{"id":8416,"date":"2013-06-21T15:58:01","date_gmt":"2013-06-21T15:58:01","guid":{"rendered":""},"modified":"2021-09-24T06:57:02","modified_gmt":"2021-09-24T08:57:02","slug":"isemines-kilmes-sirdies-nepakankamumas-geriausio-gydymo-paieskos","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/isemines-kilmes-sirdies-nepakankamumas-geriausio-gydymo-paieskos\/8416\/","title":{"rendered":"I\u0161emin\u0117s kilm\u0117s \u0161irdies nepakankamumas: geriausio gydymo paie\u0161kos"},"content":{"rendered":"<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!-- [if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:PunctuationKerning\/>\n  <w:ValidateAgainstSchemas\/>\n  <w:SaveIfXMLInvalid>false<\/w:SaveIfXMLInvalid>\n  <w:IgnoreMixedContent>false<\/w:IgnoreMixedContent>\n  <w:AlwaysShowPlaceholderText>false<\/w:AlwaysShowPlaceholderText>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n   <w:DontGrowAutofit\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!-- [if gte mso 9]><xml>\n <w:LatentStyles DefLockedState=\"false\" LatentStyleCount=\"156\">\n <\/w:LatentStyles>\n<\/xml><![endif]--><!-- [if gte mso 10]>\n\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";\n\tmso-ansi-language:#0400;\n\tmso-fareast-language:#0400;\n\tmso-bidi-language:#0400;}\n<\/style>\n\n\n\n<![endif]--> <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Epidemiologini\u0173 tyrim\u0173 duomenimis, \u0161irdies nepakankamumu (\u0160N) serga 2,2 proc. pasaulio gyventoj\u0173, Europoje \u0161i patologija diagnozuota 15 mln., o Jungtin\u0117se Amerikos Valstijose \u2013 5 mln. \u017emoni\u0173. \u0160N sergan\u010di\u0173 vyr\u0173 ir moter\u0173 santykis vienodas. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">\u0160iaur\u0117s Amerikoje ir Europoje kiekvienais metais d\u0117l pirm\u0105 kart\u0105 diagnozuoto \u0160N \u012f ligonines paguldoma per 2 mln. \u017emoni\u0173, 15 proc. j\u0173 \u0160N b\u016bna \u016bminis, 5 proc. asmen\u0173 hospitalizuojami d\u0117l \u012fsisen\u0117jusio ar \u012fprastiniam gydymui atsparaus \u0160N.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">\u0160N plitim\u0105, ypa\u010d pa\u017eangios ekonomikos \u0161alyse, lemia keletas aplinkybi\u0173:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">ilg\u0117janti vidutin\u0117 gyvenimo trukm\u0117 (senstant \u0160N da\u017enumas did\u0117ja: 80\u201390 m. grup\u0117je \u0160N paplitimas 10 kart\u0173 didesnis negu 50\u201359 m.);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">tobul\u0117janti klinikin\u0117 medicina (daugelis anks\u010diau mirtin\u0173 \u0161irdies ir kraujagysli\u0173 sistemos lig\u0173 (\u0160KL) dabar efektyviai gydomos vaistais ar chirurgi\u0161kai, tod\u0117l pacientai lieka gyvi, bet j\u0173 \u0161irdies veikla esti sutrikusi);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">\u0161ird\u012f \u017ealojan\u010di\u0173 med\u017eiag\u0173 (ypa\u010d narkotik\u0173, kokaino, nikotino, alkoholio ir kt.) vartojimas.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">\u0160N klini\u0161kai pasirei\u0161kia \u0161irdies sistolin\u0117s ir (arba) diastolin\u0117s funkcijos sutrikimu, da\u017eniausiai sutrinka kairiojo, did\u017eiausio ir aktyviausiais dirban\u010dio, \u0161irdies skilvelio (KS) funkcija. Sistolin\u0117s funkcijos sutrikimas pasirei\u0161kia:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">sutrikusia \u0161irdies raumens kontrakcija (silpnesniais susitraukimais); <\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">suma\u017e\u0117jusia KS i\u0161st\u016bmimo frakcija (IF), suma\u017e\u0117jusiu sistoliniu, o da\u017enai ir minutiniu kraujo t\u016briu (d\u0117l to pablog\u0117ja ir periferin\u0117 kraujotaka, organ\u0173 mityba).