Alteplase ni iki: Ibikoresho, Urutonde rw'imiti, Ingaruka zayo n'ibindi

Alteplase ni umuti ukomeye, ukiza ubuzima ufasha gusesa amaraso y'amaraso akomeye mu mubiri wawe. Ni icyo abaganga bita umuti wa "clot-buster" ushobora gusubiza amaraso iyo urwaye sitiroki cyangwa umutima. Uyu muti ukora yigana poroteyine karemano umubiri wawe ukora kugirango usesure amaraso, ariko ibikora vuba kandi neza kurusha uko umubiri wawe wabishobora wenyine.

Alteplase ni iki?

Alteplase ni verisiyo ya poroteyine yakozwe na genetike yitwa tissue plasminogen activator, cyangwa tPA muri make. Tekereza nk'urufunguzo rwihariye rufungura kandi rugasesa imigozi ya fibrin ifatanya amaraso. Bitandukanye n'imiti ushobora gufata mu rugo, alteplase itangwa gusa binyuze muri IV mu bitaro bikurikiranwa n'abaganga.

Uyu muti ni uwa itsinda ry'imiti yitwa thrombolytics, bisobanura mu buryo butaziguye "clot dissolvers." Igituma alteplase ikora neza cyane ni uko yagenewe kwibanda ku maraso by'umwihariko, aho kugira ingaruka ku mikorere yose y'amaraso yawe. Ariko, iracyafatwa nk'umuti ufite ibyago byinshi, ufite ingororano nyinshi bisaba gukurikiranwa neza.

Alteplase ikoreshwa kubera iki?

Alteplase ikoreshwa cyane cyane kubera ibibazo bitatu byugarije ubuzima aho amaraso ahagarika imikorere y'amaraso. Ikoreshwa cyane ni sitiroki ya ischemic, ibaho iyo amaraso ahagarika imikorere y'amaraso mu gice cy'ubwonko bwawe. Ikoreshwa kandi kubera gutera umutima guterwa n'amaraso mu miyoboro y'umutima, no kubera ibibazo byinshi bya pulmonary embolisms aho amaraso ahagarika imikorere y'amaraso mu muhaha wawe.

Itsinda ryawe ry’abaganga rishobora gukoresha alteplase kugira ngo risukure imiyoboro ya kateteri cyangwa imiyoboro ya IV yazibye, nubwo ibi bikubiyemo doze ntoya cyane ugereranije nizo bakoresha mu kuvura situroke cyangwa indwara y’umutima. Mu bihe bimwe na bimwe, abaganga barayikoresha mu kuvura thrombus yo mu mitsi yimbitse cyangwa izindi ndwara zikomeye zo gupfundika, ariko izi nshingano ntizikunze gukoreshwa kandi zisaba ibintu byihariye.

Alteplase ikora ite?

Alteplase ikora ikoresha sisitemu kamere y’umubiri wawe isesura amaraso yapfunditse, ariko ku muvuduko wihuse kandi wibanda. Iyo ufite amaraso yapfunditse, agizwe na poroteyine yitwa fibrin ikora nk'urushundura rushyira ibintu byose hamwe. Alteplase ihindura ikintu cyitwa plasminogen muri plasmin, hanyuma ikasenya urushundura rwa fibrin.

Iyi ifatwa nk'umuti ukomeye cyane kuko ukora vuba kandi ku buryo bukomeye. Nubwo iyi mbaraga ituma ikiza ubuzima mu bihe byihutirwa, bisobanura kandi ko hariho ibyago byinshi byo kuva amaraso. Uyu muti ubusanzwe utangira gukora mu minota mike nyuma yo kuwutanga, ibyiza byinshi bikagaragara mu isaha ya mbere.

Nkwiriye gufata alteplase nte?

Ntabwo uzifata alteplase wenyine - itangwa gusa n’abantu bafite ubumenyi mu by’ubuvuzi mu bitaro binyuze mu muyoboro wa IV. Uyu muti uza mu ifu abaganga cyangwa abaganga bavanga n’amazi atagira mikorobe mbere yo kuyiguha. Doze n'igihe biterwa rwose n'uburwayi bwawe bwihariye n'uburemere bw'umubiri wawe.

Mu kuvura situroke, abaganga ubusanzwe batanga alteplase mu masaha 3-4.5 nyuma yo gutangira kwerekana ibimenyetso, nubwo rimwe na rimwe ishobora gutangwa kugeza ku masaha 9 mu bihe byihariye. Ku mutima utera, idirishya ubusanzwe riri mu masaha 12. Ntabwo ukeneye guhangayika kuwufata hamwe n'ibiryo cyangwa amazi kuko ajya mu maraso yawe.

