Monga othamanga awiri aluso omwe akusewera limodzi mu timu imodzi, mankhwala awiriwa amagwira ntchito limodzi kuti apereke mpumulo waukulu ku mtima wanu.
Mankhwala awiriwa ndi awa:
1. ARB (Angiotensin II Receptor Blocker): Dzina la izi ndi Valsartan.
2. Neprilysin Inhibitor: Dzina la ichi ndi Sacubitril.
Pakadali pano, mankhwala okhawo a ARNI omwe akugwiritsidwa ntchito ku Sri Lanka ndi padziko lonse lapansi ndi Sacubitril/Valsartan . Izi zidavomerezedwa mu 2015.
Chabwino, tsopano tiyeni tiwone momwe mankhwalawa amagwirira ntchito mkati mwa thupi?
Kuti timvetse izi, tiyeni tigwiritse ntchito chitsanzo chosavuta. Tangoganizani kuti kayendedwe ka magazi m'thupi lanu kali ngati mapaipi omwe amanyamula madzi kupita nawo kumunda. Mtima wanu ndi injini yomwe imapopa madziwo.
1. Zimene Valsartan amachita: Pa vuto la mtima, mitsempha yamagazi iyi (mitsempha yamagazi) imatsekeka ndikutsekedwa. Kenako mtima umayenera kugwira ntchito molimbika kwambiri ndikupompa magazi (mitsempha yamagazi) ndi kupanikizika kwakukulu. Valsartan imagwira ntchito pokulitsa ndikumasula mitsempha yamagazi yotsekeka . Kenako mtima ukhoza kupompa magazi m'thupi lonse mosavuta popanda kugwira ntchito molimbika. Izi zimawongoleranso kuthamanga kwa magazi anu.
2. Zimene Sacubitril imachita: Iyi ndi yosiyana pang'ono. Matupi athu mwachibadwa amapanga "mahomoni abwino" omwe amathandiza mtima, kukulitsa mitsempha yamagazi, ndikuthandiza thupi kuchotsa mchere ndi madzi ochulukirapo. Komabe, enzyme yotchedwa "Neprilysin" (monga munthu woipa) imasweka mwachangu ndikuwononga mahomoni abwino awa. Zimene Sacubitril imachita ndikuti imaletsa munthu woipa, enzyme ya neprilysin, kugwira ntchito . Kenako mahomoni abwinowo amatha kukhala m'thupi nthawi yayitali ndikuchita ntchito yawo yabwino (kuchepetsa kuthamanga kwa magazi, kuchotsa mchere ndi madzi).
Mwachidule, mankhwala awiriwa amagwira ntchito limodzi kuti achepetse mtolo pamtima, pomwe amateteza mahomoni achilengedwe omwe amathandiza mtima.
Kodi mankhwala a ARNI awa akulangizidwa kwa ndani?
Dokotala wanu nthawi zambiri amasankha ngati mankhwalawa ndi oyenera kwa inu kutengera zinthu zingapo.
- Kwa anthu omwe ali ndi vuto la mtima: Mutha kuyamba kumwa mankhwalawa ngati mwapezeka ndi vuto la mtima ndipo mphamvu ya mtima wanu yopopera magazi (yomwe timaitcha kuti Ejection Fraction ) ndi 40% kapena kuchepera. (Mtengo uwu kwa munthu wathanzi wabwinobwino ndi pafupifupi 55% - 65%).
- Kwa iwo omwe asintha kuchoka ku mankhwala akale: Ngati mukumwa kale mankhwala a matenda a mtima monga ACE inhibitor (monga Enalapril, Ramipril) kapena ARB (monga Losartan, Telmisartan), mutha kusintha kupita ku ARNI m'malo mwake.
Chofunika kwambiri!
Ngati mukusintha kuchoka pa mankhwala oletsa ACE (monga Enalapril) kupita ku ARNI, muyenera kudikira maola osachepera 36 mutasiya kumwa mankhwala oletsa ACE musanayambe kumwa ARNI. Ngati musintha pakati pa mankhwala awiriwa popanda nthawi imeneyi, mutha kukhala ndi vuto loopsa la ziwengo lotchedwa angioedema , lomwe limayambitsa kutupa kwa nkhope ndi pakhosi. Chifukwa chake, ndikofunikira kwambiri kutsatira malangizo a dokotala wanu molondola.
| Ndani sayenera kutenga ARNI? | Kufotokozera |
|---|---|
| Anthu omwe anali ndi ziwengo kale | Ngati munakhalapo ndi vuto la ziwengo lomwe limayambitsa kutupa kwa nkhope (angioedema) mutamwa mankhwala oletsa ACE kapena ARB. |
| Amayi oyembekezera ndi oyamwitsa | Mankhwalawa sakuvomerezeka kugwiritsidwa ntchito panthawi ya mimba kapena poyamwitsa. |
| Anthu omwe ali ndi matenda aakulu a chiwindi | Ngati muli ndi matenda aakulu a chiwindi. |
| Anthu omwe akumwa mankhwala ena | Ngati mukumwa kale mankhwala enaake monga ACE inhibitors kapena aliskiren. |
Kodi ubwino wa mankhwala a ARNI ndi wotani?
Kafukufuku wapeza kuti mankhwala a ARNI amapereka ubwino wambiri poyerekeza ndi mankhwala akale monga ACE inhibitors.
