Txij lub sij hawm, txhua tus neeg txhawj xeeb txog kev mob ntawm ntau yam keeb kwm. Tom qab noj zaub mov tsis zoo, lub plab yuav mob, tom qab ib hmo pw tsaug zog vim kev ua haujlwm lossis kev kawm, lub taub hau mob los ntawm qhov mob impulses. Rau ntau yam, cov pob txha tawg, cov hniav, cov leeg, pob qij txha raug mob. Feem ntau nyob rau hauv xws li mob, ib tug neeg, tsis muaj hesitation, grabs ib tug analgesic los ntawm tes - qhov teeb meem yuav ploj mus thiab lub neej tau zoo dua. Txawm li cas los xij, koj yuav tsum paub tias ntau cov tshuaj tua kab mob, tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob muaj cov kev mob tshwm sim, ib qho ntawm cov nyhuv ulcerogenic.
Yuav siv tshuaj dab tsi uas kuv xav tau?
Yuav luag txhua cov tshuaj muaj mob me lossis qhia tau hais tias muaj kev sib txawv ntawm lawv qhov tshwm sim. Tag nrho cov ntawm lawv yuav tsum tau qhia nyob rau hauv cov lus qhia rau kev siv. Txawm hais tias muaj peev xwm tshwm sim ntawm cov tsos mob tsis zoo tom qab kev tswj hwm, qee cov tshuaj tsis tuaj yeem muab faib rau hauv kev kho mob. Tiv thaiv qhov mob, kub taub hau, nce ntxivNon-steroidal anti-inflammatory tshuaj (NSAIDs luv luv) pab nrog lub cev kub thiab mob hauv lub cev. Qhov no yog cov tshuaj aspirin, diclofenac, paracetamol thiab ntau lwm yam tshuaj uas muaj nyob rau hauv cov pab pawg sib txawv. Hauv cov tshuaj, NSAIDs tau muab faib ua ntau pawg nyob ntawm cov qauv tshuaj thiab kev ua haujlwm ntawm kev ua. Tag nrho cov no tau koom ua ke los ntawm qhov muaj cov nyhuv ulcerogenic.
Cov yam ntxwv zoo
Cov tshuaj feem ntau hauv pawg NSAID muaj ib qho kev mob tshwm sim tsis zoo. Nws muaj kev cuam tshuam tsis zoo rau lub cev ntawm tus neeg mob lub plab zom mov. Nrog rau lawv cov kev siv mus sij hawm ntev, thaum siv cov koob tshuaj loj, nrog rau thaum siv ob hom ntsiav tshuaj ib zaug, cov neeg mob ntsib kev tsim cov teeb meem hauv cov mucous membrane ntawm txoj hnyuv. Feem ntau, qhov teeb meem no tshwm sim nws tus kheej nyob rau hauv daim ntawv ntawm erosive thiab ulcerative lesions, txij li thaum lub active tshuaj ntawm cov tshuaj tsis tau tsuas yog ua kom puas hlwb ntawm lub mucosa, ua erosion, tab sis kuj provoke ib tug relapse ntawm peptic rwj. Cov yam ntxwv no yuav tsum tau muab coj los rau hauv tus kws kho mob thaum teeb tsa txoj kev kho mob.
NSAID classification
Ua ntej tshaj plaws, cov tshuaj uas tsis yog-steroidal anti-inflammatory tshuaj nyob rau hauv lawv cov qauv thiab kev ua yog tawm tsam glucocorticoids (cov tshuaj steroid), uas tau sau tseg thiab siv tshwj xeeb, vim muaj ntau yam kev phiv: kub siab, kev quav yeeb quav tshuaj, qhov hnyav nce thiab poob phaus.tiv thaiv kab mob. Thaum ntxov li xyoo 1830, nrog rau kev tshawb pom ntawm salicylic acid, NSAIDs pib hloov opiates. Tam sim no, cov tshuaj uas tsis yog tshuaj steroidal tau nquag siv hauv kev kho mob.