<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span lang=\"LT\" style=\"line-height: 150%;\">Adrenergin\u0117s blokados nauda<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Nustatyta, kad \u0160N progresuojant aktyv\u0117ja renino angiotenzino ir simpatin\u0117 adrenergin\u0117 nerv\u0173 sistemos. Gydant \u0160N efektyvu \u0161ias sistemas blokuoti vaistais \u2013 angiotenzin\u0105 konvertuojan\u010dio fermento inhibitoriais (AKFI) ir beta adrenoblokatoriais (BAB). Vis d\u0117lto duomenys apie BAB naud\u0105 gydant L\u0160N, \u012ftak\u0105 sergamumui ir mir\u0161tamumui n\u0117ra vienareik\u0161mi\u0161ki, o kartais net prie\u0161taringi. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Moksliniais klinikiniais tyrimais visi\u0161kai \u012frodyta BAB nauda gydant l\u0117tin\u0119 stabili\u0105kr\u016btin\u0117s angin\u0105, taip pat taikant antrin\u0119 profilaktik\u0105 apsaugoti nuo i\u0161emini\u0173 komplikacij\u0173 ir mirties po miokardo infarkto. Kadangi l\u0117tin\u0117 miokardo i\u0161emija yra viena svarbiausi\u0173 ir da\u017eniausi\u0173 L\u0160N prie\u017eas\u010di\u0173, logi\u0161kai manyti, kad i\u0161emine \u0161irdies lig\u0105 gydant BAB galima kontroliuoti L\u0160N simptomus bei progresavim\u0105. Tuo po\u017ei\u016briu didel\u012f tyr\u0117j\u0173 susidom\u0117jim\u0105 kelia naujos kartos vazodilatacinis beta adrenoblokatorius nebivololis (<em style=\"mso-bidi-font-style: normal;\"><a href=\"https:\/\/pasveik.lt\/vaistai\/35311\/nebilet\/\">Nebilet<\/a><\/em>), pasi\u017eymintis labai selektyvia beta 1 receptori\u0173 blokada ir unikalia savybe skatinti azoto monoksido (NO) sintez\u0119 kraujagysli\u0173 endotelyje. D\u0117l didelio vaisto selektyvumo nepasirei\u0161kia neigiamas inotropinis poveikis, ypa\u010d \u017ealingas esant L\u0160N, o padid\u0117j\u0119s NO i\u0161siskyrimas lemia sistemin\u012f periferini\u0173 arterioli\u0173 i\u0161sipl\u0117tim\u0105, arterinio kraujosp\u016bd\u017eio ir periferinio pasiprie\u0161inimo suma\u017e\u0117jim\u0105, trombocit\u0173 ir leukocit\u0173 agregacijos silpn\u0117jim\u0105, o tai gerina sutrikusi\u0105 KS funkcij\u0105. Svarbu ir tai, kad nebivololis, ne taip kaip kiti BAB, aktyviai ma\u017eina centrin\u012f kraujo spaudim\u0105, kuris laikomas reik\u0161mingu L\u0160N ir kit\u0173 \u0160KL patofiziologijos veiksniu.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span lang=\"LT\" style=\"line-height: 150%;\">Nebivololis \u2013 papildomas antii\u0161eminis poveikis<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Nebivololio nauda sergant L\u0160N pirm\u0105 kart\u0105 patikimai \u012frodyta tyrim\u0173 programoje SENIORS (angl. <em style=\"mso-bidi-font-style: normal;\">Study of the Effects of Nebivolol Intervention on Outcomes and Hospitalisation in Seniors with Heart Failure<\/em>). Nustatyta, kad L\u0160N sergantiems pacientams (70 met\u0173 ar vyresniems) prie standartinio gydymo prid\u0117jus nebivololio reik\u0161mingai suma\u017e\u0117jo bendras mirties nuo vis\u0173 prie\u017eas\u010di\u0173 ir hospitalizavimo d\u0117l \u0160KL rodiklis. Nebivololio nauda nepriklaus\u0117 nuo KS IF prie\u0161 gydym\u0105.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Esant i\u0161emin\u0117s kilm\u0117s L\u0160N (miokardo pa\u017eeidimui serganti i\u0161emine \u0161irdies liga), vazodilatacinio BAB nebivololio, NO sintez\u0117s stimuliatoriaus, nauda tur\u0117t\u0173 b\u016bt\u0173 i\u0161skirtin\u0117, nes NO yra galinga vazodilatacin\u0117 med\u017eiaga: i\u0161pl\u0117sdamas vainikines arterijas ir slopindamas trombocit\u0173 bei leukocit\u0173 agregacij\u0105, NO pagerina miokardo hemodinamik\u0105 ir ma\u017eina i\u0161emij\u0105. