Masiqaphele i-Neuroleptic Malignant Syndrome, isimo esiyingozi esibangelwa yimithi ye-neuroleptic!

Wena noma othile omaziyo kungenzeka ukuthi nisebenzisa uhlobo lomuthi olubizwa ngokuthi i-neuroleptic, olusetshenziselwa ukwelapha izimo ezithile zempilo yengqondo. Nakuba le mithi ingaba usizo kakhulu kubantu abaningi, kunezimo ezingavamile kakhulu lapho le mithi ingabangela isimo esiyingozi, ngisho nesisongela ukuphila. Yilokho esikubiza ngokuthi i-Neuroleptic Malignant Syndrome (NMS). Liyigama eliyinkimbinkimbi, kodwa kubalulekile ukwazi ngalo.

Iyini i-Neuroleptic Malignant Syndrome (NMS)? Masiyiqonde kalula!

Kalula nje, i-neuroleptic malignant syndrome (i-NMS) iyindlela engavamile kakhulu futhi esongela impilo ekilasini lemithi ebizwa ngokuthi i-neuroleptics (eyaziwa nangokuthi imithi yokulwa nesifo sengqondo). Le mithi isetshenziselwa ukuphatha nokwelapha izimpawu zezinkinga eziningi zempilo yengqondo.

Izimpawu eziningana eziyinhloko zingabonakala kulesi simo se-'NMS':

• Ukuba nomkhuhlane ophezulu (i-hyperthermia).
• Imisipha emzimbeni iba lukhuni futhi ibe buhlungu (uma lokhu kuqhubeka, imisipha ingase iqhume ngisho).
• Izinguquko esimweni sengqondo (njengokudideka, ukulahlekelwa yinkumbulo).
• Ukungasebenzi kahle kwesistimu yezinzwa ezizimele noma i-dysautonomia.

Uhlelo lwethu lwezinzwa oluzimele lufana nohlelo oluzenzakalelayo emzimbeni wethu. Lulawula izinto ezifana nomfutho wegazi kanye nesivinini sokuphefumula. Uma lungasebenzi kahle, umfutho wegazi ungakhuphuka futhi wehle ngokuzumayo, ubangele ukujuluka ngokweqile (i-hyperhidrosis yesibili), futhi ubangele ukuqunjelwa ngokweqile.

I-NMS iyisimo esiphuthumayo sezokwelapha esisongela ukuphila, esidinga ukunakekelwa kwezokwelapha okusheshayo. Ngakho-ke, uma uhlangabezana nalezi zimpawu, into engcono kakhulu ongayenza ukuya esibhedlela ngokushesha.

Yimiphi le mithi ye-neuroleptic?

Imithi ye-neuroleptic, noma imithi ye-antipsychotic, ingahlukaniswa ngezigaba ezimbili eziyinhloko.

1. Ama-antipsychotics esizukulwane sokuqala noma "avamile".

2. Ama-antipsychotics esizukulwane sesibili noma "angavamile".

Odokotela banikeza lawa ma-antipsychotics esizukulwane sokuqala nesesibili ezimweni ezahlukene zengqondo nezezinzwa. Nazi izibonelo ezimbalwa:

• Izinkinga zokuziphatha ezenzeka ku-dementia.
• Isifo se-bipolar.
• Ukucindezeleka.
• Izinkinga zokudla.
• Isifo sokukhathazeka esijwayelekile.
• Ukuphazamiseka kwasebekhulile.
• Ukungalali.
• Isifo sokuzikhukhumeza ngokweqile (OCD).
• Ukuphazamiseka kobuntu.
• Isifo sokucindezeleka ngemva kokucindezeleka (PTSD).
Isifo sokungezwani komzimba (Schizoaffective disorder). I-Schizophrenia kanye nezifo ezihlobene nayo.

Yimiphi imithi engabangela i-neuroleptic malignant syndrome (NMS)?

Kunezinhlobo eziningana zemithi engabangela i-'NMS'. Ake sibheke ukuthi iyini.

