Cardiac glycosides yog cov tshuaj mob plawv thiab tshuaj tiv thaiv arrhythmic ntawm cov nroj tsuag keeb kwm. Txawm hais tias ntuj muaj pes tsawg leeg, lawv yuav tsum tau siv nrog ceev faj heev. Raws li kev txheeb cais, glycoside intoxication tshwm sim hauv 25% ntawm cov neeg mob uas siv cov tshuaj uas muaj digoxin ua cov tshuaj nquag. Xws li ib tug siab feem pua yog vim lub peculiarities ntawm cov tshuaj cov qauv thiab cov pharmacological kev txiav txim ntawm cov tshuaj. Kab lus yuav piav qhia txog cov tsos mob, kev kuaj mob thiab kev tiv thaiv ntawm glycoside intoxication. Kev kho lub plawv dhia thiab lwm yam txawv txav yuav raug txiav txim siab.
YGlycosides
Cov tshuaj organic uas muaj cov carbohydrate residue thiab aglycone yog glycosides (heterosides). Yeej, cov no yog crystalline los yog condensed tshuaj nrog zoo solubility hauv cawv thiab dej.
Cov tshuaj muaj dav dav hauv cov xwm txheej, feem ntau hauvcog ntiaj teb. Lawv kuj tau txais synthetically. Ntau cov heterosides muaj tshuaj lom, ua rau muaj kev nce lossis txo qis hauv qee lub cev ua haujlwm. Nyob rau hauv glycoside molecules, furanoside thiab pyranoside residues yog txuas mus rau lub pharmacologically active ib feem ntawm cov tshuaj los ntawm aglycone los ntawm O, N, S, thiab C atoms.
- O-glycosides yog qab zib derivatives uas cov hydrogen atom hloov los ntawm carbocyclic compound radicals uas tsis muaj aromatic bonds los yog heterocyclic compounds. Raws li qhov xwm txheej ntawm cov tshuaj pharmacological, cov tshuaj tau muab faib ua cerebrosides, cardiac glycosides, nitrogen-muaj, glycoalkoloids.
- N-glycosides yog derivatives ntawm thawj glycosylamine.
- S-glycosides yog thioglycosides, derivatives ntawm I-thiosaccharins. Hauv qhov xwm txheej, lawv pom muaj ntau ntau hauv cov mustard dub.
- С-glycosides - demethylated qabzib oxide. Nws muaj zog immunomodulatory nyhuv. Tsis zoo li lwm pawg, C-glycosides tsis muaj peev xwm ntawm hydrolysis.
Kev faib tawm ntawm cov tshuaj glycosides
Systematize cov tshuaj raws li cov qauv tshuaj ntawm aglycones.
- Cyanogenic - glycosides ntawm qee yam cyanogenic cawv thiab ketones uas tso tawm hydrocyanic acid thaum lub sij hawm hydrolysis. Pom muaj nyob rau hauv apricots, txiv duaj, almonds.
- Saponins yog cov organic tsis muaj nitrogen nrog cov khoom ua haujlwm saum npoo av. Lawv siv los ua expectorants, tonics, sedatives.
- Anthraglycosides yog cov khoom siv ntuj tsim uas muaj li aglyconeCov tshuaj anthracene derivatives.
- Cardiac glycosides yog cov tshuaj nrog cardiotonic thiab antiarrhythmic zog. Hauv cov koob tshuaj loj, cov tshuaj ua tshuaj lom thiab ua rau glycoside intoxication. Cov tsos mob ntawm kev ua xua yog nyob ntawm qhov kev ua ntawm cov tshuaj ntawm myocardium.
Kev mob plawv glycosides: kev piav qhia dav dav
Cov tshuaj Cardiotonic hu ua cardiac glycosides. Nyob rau hauv cov xwm, cov tshuaj no muaj nyob rau hauv cov nroj tsuag ntawm buttercup, kutra, legume, lily tsev neeg, raws li zoo raws li nyob rau hauv daim tawv nqaij lom ntawm ib co hom ntawm toads.
