Heparin: ndi chiyani, ndi chiyani, imagwiritsidwa ntchito bwanji ndi zotsatirapo zake

Zamkati

• Ndi chiyani
• Kodi pali ubale wotani pakati pa kugwiritsidwa ntchito kwa heparin ndi COVID-19?
• Momwe mungagwiritsire ntchito
• Zotsatira zoyipa
• Yemwe sayenera kugwiritsa ntchito

Heparin ndi anticoagulant yogwiritsira ntchito jakisoni, yomwe imawonetsa kuchepa kwamitsempha yamagazi ndikuthandizira pochiza ndi kupewa mapangidwe am'magazi omwe amatha kulepheretsa mitsempha yamagazi ndikupangitsa kufalikira kwa mitsempha ya m'mitsempha, thrombosis yakuya kapena stroko, mwachitsanzo.

Pali mitundu iwiri ya heparin, heparin yosatulutsidwa yomwe ingagwiritsidwe ntchito mwachindunji mumtsempha kapena ngati jakisoni wocheperako, ndipo imayendetsedwa ndi namwino kapena dokotala, pongogwiritsira ntchito chipatala, komanso ma heparin ochepa, monga enoxaparin kapena dalteparin, ya Mwachitsanzo, imakhala ndi nthawi yayitali yogwira ntchito komanso zoyipa zochepa kuposa heparin wosatulutsidwa ndipo itha kugwiritsidwa ntchito kunyumba.

Ma heparinwa nthawi zonse amayenera kuwonetsedwa ndi adotolo monga katswiri wamtima, hematologist kapena dokotala wamba, mwachitsanzo, ndikuwunika pafupipafupi kuti athe kuwunika momwe mankhwalawo aliri kapena kuwonekera kwa zovuta zake.

Ndi chiyani

Heparin imawonetsedwa popewa komanso kuchiza matenda omwe amakhudzana ndi zinthu zina, monga:

• Thrombosis yakuya;
• Zimafalitsa kugunda kwamitsempha yamagazi;
• Embolism m'mapapo mwanga;
• Embolism yazovuta;
• Kusokoneza;
• Matenda a atrial;
• Catheterization yamtima;
• Kusanthula magazi;
• Opaleshoni ya mtima kapena ya mafupa;
• Kuika magazi;
• Kuzungulira kwa magazi kwina.

Kuphatikiza apo, heparin itha kugwiritsidwa ntchito popewa kupangika kwa magazi kwa anthu ogona, chifukwa samasuntha, ali pachiwopsezo chambiri chokhala ndi magazi ndi thrombosis.

Kodi pali ubale wotani pakati pa kugwiritsidwa ntchito kwa heparin ndi COVID-19?

Heparin, ngakhale sichimathandizira kuthana ndi coronavirus yatsopano mthupi, yagwiritsidwa ntchito, mozama kapena pamavuto akulu, kupewa zovuta zamatenda zomwe zimatha kubwera ndi matenda a COVID-19 monga kufalikira kwa intravascular coagulation, pulmonary embolism kapena deep venous thrombosis .

Malinga ndi kafukufuku wopangidwa ku Italy ^[1], coronavirus imatha kuyambitsa kutsekemera kwa magazi komwe kumabweretsa kuwonjezeka kwakukulu kwa magazi ndipo chifukwa chake, prophylaxis yogwiritsa ntchito ma anticoagulants monga heparin wosatulutsidwa kapena kuchepa kwa maselo a heparin kumatha kuchepetsa coagulopathy, mapangidwe a microthrombi, komanso chiopsezo chowonongeka kwa ziwalo, kuchuluka kwake komwe kuyenera kutengera chiopsezo cha munthu coagulopathy ndi thrombosis.

