Ngatizivei nezveNeuroleptic Malignant Syndrome, chirwere chine njodzi chinokonzerwa nemishonga ye neuroleptic!

Iwe kana mumwe munhu waunoziva mungave muchitora mhando yemushonga unonzi neuroleptic, unoshandiswa kurapa mamwe matambudziko epfungwa. Kunyange zvazvo mishonga iyi ichigona kubatsira vanhu vazhinji, pane zviitiko zvisingawanzoitiki apo mishonga iyi inogona kukonzera chirwere chine njodzi, chinotouraya. Ndiro ratinodaidza kuti Neuroleptic Malignant Syndrome (NMS). Izita iri rakaoma, asi zvakakosha kuziva nezvaro.

Chii chinonzi Neuroleptic Malignant Syndrome (NMS)? Ngatizvinzwisise zviri nyore!

Zvichitaurwa zviri nyore, chirwere cheneuroleptic malignant syndrome (NMS) chiitiko chisingawanzoitiki uye chinogona kutyisidzira hupenyu kune mhando yemishonga inonzi neuroleptics (inozivikanwawo semishonga yekurwisa pfungwa). Mishonga iyi inoshandiswa kudzora nekurapa zviratidzo zvezvirwere zvakawanda zvepfungwa.

Zviratidzo zvikuru zvakawanda zvinogona kuonekwa mune iyi `NMS` mamiriro:

• Kuva nefivha yakanyanya (hyperthermia).
• Tsandanyama dziri mumuviri dzinova dzakasimba uye dzinorwadza (kana izvi zvikaramba zvichiitika, tsandanyama dzinogona kutotsemuka).
• Kuchinja kwemamiriro epfungwa (sekuvhiringidzika, kurasikirwa nendangariro).
• Kusashanda zvakanaka kwehurongwa hwetsinga hwemuviri (autonomic nervous system) kana dysautonomia.

Sisitimu yedu yetsinga inongoerekana yaita sesisitimu inongoerekana yaita mumuviri wedu. Inodzora zvinhu zvakaita seBP uye kufema kwakawanda. Kana ikasashanda zvakanaka, BP inogona kukwira nekudzika kamwe kamwe, kukonzera kudikitira kwakanyanya (secondary hyperhidrosis), uye kukonzera mate akawandisa.

NMS chirwere chinouraya vanhu vakawanda, chinoda kurapwa nekukurumidza. Saka, kana ukaona zviratidzo izvi, chinhu chakanakisa chekuita kuenda kuchipatara nekukasika.

Ndeipi mishonga iyi ye neuroleptic?

Mishonga yeNeuroleptic, kana kuti mishonga yekurwisa psychotic, inogona kukamurwa kuita mapoka maviri makuru.

1. Mishonga yekurwisa pfungwa yechizvarwa chekutanga kana kuti "yakajairika".

2. Mishonga yekurwisa pfungwa yechizvarwa chechipiri kana kuti "isingawanzoitiki".

Vanachiremba vanopa mishonga iyi yechizvarwa chekutanga nechechipiri yekurwisa zvirwere zvepfungwa zvakasiyana-siyana zvepfungwa netsinga. Heano mimwe mienzaniso mishoma:

• Matambudziko ekuzvibata anoitika mu dementia.
• Dambudziko reBipolar.
• Kuora mwoyo.
• Matambudziko ekudya.
• Dambudziko rekuzvidya mwoyo rakajairika.
• Kushungurudzika kwevanhu vakwegura.
• Kushaya hope.
• Dambudziko rekufunganya nekufunganya (OCD).
• Kusagadzikana kwehunhu.
• Dambudziko rekushungurudzika mushure mekutambudzika (PTSD).
Chirwere cheSchizoaffective . Schizophrenia nezvimwe zvirwere zvine chekuita nazvo.

Ndeipi mishonga inogona kukonzera neuroleptic malignant syndrome (NMS)?

Kune mhando dzakasiyana dzemishonga dzinogona kukonzera `NMS`. Ngationei kuti chii.

