BO’LMACHALAR FIBRILLYATSIYASI VA ISHEMIK YURAK KASALLIGI BILAN OG'IRGAN BEMORLARDA ANTITROMBOTSITAR TERAPIYA ASPEKTLARI(SHARH)
Keywords:
ishemik yurak kasalligi; bo’lmachalar fibrillyatsiyasi; profilaktika; antitrombotsitar terapiya.Abstract
Ishemik yurak kasalligi yurak-qon tomir kasalliklari orasida eng keng tarqalgan bo'lib, bo’lmachalar fibrillyatsiyasi esa yurak ritmini buzilishining eng ko'p uchraydigan turi hisoblanadi. Ushbu patologiyalar umumiy xavf omillariga ega, bular gipertoniya, qandli diabet, uyqu apnoesi, ortiqcha vazn va chekishni o'z ichiga oladi. Bundan tashqari, yallig'lanish ham har ikkala kasallikning rivojlanishida muhim rol o'ynaydi. Bo’lmachalar fibrillyatsiyasi bilan og'rigan bemorlarda ishemik yurak kasalligi tarqalish tezligi 17 dan 46,5 foizgacha bo'lsa, ishemik yurak kasalligi bo'lgan bemorlarda bo’lmachalar fibrillyatsiyasi tarqalishi past bo'lib, faqatgina 0,2–5% ni tashkil etadi. Bo’lmachalar fibrillyatsiyasi – o'tkir miokard infarkti bilan og'rigan bemorlarda qisqa muddatli va uzoq muddatli yomon prognozning yaxshi ma'lum bo'lgan faktori bo'lib, bu umumiy o'lim ko'rsatkichining sezilarli darajada oshishiga olib keladi. Yurak ritmining buzilishi yurakdagi operatsiyalardan keyin kam uchramaydi va aortokoronar shuntlash operatsiyasidan keyin taxminan 30–40% bemorlarda yuzaga keladi. Taxminan 5–15% holatlarda bo’lmachalar fibrillyatsiyasida koronar arteriyalarni stentlash zarurati tug'iladi va shu bilan birga, aspirinni, klopidogrelni yoki tikagrelorni va peroral antikoagulyantni o'z ichiga olgan uch tomonlama terapiya talab qilinadi. Bu juda ehtiyotkorlik bilan muvozanatli antitrombotsitar terapiyani ko'rib chiqishni talab qiladi, chunki qon ketish xavfi yuqori, insult va stent trombozi xavfi va keyingi o'tkir koronar sindrom kuzatilishi mumkin. Peroral antikoagulyantlar va antiagregantlar, ayniqsa uch tomonlama terapiya birgalikda qo'llanilishi jiddiy qon ketishi xavfini sezilarli darajada oshiradi. Bundan tashqari, og'ir qon ketishi o'tkir koronar sindromdan keyin salbiy natijalar xavfini besh baravar oshiradi. Bo’lmachalar fibrillyatsiyasi va ishemik yurak kasalligi mavjudligi prognozni yomonlashtiradi, hatto ehtiyotkorlik bilan davolash olib borilgan bemorlarda ham.
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