Imithi ejwayelekile ye-neuroleptic (antipsychotic):

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

Imithi ye-neuroleptic (antipsychotic) engavamile:

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

Eminye imithi yokulwa nokuqunjelwa:

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

Imithi ye-dopaminergic (Parkinson's) (ngokuyeka lokhu ngokuzumayo):

• I-Amantadine
• Ama-agonist e-dopamine
• I-Levodopa
• I-Tolcapone

Ungakhathazeki ngalolu hlu. Akuwona wonke umuntu othatha le mithi ozoba ne-NMS. Lesi yisimo esingavamile kakhulu . Kodwa uma uthatha le mithi, kubalulekile ukuqaphela lokhu.

Uyini umehluko phakathi kwe-NMS ne-malignant hyperthermia?

Kungenzeka ukuthi uke wezwa ngesimo esibizwa ngokuthi i-malignant hyperthermia. Futhi kuyimpendulo engavamile futhi enzima. Kodwa ibangelwa imithi yokubulala izinzwa evamile kanye neziphumuli zemisipha .

Kungabangela nokuqina kwemisipha, ukwehla kwe-reflexes (hyporeflexia), kanye nokushintsha kwesikhumba (ubuluhlaza okwesibhakabhaka, ukubomvu). Lezi zimpawu zingafana neze-NMS. Kodwa-ke, odokotela bangahlukanisa lokhu kokubili ngokubheka umlando wezokwelapha wesiguli. Okusho ukuthi, kungakhathaliseki ukuthi basanda kubhekana ne-anesthesia noma bathathe umuthi we-neuroleptic.

Uyini umehluko phakathi kwe-NMS ne-Serotonin Syndrome?

I-Serotonin syndrome ingenye inkinga edidayo. Ibangelwa imithi engaphansi kwesigaba se-serotonergic, njengeminye imithi yokucindezeleka, ama-amphetamine, ama-antihistamine, kanye nemithi yokuqinisa imizwa. Kalula nje, kwenzeka uma kunekhemikhali eningi kakhulu emzimbeni ebizwa ngokuthi i-serotonin.

Izimpawu ze-serotonin syndrome zifaka phakathi ukuqina kwemisipha, i-hyperreflexia, isifo sohudo, ukujuluka, ukudikiza kwemisipha (i-myoclonus), kanye nokushintsha kwesimo sengqondo. Kodwa-ke , umkhuhlane kanye nokuqina kwemisipha ngokuvamile akuvamile kakhulu kwi-serotonin syndrome kunakwi-NMS.

Udokotela wakho uzohlukanisa phakathi kwalezi zimo ezimbili ngokulalela izimpawu zakho kanye nemithi oyiphuzayo.

Ubani othola i-neuroleptic malignant syndrome (NMS)?

I-NMS ingenzeka kunoma ubani othatha imithi ye-neuroleptic (antipsychotic).

Nakuba kucatshangwa ukuthi cishe izingxenye ezimbili kwezintathu zamacala e-'NMS' zenzeka phakathi nesonto lokuqala lokuqala imithi ye-neuroleptic, kubalulekile ukukhumbula ukuthi lesi simo singavela nganoma yisiphi isikhathi ngesikhathi sokwelashwa.

Sivame kangakanani lesi simo se-'NMS'?

Eqinisweni, i-neuroleptic malignant syndrome (i-NMS) iyisimo esingavamile kakhulu. Sivela phakathi kuka-0.01% no-3.2% wabantu abasebenzisa imithi ye-neuroleptic.

Kodwa-ke, izindaba ezinhle ukuthi inani lemibiko ye-NMS liyehla ngenxa yokwethulwa kwemithi emisha enengozi ephansi yokubangela i-NMS, kanye nokwaziwa kodokotela neziguli ngalesi simo.

Ziyini izimpawu ze-neuroleptic malignant syndrome (NMS)?

Izimpawu ze-'NMS' zivame ukuqala ukubonakala zingakapheli izinsuku ezintathu . Izimpawu eziyinhloko yilezi:

• Umkhuhlane ophakeme kakhulu (102 kuya ku-104 degrees Fahrenheit - 38.9 kuya ku-40 degrees Celsius).
• Ukungalingani kwesigqi senhliziyo (i-arrhythmia).
• Ukwanda kwesilinganiso senhliziyo (i-tachycardia).
• Ukwanda kwesilinganiso sokuphefumula (i-tachypnea).
• Ukuqina/ukuqina kwemisipha `(ukuqina kwemisipha)`.
• Izinguquko esimweni sengqondo (njengokudideka, ukucasuka, ukulahlekelwa ukwazi).
• Umfutho wegazi ophezulu noma umfutho wegazi ophansi.
• Ukujuluka ngokweqile.