Mishonga yakajairika yekurapa marwadzo epfungwa (neuroleptic):

• Bromperidol
• Chlorpromazine (Chlorpromazine)`
• Clopenthixol
• Fluphenazine `(Fluphenazine)`
• Haloperidol `(Haloperidol)`
• Loxapine
• Promazine
• Thioridazine `(Thioridazine)`
• Thiothixene
• Trifluoperazine `(Trifluoperazine)`

Mishonga isingawanzoitiki yekurapa uropi (antipsychotic):

• Amisulpride
• Aripiprazole
• Clozapine
• Olanzapine
• Quetiapine
• Risperidone
• Ziprasidone
• Zotepine

Mimwe mishonga yekudzivirira kusvotwa:

• Domperidone
• Droperidol `(Droperidol)`
• Metoclopramide
• Prochlorperazine `(Prochlorperazine)`
• Promethazine

Mishonga yeDopaminergic (Parkinson's) (nekuimisa kamwe kamwe):

• Amantadine
• Vadyi veDopamine
• Levodopa
• Tolcapone

Usavhunduke nerunyorwa urwu. Havasi vese vanotora mishonga iyi vanozobatwa neNMS. Ichi chirwere chisingawanzoitiki . Asi kana uri kutora mishonga iyi, zvakakosha kuti uzive izvi.

Ndeupi musiyano uripo pakati peNMS nechirwere chemwoyo chinonzi malignant hyperthermia?

Ungave wakambonzwawo nezvechirwere chinonzi malignant hyperthermia. Izvi zvinoitikawo zvisingawanzoitiki uye zvakakomba. Asi zvinokonzerwa nemishonga inopedza simba uye mishonga inozorodza tsandanyama .

Zvinogonawo kukonzera kuomarara kwetsandanyama, kudzikira kwe reflexes (hyporeflexia), uye shanduko dzeganda (bhuruu, kutsvuka). Zviratidzo izvi zvinogona kufanana nezveNMS. Zvisinei, vanachiremba vanogona kusiyanisa zviviri izvi nekutarisa nhoroondo yezvekurapa kwemurwere. Kureva, vangave vachangobva kupiwa anesthesia kana kuti vakatora mushonga we neuroleptic.

Ndeupi musiyano uripo pakati peNMS neSerotonin Syndrome?

Serotonin syndrome chimwe chirwere chinovhiringidza. Chinokonzerwa nemishonga iri muboka re serotonergic, yakadai semimwe mishonga inorwisa kuora mwoyo, amphetamines, antihistamines, uye zvinogadzirisa mafungiro. Zvichitaurwa zviri nyore, zvinoitika kana paine kemikari yakawandisa mumuviri inonzi serotonin.

Zviratidzo zve serotonin syndrome zvinosanganisira kuomarara kwetsandanyama, hyperreflexia, manyoka, kudikitira, kugwinha kwetsandanyama (myoclonus), uye kuchinja kwemamiriro epfungwa. Zvisinei , fivha uye kuomarara kwetsandanyama hazviwanzoitika mu serotonin syndrome pane muNMS.

Chiremba wako achasiyanisa zvirwere izvi zviviri nekuteerera zviratidzo zvako nemishonga yauri kutora.

Ndiani anowana chirwere cheneuroleptic malignant syndrome (NMS)?

NMS inogona kuitika kune chero munhu anotora mishonga ye neuroleptic (antipsychotic).

Kunyangwe zvichifungidzirwa kuti zvikamu zviviri muzvitatu zvezviitiko zve `NMS' zvinoitika mukati mevhiki yekutanga yekutanga mishonga ye neuroleptic, zvakakosha kuyeuka kuti chirwere ichi chinogona kuitika chero nguva panguva yekurapwa.

Dambudziko iri rekuti 'NMS' rakajairika zvakadii?

Kutaura zvazviri, chirwere cheneuroleptic malignant (NMS) chirwere chisingawanzoitiki. Chinoitika pakati pe0.01% ne3.2% yevanhu vari kutora mishonga yeneuroleptic.