Mugihe cyo kuvurwa, uzakurikiranwa neza hamwe no gupima umuvuduko w'amaraso kenshi no gusuzuma imikorere y'imitsi. Itsinda ry’abaganga rizakurikirana ibimenyetso byose byo kuva amaraso cyangwa izindi ngorane muri ubu buryo.

Ndebera Igihe Nzagirira Alteplase?

Ubuvuzi bwa Alteplase akenshi ni igikorwa kimwe aho kuba umuti ukomeza gufatwa. Mu bibazo byinshi, uzahabwa urugero rwose mu minota 60-90 unyuze mu muyoboro wa IV. Iyo urwo rugero rurangije, umuti ukomeza gukora mu mubiri wawe amasaha menshi uko umubiri wawe ugitunganya.

Ingaruka za alteplase muri rusange zikunda kugaragara cyane mu masaha make ya mbere nyuma yo kuyitanga. Itsinda ryawe ry'abaganga rizakomeza kugukurikiranira byibuze amasaha 24 nyuma yo kuvurwa kugira ngo barebe niba hari izindi ngaruka zatinze cyangwa ibibazo, cyane cyane kuva amaraso.

Ni Iyihe Miterere ya Alteplase?

Ingaruka ikomeye ya alteplase ni kuva amaraso, bishobora kuva ku bito bikagera ku byica. Ibi bibaho kuko umuti ugira ingaruka ku bushobozi bw'amaraso yawe bwo kuvura, atari gusa ahari ikibazo ahubwo mu mubiri wawe wose. Kumva ibi byago bifasha kumenya icyo witegura n'igihe cyo kumenyesha itsinda ryawe ry'abaganga.

Ingaruka zisanzwe ushobora guhura nazo zirimo:

• Gukomeretswa ahantu ha IV cyangwa aho batera inshinge
• Kuva amaraso gake ku bikomere cyangwa ibikomere byoroheje
• Isesemi cyangwa kuribwa mu nda
• Urubanza ruto rw'umuriro
• Umutwe

Izi ngaruka zisanzwe akenshi zishobora gucungwa kandi zikaba iz'agateganyo, zigakemuka mu munsi umwe cyangwa ibiri nyuma yo kuvurwa.

Ingaruka zikomeye zisaba ubufasha bw'ubuvuzi bwihuse kandi zirimo:

• Kuva amaraso imbere mu nda, mu bwonko, cyangwa mu zindi ngingo
• Kuva amaraso cyane bitahagarara
• Ibimenyetso byo kuva amaraso mu bwonko nk'umutwe ukomeye utunguranye, urujijo, cyangwa impinduka mu iyerekwa
• Urugero rw'uburwayi bwo kwanga imiti hamwe no guhumeka bigoranye cyangwa kubyimba
• Kugabanuka gutunguranye kw'umuvuduko w'amaraso

Ibikomere bikeye ariko bikomeye bishobora kwibandaho harimo sitiroki iterwa no kuva amaraso mu bwonko, bibaho ku baganga bari hagati ya 3-7% bavurwa sitiroki. Izindi ngaruka bikeye zirimo allergie ikaze, ibibazo by'umutima, cyangwa kuva amaraso ahantu hatari hasanzwe nk'amaso cyangwa ingingo.

Ninde utagomba gufata Alteplase?

Ibyiciro byinshi bituma alteplase iba mbi cyane gukoreshwa, ndetse no mu bihe by'ubutabazi. Itsinda ryawe ry'abaganga rizasuzuma vuba amateka yawe y'ubuvuzi n'uburwayi bwawe bwa none kugirango bamenye niba alteplase ikugirira neza. Icyemezo akenshi kirimo gupima akaga gakomeye gahutaza ubuzima n'ibishobora gutera ibikomere bikomeye byo kuva amaraso.