- Kuwonjezeka kwa nthawi yoyembekezera moyo: Mankhwalawa apezeka kuti amachepetsa chiopsezo cha imfa chifukwa cha matenda a mtima, zomwe zikutanthauza kuti mutha kukhala ndi moyo wathanzi kwa nthawi yayitali.
- Moyo wabwino: Mankhwalawa amakuthandizani kuchita zinthu zanu za tsiku ndi tsiku mosavuta pochepetsa zizindikiro monga kutopa, kutopa, ndi kutupa kwa miyendo.
- Kuchepa kwa kuchuluka kwa anthu ogonekedwa m'chipatala: Kafukufuku wasonyeza kuti zimachepetsa chiopsezo chogonekedwa m'chipatala pafupipafupi chifukwa cha matenda a mtima omwe akuipiraipira ndi pafupifupi 20%.
- Kubwezeretsa ntchito ya mtima: Mphamvu ya mtima yopompa (gawo lotulutsa mpweya) ya odwala ena imakula kwambiri akamamwa mankhwalawa kwa nthawi ndithu.
Kafukufuku wina waukulu adapeza kuti ngati munthu wazaka 55 agwiritsa ntchito mankhwalawa, adzatha kukhala ndi moyo zaka zina 2.1 popanda kugonekedwa m'chipatala kapena kufa ndi matenda a mtima.
Kodi tiyeneranso kudziwa zotsatira zake?
Monga mankhwala ena aliwonse, pakhoza kukhala zotsatirapo zina zazing'ono. Koma musadandaule, dokotala wanu adzakuphunzitsani za izi.
| Zotsatirapo zomwe zingatheke | Zoyenera kuchita? |
|---|---|
| Kuthamanga kwa magazi pang'ono (Hypotension) | Mungakhale ndi chizungulire, mutu wopepuka, kapena maso abuluu. Mutha kulankhula ndi dokotala wanu ndikusintha nthawi yomwe mumamwa mankhwala anu. |
| Zotsatira pa ntchito ya impso | Mukayamba kumwa mankhwalawo komanso miyezi ingapo iliyonse, dokotala wanu adzakuyesani magazi kuti aone momwe impso zanu zimagwirira ntchito. Ngati pakufunika kutero, adzasintha mlingo wake. |
| Kuchuluka kwa potaziyamu m'magazi (Hyperkalemia) | Izi zitha kudziwikanso kudzera mu mayeso a magazi. Dokotala adzayang'anitsitsa izi. |
| Angioedema | Izi sizichitika kawirikawiri. Ngati mukumva kutupa pankhope, milomo, lilime kapena pakhosi, kapena kupuma movutikira, siyani kumwa mankhwala nthawi yomweyo ndipo pitani ku dipatimenti yapafupi yazadzidzidzi yachipatala (ETU). |
Zotsatirapozi nthawi zambiri zimatha pakatha milungu iwiri. Ngati sizichitika, uzani dokotala wanu. Angachepetse mlingo kenako n’kuwonjezeranso patatha masiku angapo. Musasiye kumwa mankhwala kapena kusintha mlingo popanda upangiri wa dokotala wanu.
Ndiyenera kupita kwa dokotala liti?
Ngati mukukumana ndi zizindikiro zotsatirazi mukugwiritsa ntchito ARNI, dziwitsani dokotala wanu.
- Ngati mukumva chizungulire chachikulu
- Ngati mukumva mutu wopepuka ndipo maso anu akuyamba kuoneka abuluu
- Ngati mukumva ngati mukutaya chidziwitso
- Ngati kuthamanga kwa magazi kuli pansi pa 90 (systolic)
Ndizachibadwa kukhala ndi nkhawa pang'ono yokhudza kusintha mankhwala atsopano mukazolowera mankhwala akale. Komabe, ndikofunikiranso kuganizira zabwino zomwe mankhwala atsopano angabweretse pamoyo wanu. Lankhulani ndi dokotala wanu za izi momasuka. Mvetserani zonse momveka bwino za zabwino ndi zoyipa za mankhwalawa, komanso ngati ndi oyenera kwa inu. Kenako mutha kupanga chisankho chodziwa bwino.
Uthenga Wopita Nawo Kunyumba
- ARNI ndi gulu la mankhwala opambana kwambiri komanso amakono omwe amachiritsa kulephera kwa mtima.
- Izi ndi kuphatikiza kwa mankhwala awiri. Limodzi limachepetsa mtolo pamtima, ndipo lina limateteza mahomoni achilengedwe omwe amathandiza mtima.
- Mankhwala a ARNI ali ndi kuthekera kowonjezera moyo wa wodwalayo, kuchepetsa kugonekedwa m'chipatala, komanso kukonza moyo wa wodwalayo poyerekeza ndi mankhwala akale.
- Ngati mukusintha kuchoka pa ACE inhibitor kupita ku ARNI, muyenera kusiya mpata wa maola 36.
- Ndikofunikira kwambiri kuyezetsa magazi nthawi yomwe yakonzedwa monga momwe dokotala wanu walangizira, chifukwa zotsatirapo zake monga kutsika kwa kuthamanga kwa magazi ndi kuwonongeka kwa impso zimatha kuchitika.
- Nthawi zonse kambiranani momasuka ndi dokotala wanu za chithandizo chomwe chili chabwino kwa inu.
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