Zvisinei, mashoko akanaka ndeekuti huwandu hwemishumo yeNMS huri kudzikira nekuda kwekuunzwa kwemishonga mitsva ine njodzi shoma yekukonzera NMS, uye kuziva kwevanachiremba nevarwere nezvechirwere ichi.

Ndezvipi zviratidzo zve neuroleptic malignant syndrome (NMS)?

Zviratidzo zve `NMS` zvinowanzotanga kuoneka mukati mezuva rimwe kusvika matatu . Zviratidzo zvikuru ndeizvi:

• Fivha yakanyanya (102 kusvika 104 degrees Fahrenheit - 38.9 kusvika 40 degrees Celsius).
• Kusarongeka kwemutinhimira wemoyo (arrhythmia).
• Kuwedzera kwekurova kwemoyo (tachycardia).
• Kuwedzera kwekufema (tachypnea).
• Kuoma/kuoma kwetsandanyama `(kuoma kwetsandanyama)`.
• Kuchinja kwemamiriro epfungwa (sekuvhiringidzika, kusagadzikana, kurasikirwa nepfungwa).
• Kukwira kweropa kana kuderera kweropa.
• Kudikitira zvakanyanya.

Kana uine chimwe chezviratidzo izvi kana kupfuura, kunyanya kana uri kutora mushonga we neuroleptic, ndapota fonera 911 kana kuenda kuchipatara chiri pedyo nekukasika. Iyi inyaya yekurapa.

Mishonga ye neuroleptic inokonzera sei `NMS`?

Dambudziko re'NMS' rinokonzerwa nemushonga wepfungwa (neuroleptic).Zvinogona kuitika nedosi imwe chete, nekuwedzera kwedosi, kana nekushandisa dosi imwe chete nguva dzose. Kunyangwe NMS ichinyanya kusanganiswa nemishonga yekurwisa pfungwa yechizvarwa chekutanga, inogonawo kuitika, zvishoma, nekubviswa kamwe kamwe kwemishonga yekurwisa pfungwa yechizvarwa chechipiri, mimwe mishonga yekurwisa kugaya, uye mishonga yedopaminergic inoshandiswa pakurapa chirwere cheParkinson.

Masayendisiti achiri kuedza kutsvaga kuti chii chinokonzera NMS. Dzidziso iripo ndeyekuti inokonzerwa nekusawirirana kwedopamine D2 receptor . Dopamine ineurotransmitter muuropi hwedu. Ikemikari inotakura mameseji pakati pemasero. Mishonga yeNeuroleptic inoshanda nekudzivirira iyi dopamine messenger kuti isapinde mumasero kuburikidza nemareceptor chaiwo.

Kana ma dopamine receptors ari mu hypothalamus yako uye/kana spinal cord akavharwa, kushushikana kwetsandanyama kunowedzera. Zvakare, kukanganiswa kwema dopamine receptors ari mu hypothalamus ndiko kunokonzera fivha yakanyanya uye kuchinja kukuru kweBP kunoonekwa muNMS.

Chirwere cheNeuroleptic Malignant (NMS) chinoonekwa sei?

Kuti vanachiremba vaongorore NMS, munofanira kunge muine zviratidzo kana mamiriro ezvinhu anotevera :

• Uri kutora mushonga we neuroleptic kana kuti wakangoerekana warega kutora mushonga we dopaminergic.
• Une tsandanyama dzakasimba/dzinosimba zvakanyanya (izvi zvinogona kutokonzera tsandanyama kuputika).
• Une fivha yakanyanya.
• Pane shanduko mupfungwa dzako.

Pamusoro pezvo, hunhu huviri hunotevera hunofanira kunge huripo:

• Kudikitira zvakanyanya kana kuti kusingawanzoitiki.
• Kuoma kumedza.
• Kusakwanisa kudzora weti kana tsvina (kusazvidzora).
• Kuwedzera kwekurova kwemoyo (tachycardia).
• Kamwe kamwe haachagoni kutaura.
• Kuchinja kweBP kwakawedzera kana kuti kwakawanda.
• Kuwedzera kwehuwandu hwemasero machena eropa (Leukocytosis).
• Kuwedzera kwehuwandu hwe creatine phosphokinase (CPK) nekuda kwekuputsika kwetsandanyama.
• Kufembera zvishoma nezvishoma kana kuti zvishoma (hyporeflexia).