Uma unesinye noma ngaphezulu salezi zimpawu, ikakhulukazi uma uthatha umuthi we-neuroleptic, sicela ushayele u-911 noma uye esibhedlela esiseduze ngokushesha. Lesi yisimo esiphuthumayo sezokwelapha.

Umuthi we-neuroleptic uyibangela kanjani i-'NMS'?

Isimo se-`NMS` sibangelwa umuthi we-neuroleptic (antipsychotic).Kungenzeka ngomthamo owodwa, ngokwanda komthamo, noma ngokuqhubeka nokusebenzisa umthamo ofanayo. Nakuba i-NMS ihlotshaniswa kakhulu nemithi yokulwa nokuphazamiseka kwengqondo yesizukulwane sokuqala, ingenzeka futhi, ngezinga elincane, ngokuhoxiswa okungazelelwe kwemithi yokulwa nokuphazamiseka kwengqondo yesizukulwane sesibili, eminye imithi yokulwa nokuphazamiseka kokugaya ukudla, kanye nemithi ye-dopaminergic esetshenziselwa isifo sikaParkinson.

Ososayensi basazama ukuthola ukuthi yini ngempela ebangela i-NMS. Inkolelo-mbono yamanje ukuthi ibangelwa ukuphikisana kwe-dopamine D2 receptor . I-Dopamine iyi-neurotransmitter ebuchosheni bethu. Iyikhemikhali ethwala imiyalezo phakathi kwamaseli. Imithi ye-neuroleptic isebenza ngokuvimbela lesi sithunywa se-dopamine ekungeneni kwamaseli ngama-receptor athile.

Uma ama-receptor e-dopamine ku-hypothalamus yakho kanye/noma umgogodla evalekile, ukucindezeleka kwemisipha kuyanda. Futhi, ukuphazamiseka kwama-receptor e-dopamine ku-hypothalamus yikho okubangela umkhuhlane ophezulu kanye nokushintshashintsha okukhulu komfutho wegazi okubonakala ku-NMS.

Itholakala kanjani i-neuroleptic malignant syndrome (NMS)?

Ukuze odokotela bakwazi ukuxilonga i-NMS, kumele ube nazo zonke lezi zimpawu noma izimo ezilandelayo :

• Uthatha umuthi we-neuroleptic noma uyeke ngokuzumayo ukuthatha umuthi we-dopaminergic.
• Unemisipha eqinile/eqinile (lokhu kungaholela nasekuqhekekeni kwemisipha).
• Unomkhuhlane ophezulu.
• Kukhona ushintsho esimweni sakho sengqondo.

Ngaphezu kwalokho, okungenani izici ezimbili ezilandelayo kumele zibe khona:

• Ukujuluka ngokweqile noma okungajwayelekile.
• Ubunzima bokugwinya.
• Ukungakwazi ukulawula umchamo noma indle (ukungakwazi ukuzibamba).
• Ukwanda kwesilinganiso senhliziyo (i-tachycardia).
• Kungazelelwe angakwazi ukukhuluma.
• Izinguquko ezikhulayo noma eziphindaphindayo ekucindezelweni kwegazi.
• Ukwanda kwenani lamaseli amhlophe egazi (i-Leukocytosis).
• Amazinga akhuphukile e-creatine phosphokinase (CPK) ngenxa yokuphuka kwemisipha.
• Ukusabela okuhamba kancane noma okulinganiselwe (i-hyporeflexia).

Yiziphi izivivinyo ezenziwayo ukuze kutholakale i-'NMS'?

Uma udokotela wakho esola ukuthi une-NMS, angase akucele ukuhlolwa okufana nalokhu:

• Iphaneli ephelele ye-metabolic.
• Ukuhlolwa komchamo.
• Ukuhlolwa kwegesi yegazi lemithambo noma lemithambo yegazi.
• Ukuhlolwa kwegazi kwe-Creatine phosphokinase (CPK).