Kafukufuku wina mu m'galasi adawonetsa kuti ma heparin otsika a molekyulu anali ndi ma virus komanso ma immunomodulatory katundu motsutsana ndi coronavirus, koma palibe umboni mu vivo alipo ndipo mayesero azachipatala mwa anthu amafunikira kuti atsimikizire kuti ndi othandiza mu vivo, komanso kuchuluka kwa mankhwala ndi chitetezo cha mankhwala ^[2].

Kuphatikiza apo, World Health Organisation, mu Buku la COVID-19 ku Clinical Management ^[3], akuwonetsa kugwiritsidwa ntchito kwa ma molekyulu otsika a heparin, monga enoxaparin, pofuna kuteteza matenda am'mimba mwa odwala achikulire ndi achinyamata omwe agonekedwa ndi COVID-19, malinga ndi momwe akumvera komanso akunja, pokhapokha ngati wodwalayo ali ndi zotsutsana ndi zomwe mumagwiritsa ntchito.

Momwe mungagwiritsire ntchito

Heparin iyenera kuperekedwa ndi katswiri wazachipatala, mwina mwakachetechete (pansi pa khungu) kapena kudzera m'mitsempha (mumitsempha) ndipo Mlingo uyenera kuwonetsedwa ndi dokotala poganizira kulemera kwa munthuyo komanso kuopsa kwa matendawa.

Mwambiri, mankhwala omwe amagwiritsidwa ntchito muzipatala ndi awa:

• Jekeseni yopitilira mtsempha: mlingo woyambirira wa mayunitsi a 5000, omwe atha kufikira 20,000 mpaka 40,000 mayunitsi omwe agwiritsidwa ntchito maola 24, malinga ndi kuwunika kwamankhwala;
• Jekeseni mumtsinje maola 4 kapena 6 aliwonse: mlingo woyambira ndi mayunitsi 10,000 kenako amatha kusiyanasiyana pakati pa 5,000 ndi 10,000 mayunitsi;
• Jekeseni wamagetsi: Mlingo woyambirira ndi mayunitsi 333 pa kg ya kulemera kwa thupi, kutsatiridwa ndi mayunitsi 250 pa kg pa maola 12 aliwonse.

Pogwiritsira ntchito heparin, adotolo amayenera kuwunika magazi potseka magazi poyesa magazi ndikusintha kuchuluka kwa heparin malinga ndi mphamvu yake kapena mawonekedwe azovuta.

Zotsatira zoyipa

Zina mwazovuta zomwe zimachitika mukalandira mankhwala a heparin ndikutuluka magazi kapena magazi, kupezeka kwa magazi mumkodzo, mipando yakuda ndi mawonekedwe a khofi, mabala, kupweteka pachifuwa, kubuula kapena miyendo, makamaka ng'ombe, zovuta kupuma kapena kutuluka magazi m'kamwa.

Momwe ntchito ya heparin imapangidwira muzipatala ndipo adotolo amayang'anira kuwundana kwa magazi komanso mphamvu ya heparin, pakafika vuto lililonse, chithandizo chimayamba msanga.

Yemwe sayenera kugwiritsa ntchito

Heparin imatsutsana ndi anthu omwe ali ndi hypersensitive heparin ndi mapangidwe am'magazi ndipo sayenera kugwiritsidwa ntchito ndi anthu omwe ali ndi thrombocytopenia, bakiteriya endocarditis, amaganiza kuti kukha mwazi muubongo kapena mtundu wina wamagazi, haemophilia, retinopathy kapena m'malo omwe mulibe zofunikira kuchita mayesedwe okwanira a coagulation.

Kuphatikiza apo, sayeneranso kugwiritsidwa ntchito pama diastases a hemorrhagic, opareshoni ya msana, m'malo omwe kutaya mimba kwayandikira, matenda oziziritsa kwambiri, chiwindi ndi impso zolephera, pamaso pa zotupa zoyipa zam'mimba ndi zina za mtima wa purpura. .

Heparin sayenera kugwiritsidwa ntchito ndi amayi apakati kapena oyamwitsa popanda upangiri wachipatala.