Ndedzipi bvunzo dzinoitwa kuti paonekwe `NMS`?

Kana chiremba wako achifungidzira kuti une NMS, anogona kuraira bvunzo dzakadai se:

• Panel yakazara yemetabolism.
• Kuongororwa kweweti.
• Kuongororwa kwegasi reropa remutsinga kana kuti remutsinga.
• Kuongororwa kweropa reCreatine phosphokinase (CPK).

Chirwere cheNeuroleptic Malignant Syndrome (NMS) chinorapwa sei?

NMS idambudziko rehutano. Saka zvakakosha kuongorora chirwere chacho uye kutanga kurapwa nekukurumidza. Kana uine NMS, ungangoda kuendeswa kuchipatara.Uchafanirwa kurapwa muchikamu chevarwere vanorwara zvakanyanya (ICU).

Muzviitiko zvese zve `NMS`, vanachiremba vanomisa pakarepo mushonga we neuroleptic (antipsychotic) wakakonzera `NMS`. Pamusoro pezvo, vacharapa zviratidzo zve `NMS` uye vanotora matanho ekudzivirira matambudziko angangoitika. Kurapa uku kunogona kusanganisira:

• Kuchengetedza kugadzikana kwemwoyo nekufema uchishandisa michina yekufema, mishonga inoderedza kusagadzikana kwemoyo, uye/kana pacemaker.
• Kuchengetedza chiyero che electrolyte mumuviri nekupa mvura inoyerera mutsinga (IV fluids).
• Kuderedza tembiricha yemuviri uchishandisa magumbeze anotonhodza, mvura yechando, uye/kana mapaketi echando.
• Kana BP yakakwira, idzore nemishonga.
• Kupa mishonga yakaita seheparin kudzivirira kugwinha kweropa.
• Kupa mishonga inogona kudzoreredza huwandu hwakaderera hwedopamine mumuviri.
• Zvinopa mishonga yekuzorodza tsandanyama kana mapfupa.

Ndezvipi zvinhu zvinokonzera njodzi pakukura kwe "NMS"?

Kune zvinhu zvakawanda zvinowedzera njodzi yekubatwa nechirwere cheneuroleptic malignant syndrome (NMS):

• Kutanga mushonga mutsva wepfungwa kana kuwedzera mushonga wacho.
• Kushandisa mishonga inopfuura imwe chete ye neuroleptic kana kushandisa mushonga we lithium.
• Kurega kamwe kamwe mushonga wedopaminergic wechirwere cheParkinson.

Zvinotora nguva yakareba sei kuti munhu apore kubva ku'NMS'? (Kufungidzira)

Kana NMS ikaonekwa nekukurumidza uye ikarapwa nekukurumidza uye nemazvo, vanhu vazhinji vanopora mukati memavhiki maviri kusvika kumazuva gumi nemana.

Zvisinei, kana kurapwa kukanonoka, matambudziko akakomba anogona kuitika anokanganisa tsandanyama, itsvo, moyo, uye/kana mapapu.

Kana ikasarapwa nekukasika, NMS inogona kuuraya. Huwandu hwevanhu vanofa neNMS hunobva pa5% kusvika pa20%. Zvisinei, kuwedzera kweruzivo nezveNMS uye kushandiswa kwemishonga mitsva yekurwisa psychotic zvakaderedza huwandu hwevanhu vanofa mumakumi emakore apfuura.

Vanhu vazhinji, vachitungamirirwa nachiremba, vanokwanisa kutangazve mishonga yekurapa nepfungwa.

Ndezvipi zvinetso zvinokonzerwa ne neuroleptic malignant syndrome (NMS)?

Zvinosuwisa kuti matambudziko eNMS anowanzoitika uye akaoma. Mamwe matambudziko anokonzerwa nezviratidzo zveNMS uye kusashanda zvakanaka kwehurongwa hwetsinga hwemuviri, nepo mamwe, kunyanya hutachiona, anogona kukonzerwa nekugara kwenguva refu muchikamu chevarwere vanorwara zvakanyanya (ICU).