Nyob ntawm cov tshuaj muaj pes tsawg leeg, kev ua tau zoo thiab kev ua haujlwm, txhua NSAIDs tau muab faib ua ntau pawg. Hais txog cov qauv tshuaj thiab kev ua tau zoo, cov pab pawg hauv qab no tuaj yeem paub qhov txawv: acids, non-acid derivatives thiab NSAIDs nrog kev ua haujlwm tsis muaj zog. Ntawm cov kua qaub, ib pawg ntawm salicylates sawv tawm thiab nws cov neeg sawv cev tseem ceeb yog cov tshuaj aspirin, uas muaj cov nyhuv ulcerogenic zoo tshaj plaws ntawm lwm cov neeg sawv cev ntawm cov kua qaub. Pyrazolidines, derivatives ntawm indolacetic thiab phenylacetic, priionic acids kuj yog cov pab pawg neeg ntawm acids.
Sulfonamide derivatives belongs rau pab pawg neeg ntawm non-acidic derivatives. Cov pab pawg kawg ntawm NSAIDs nrog tsis muaj zog tiv thaiv kev ua haujlwm, cais tawm ntawm lub hauv paus ntawm kev ua tau zoo, suav nrog pyrazolones thiab derivatives ntawm anthranilic, heteroarylacetic acids.
Txoj Haujlwm NSAID
Cov tshuaj tiv thaiv kab mob ua haujlwm ntawm lub hauv paus ntsiab lus ntawm inhibition (txo qis cov tshuaj tiv thaiv enzymatic) ntawm cyclooxygenase, uas yog nws thawj thiab thib ob ntau yam. Muaj ib qho inhibition ntawm kev tsim cov prostaglandins lub luag haujlwm rau cov txheej txheem inflammatory. Kev nqus ntawm cov tshuaj steroid tshwm sim hauv plab hnyuv, uas ua rau cov nyhuv ulcerogenic ntawm NSAIDs. Cov hlwb ntawm lub plab mucosa raug rhuav tshem vim qhov sib txuam ntawm cov tshuaj hauvcytoplasm, nws kuj nkag mus rau hauv cov kua synovial (ib qho elastic loj uas ua rau cov pob qij txha thiab ua kom yooj yim rau kev sib koom tes), uas txo thiab tshem tawm qhov mob pob qij txha.
Analgesic nyhuv yog ua tiav los ntawm kev hloov tus cwj pwm ntawm qhov mob impulses hauv qaum qaum thiab nkag mus rau hauv kev ua haujlwm ntawm opioid receptors. Cov nyhuv anti-inflammatory yog txuam nrog inhibition ntawm cov txheej txheem ntawm neutrophil activation thiab tom qab tsis muaj zog ntawm inflammatory mediators. Ib qho kev phiv ntawm cov tshuaj uas muaj kev cuam tshuam zoo sib xws yog kev loj hlob ntawm cov kab mob ntawm lub plab thiab duodenum.
tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob
Lub luag haujlwm tseem ceeb ntawm NSAIDs, raws li kev txiav txim siab ntawm tus lej nws tus kheej, yog txhawm rau txo qis kev mob hauv lub cev. Cov tshuaj ntawm thawj pab pawg neeg, acids, muaj cov tshuaj tiv thaiv zoo tshaj plaws. Txhawm rau tiv thaiv cov txheej txheem inflammatory, tshuaj aspirin, diclofenac, ibuprofen, thiab ketorolac yog siv. Cov txhais tau tias ntawm pab pawg thib ob muaj qhov tsis muaj zog tiv thaiv kab mob, thiab hauv kev kho mob feem ntau hu ua "non-narcotic analgesics". Ntxiv mus, rau qhov pib ntawm cov tshuaj tiv thaiv kab mob, nws yog ib qho tsim nyog yuav tau noj tshuaj rau 10-14 hnub, piv rau cov nyhuv analgesic, uas tshwm sim ib lossis ob lossis ob peb teev tom qab noj tshuaj.
