I-heparin: iyini, yenzelwa ini, ungayisebenzisa kanjani nemiphumela engemihle

-Delile

• Yenzelwe ini
• Buyini ubudlelwane phakathi kokusetshenziswa kwe-heparin ne-COVID-19?
• Isetshenziswa kanjani
• Imiphumela emibi engaba khona
• Ngubani ongafanele asebenzise

I-Heparin iyi-anticoagulant yokusetshenziswa ngomjovo, ikhonjiswe ukwehlisa amandla okuvala igazi nokusiza ekwelapheni nasekuvimbeleni ukwakheka kwamahlule okungavimba imithambo yegazi futhi kubangele ukusatshalaliswa kwe-intravascular coagulation, i-vein thrombosis ejulile noma isifo sohlangothi.

Kunezinhlobo ezimbili ze-heparin, i-heparin engakhipheki engasetshenziswa ngqo emthanjeni noma njengomjovo ongena ngaphansi kwesikhumba, futhi inikezwe umhlengikazi noma udokotela, esetshenziselwa kuphela isibhedlela, kanye ne-heparin yesisindo esiphansi, njenge-enoxaparin noma i-dalteparin, ye isibonelo, inesikhathi eside esenziwayo nemiphumela emibi embalwa kune-heparin engakhipheki futhi ingasetshenziswa ekhaya.

La ma-heparin kufanele akhonjiswe njalo ngudokotela onjenge-cardiologist, i-hematologist noma udokotela ojwayelekile, ngokwesibonelo, futhi ukuqapha okujwayelekile kufanele kwenziwe ukuhlola ukusebenza kokwelapha noma ukubukeka kwemiphumela emibi.

Yenzelwe ini

I-heparin ikhonjisiwe ngokuvikela nokwelashwa kwamahlule ahlobene nezimo ezithile, okubandakanya:

• I-vein thrombosis ejulile;
• Kusatshalaliswe i-coagulation ye-intravascular;
• I-embolism yamaphaphu;
• I-embolism yama-arterial;
• Isifinyezo;
• I-atrial fibrillation;
• I-catheterization yenhliziyo;
• Ukuhlolwa kwe-hemodialysis;
• Ukuhlinzwa kwenhliziyo noma kwamathambo;
• Ukumpontshelwa igazi;
• Ukujikeleza kwegazi okungaphandle.

Ngaphezu kwalokho, i-heparin ingasetshenziselwa ukuvimbela ukwakheka kwamahlule kubantu abalele embhedeni, ngoba awahambi, asengozini enkulu yokuthola amahlule egazi ne-thrombosis.

Buyini ubudlelwane phakathi kokusetshenziswa kwe-heparin ne-COVID-19?

I-Heparin, yize ingabambiqhaza ekuqedeni i-coronavirus entsha emzimbeni, isetshenzisiwe, ezimeni ezilinganiselayo noma ezinzima, ukuvimbela izingqinamba ze-thromboembolic ezingavela ngesifo se-COVID-19 esifana nokusatshalaliswa kwe-intravascular coagulation, embolism pulmonary or thrombosis ejulile ye-venous thrombosis .

Ngokwesifundo esenziwe e-Italy ^[1], i-coronavirus ingavula ukujiya kwegazi okuholela ekwandeni okukhulu ekunqandeni kwegazi, ngakho-ke, i-prophylaxis ngokusetshenziswa kwama-anticoagulants anjenge-heparin engakhipheki noma i-heparin enesisindo esiphansi inganciphisa i-coagulopathy, ukwakheka kwe-microthrombi, kanye nengozi yokulimala komzimba, umthamo okufanele ususelwe engcupheni ngayinye ye-coagulopathy ne-thrombosis.

Esinye isifundo i-in vitro ikhombise ukuthi i-heparin enesisindo esiphansi yayinezinto zokulwa namagciwane kanye ne-immunomodulatory against coronavirus, kepha abukho ubufakazi ku-vivo iyatholakala futhi izivivinyo zomtholampilo kubantu ziyadingeka ukuqinisekisa ukusebenza kwayo ku-vivo, kanye nomthamo wokwelashwa nokuphepha komuthi ^[2].

