Kuvamile ukuzizwa wesaba kakhulu futhi ukhathazekile lapho udokotela ekutshela ukuthi inhliziyo yakho ibuthakathaka, noma njengoba sikubiza kanjalo, unesifo sokuhluleka kwenhliziyo. Uyazi ukuthi kunzima kangakanani ukuphila nezinkinga ezifana nokukhathala, imilenze evuvukele, nokungakwazi ukulala kahle ebusuku ngisho nangemva komzamo omncane. Kunezikhathi lapho imiphumela emibi efana nokukhwehlela ehambisana neminye yemithi emidala enikezwa lesi simo ingaba yinto ekhungathekisa kakhulu. Kodwa-ke, ngokuthuthuka kwesayensi yezokwelapha, ukwelashwa okuphumelelayo kakhulu nokusha sekuvele kwavela kulezi zimo. Elinye uhlobo olusha lwemithi olulethe impumuzo kubantu abaningi yi-ARNI. Ake sixoxe ngalokhu namuhla nje.
Kalula nje, iyini i-ARNI?
Nakuba igama elithi ARNI lingase lizwakale liyinkimbinkimbi kancane, incazelo yalo ilula kakhulu. I-ARNI (i-Angiotensin Receptor/Neprilysin Inhibitor) umuthi okhethekile owenziwa ngokuhlanganisa izinhlobo ezimbili zemithi ukwelapha izifo zenhliziyo. Njengabadlali ababili abanamakhono abadlala ndawonye eqenjini elifanayo, le mithi emibili isebenza ndawonye ukunikeza impumuzo enkulu enhliziyweni yakho.
Le mithi emibili yile:
1. I-ARB (i-Angiotensin II Receptor Blocker): Igama lale nto yi-Valsartan.
2. I-Neprilysin Inhibitor: Igama lale nto yi-Sacubitril.
Njengamanje, umuthi we-ARNI kuphela osetshenziswa eSri Lanka nasemhlabeni wonke yiSacubitril /Valsartan . Lokhu kwavunywa ngo-2015.
Kulungile, manje ake sibone ukuthi lo muthi usebenza kanjani emzimbeni?
Ukuze siqonde lokhu, ake sisebenzise isibonelo esilula. Cabanga ukuthi uhlelo lokujikeleza kwegazi emzimbeni wakho lufana nohlelo lwamapayipi athwala amanzi aya engadini. Inhliziyo yakho ingumshini opompa amanzi kuyo.
1. Lokho okwenziwa yiValsartan: Ekuhlulekeni kwenhliziyo, le mithambo yegazi (imithambo yegazi) iyavaleka futhi ivaleke. Ngemuva kwalokho inhliziyo kufanele isebenze kanzima kakhulu futhi ipompe igazi (imithambo yegazi) ngokucindezela okukhulu. IValsartan isebenza ngokukhulisa nokukhulula imithambo yegazi evalekile . Ngemuva kwalokho inhliziyo ingapompa igazi emzimbeni wonke kalula ngaphandle kokusebenza kanzima kangaka. Lokhu kulawula nomfutho wegazi lakho.
2. Lokho okwenziwa yiSacubitril: Lona uhlukile kancane. Imizimba yethu ngokwemvelo ikhiqiza "ama-hormone amahle" asiza inhliziyo, andise imithambo yegazi, futhi asize umzimba ukhiphe usawoti namanzi amaningi. Kodwa-ke, i-enzyme ebizwa ngokuthi "iNeprilysin" (njengomuntu omubi) iyaphuka ngokushesha futhi ibhubhise la ma-hormone amahle. Lokho okwenziwa yiSacubitril ukuthi iyeka umuntu omubi, i-enzyme ye-neprilysin, ukuthi isebenze . Khona-ke lawo ma-hormone amahle angahlala emzimbeni isikhathi eside futhi enze umsebenzi wawo omuhle (ukwehlisa umfutho wegazi, ukususa usawoti namanzi).
Kalula nje, le mithi emibili isebenza ndawonye ukunciphisa umthwalo enhliziyweni, kuyilapho ivikela ama-hormone emvelo asiza inhliziyo.