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><em style=\"mso-bidi-font-style: normal;\"><span lang=\"LT\" style=\"line-height: 150%;\">SENIORS tyrimo duomenys<\/span><\/em><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Giuseppe Ambrosio su bendradarbiais, remdamiesi SENIORS tyrimo duomenimis, analizavo, ar gydymas nebivololiu gali suma\u017einti miokardo i\u0161emijos epizod\u0173 da\u017enum\u0105 sergant i\u0161emin\u0117s kilm\u0117s L\u0160N. Analiz\u0117s i\u0161vados labai patikimos, nes gr\u012fstos daugiacentrinio atsitiktini\u0173 im\u010di\u0173 dvigubai aklo tyrimo duomenis, gautais lyginant papildom\u0105 nebivololio ir placebo poveik\u012f L\u0160N pacientams, iki tol gavusiems standartin\u012f gydym\u0105. SENIORS tyrime dalyvavo 2128 L\u0160N sergantys 70 met\u0173 ir vyresni pacientai, per pra\u0117jusius 12 m\u0117nesi\u0173 bent kart\u0105 hospitalizuoti d\u0117l \u0160N arba kuri\u0173 KS IF buvo 35 proc. arba ma\u017eesn\u0117. 1067 i\u0161 j\u0173 vartojo nebivolol\u012f, 1061 \u2013 placeb\u0105. Per pirm\u0105sias 4\u201316 tyrimo savai\u010di\u0173 nebivololio paros doz\u0117 buvo titruojama pagal poveik\u012f nuo 1,25 mg iki 10 mg.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">I\u0161 SENIORS tyrime dalyvavusi\u0173 pacient\u0173 68,2 proc. (n = 1452) tur\u0117jo dokumentuot\u0105 i\u0161emin\u0117s \u0161irdies ligos istorij\u0105, apie 90 proc. tyrimo dalyvi\u0173 sirgo II arba III funkcin\u0117s klas\u0117s \u0160N (pagal N\u0160A). Apie 50 proc. pacient\u0173, vartojusi\u0173 nebivololio arba placeb\u0105, buvo patyr\u0119 miokardo infarkt\u0105, sirgo arterine hipertenzija arba tur\u0117jo dislipidemij\u0105. Daugiau kaip 90 proc. tyrimo dalyvi\u0173 iki SENIORS tyrimo buvo gydomi AKF inhibitoriumi ir diuretiku.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Svarbiausios SENIORS tyrimo analiz\u0117s i\u0161vados: <\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">gydant nebivololiu, miokardo i\u0161emijos epizod\u0173 da\u017enumas buvo reik\u0161mingai ma\u017eesnis (placebo grup\u0117je j\u0173 buvo 15,9 proc. pacient\u0173, o nebivololio grup\u0117je \u2013 10,7 proc. pacient\u0173);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">kr\u016btin\u0117s anginos epizod\u0173 da\u017enumas suma\u017e\u0117jimas gydant nebivololiu buvo statisti\u0161kai reik\u0161mingas netgi atmetus kitus veiksnius (paciento am\u017ei\u0173, lyt\u012f, KS IF skirtumus ir kt.), gal\u0117jusius tur\u0117ti \u012ftakos i\u0161emijos epizod\u0173 atsiradimui;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">nebivololio prana\u0161umas ma\u017einant i\u0161emijos epizod\u0173 da\u017enum\u0105 i\u0161ry\u0161k\u0117jo grei\u010diau nei per 6 m\u0117nesius nuo tyrimo prad\u017eios ir toliau vis did\u0117jo;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">gydant nebivololiu, reik\u0161mingai suma\u017e\u0117jo pacient\u0173, sergan\u010di\u0173 i\u0161emin\u0117s kilm\u0117s \u0160N, staigios mirties rizika;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">sunki\u0173 \u0160KL komplikacij\u0173 (jungtinis hospitalizavimo d\u0117l miokardo infarkto ar nestabilioskr\u016btin\u0117s anginos ir mirties nuo j\u0173 rodiklis) placebo grup\u0117je patyr\u0117 8,4 proc., o nebivololio grup\u0117je \u2013 3,1 proc. pacient\u0173.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Gydymo nebivololiu nauda buvo akivaizdi visuose sergan\u010di\u0173 i\u0161emin\u0117s kilm\u0117s \u0160N pogrupiuose, t. y. nepriklaus\u0117 nuo paciento lyties, KS IF, gretutinio cukrinio diabeto.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Nebivololis efektyviau negu placebas suma\u017eino i\u0161emijos epizod\u0173 rizik\u0105 pacientams, sergantiems dokumentuota i\u0161emine \u0161irdies liga:kr\u016btin\u0117s anginos epizod\u0173 patyr\u0117 30,3 nebivolol\u012f vartojusi\u0173 pacient\u0173 ir 34,5 proc. \u2013 placeb\u0105, t. y. nebivololis rizik\u0105 suma\u017eino 4,2 proc.