Ntugomba guhabwa alteplase niba ufite:

• Kuva amaraso mu mubiri cyangwa kubagwa bikomeye vuba muri icyumweru 2
• Amateka yo kuva amaraso mu bwonko cyangwa ubwonko buzwi
• Umubyigano ukaze udakontrolwa w'amaraso (he above 180/110)
• Urukomere rwo mu mutwe rwa vuba cyangwa kubagwa mu bwonko muri amezi 3
• Gukoresha ubu imiti ituma amaraso atavura nka warfarin hamwe n'igihe kirekire cyo kuvura

Ibitekerezo byongerewe bishobora gutuma alteplase idakwiriye harimo kubyara vuba, ubwoko bumwe bwa kanseri, indwara ikaze y'umwijima, cyangwa amateka y'indwara zo kuva amaraso. Itsinda ryawe ry'abaganga rizareba kandi imyaka yawe, ubuzima muri rusange, n'imimerere yihariye y'uburwayi bwawe.

Amazina ya Alteplase

Alteplase izwi cyane nka Activase muri Leta Zunze Ubumwe z'Amerika. Mu bindi bihugu, ushobora kumva bavuga Actilyse. Iyi ni imiti imwe - recombinant tissue plasminogen activator - igurishwa munsi y'amazina atandukanye n'uruganda rumwe.

Tutitaye ku izina ry'ubwoko, ubwoko bwose bwa alteplase bukora kimwe kandi bufite ingaruka zimwe n'ibibazo bimwe. Uyu muti ukorwa na Genentech kandi uboneka mu bitaro ku isi hose munsi y'aya mazina atandukanye.

Uburyo bwa Alteplase

Imiti myinshi ivura ibibumbye by'amaraso rimwe na rimwe ishobora gukoreshwa mu mwanya wa alteplase, nubwo guhitamo biterwa n'uburwayi bwawe bwihariye n'uko bimeze. Izi nzira zindi zirimo tenecteplase (TNKase), reteplase (Retavase), na streptokinase, buri kimwe gifite imitungo itandukanye gato n'imikoreshereze.

Ku ndwara zimwe na zimwe, uburyo bwo gukuraho ibibumbye by'amaraso hakoreshejwe imashini bushobora kuba izindi nzira zo kuvura hakoreshejwe imiti. Ibi bikubiyemo gushyira igikoresho mu miyoboro y'amaraso yawe kugirango ukureho cyangwa umenagure ibibumbye by'amaraso. Itsinda ryawe ry'abaganga rishobora kandi gutekereza ku bindi byongera amaraso cyangwa imiti irinda ibibumbye by'amaraso, nubwo bikora mu buryo butandukanye kandi buhoro ugereranije na alteplase.

Gu hitamo uburyo bwo kuvura biterwa n'ibintu nk'igihe, aho ibibumbye by'amaraso biherereye, ubuzima bwawe muri rusange, n'icyo gihari ako kanya mu bitaro byawe. Mu bihe byinshi, alteplase ikomeza kuba uburyo bwa mbere bwo kuvura abantu bakwiriye.

Ese Alteplase iruta Tenecteplase?

Zombi alteplase na tenecteplase ni imiti ivura ibibumbye by'amaraso ifite akamaro, ariko ifite itandukaniro rikomeye. Tenecteplase ishobora gutangwa nk'urushinge rumwe aho gutangwa mu buryo buhoraho, ibyo bikaba byoroshya kuyitanga. Ubushakashatsi bumwe buvuga ko tenecteplase ishobora kuba ifite akamaro gato ku bwoko bumwe bwa sitiroko kandi ishobora kugira ibyago bike byo kuva amaraso.

Ariko, alteplase imaze igihe kinini ikoreshwa kandi ifite ubushakashatsi bwinshi bushingiye ku mikoreshereze yayo mu ndwara zitandukanye. Ibitaro byinshi bimenyereye amabwiriza ya alteplase, kandi ikomeza kuba uburyo busanzwe bwo kuvura mu bigo byinshi by'ubutabazi. Guhitamo hagati yabyo akenshi biterwa n'uko ubuzima bwawe buhagaze, amabwiriza y'ibitaro, n'uburambe bw'abaganga bawe.

Ubushakashatsi buheruka butanga icyizere ko kuri abarwayi benshi, tenecteplase ishobora kuba igisubizo cyiza, ariko imiti yombi ishobora kurokora ubuzima iyo ikoreshejwe neza. Itsinda ryawe ry'abaganga rizagena igisubizo cyiza hashingiwe ku miterere yawe bwite n'ibiboneka mu kigo kivurirwamo.

Ibikunze Kubazwa ku bijyanye na Alteplase

Ese Alteplase irakwiriye ku bantu barwaye diyabete?

