IHeparin: yintoni, iyintoni, uyisebenzisa njani kunye neziphumo ebezingalindelekanga

Umxholo

• Yenzelwe ntoni
• Luphi ubudlelwane phakathi kokusetyenziswa kweherparin kunye ne-COVID-19?
• Kusetyenziswa kwanjani
• Iziphumo ebezingalindelekanga ezinokwenzeka
• Ngubani ongafanele asebenzise

I-Heparin yi-anticoagulant yokusetyenziswa ngenaliti, kubonisiwe ukunciphisa amandla okujija kwegazi kunye noncedo kunyango kunye nokuthintela ukwenziwa kwamahlwili anokuthintela imithambo yegazi kunye nokubangela ukusasazeka kwe-intravascular coagulation, i-vein thrombosis enzulu okanye ukubetha, umzekelo.

Zimbini iintlobo zeheparin, i-heparin engasetyenziswanga enokusetyenziswa ngokuthe ngqo emthanjeni okanye isitofu esingaphantsi, kwaye ilawulwa ngumongikazi okanye ugqirha, isetyenziselwa kuphela isibhedlele, kunye ne-heparin yesisindo esisezantsi, njenge-enoxaparin okanye i-dalteparin, ye Umzekelo, inexesha elide lokusebenza kunye neziphumo ebezingalindelekanga ezimbalwa kune-heparin engafakwanga kwaye inokusetyenziswa ekhaya.

Ezi heparins kufuneka zisoloko ziboniswa ngugqirha onjenge-cardiologist, i-hematologist okanye ugqirha jikelele, umzekelo, kwaye ukubeka esweni rhoqo kufuneka kwenziwe ukuvavanya ukusebenza konyango okanye ukubonakala kweziphumo ebezingalindelekanga.

Yenzelwe ntoni

IHeparin ibonakalisiwe kuthintelo kunye nonyango lwamahlwili ahambelana nezinye iimeko, ezibandakanya:

• I-vein thrombosis enzulu;
• Kusasazwa i-intravascular coagulation;
• Ukubethelwa kwemiphunga;
• Ubumbano lwearterial;
• Isuntswana lomfanekiso
• I-Atrial fibrillation;
• Ukucinywa kwentliziyo;
• Uhlalutyo lweHemodialysis;
• Utyando lwentliziyo okanye lwamathambo;
• Utofelo-gazi;
• Ukujikeleza kwegazi kwangaphandle.

Ukongeza, i-heparin inokusetyenziselwa ukuthintela ukwakheka kwamahlwili kubantu abalele ebhedini, kuba abahambeli, basemngciphekweni omkhulu wokuphuhliswa kwegazi kunye ne-thrombosis.

Luphi ubudlelwane phakathi kokusetyenziswa kweherparin kunye ne-COVID-19?

I-Heparin, nangona ingenayo igalelo ekupheliseni i-coronavirus entsha emzimbeni, isetyenzisiwe, kwiimeko ezimodareyithayo okanye ezinzima, ukukhusela iingxaki ze-thromboembolic ezinokuvela ngesifo se-COVID-19 esifana nokusasazwa kwe-intravascular coagulation, embolism pulmonary or deep venous thrombosis .

Ngokutsho kwesifundo esenziwe e-Itali ^[1], I-coronavirus inokusebenzisa ukujiya kwegazi okukhokelela kukonyuka okuqatha kwegazi kwaye, ke, iprophylaxis ngokusetyenziswa kwe-anticoagulants ezinje nge-heparin engafakwanga okanye i-heparin ephantsi ye-molekyuli inokunciphisa i-coagulopathy, ukuyilwa kwe-microthrombi, kunye nomngcipheko wokonakala komzimba, idosi ekufuneka isekwe kumngcipheko ngamnye we-coagulopathy kunye ne-thrombosis.

Olunye uphononongo i-In vitro ibonakalise ukuba i-heparin yesisindo esiphantsi yayineempawu zokulwa intsholongwane kunye ne-immunomodulatory ngokuchasene ne-coronavirus, kodwa akukho bungqina kwi vivo iyafumaneka kwaye iimvavanyo zeklinikhi ebantwini ziyafuneka ukuqinisekisa ukusebenza kwayo kwi vivo, kunye nedosi yokunyanga kunye nokhuseleko lwamayeza ^[2].