Txhua yam tshuaj, txawm tias lawv nyob hauv tib pab pawg, muaj feem cuam tshuam sib txawv, qhov tseem ceeb yogulcerogenic nyhuv. Tsis tas li, cov tshuaj uas tsis yog tshuaj steroidal feem ntau tau siv los txo cov leeg nqaij thiab pob qij txha, mob hniav lossis mob taub hau, vim lawv muaj cov nyhuv analgesic. Txawm li cas los xij, nrog qhov mob hnyav heev, piv txwv li, vim yog mob qog noj ntshav, NSAIDs raug suav hais tias tsis muaj txiaj ntsig thiab tsis ua rau qhov xav tau. Nyob rau hauv cov ntaub ntawv no, tus kws kho mob resorts mus rau heev heev ntsuas thiab sau tshuaj narcotic analgesics uas yog ib feem ntawm morphine pawg, uas yog heev txaus ntshai rau tib neeg lub cev thiab muaj yees.
Antipyretics thiab antiplatelet agents
Hais txog NSAIDs, ib tus tsis tuaj yeem hais txog cov tshuaj uas siv los txo lub cev kub uas sib txawv ntawm cov qib ib txwm muaj. Tsis tas li ntawd, qee cov NSAIDs yog cov tshuaj tiv thaiv kab mob, uas nws txoj haujlwm yog los tiv thaiv kev tsim cov ntshav txhaws hauv cov hlab ntsha. Nws tshwm sim los ntawm inhibiting txheej txheem ntawm kev koom tes ntawm platelets thiab cov qe ntshav liab. Cov ntshav ntws tseem nyob ntawm qhov pom tau, nws tsis khov, yog li tiv thaiv kev tsim cov ntshav txhaws.
Tshuaj tsom txo lub cev kub kom qis qis tsuas muaj cov tsos mob tshwm sim, uas txhais tau hais tias cov tshuaj tsis muaj tshuaj tua kab mob thiab tshuaj tua kab mob. Lawv tsis kho tus kab mob, tab sis tsuas yog suppress nws cov tsos mob nyob rau hauv daim ntawv ntawm kub taub hau. Yog li ntawd, yog tias nws nyob ntev dua 3 hnub, yog kub taub hau thiab mob leeg, mob taub hau, ces yuav tsum tau mus pw hauv tsev kho mob thiab kws kho mob tshwj xeeb.
Drug side effects
Raws li yav tas lostau sau tseg saum toj no, yuav luag txhua cov tshuaj uas tsis yog tshuaj steroidal muaj cov kev mob tshwm sim, qhov ua tau txawv ntawm cov tshuaj mus rau tshuaj. Los ntawm 30 mus rau 40% ntawm cov neeg mob uas tsis tu ncua thiab ua tib zoo noj NSAIDs yws txog cov teeb meem ntawm txoj hnyuv. Lawv tshwm sim raws li qhov mob hauv plab, hnyuv, xeev siab thiab ntuav. Lawv txoj kev yog kab mob dyspeptic.
Cov neeg mob tsawg dua (10-20%) muaj teeb meem loj dua - cov kab mob erosive hauv plab thiab cov hnyuv, nrog rau qhov tshwm sim ntawm peptic ulcers. Kev mob tshwm sim ntawm NSAIDs hauv 2-3% ntawm cov neeg mob muaj xws li los ntshav sab hauv. Yog li, tus neeg mob, vim los ntshav qhov txhab hauv plab lossis txoj hnyuv, tuaj yeem poob txog 5 ml ntawm cov ntshav txhua hnub nrog cov quav.
Daim npe tshuaj tsis yog tshuaj steroid
Raws li rau daim ntawv teev npe NSAIDs, nws yog qhov zoo dua los tsim nws raws li kev faib cov tshuaj raws li lub hauv paus ntsiab lus ntawm cov tshuaj muaj pes tsawg leeg, uas yog, rau hauv cov kua qaub thiab cov tsis muaj kua qaub. Cais, NSAIDs nrog tsis muaj zog tiv thaiv kev ua haujlwm kuj tuaj yeem paub qhov txawv.