Ubani onconyelwa lo muthi we-ARNI?
Udokotela wakho uzovame ukunquma ukuthi lo muthi ukulungele yini ngokusekelwe ezicini eziningana.
- Kubantu abanesifo senhliziyo: Ungase uqale ukusebenzisa lo muthi uma usanda kutholwa unesifo senhliziyo futhi ukusebenza kahle kwenhliziyo yakho ekupompeni igazi (esikubiza ngokuthi i -Ejection Fraction ) kungu-40% noma ngaphansi. (Leli nani lomuntu ophilile kahle licishe libe ngu-55% - 65%).
- Kulabo abashintsha imithi emidala: Uma usuvele uthatha imithi yokuhlaselwa yinhliziyo efana ne-ACE inhibitor (isib. i-Enalapril, i-Ramipril) noma i-ARB (isib. i-Losartan, i-Telmisartan), ungase ukwazi ukushintshela ku-ARNI esikhundleni salokho.
Kubaluleke kakhulu!
Uma ushintsha kusuka ku-ACE inhibitor (isb. i-Enalapril) uye ku-ARNI, kufanele ulinde okungenani amahora angu-36 ngemuva kokuyeka i-ACE inhibitor ngaphambi kokuqala i-ARNI. Uma ushintsha phakathi kwemithi emibili ngaphandle kwalesi sikhathi, ungase ube nokusabela okuyingozi kokungezwani komzimba okubizwa ngokuthi i-angioedema , okubangela ukuvuvukala kobuso nomphimbo. Ngakho-ke, kubaluleke kakhulu ukulandela imiyalelo kadokotela wakho ngqo.
| Ubani okungafanele athathe i-ARNI? | Incazelo |
|---|---|
| Abantu ababenokungezwani komzimba ngaphambilini | Uma uke waba nokusabela kokungezwani komzimba okubangela ukuvuvukala kobuso (i-angioedema) ngemuva kokuthatha umuthi we-ACE inhibitor noma we-ARB. |
| Omama abakhulelwe nabancelisayo | Lo muthi awunconywa ukuthi usetshenziswe ngesikhathi sokukhulelwa noma ngesikhathi sokuncelisa. |
| Abantu abanesifo sesibindi esibi kakhulu | Uma unesifo sesibindi esibi kakhulu. |
| Abantu abasebenzisa eminye imithi | Uma usuvele uthatha eminye imithi ethile efana ne-ACE inhibitors noma i-aliskiren. |
Yiziphi izinzuzo zokwelapha i-ARNI?
Ucwaningo luthole ukuthi imithi ye-ARNI inikeza izinzuzo eziningana ezibalulekile kunemithi emidala njengemithi yokuvimbela i-ACE.
- Ukwanda kwesikhathi sokuphila: Lo muthi utholakale unciphisa ingozi yokufa ngenxa yesifo senhliziyo, okusho ukuthi ungaphila impilo enempilo isikhathi eside.
- Ikhwalithi yokuphila ethuthukisiwe: Lo muthi ukusiza ukuthi wenze imisebenzi yakho yansuku zonke kalula ngokunciphisa izimpawu ezifana nokukhathala, ukukhathala, nokuvuvukala kwemilenze.
- Ukuncipha kwezikhathi zokulaliswa esibhedlela: Ucwaningo lukhombisile ukuthi kunciphisa ingozi yokulaliswa esibhedlela njalo ngenxa yesifo senhliziyo esibi kakhulu cishe ngo-20%.
- Ukubuyisela ukusebenza kwenhliziyo: Ikhono lokushaya inhliziyo lezinye iziguli (ingxenye yokukhipha) lithuthuka kakhulu lapho lithatha lo muthi isikhathi esithile.
Ucwaningo olukhulu luthole ukuthi uma umuntu oneminyaka engu-55 esebenzisa lo muthi, uzokwazi ukuphila eminye iminyaka engu-2.1 ngaphandle kokulaliswa esibhedlela noma ukufa ngenxa yesifo senhliziyo.