Ukongeza, uMbutho wezeMpilo weHlabathi, kwisikhokelo se-COVID-19 kuLawulo lweKlinikhi ^[3], ibonisa ukusetyenziswa kwesisindo esisezantsi se-heparin, njenge-enoxaparin, ye-prophylaxis ye-venous thromboembolism kwizigulana zabantu abadala nakwishumi elivisayo ezibhedlele ezibhedlele nge-COVID-19, ngokwemigangatho yasekhaya nakwamanye amazwe, ngaphandle kwaxa isigulana sinokungahambelani nokusetyenziswa kwakho.

Kusetyenziswa kwanjani

I-Heparin kufuneka ilawulwe ngumsebenzi wezempilo, nokuba kungaphantsi (phantsi kolusu) okanye ngaphakathi (ngaphakathi emthanjeni) kunye needosi kufuneka ziboniswe ngugqirha kuthathelwa ingqalelo ubunzima bomntu kunye nobukrakra besifo.

Ngokubanzi, iidosi ezisetyenziswa ezibhedlele zezi:

• Inaliti eqhubekayo emthanjeni: idosi yokuqala yeeyunithi ze-5000, ezinokufikelela kwiiyunithi ezingama-20,000 ukuya kuma-40,000 ezisetyenziswe ngaphezulu kweeyure ezingama-24, ngokuvavanywa kwezonyango;
• Inaliti emthanjeni rhoqo kwiiyure ezi-4 ukuya kwezi-6: idosi yokuqala iiyunithi ezingama-10,000 kwaye emva koko ingahluka ukusuka kwiiyunithi ezingama-5 000 ukuya ku-10 000;
• Inaliti engaphantsi: idosi yokuqala iiyunithi ezingama-333 ngekhilog nganye yobunzima bomzimba, ilandelwa ziiyunithi ezingama-250 ngeekhilogram rhoqo kwiiyure ezili-12.

Ngexesha lokusetyenziswa kweherparin, ugqirha kufuneka abeke iliso ekunqandeni kwegazi kuvavanyo lwegazi kwaye ahlengahlengise idosi yeheparin ngokokusebenza kwayo okanye ukubonakala kweziphumo ebezingalindelekanga.

Iziphumo ebezingalindelekanga ezinokwenzeka

Ezinye zeempembelelo eziqhelekileyo ezinokuthi zenzeke ngexesha lokunyanga nge-heparin ukuphuma okanye ukuphuma kwegazi, kunye negazi kumchamo, izitulo ezimnyama ezinendawo yokubonakalisa ikofu, ukutyumka, iintlungu zesifuba, ukuqaqamba okanye imilenze, ngakumbi etholeni, ubunzima ukuphefumla okanye ukopha iintsini.

Njengoko ukusetyenziswa kweheparin kusenziwa ezibhedlele kwaye ugqirha ubeka iliso ekunqandeni kwegazi kunye nokusebenza kweheparin, xa kuvela naliphi na icala, unyango lukhawuleza.

Ngubani ongafanele asebenzise

I-Heparin iyaphikiswa kubantu abane-hypersensitive kwi-heparin kunye nezinto zefomula kwaye akufuneki zisetyenziswe ngabantu abane-thrombocytopenia eqatha, i-endocarditis yebhaktiriya, ukukrokrelwa kobuchopho okanye olunye uhlobo lwe-hemorrhage, i-haemophilia, i-retinopathy okanye iimeko apho kungekho meko ukwenza uvavanyo olwenziweyo lokuxinana.

Ukongeza, akufuneki ukuba isetyenziswe kwidayastase eyophayo, kuqhaqho lomqolo, kwiimeko apho isisu sisondele, izifo ezixineneyo zesibindi kunye nokusilela kwezintso, phambi kwamathumba amabi enkqubo yokwetyisa kunye neepraura zeethambo. .

IHeparin akufuneki isetyenziswe ngabafazi abakhulelweyo okanye abancancisayo ngaphandle kwengcebiso zonyango.