Ngaphezu kwalokho, i-World Health Organisation, ku-COVID-19 Guide to Clinical Management ^[3], kukhombisa ukusetshenziswa kwesisindo esiphansi samangqamuzana, njenge-enoxaparin, ye-prophylaxis ye-venous thromboembolism ezigulini zabantu abadala nezentsha ezibhedlela eziboshwe nge-COVID-19, ngokuya ngamazinga wendawo nakwamanye amazwe, ngaphandle kwalapho isiguli sinokuphikisana nokusetshenziswa kwakho.

Isetshenziswa kanjani

I-Heparin kufanele ilawulwe uchwepheshe wezokunakekelwa kwempilo, kungaba ngaphansi kwesikhumba (ngaphansi kwesikhumba) noma ngemithambo yegazi (emthanjeni) kanye namanani kufanele akhonjiswe ngudokotela ngokucabangela isisindo somuntu nobukhulu besifo.

Ngokuvamile, amanani asetshenziswa ezibhedlela yilawa:

• Ukujova okuqhubekayo emthanjeni: umthamo wokuqala wamayunithi angama-5000, ongafinyelela kumayunithi angama-20 000 kuya kwangu-40,000 asetshenziswe ngaphezu kwamahora angama-24, ngokuya ngokuhlolwa kwezokwelapha;
• Ukujova emthanjeni njalo emahoreni amane kuya kwayisithupha: umthamo wokuqala ungamayunithi ayi-10,000 bese ungahluka kusuka kumayunithi ayizi-5 000 kuya kwayi-10 000;
• Umjovo ongaphansi: umthamo wokuqala ungamayunithi angama-333 ngekhilogremu ngayinye yesisindo somzimba, kulandelwe amayunithi angama-250 ngekhilo njalo ngamahora ayi-12.

Ngesikhathi sokusebenzisa i-heparin, udokotela kufanele aqaphe ukunqamuka kwegazi ngokuhlolwa kwegazi futhi alungise umthamo we-heparin ngokusebenza kwawo noma ngokuvela kwemiphumela emibi.

Imiphumela emibi engaba khona

Eminye yemiphumela emibi kakhulu engahle yenzeke ngenkathi welashwa nge-heparin ukuphuma noma ukuphuma kwegazi, lapho kukhona khona igazi emchameni, izitulo ezimnyama ezinendawo yekhofi, ukulimaza, ubuhlungu besifuba, izinhlungu noma imilenze, ikakhulukazi enkonyane, ubunzima ukuphefumula noma ukuphuma kwezinsini.

Njengoba ukusetshenziswa kwe-heparin kwenziwa ezibhedlela futhi udokotela eqapha ukujiya kwegazi nokusebenza kwe-heparin, lapho kuvela noma yimuphi umphumela, ukwelashwa kuyashesha.

Ngubani ongafanele asebenzise

I-Heparin iyaphikiswa kubantu abane-hypersensitive to heparin kanye ne-formula components futhi akumele isetshenziswe ngabantu abane-thrombocytopenia enamandla, i-endocarditis yebhaktheriya, okusolakala ukuthi ukopha kobuchopho noma olunye uhlobo lwe-hemorrhage, haemophilia, retinopathy noma ezimeni lapho kungekho mibandela khona ukwenza ukuhlolwa okwanele kwe-coagulation.

Ngaphezu kwalokho, akumele futhi isetshenziselwe ukwelashwa okweqile, ukuhlinzwa kwentambo yomgogodla, ezimweni lapho ukukhipha isisu kuseduze, izifo ezinzima ze-coagulation, ekuhlulekeni okukhulu kwesibindi nezinso, phambi kwezimila ezimbi zesistimu yokugaya kanye ne-purpura ethile yemithambo yegazi. .

I-Heparin akufanele isetshenziswe ngabesifazane abakhulelwe noma abancelisayo ngaphandle kwezeluleko zezokwelapha.