Heparin: chii icho, chii chaicho, maitiro ekuishandisa uye mhedzisiro

Zvemukati

• Chii ichochi
• Ndeupi hukama pakati pekushandisa heparin uye COVID-19?
• Kushandisa sei
• Zvinogona kuitika mhedzisiro
• Ndiani asingafanire kushandisa

Heparin inorwisa anticoagulant yekushandisa jekiseni, inoratidzirwa kudzikisa kugona kwekuvhara ropa uye kubatsira pakurapa nekudzivirira kuumbwa kwemacopa anogona kutapudza tsinga dzeropa uye kukonzera kupararira kwemukati mevascular coagulation, yakadzika tsinga thrombosis kana sitiroko, semuenzaniso.

Kune mhando mbiri dzeparparin, isina kubviswa heparin inogona kushandiswa yakananga mutsinga kana seinopinda jekiseni, uye inodzidziswa nemukoti kana chiremba, ichingoitirwa kushandiswa kwechipatara chete, uye yakaderera mamorekuru uremu hweparpar, senge enoxaparin kana dalteparin, ye Semuenzaniso, ine nguva yakareba yekuita uye mashoma mhedzisiro pane isina kubviswa heparin uye inogona kushandiswa pamba.

Aya heparin anofanirwa kugara achiratidzwa nachiremba senge chiremba wezvemwoyo, wehematologist kana wezvekurapa, semuenzaniso, uye kugara uchiongorora kunofanirwa kuitwa kuti uongorore kushanda kwemushonga kana kuoneka kwemhedzisiro.

Chii ichochi

Heparin inoratidzirwa yekudzivirira uye kurapwa kwemachira ane chekuita nemamwe mamiriro, anosanganisira:

• Yakadzika tsinga thrombosis;
• Yakaparadzirwa intravascular coagulation;
• Pulmonary embolism;
• Arterial embolism;
• Infarction;
• Atrial fibrillation;
• Catheterization yemwoyo;
• Hemodialysis;
• Cardiac kana orthopedic kuvhiya;
• Kuwedzerwa ropa;
• Kupararira kweropa kwakawanda.

Uye zvakare, heparin inogona kushandiswa kudzivirira kuumbwa kwemachira mune vanhu vakavata pamubhedha, sezvo iwo asingafambi, ivo vari panjodzi yekuwedzera yekugwamba kweropa uye thrombosis.

Ndeupi hukama pakati pekushandisa heparin uye COVID-19?

Heparin, kunyangwe iyo isinga tsigire kubvisa iyo nyowani coronavirus kubva mumuviri, yakashandiswa, mune zvine mwero kana zvakakomba zviitiko, kudzivirira kusagadzikana kwetromboembolic kunogona kumuka ne COVID-19 chirwere chakadai sekuparadzira intravascular coagulation, pulmonary embolism kana yakadzika venous thrombosis .

Zvinoenderana nekudzidza kwakaitwa muItari ^[1], iyo coronavirus inogona kumisikidza kugwamba kweropa kunotungamira mukuwedzera kwakanyanya mukugwamba kweropa uye, nekudaro, prophylaxis nekushandiswa kwemishonga inorwisa mabhakitiriya yakadai seisina kubviswa heparin kana yakaderera mamorekuru uremu heparin inogona kudzikamisa coagulopathy, kuumbwa kwe microthrombi, uye njodzi yekukuvara kwemuviri, iyo idhiyo inofanirwa kuve yakavakirwa panjodzi yega yemunhu coagulopathy uye thrombosis.

Chimwe chidzidzo in vitro yakaratidza kuti yakaderera mamorekuru uremu heparin aive neantiviral uye immunomodulatory zvinhu zvinopesana necoronavirus, asi hapana humbowo mu vivo inowanikwa uye zviedzo zvemakiriniki muvanhu zvinodiwa kuti zvioneke kushanda kwayo mu vivo, pamwe neiyo yekurapa dhizaini uye kuchengetedzeka kwemushonga ^[2].

Uye zvakare, iyo World Health Organisation, mune iyo COVID-19 Nongedzo kuClinical Management ^[3], inoratidza kushandiswa kweakaderera mamorekuru uremu heparin, senge enoxaparin, yeprophylaxis ye venous thromboembolism muvakuru uye vechidiki vari muchipatara vakaiswa muchipatara neCOVID-19, zvinoenderana nemunharaunda uye nepasi rose zviyero, kunze kwekunge murwere aine chero zvinopesana nekushandisa kwako.

Kushandisa sei

Heparin inofanirwa kupihwa nehunyanzvi hwekuchengetedza hutano, kungave pasi peganda (pasi peganda) kana kupinda mukati (mukati mutsinga) uye madosi anofanirwa kuratidzwa nachiremba achifunga huremu hwemunhu uye kuomarara kwechirwere.

Muzhinji, iyo mishonga inoshandiswa muzvipatara ndeiyi:

• Inoenderera jekiseni mukati mutsinga: iyo yekutanga dhizaini yezvikamu zve5000, iyo inogona kusvika zviuru makumi maviri kusvika makumi mana emayunitsi anoshandiswa anopfuura makumi maviri nemana maawa, zvinoenderana nekuongororwa kwechiremba;
• Jekiseni kupinda mutsinga maawa mana kusvika kumatanhatu ese: iyo yekutanga dhizaini zviuru gumi uyezve inogona kusiyana kubva zviuru zvishanu kusvika zviuru gumi;
• Subcutaneous jekiseni: iwo wekutanga muyero zvikamu makumi matatu nematatu pamakirogiramu ehuremu hwemuviri, zvichiteverwa nemayuniti mazana maviri nemakirogiramu paawa gumi nemaviri.

Munguva yekushandisa heparin, chiremba anofanira kuongorora kuvhara kweropa kuburikidza nekuongororwa kweropa uye kugadzirisa dhizaini yeparpar maererano nekushanda kwayo kana kuoneka kwemhedzisiro.

Zvinogona kuitika mhedzisiro

Mimwe yemhedzisiro inowanzoitika panguva yekurapwa ne heparin iri kubuda ropa kana kubuda ropa, nekuvapo kweropa mumuti weti, zvituru zvakasviba zvine nzvimbo yekofi kutaridzika, kupwanya, kurwadziwa pachipfuva, kugomera kana makumbo, kunyanya mumhuru, kunetsekana kufema kana kubuda ropa mazino.

Sezvo kushandiswa kweherparini kunoitwa muzvipatara uye chiremba vanoongorora kugwamba kweropa uye kushanda kweherparini, kana chero mhedzisiro ichionekwa, kurapwa kuri nekukurumidza.

Ndiani asingafanire kushandisa

Heparin inopesana nevanhu vane hypersensitive kune heparin uye fomula zvinhu uye haifanire kushandiswa nevanhu vane thrombocytopenia yakaoma, bacterial endocarditis, fungidziro yekubuda ropa kwehuropi kana imwe mhando yeropa, haemophilia, retinopathy kana mumamiriro ezvinhu asina mamiriro uchiita yakakwana coagulation bvunzo.

Uye zvakare, haifanire kushandiswa mumadhigra ane hemorrhagic, oparesheni yemuzongoza, mumamiriro ezvinhu ekuti kubvisa nhumbu kuri padyo, zvakanyanya kukonzeresa zvirwere, mukurwara kwakakomba kwechiropa neitsvo, pamberi pemamota ane utsinye egadziriro yekugaya uye imwe vasura purpura. .

Heparin haifanire kushandiswa nevakadzi vane nhumbu kana kuyamwisa vasina mazano ekurapa.