Ingabe kufanele futhi siqaphele imiphumela emibi?
Njenganoma yimuphi umuthi, kungase kube nemiphumela emibi emincane. Kodwa ungakhathazeki, udokotela wakho uzokufundisa ngalezi zinto.
| Imiphumela emibi engaba khona | Okufanele ngikwenze? |
|---|---|
| Umfutho wegazi ophansi (i-Hypotension) | Ungase ube nesiyezi, ikhanda elikhanyayo, noma amehlo aluhlaza okwesibhakabhaka. Ungakhuluma nodokotela wakho futhi ushintshe isikhathi osithatha ngaso imithi yakho. |
| Imiphumela ekusebenzeni kwezinso | Uma uqala ukuthatha umuthi njalo ezinyangeni ezimbalwa, udokotela wakho uzokwenza ukuhlolwa kwegazi ukuze ahlole ukusebenza kwezinso zakho. Uma kudingeka, uzolungisa umthamo. |
| Ukwanda kwamazinga e-potassium egazini (i-Hyperkalemia) | Lokhu kungatholakala nangokuhlolwa kwegazi. Udokotela uzonaka kakhulu nalokhu. |
| I-Angioedema | Lokhu akuvamile kakhulu. Uma uzwa ukuvuvukala kobuso, izindebe, ulimi noma umphimbo, noma ubunzima bokuphefumula, yeka ukuthatha umuthi ngokushesha bese uya emnyangweni wezimo eziphuthumayo esibhedlela esiseduze (ETU). |
Le miphumela emibi ivame ukuphela cishe emavikini amabili. Uma ingaphenduki, tshela udokotela wakho. Angase anciphise umthamo bese ewukhuphula futhi ngemva kwezinsuku ezimbalwa. Ungalokothi uyeke ukuthatha umuthi noma ushintshe umthamo ngaphandle kweseluleko sikadokotela wakho.
Kufanele ngimbone nini udokotela?
Uma uhlangabezana nezimpawu ezilandelayo ngenkathi usebenzisa i-ARNI, yazisa udokotela wakho.
- Uma uzwa isiyezi esinzima
- Uma uzizwa unesizungu futhi amehlo akho eba luhlaza okwesibhakabhaka
- Uma uzizwa sengathi ulahlekelwa ingqondo
- Uma ukufundwa komfutho wegazi lakho kungaphansi kwama-90 (i-systolic)
Kuvamile ukuzizwa ukhathazekile kancane ngokushintshela emithini emisha uma usujwayele endala. Kodwa-ke, kubalulekile futhi ukucabangela izinzuzo ezizolethwa ukwelashwa okusha empilweni yakho. Khuluma nodokotela wakho ngalokhu ngokukhululekile. Lalela konke ngokucacile mayelana nezinzuzo nezinkinga zalo muthi, nokuthi ngabe ukulungele yini. Ngemuva kwalokho ungenza isinqumo esinolwazi.
Umlayezo Wokuya Nawe Ekhaya
- I-ARNI iyiklasi yemithi yesimanje ephumelela kakhulu, ephumelela kakhulu elapha ukwehluleka kwenhliziyo.
- Lokhu kuyinhlanganisela yemithi emibili. Omunye unciphisa umthwalo enhliziyweni, kanti omunye uvikela ama-hormone emvelo asiza inhliziyo.
- Ama-ARNI anamandla okwandisa isikhathi sokuphila, ukunciphisa ukulaliswa esibhedlela, nokuthuthukisa ikhwalithi yokuphila uma kuqhathaniswa nemithi emidala.
- Uma ushintsha kusuka ku-ACE inhibitor uye ku-ARNI, kufanele ushiye igebe lamahora angu-36.
- Kubaluleke kakhulu ukuhlolwa kwegazi ngezikhathi ezihleliwe njengoba kuqondiswe udokotela wakho, njengoba imiphumela emibi efana nomfutho wegazi ophansi kanye nokulimala kwezinso kungenzeka.
- Hlala uxoxa nodokotela wakho ngokukhululekile ngokuthi yikuphi ukwelashwa okungcono kakhulu kuwe.
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