Cov kev npaj siv dav tshaj plaws yog foxglove ("Digitoxin", "Digoxin", "Celanin"), strophanthus ("Karglikon"), adonis ("Adonizide"). Cardiac glycosides muaj kev xaiv ntawm myocardium, ua rau muaj kev nce siab hauv plawv, thiab txo lub plawv dhia.
Cov txiaj ntsig zoo inotropic vim qhov nce ntawm calcium cov ntsiab lus hauv cardiomyocytes. Qhov no ua rau muaj kev cuam tshuam ntawm sodium-calcium metabolism, nyob rau hauv uas ib qho calcium ion raug tso tawm los ntawm cardiomyocyte pauv rau peb sodium ions. Raws li qhov tshwm sim, cov ntsiab lus calcium hauv cytosol ntawm ntau ntawm myocardium nce, thiab kev ua haujlwm ntawm kev cog lus nce.
Thaum pom cov koob tshuaj kho mob, cov teebmeem no tshwm sim. Tsawg conductivity (dromotropic nyhuv) thiab nce excitability ntawm lub plawv system, tshwj tsis yog rau lub sinus node (batmotropic nyhuv). yog cov cim qhia ntawm glycoside intoxication. Cov tsos mob ntawm kev lom yog nyob ntawm qhov concentration ntawm cov tshuaj, ntawm homaglycone.
Kev mob ntshav siab
Raws li txoj cai, qhov mob hnyav no yog tshwm sim los ntawm cov tshuaj lom ntawm lub plawv glycosides. Cov txheej txheem ntawm cov kab mob pathological yog mob, daim ntawv mob ntev tsis tau pom. Lub pathogenesis ntawm glycoside intoxication tej zaum yuav yog vim ib tug overdose los yog ib tug txawv txav teb ntawm lub cev rau kev kho koob tshuaj vim muaj ntau yam pathologies.
Lub cev khaws ntau cov sodium thiab calcium. Hauv cov koob tshuaj me me, lub plawv glycosides xyaum tsis hloov qhov loj ntawm lub peev xwm so, thiab ntawm kev siv tshuaj ntau ntxiv, lawv txo qis heev. Nyob rau hauv cov ntaub ntawv ntawm kev lom, lub automatism ntawm cov nodes, bundles thiab fibers ntawm lub plawv nce, uas pab mus rau lub manifestation ntawm ectopic kev ua si.
Cov tsos mob ntawm glycoside intoxication
Kev tshwm sim ntawm cov tshuaj lom tuaj yeem ua rau mob plawv thiab tsis mob plawv. Thawj yog tus cwj pwm los ntawm cov nyhuv ntawm cov tshuaj ntawm myocardium. Qhov thib ob - neurological thiab gastrointestinal mob. Cov tsos mob ntawm glycoside intoxication suav nrog:
- Non-paroxysmal tachycardia.
- Polytopic ventricular tachycardia.
- Txo lub plawv dhia (tsawg dua 60 tus neeg ntaus ib feeb).
- Sinus arrhythmia.
- Kev mob plawv tsis ua hauj lwm.
- Myocardial conduction tsis ua haujlwm.
- Stop the sinus node.
- kiv taub hau nrog mob.
- Kev tsis pom kev tsis pom kev.
- Insomnia.
- Delirious Syndrome (delirium tremens, kub taub hau).
- Anorexia.
- Nausea.
- mob plab plab.
- Stool disorder.
Tsis tshua muaj teeb meem suav nrog:
- Gynecomastia yog ib qho kev loj hlob ntawm cov qog mammary nrog kev nce ntawm cov ntaub so ntswg adipose.
- Kev tsis haum tshuaj tshwm sim ntawm daim tawv nqaij.
- Immune thrombocytopenia.