Mamwe ematambudziko eNMS ndeaya:

• Rhabdomyolysis (kuparara kwemasero emhasuru - iyi ndiyo dambudziko rinowanzoitika).
• Kushaya mvura mumuviri.
• Kukundikana kweitsvo zvakanyanya.
• Kutadza kufema zvakanaka.
• Zvirwere zvepfari/ pfari .
• Kukuvara kwemwoyo.
• Kugwamba kweropa mumuviri wese (Disseminated intravascular coagulation).
• Kukundikana kwechiropa zvakanyanya.
• Chirwere chemabayo.
• Sepsis (majemusi anopinda muropa).
• Utachiona hwemunzira weti (UTI).
• Kuvimba kwemapapu.

Nekuti matambudziko aya akanyanya kuipa uye anotyisidzira hupenyu, zvakakosha zvikuru kufonera 911 nekukasika woenda kuchipatara chiri pedyo kuti unorapwa kana uine zviratidzo zveNMS. Zvakare, NMS idambudziko rinotyisidzira hupenyu uye rinogona kuda kurapwa muIntensive Care Unit (ICU).

Ndinofanira kuona chiremba wangu rini?

Kana uri kutora mushonga mumwe chete kana kupfuura we neuroleptics (antipsychotics), antiemetics, uye/kana dopaminergic (Parkinson's), zvakakosha kuti ugare uchiona chiremba wako kuti uve nechokwadi chekuti ari kushanda zvakanaka kwauri. Zvakare, bvunza chiremba wako nezvemigumisiro yemishonga yauri kutora uye zviratidzo zvaunofanira kuziva.

Ndinofanira kuenda kuEmergency Department (ETU) here kana ndine zviratidzo zve `NMS`?

Kana uine zviratidzo zve neuroleptic malignant syndrome (NMS), zvakaita sefivha yakanyanya uye kuomarara kwetsandanyama, zvakakosha kufonera 911 kana kuenda kuchipatara chiri pedyo nekukasika. NMS inoda rubatsiro rwechiremba nekukasika. Kana ikasarapwa nekukurumidza uye nemazvo, inogona kutokonzera rufu.

Neuroleptic malignant syndrome (NMS) chirwere chakakomba uye chinoisa hupenyu panjodzi. Saka kana uine zviratidzo, zvakakosha kutsvaga rubatsiro rwechiremba nekukurumidza. NMS iri nyore kurapa kana ikabatwa nekukurumidza. Kunyangwe NMS isingawanzoitiki, kana uri kutora mushonga we neuroleptic (antipsychotic), taura nachiremba wako kana wemishonga nezvemigumisiro nezviratidzo zvekutarisira. Varipo kuti vakubatsire.

Zvinhu zvakakosha zvatakadzidza kubva muchinyorwa chino (Mharidzo Yekuenda Kumba)

Zvakanaka, ngatikuyeuchidzei zvimwe zvezvinhu zvakakosha zvekurangarira kubva pane zvatataura nezvazvo mu 'NMS' iyi:

• NMS chirwere chisingawanzoitiki, asi chinogona kuisa hupenyu pangozi chinokonzerwa nemishonga ye neuroleptic.
• Fivha yakanyanya, kurwadziwa kwetsandanyama, uye kuvhiringidzika kwepfungwa ndizvo zviratidzo zvikuru.
• Kana ukaona chimwe chezviratidzo izvi, tsvaga rubatsiro rwechiremba nekukasika. Usanonoka.
• Kana uri kutora mushonga we neuroleptic, taura nachiremba wako nezvemushonga wacho uye migumisiro yawo. Usatya kubvunza mibvunzo.
• NMS inogona kurapwa zvachose kana ikaonekwa uye ikarapwa nekukurumidza.

Tinovimba kuti waziviswa neruzivo urwu. Ramba uine hutano hwakanaka!

Neuroleptic Malignant Syndrome, NMS, mishonga yepfungwa, migumisiro yakaipa, fivha yakanyanya, kuomarara kwetsandanyama