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Pacientams, sergantiems nei\u0161emin\u0117s kilm\u0117s L\u0160N (<a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/isemine-sirdies-liga\/4518\">i\u0161emin\u0117 \u0161irdies liga<\/a> nedokumentuota), nebivololio nauda nebuvo akivaizdi. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">BAB, \u012fskaitant nebivolol\u012f, efektyv\u016bs L\u0160N, kai yra suma\u017e\u0117jusi KS IF, gydyti. SENIORS tyrimas \u012frod\u0117, kad vazodilatacinis BAB nebivololis naudingas tais atvejais, kai, sergant L\u0160N, KS IF i\u0161likusi patenkinama (35 proc. ar daugiau). <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">BAB tiesiogiai slopina adrenergin\u0117s, o netiesiogiai \u2013 renino angiotenzino sistem\u0173 aktyvum\u0105, tod\u0117l stabdo \u0160N atsiradim\u0105 ir progresavim\u0105, patologin\u0119 \u0161irdies remodeliacij\u0105. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Daugeliu patikim\u0173 klinikini\u0173 tyrim\u0173 (CAPRICORN, COPERNICUS, COMET, BEST, MERIT-HF ir kt.) \u012frodyta, kad BAB reik\u0161mingai pagerina i\u0161gyvenamum\u0105 ir suma\u017eina hospitalizavimo da\u017enum\u0105 sergant i\u0161emin\u0117s kilm\u0117s \u0160N, taip pat suma\u017eina mir\u0161tamum\u0105 ir pakartotinio infarkto rizik\u0105 po patirto miokardo infarkto. Pavyzd\u017eiui, MERIT-HF duomenimis, gydymas BAB 40 proc. suma\u017eino bendr\u0105j\u012f mir\u0161tamum\u0105 pacient\u0173, patyrusi\u0173 miokardo infarkt\u0105. Iki \u0161iol ma\u017eiau buvo tyrin\u0117ta, kaip gydymas BAB veikiakr\u016btin\u0117s anginos epizod\u0173 da\u017enum\u0105 sergant i\u0161emin\u0117s kilm\u0117s L\u0160N.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Apsaugoti L\u0160N ligonius nuo miokardo i\u0161emijos ar bent suma\u017einti i\u0161emijos epizod\u0173 da\u017enum\u0105 labai svarbu siekiant pagerinti \u0161i\u0173 pacient\u0173 i\u0161gyvenamum\u0105 ir prognoz\u0119, nes<span class=\"msoDel\"><del cite=\"mailto:User\" datetime=\"2012-05-07T10:21\">:<\/del><\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">\u016bmin\u0117 miokardo i\u0161emija \u2013 svarbiausia ir da\u017eniausia gyvybei gr\u0117sming\u0173 ar net mirtin\u0173 aritmij\u0173 sergant L\u0160N prie\u017eastis<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T10:21\">.<\/ins><\/span><span class=\"msoDel\"><del cite=\"mailto:User\" datetime=\"2012-05-07T10:21\">;<\/del><\/span><\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"disc\">\n<li class=\"MsoNormal\" style=\"text-align: justify; text-indent: -18.0pt !msorm; line-height: 150%; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; mso-layout-grid-align: none; text-autospace: none; mso-prop-change: Rita 20120507T1320; margin: 0cm !msorm 0cm !msorm .0001pt 36.0pt !msorm;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">I\u0161emin\u0117s kilm\u0117s L\u0160N<\/span><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">\u0161\u012f beta 1 receptoriams selektyv\u0173, centrin\u012f kraujosp\u016bd\u012f aktyviai veikiant\u012f ir antioksidacin\u012f efekt\u0105 sukeliant\u012f vaist\u0105<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T11:36\">,\u00a0<\/ins><\/span>pagerina<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T11:36\">ma<\/ins><\/span> vainikinir periferin<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T11:36\">\u0117<\/ins><\/span> kraujotak<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T11:36\">a<\/ins><\/span>, slopina<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T11:37\">ma<\/ins><\/span> trombocit\u0173 agregacij<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T11:37\">a<\/ins><\/span>, palankiai veikia<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T11:37\">ma<\/ins><\/span> lipid\u0173 ir gliukoz\u0117s pusiausvyra <\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none; mso-prop-change: Rita 20120507T1320;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Nustatyta, kad nebivololis skatina NO sintez\u0119 endotelyje, aktyvindamas beta 3 adrenoreceptorius ir ferment\u0105 NO sintaz\u0119. Veikiant nebivololiui, pailg\u0117ja NO aktyvumo periodas ir antioksidacinio poveikio trukm\u0117. Tai suteikia nebivololiui papildomo antii\u0161eminio paj\u0117gumo. Kiti BAB, \u012fskaitant naujuosius, tokiu poveikiu nepasi\u017eymi, tod\u0117l, tik\u0117tina, j\u0173 antii\u0161eminis poveikis gali b\u016bti ne toks ry\u0161kus.