Vim li cas cov tshuaj pib ua yeeb yam li tshuaj lom
Qhov laj thawj tseem ceeb ntawm glycoside intoxication yog kev hloov pauv hauv cov tshuaj pharmacokinetics hauv qee yam kab mob. Qee lub sij hawm muaj kev txhob txwm tshaj tawm ntawm cov tshuaj vim muaj kev xav tua tus kheej. Txoj kev loj hlob ntawm glycoside intoxication nyob rau hauv cov neeg laus pab txhawb rhiab heev rau cov tshuaj mob plawv.
Risk yam ua rau lom lom:
- Kev siv cov tshuaj uas txhim kho cov tshuaj ua haujlwm ntawm lub plawv glycosides.
- Hypothyroidism.
- Y Cardiomyopathy.
- Oxygen tshaib plab ntawm myocardium.
- Hypokalemia.
- Hypercalcemia.
- Ib qho teeb meem acid-base tshwm sim los ntawm kev nce hauv cations (alkalosis).
- Hypomagnesemia.
- Hemodialysis.
- Kev phais plawv dhau los.
Kev pab ib zaug
Raws li koj paub, kev ua tau zoo ntawm kev kho mob feem ntau nyob ntawm qhov nrawm ntawm kev ua. Thaum muaj kev lom, nws yog ib qho tsim nyog yuav tsum hu rau pab neeg kho mob xwm txheej ceev kom rov qab los ntawm kws kho mob. Ua ntej lawv tuaj txog, nws yuav tsum tau muab kev pab rau cov neeg raug tsim txom ntawm lawv tus kheej. Rau qhov noxav tau:
- Tsev siv lub plawv glycosides.
- Nyob zoo tag nrho ntawm tus neeg raug tsim txom.
- Txhawm rau qeeb qhov nqus thiab ncig ntawm cov tshuaj lom, noj cov roj vaseline ntawm qhov ncauj.
- Txhawm rau txo cov tshuaj lom, haus cov tshuaj nqus dej (activated charcoal, "Smecta"). Lawv yuav nqus cov glycosides ntxiv. Yog tias tus neeg raug tsim txom nqos tsis tau cov tshuaj ntawm nws tus kheej, nws raug muab los ntawm lub raj.
Npaj plab nyob rau hauv cov ntaub ntawv ntawm glycoside intoxication los ntawm artificially induced ntuav yog heev poob siab, raws li parasympathetic tone yuav nce, ua rau ib tug zuj zus ntawm tus mob.
Kev ua kom resuscitation ntxiv yog ua los ntawm cov neeg ua haujlwm kho mob:
- Glucose thiab vitamin B6 raug txhaj rau hauv cov leeg.
- Yog tias tsim nyog, siv txoj kev nqus pa ntawm lub ntsws.
- tshuaj tiv thaiv arrhythmia yog siv los ua kom lub plawv dhia zoo li qub.
- Nyob rau hauv cov mob hnyav, pacing thiab defibrillation yog siv.
Siv tshuaj tiv thaiv
Fab-fragments ntawm cov tshuaj tiv thaiv rau digoxin ("Antidigoxin") yog siv los ua tshuaj tua kab mob. Raws li txoj cai, tom qab nws cov tshuaj txhaj tshuaj, lub plawv dhia rov qab nyob rau hauv ib teev. "Antidigoxin" khi tsis tau tsuas yog digoxin, tab sis kuj muaj lwm yam glycosides. Muaj tseeb tiag, txhawm rau ua kom tsis zoo rau lawv, nws yog ib qho tsim nyog yuav tsum tau nce koob tshuaj tiv thaiv kab mob.
Yog tias tag nrho cov ntsiab lus ntawm digoxin hauv lub cev tau nce me ntsis, 1-2 lub raj mis tshuaj tua kab mob tau muab tshuaj, thiab hauv cov xwm txheej hnyav - 5-6.vials. Yog tias tsim nyog, nce qhov koob tshuaj.
