ʻO nā maʻi ʻōpū i hoʻokumu ʻia e nā NSAID: he aha lākou, he aha nā pilikia a lākou e hana ai
Hoʻopau lākou i ka ʻeha a me ke kuni haʻahaʻa. I ka ʻoiaʻiʻo, akā naʻe, hiki i nā NSAID ke hōʻino i ka mucosa ʻōpū ma o nā hana ʻelua
I kēlā me kēia lā, pono nā miliona o ka poʻe a puni ka honua e hoʻopau i ka ʻeha a i ʻole e hōʻemi i ke kuni, a no ka hana ʻana pēlā, lawe lākou i ka mea i kapa ʻia ʻo nā lāʻau anti-inflammatory non-steroidal (NSAIDs)
ʻO ka mea pōʻino, ʻo ka hana therapeutic koʻikoʻi o kēlā me kēia lāʻau lapaʻau e hui pū ʻia me nā hopena ʻaoʻao, ʻo kekahi o ia mau hopena ʻaoʻao makemake ʻole.
ʻO nā maʻi ʻōpū i hoʻokumu ʻia e nā NSAID, mai ka dyspepsia a i nā pilikia ʻeha peptic, ʻo ia paha ka hopena ʻaoʻao pinepine o ka lāʻau.
ʻO ka pilikia o ka pathology acid e pili ana i ka hoʻohana ʻana i nā NSAID me he mea lā e pili ana i ka nui o ka lāʻau lapaʻau a ʻoi aku ka kiʻekiʻe o nā kumuhana i lawe i nā NSAID no ka liʻiliʻi o hoʻokahi mahina a i ʻole e lawe pū ana i kekahi mau NSAID a i ʻole corticosteroids.
ʻO ka poʻe ʻelemakule, ʻo ia ka poʻe hoʻohana nui i nā NSAID, ua pilikia pū kekahi, ma muli paha o ka emi ʻana o ka metabolization o nā lāʻau lapaʻau, i kahi nāwaliwali o ka mucosa ma muli o ke atrophy senile a me ka pilina lōʻihi ma waena o nā NSAID a me ka mucosa ʻōpū ma muli o ka lohi. ʻāʻī ʻōpū.
I ka wā o ka lawe ʻana i nā NSAID, hiki i nā maʻi dyspeptic a hiki i ka 60% o nā hihia, 20% o ia mau mea ʻaʻole i hōʻike i ka loli ma ka hoʻokolokolo endoscopic.
ʻO nā kumu pilikia no ka hoʻomohala ʻana i nā maʻi ʻeha gastroduodenal ma hope o ka lawe ʻana i ka NSAID:
- makahiki kiʻekiʻe (>60 makahiki)
- Moʻolelo o ka digestive pathology
- ʻO ka hui pū ʻana me nā anticoagulants
- ʻO ka hui pū ʻana me nā corticosteroids
- ʻO nā maʻi pili koʻikoʻi (e laʻa me ka maʻi cardiovascular, rheumatoid arthritis)
- Ka hoʻohana ʻana i nā kau kiʻekiʻe a ʻoi aku paha ma mua o hoʻokahi NSAID i ka manawa like.
Hiki i nā NSAID ke hoʻopōʻino i ka mucosa gastro-duodenal e ʻelua mau hana nui
ʻO kahi hopena kūloko kūpono, ʻike maopopo ʻia ma hope o ka lawe waha o ka lāʻau lapaʻau, a me kahi hopena systemic, ʻelua i ka absorption o ka lāʻau.
Hiki i nā hopena ʻaoʻao ke kūloko a ʻōnaehana paha; no ka hui mua:
- Hoʻopuehu intracellular;
- Poino pololei i ka mucus a me ka phospholipid surface;
- Hoʻopaʻa pololei i ka hana HCO3 a me ke kahe koko;
Loaʻa nā hopena ʻōnaehana:
- Hoʻopaʻa i ka cyclooxygenase me ka hoʻohaʻahaʻa PG synthesis;
- Hoʻololi pololei ʻole o ka huna ʻana o ka mucus, HCO3 a me ke kahe koko;
- Hyperproduction o lipoxygenase derivatives.
ʻO ka hopena ʻawaʻawa pololei ma muli o ka liposolubility o nā NSAID, e hiki ai iā lākou ke hoʻolaha manuahi ma o nā membrane cell i loko o nā mucous cell.
Ke alakaʻi nei kēia i ka hoʻololi ʻana o ka cell permeability me ka backscattering o nā ion hydrogen mai ka lumen a me ka hopena o ka pōʻino i ka mucosa.
Eia kekahi, ʻo ka pilina pololei ma waena o nā NSAID a me ka mucosa e alakaʻi i ka nāwaliwali o nā mea pale o ka mucosa (ka hoʻemi ʻana o ka mucus a me ka huna bicarbonate a me ke kahe koko).
Loaʻa ka hopena indirect ma o ka pale ʻana i kahi enzyme, cyclooxygenase, nona ke kuleana no ka synthesis o prostaglandins.
ʻO nā Prostaglandins nā mea me kahi hana kūloko, e hoʻoulu ai i ka mucus a me ka bicarbonate i loko o ka gastroduodenal tract a hoʻonui i ke kahe koko kūloko, no laila e loaʻa ai kahi hopena pale i nā mucous cell (cytoprotection).