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none; mso-prop-change: Rita 20120507T1320;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Naujausi tyrimai rodo, kad, gydant nebivololiu, miokardas geriau prisitaiko funkcionuoti i\u0161emijos s\u0105lygomis, tod\u0117l lengviau pakelia i\u0161emijos epizodus. Tai susij\u0119 su savito antioksidacinio rezervo susidarymu miokarde trump\u0173 i\u0161emijos epizod\u0173 metu. Pana\u0161\u016bs procesai vyksta i\u0161emine \u0161irdies liga sergantiems pacientams skyrus NO donor\u0173 arba vaist\u0173, gerinan\u010di\u0173 NO panaudojim\u0105 miokardo reikm\u0117ms. Veikiant nebivololiui susidar\u0119s antioksidacinis rezervas (su NO susij\u0119s fenomenas) apsaugo miokardo l\u0105steles nuo nekroz\u0117s \u016bmini\u0173 i\u0161emini\u0173 sindrom\u0173 metu ir po vainikin\u0117s angioplastikos. Tod\u0117l gydant nebivololiu net<span class=\"msoIns\"><ins cite=\"mailto:User\" datetime=\"2012-05-07T10:20\">ik<\/ins><\/span> efektyviai slopinami miokardo i\u0161emijos simptomai, bet ir nuo i\u0161emini\u0173 pa\u017eeidim\u0173 geriau apsaugomas \u0161irdies raumuo.\u00a0 <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%; mso-layout-grid-align: none; text-autospace: none;\"><span lang=\"LT\" style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\">Pareng\u0117 dr. R. Zaleckis<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:PunctuationKerning\/>\n  <w:ValidateAgainstSchemas\/>\n  <w:SaveIfXMLInvalid>false<\/w:SaveIfXMLInvalid>\n  <w:IgnoreMixedContent>false<\/w:IgnoreMixedContent>\n  <w:AlwaysShowPlaceholderText>false<\/w:AlwaysShowPlaceholderText>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n   <w:DontGrowAutofit\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if gte mso 9]><xml>\n <w:LatentStyles DefLockedState=\"false\" LatentStyleCount=\"156\">\n <\/w:LatentStyles>\n<\/xml><![endif]--><!--[if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";\n\tmso-ansi-language:#0400;\n\tmso-fareast-language:#0400;\n\tmso-bidi-language:#0400;}\n<\/style>\n\n\n<![endif]--> <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Epidemiologini\u0173 tyrim\u0173 duomenimis, \u0161irdies nepakankamumu (\u0160N) serga 2,2 proc. pasaulio gyventoj\u0173, Europoje \u0161i patologija diagnozuota 15 mln., o Jungtin\u0117se Amerikos Valstijose \u2013 5 mln. \u017emoni\u0173. \u0160N sergan\u010di\u0173 vyr\u0173 ir moter\u0173 santykis vienodas. <\/span><\/p>\n","protected":false},"author":1,"featured_media":8417,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[1081,1798,751,1113],"site":[],"post_item_type":[27345],"class_list":["post-8416","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-gydant-nebivololiu","tag-krutines-anginos","tag-placebo","tag-sirdies-liga"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8416","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=8416"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8416\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/8417"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=8416"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=8416"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=8416"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=8416"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=8416"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}