Iphathwa kanjani i-neuroleptic malignant syndrome (NMS)?

I-NMS iyisimo esiphuthumayo sezokwelapha. Ngakho-ke kubalulekile ukuxilonga lesi simo bese uqala ukwelashwa ngokushesha. Uma une-NMS, cishe kuzodingeka ulaliswe esibhedlela.Kuzodingeka uthole ukwelashwa egunjini lokunakekela abagula kakhulu (ICU).

Kuzo zonke izimo ze-'NMS', odokotela bazoyeka ngokushesha umuthi we-neuroleptic (antipsychotic) owabangela i-'NMS'. Ngaphezu kwalokho, bazokwelapha izimpawu ze-'NMS' futhi bathathe izinyathelo zokuvimbela izinkinga ezingaba khona. Lokhu kwelashwa kungafaka:

• Ukugcina ukuqina kwenhliziyo nokuphefumula kusetshenziswa umoya wokuphefumula owenziwe ngomshini, imithi yokulwa nokushaya kwenhliziyo, kanye/noma ama-pacemaker.
• Ukugcina ibhalansi ye-electrolyte emzimbeni ngokunikeza uketshezi olufakwa ngemithambo yegazi (i-IV fluids).
• Ukwehlisa izinga lokushisa lomzimba kusetshenziswa izingubo zokulala ezipholile, amanzi eqhwa, kanye/noma amaphakethe eqhwa.
• Uma umfutho wegazi uphezulu, lawula ngemithi.
• Ukunikeza imithi efana ne-heparin ukuvimbela ukujiya kwegazi.
• Ukunikeza imithi engabuyisela amazinga aphansi e-dopamine emzimbeni.
• Ukunikeza imithi yokuphumula imisipha noma amathambo.

Yiziphi izici eziyingozi zokuthuthukisa i-'NMS'?

Kunezici eziningana ezandisa ingozi yokuthola i-neuroleptic malignant syndrome (NMS):

• Ukuqala umuthi omusha we-neuroleptic (antipsychotic) noma ukwandisa umthamo.
• Ukusebenzisa imithi engaphezu kweyodwa ye-neuroleptic noma ukusebenzisa umuthi i-lithium.
• Ukuyeka ngokuzumayo umuthi we-dopaminergic wesifo sikaParkinson.

Kuzothatha isikhathi esingakanani ukululama ku-'NMS'? (Isibikezelo)

Uma i-NMS itholakala kusenesikhathi futhi yelashwa ngokushesha nangendlela efanele, abantu abaningi bayalulama zingakapheli amasonto amabili kuya ezinsukwini ezingu-14.

Kodwa-ke, uma ukwelashwa kwephuza, kungavela izinkinga ezinkulu ezithinta imisipha, izinso, inhliziyo, kanye/noma amaphaphu.

Uma ingelashwa ngokushesha, i-NMS ingaba yingozi. Izinga lokufa kwe-NMS lisukela ku-5% kuya ku-20%. Kodwa-ke, ukuqwashisa okwengeziwe nge-NMS kanye nokusetshenziswa kwemithi emisha yokulwa nesifo sengqondo kuye kwehlisa leli zinga lokufa emashumini eminyaka ambalwa edlule.

Abantu abaningi, ngaphansi kokuqondiswa udokotela, bayakwazi ukuqala kabusha ngempumelelo imithi ye-neuroleptic (antipsychotic).

Yiziphi izinkinga ze-neuroleptic malignant syndrome (NMS)?

Ngeshwa, izinkinga ze-NMS zivamile futhi zinzima. Ezinye izinkinga zibangelwa izimpawu eziphawulekayo ze-NMS kanye nokungasebenzi kahle kwesistimu yezinzwa ezizimele, kanti ezinye, ikakhulukazi izifo, zingabangelwa ukuhlala isikhathi eside egunjini lokunakekelwa okujulile (ICU).