Acids
Tus neeg sawv cev tseem ceeb ntawm cov kua qaub yog tshuaj aspirin. Cov kua qaub kuj muaj xws li: phenylbutazone (siv rau mob hniav, mob taub hau, dermatitis, mob caj dab); diclofenac (rau mob caj dab, osteochondrosis, hernia, ntau yam mob) thiab piroxicam; Ibuprofen (mob caj dab, gout, sciatica, toothaaches thiab mob taub hau) thiab ketoprofen.
Non-acid derivatives
Cov no suav nrog tsuas yog sulfonamide derivatives: nimesulide, celecoxib, rofecoxib. Cov ntaub ntawvtshuaj, zoo li lwm yam NSAIDs, pab txo qhov mob, txo lub cev kub thiab lub zog ntawm cov txheej txheem inflammatory. Symptomatically zoo cuam tshuam rau gout, arthrosis thiab lwm yam kab mob uas ua rau mob hnyav.
NSAIDs nrog tsis muaj zog tiv thaiv kev ua haujlwm
Ntawm lawv, ob tus neeg sawv cev tseem ceeb tuaj yeem paub qhov txawv - paracetamol thiab ketorolac. Paracetamol paub txog yuav luag txhua tus neeg thiab feem ntau yog siv los txo qhov kub thiab txias thaum muaj mob. Xws li nyob rau hauv muaj pes tsawg leeg ntawm cov tshuaj xws li Fervex thiab Teraflu. Raws li tus neeg sawv cev thib ob, cov khw muag tshuaj feem ntau nug txog dab tsi Ketorolac yog los ntawm. Nws yog qhov tsim nyog los txo qhov mob: nyob rau hauv cov hniav, nrog rau ntau yam kev raug mob, sprains thiab sprains, sciatica.
Noj NSAIDs rau teeb meem plab hnyuv
tshuaj tsis yog tshuaj steroid yuav tsum tau saib xyuas tshwj xeeb rau cov neeg mob uas muaj kev yaig lossis mob hauv plab, duodenum. Kev puas tsuaj ntawm cov tshuaj nyob rau hauv lub hlwb ntawm lub plab hnyuv mucosa yuav txo tau los ntawm ib txhij siv tshuaj xws li Misoprostol thiab Omeprazole, uas tiv thaiv kev loj hlob ntawm ulcers thiab yaig.
Cov kev mob tshwm sim ntawm cov tshuaj kuj tuaj yeem txo los ntawm kev txo cov koob tshuaj, hloov mus rau qhov quav lossis tshuaj pleev tshuaj. Nyob rau hauv cov nqe lus ntawm kev txo cov load ntawm lub plab zom mov, nws yog qhov zoo tshaj plaws los siv cov ntsiav tshuaj enteric-coated. Kev kho mob ntawm cov neeg mob tshwj xeeb yog raug rau txoj kev loj hlob ntawm erosions thiabCov kab mob yuav tsum tau nrog rau kev soj ntsuam tas li endoscopic.
Kev xaus lus dav dav
Hmoov tsis zoo, ntau yam tshuaj, suav nrog NSAIDs, kho ib yam thiab ua rau lwm tus ua tsis taus. Txhais tau hais tias xws li tshuaj aspirin, diclofenac, ibuprofen, paracetamol, ketorolac, uas tsis tuaj yeem muab faib rau hauv kev kho mob, nyiam ua kom puas cov hlwb ntawm cov mucous membrane ntawm lub plab zom mov. Kev noj tshuaj tsis tu ncua ntawm cov tshuaj tiv thaiv kab mob, tshuaj tua kab mob, tshuaj tua kab mob ua rau muaj kev pheej hmoo ntawm erosions thiab rwj hauv plab thiab duodenum. Saib saum toj no rau cov npe NSAIDs thiab lawv cov kev mob tshwm sim.