Yego, kurwara diyabete ntibibuza umuntu guhabwa alteplase, ariko bisaba kwitondera by'umwihariko. Abantu barwaye diyabete bashobora kugira ibindi bibazo nk'umuvuduko ukabije w'amaraso cyangwa ibibazo by'impyiko bishobora kugira ingaruka ku gukomera kw'amaraso. Itsinda ryawe ry'abaganga rizagenzura neza ubuzima bwawe muri rusange, uko isukari mu maraso yawe yifashe, n'ibibazo byose bifitanye isano na diyabete mbere yo gufata icyemezo cyo kuvura.

Niba ufite indwara ya retinopathy ya diyabete (ibibazo by'amaso biturutse kuri diyabete), ibi bishobora kongera ibyago byo kuva amaraso mu maso. Abaganga bawe bazagereranya ibyo byago n'akaga gahita kava ku gukomera kw'amaraso yawe kugira ngo bafate icyemezo cyiza ku miterere yawe.

Nigomba gukora iki niba mbonye alteplase nyinshi mu buryo butunganye?

Kubera ko alteplase itangwa gusa n'abantu b'inzobere mu by'ubuvuzi mu bitaro, ntuzabona nyinshi mu buryo butunganye. Ariko, niba hari ikosa ryakozwe mu miti, itsinda ryawe ry'abaganga ryatojwe guhita ryitaba. Bazahagarika gutera urushinge, bakurikirane neza ibimenyetso byo kuva amaraso, kandi bashobora gutanga imiti ifasha amaraso yawe gukomera bisanzwe.

Ibitaro bishobora kugufata neza by'umwihariko byibuze amasaha 24, bigenzura imikorere y'amaraso yawe kenshi kandi bareba ibimenyetso byose byo kuva amaraso imbere. Mu bihe bikomeye, bashobora gukenera kuguha ibicuruzwa by'amaraso cyangwa indi miti yo guhindura ingaruka.

Nigomba gukora iki niba ntashe urugero rwa alteplase?

Iki kibazo ntikireba neza alteplase kuko atari umuti ufata buri gihe uri mu rugo. Alteplase itangwa nk'umuti w'ubutabazi umwe rukumbi mu bitaro. Iyo umaze guhabwa urugero rwose, ubuvuzi burarangira, kandi ntuzongera gukenera izindi doze.

Niba hari impamvu iyo ari yo yose ituma alteplase yawe ihagarara mugihe cy'ubuvuzi, itsinda ryawe ry'abaganga rizagena niba byemewe kongera gutangira cyangwa niba hakenewe ubundi buvuzi. Iyi myanzuro ishingiye ku rugero umaze guhabwa n'uko umeze ubu.

Nshobora guhagarika ryari gufata Alteplase?

Ntuhagarika gufata alteplase mu buryo busanzwe kuko ni ubuvuzi bumwe butangwa mu minota 60-90. Iyo gushyirwa mu mubiri kurangije, umuti ugenda uva mu mubiri wawe buhoro buhoro mu masaha make akurikira. Itsinda ryawe ry'abaganga rifata umwanzuro wo kurangiza ubuvuzi hashingiwe ku rugero rwategetswe n'uburyo wabyitwayemo.

Mu bihe bidasanzwe, abaganga bashobora gukenera guhagarika gushyirwa mu mubiri kwa alteplase kare niba ugize ibibazo bikomeye byo kuva amaraso cyangwa ibimenyetso by'uburwayi. Uyu mwanzuro ufatwa n'itsinda ryawe ry'abaganga hashingiwe ku mutekano wawe wihuse n'uburyo wabyitwayemo ku buvuzi.

Nshobora gufata imiti ituma amaraso atavura nyuma yo kuvurwa na Alteplase?

Niba ushobora gufata imiti ituma amaraso atavura nyuma ya alteplase biterwa n'uburwayi bwawe bwihariye n'uburyo wabyitwayemo ku buvuzi. Itsinda ryawe ry'abaganga rizategereza byibuze amasaha 24 nyuma ya alteplase mbere yo gutangira imiti iyo ari yo yose ituma amaraso atavura kugirango bagabanye ibyago byo kuva amaraso.

Abantu benshi bakomeza gufata imiti ituma amaraso atavura nka aspirine, clopidogrel, cyangwa warfarin kugirango birinde ibindi byivumbagatanya, ariko igihe n'ubwoko bw'umuti biterwa n'uko umuntu ahagaze. Abaganga bawe bazagenzura neza icyo bakeneye kugirango birinde ibindi byivumbagatanya ku bijyanye n'ibyago bikomeje byo kuva amaraso kuva ku buvuzi bwa alteplase.