Ezinye zezinkinga ze-NMS yilezi:

• I-Rhabdomyolysis (ukuwohloka kwamangqamuzana emisipha - lokhu kuyimbangela evame kakhulu).
• Ukuphelelwa amanzi emzimbeni.
• Ukwehluleka kwezinso okukhulu.
• Ukwehluleka okukhulu kokuphefumula.
• Izimo zesifo sokuwa/ ukuwa .
• Ukuhlaselwa yinhliziyo.
• Ukujiya kwegazi emzimbeni wonke (ukujiya kwegazi okusabalalisiwe ngaphakathi kwemithambo yegazi).
• Ukwehluleka kwesibindi okukhulu.
• Inyumoniya.
• I-Sepsis (amagciwane angena egazini).
• Ukutheleleka komgudu womchamo (UTI).
• I-embolism yamaphaphu.

Ngenxa yokuthi lezi zinkinga zinzima kakhulu futhi zisongela ukuphila, kubaluleke kakhulu ukushayela ucingo ku-911 ngokushesha bese uya esibhedlela esiseduze ukuze uthole ukwelashwa uma unezimpawu ze-NMS. Futhi, i-NMS iyisimo esiphuthumayo esisongela ukuphila futhi ingadinga ukwelashwa e-Intensive Care Unit (ICU).

Kufanele ngimbone nini udokotela wami?

Uma uthatha umuthi owodwa noma ngaphezulu we-neuroleptics (ama-antipsychotics), ama-antiemetics, kanye/noma i-dopaminergic (Parkinson's), kubalulekile ukubona udokotela wakho njalo ukuqinisekisa ukuthi usebenza kahle kuwe. Futhi, buza udokotela wakho ngemiphumela emibi yemithi oyithathayo nokuthi yiziphi izimpawu okufanele uziqaphele.

Ingabe kufanele ngiye eMnyangweni Wezimo Eziphuthumayo (ETU) uma nginezimpawu ze-'NMS'?

Uma unezimpawu ze-neuroleptic malignant syndrome (NMS), njengomkhuhlane ophakeme kakhulu kanye nokuqina kwemisipha, kubalulekile ukushayela u-911 noma uye esibhedlela esiseduze ngokushesha. I-NMS idinga ukunakekelwa kwezokwelapha okusheshayo. Uma ingelashwa ngokushesha nangokufanele, ingaholela ngisho nasekufeni.

I-Neuroleptic Malignant Syndrome (NMS) iyisimo esibi kakhulu nesisongela impilo. Ngakho-ke uma unezimpawu, kubalulekile ukufuna usizo lwezokwelapha ngokushesha okukhulu. I-NMS kulula kakhulu ukuyilapha uma itholakale kusenesikhathi. Nakuba i-NMS ingavamile, uma uthatha imithi ye-neuroleptic (antipsychotic), khuluma nodokotela wakho noma nosokhemisi mayelana nemiphumela emibi kanye nezimpawu okufanele uziqaphele. Bakhona ukukusiza.

Izinto ezibaluleke kakhulu esizifundile kulesi sihloko (Umyalezo Wokuya Ekhaya)

Kulungile, ngakho-ke ake sikukhumbuze ezinye zezinto ezibaluleke kakhulu okufanele uzikhumbule kulokho esikhulume ngakho kule 'NMS':

• I-NMS yisimo esingavamile, kodwa esingasongela ukuphila esibangelwa imithi ye-neuroleptic.
• Umkhuhlane omkhulu, izinhlungu zemisipha, kanye nokudideka kwengqondo yizimpawu eziyinhloko.
• Uma ubona noma yiziphi zalezi zimpawu, funa iseluleko sezokwelapha ngokushesha. Ungalibali.
• Uma uthatha imithi ye-neuroleptic, khuluma nodokotela wakho mayelana nomuthi kanye nemiphumela yawo emibi. Ungesabi ukubuza imibuzo.
• I-NMS ingelapheka ngokuphelele uma itholakale futhi yelashwa kusenesikhathi.

Sithemba ukuthi lolu lwazi selukutshelile. Hlala uphilile!

I- Neuroleptic Malignant Syndrome, i-NMS, imithi yengqondo, imiphumela emibi, umkhuhlane omkhulu, ukuqina kwemisipha