Muaj Teeb Meem
Kev lees paub tsis tu ncua ntawm glycoside intoxication tuaj yeem ua rau lub plawv tsis zoo uas twb muaj lawm (lub plawv tsis ua haujlwm, ventricular fibrillation). Thaum lub sij hawm tsis ua hauj lwm ntawm lub plawv contractions, lub paj hlwb tsis txaus txaus nrog cov pa oxygen nkag los ntawm cov ntshav los ntawm cov hlab ntsha hauv hlwb. Tsis muaj cov as-ham provokes kev loj hlob ntawm pathologies loj ntawm lub hauv paus paj hlwb (lub hlwb infarction, tuag tes tuag taw, parkinsonism).
Kev kho mob ntawm glycoside intoxication
Txoj kev kuaj mob tseem ceeb hauv kev kuaj pom cov teeb meem ntawm kev lom yog txoj kev electrophysiological rau kev kawm txog biopotentials ntawm lub plawv. Cov tshuaj ua rau so ntawm myocardium thiab hloov cov kev taw qhia ntawm repolarization. Lub ntsiab ECG-kuaj pom ntawm glycoside intoxication yuav yog sinus bradycardia, ventricular thiab supraventricular arrhythmias, thiab atrioventricular dissociation.
Kev kho mob tau sau tseg rau hauv tus account cov kab mob uas tau txheeb xyuas thaum kuaj. Kev kho mob hauv tsev kho mob nkaus xwb. Cov kws kho mob ua cov nram qab no manipulations:
- txhawm rau txo cov tshuaj lom, "Unithiol" 5%, 5 ml, 4 zaug hauv ib hnub, yog muab tshuaj intramuscularly. Disodium ntsev, diluted nyob rau hauv 5% qabzib tov, kuj yog siv los txo cov tshuaj lom, nws yog muab tso rau thawj 3-4 teev.
- Txhawm rau txo qis myocardial excitability thiab tshem tawm tachycardia, Anaprilin tau muab 20 mg peb zaug ib hnub.
- Qhov tshwm sim ntawm bradycardia thiab xeev siab yog nres los ntawm kev qhia txog "Atropine sulfate" 0, 1%, 1 ml.
- Rau lub cev qhuav dej, muab tshuaj rau qhov ncaujKev daws ntawm sodium chloride thiab qabzib 5%.
- Excitation suppressed los ntawm barbiturates.
- Cardiogenic vau yog kho nrog potassium chloride.
Yuav ua li cas tiv thaiv kev lom
Qhov kev ntsuas tseem ceeb rau kev tiv thaiv glycoside intoxication yog kev kho cov tshuaj ntau npaum li cas. Nws yuav tsum tau nqa tawm, coj mus rau hauv tus account lwm yam pathologies ntawm tus neeg mob, raws li zoo raws li nws lub hnub nyoog. Kev tiv thaiv:
- Kev siv lub plawv glycosides yog ua raws li kev tshuaj xyuas ntawm kws kho plawv thiab nyob rau hauv nws cov kev tswj nruj.
- Yog tias kuaj pom lwm yam pathologies thaum lub sijhawm kho, cov tshuaj kho yuav raug kho nrog rau lwm cov tshuaj uas tau sau tseg.
- Tsis suav cov khoom lag luam nrog cov ntsiab lus ntau dhau ntawm glycosides (apricots, txiv duaj, taum).
- Thaum siv lub plawv glycosides, tsis tu ncua xyuas cov ntsiab lus ntawm sodium, calcium, thiab potassium hauv cov ntshav. Yog tias tsim nyog, kho cov ntsiab lus ntawm cov ntsiab lus hauv lub cev.
- Cov neeg mob laus yuav tsum siv cov tshuaj heterosides kom zoo, ntau zaus kom kuaj xyuas.
Thaum thawj qhov tshwm sim ntawm kev qaug cawv, nres noj tshuaj thiab hu rau tus kws kho mob.