Eia kekahi, ʻo ka inhibition o ka cyclooxygenase e hoʻonui ai i ka hana o kahi enzyme ʻē aʻe, lipoxygenase, me ka hoʻonui ʻana i nā mea ʻē aʻe me kahi hopena kūloko, nā leukotrienes, e hoʻokau i nā hopena pōʻino i ka mucosa gastric.
NSAIDs gastroduodenopathy, nā hōʻailona
ʻO kēia ʻano o ka gastroduodenopathy hiki ke asymptomatic a loaʻa paha me ka dyspepsia, ʻeha a me / a i ʻole ke ahi ma ka wahi epigastric, ka ulu ʻana o nā pilikia maʻi peptic e like me ka digestive hemorrhage (inā inā nui ka make ma kahi o 10%), stenosis o ka lumen. a me ka perforation o ka ʻōpū a i ʻole ka pinepine o ka paia duodenal.
ʻAʻole maʻamau ka hoʻoheheʻe ʻana o ka occult, a hiki ke alakaʻi i ka anemia sideropenic.
He mea hoʻopaʻapaʻa inā alakaʻi ka lawe ʻana i kēia mau lāʻau i ka hoʻonui ʻana i ka gastro-oesophageal reflux a / a i ʻole nā hōʻailona o ka maʻi reflux.
He manaʻo maʻamau i waena o nā kauka ʻo ka hoʻohana ʻana i nā lāʻau anti-inflammatory non-steroidal e hōʻeha i nā maʻi o ka maʻi o ka gastro-oesophageal reflux, akā naʻe nā haʻawina hoʻomaʻamaʻa e hōʻoia ana i kēia nele.
Nā hōʻike a me ka hōʻoia
ʻO ka noiʻi nui e ʻike i ka maʻi gastroduodenal e pili ana i ka hoʻohana ʻana i nā lāʻau anti-inflammatory non-steroidal ʻo ia ka hoʻokolokolo endoscopic.
I ka hihia o nā hōʻailona maʻalahi, hiki ke hana ʻia ka maʻi ex adiuvantibus, ma ka nānā ʻana i ka hoʻonā ʻana o nā hōʻailona ma hope o ka hoʻopau ʻana i nā NSAID a me ka lawe ʻana i nā antacids.
He aha e hana
I nā poʻe maʻi me nā maʻi gastroduodenal mai nā lāʻau anti-inflammatory non-steroidal e hoʻopau i ka mālama anti-inflammatory, ʻoi aku ka maikaʻi o ka lāʻau me ka H2 antagonists a i ʻole ka proton pump inhibitors e like me ka poʻe maʻi me nā erosions a i ʻole nā ʻeha ʻaʻole i hoʻokumu ʻia e NSAID.
ʻAʻole i hoʻopaʻa ʻia inā ʻo ka mālama ʻana i kahi maʻi Helicobacter Pylori hiki ke hōʻemi i ka hiki ʻana mai o nā pilikia gastroduodenal mai ka lawe ʻana i nā lāʻau anti-inflammatory non-steroidal.
ʻO ka lawe ʻana i nā NSAID, kekahi mau ʻōlelo aʻoaʻo
ʻO ka hana pale nui e pale i ka hoʻohana nui ʻana, overdosing a me ka lawe ʻana i kekahi mau NSAID i ka manawa like.
I kēia mau lā, ua hōʻike hope ʻia kahi noiʻi ʻepekema i ka maikaʻi o ka pale ʻana i ka lāʻau lapaʻau (me nā lāʻau lapaʻau e pale ana i ka huna ʻana o ka ʻōpū) o nā maʻi gastroduodenal i hoʻokumu ʻia e ka hoʻohana mau ʻana i nā NSAID.
ʻO nā mea kōkua lapaʻau ʻē aʻe i hiki ke hoʻohana i ka pale ʻana i nā ʻeha NSAID he antacids, pale mucosal a me nā analogues prostaglandin synthetase.
Pono ka mālama pale ʻana i nā poʻe maʻi e lawe i nā NSAID a ʻoi aku ka nui o nā kumu pilikia.
I kēia mau lā, nui ka hoihoi i hoʻāla ʻia e ka hoʻokomo ʻana i nā lāʻau anti-inflammatory hou e ālai hapa i ka cyclooxygenase.
ʻElua isoforms o cyclooxygenase: COX-1 a me COX-2. ʻO COX-1 ka mea nāna e hoʻopuka i nā mea (prostaglandins) e pale ai i nā pūnaewele.
ʻO ka COX-2, ma kekahiʻaoʻao, ua hoʻokomoʻia i loko o nā pūnaewele inflammatory a no laila he mea nui ia i ke kaʻina hana a me kaʻeha.
No laila, ʻo ka hoʻohana ʻana i nā lāʻau lapaʻau e hoʻokaʻawale i ka COX-2 e hōʻemi i ka nui o nā maʻi gastro-duodenal.
E heluhelu pū nō hoʻi:
Nā ʻAla ʻAla lāʻau: He aha nā hōʻailona a pehea e ʻike ʻia ai?
ʻO ka maʻi maʻi peptic: nā ʻokoʻa ma waena o ka maʻi maʻi ʻōpū a me ka maʻi maʻi duodenal
Ka Manaʻo o ka Gastritis: He aha ia, pehea e mālama ai