Cov tshuaj uas so cov leeg pob txha yog dav siv tsis yog rau kev phais nruab nrab thiab ntev ntev, tab sis kuj tseem muaj kev cuam tshuam rau lub hom phiaj ntawm kev rov ua haujlwm lossis cov pob qij txha. "Pipecuronium bromide" belongs rau cov pab pawg neeg ntawm antidepolarizing nqaij relaxants thiab muaj lub sij hawm ntev ntawm kev txiav txim siab txog li 50-70 feeb, nyob ntawm seb tus yam ntxwv ntawm lub cev. Cia peb saib cov lus qhia rau kev siv cov tshuaj no, nrog rau cov yam ntxwv ntawm nws txoj kev siv tshuaj loog.
tshuaj yam ntxwv
Lub tswv yim ntawm kev ua ntawm cov tshuaj yog cuam tshuam nrog kev thaiv cov kab mob sib kis hauv cov neuromuscular synapse. Vim li no, qhov tshwm sim ntawm qhov ua tau zoo ntawm daim nyias nyias ntawm cov leeg nqaij fiber ntau yog inhibited, thiab raws li, cov leeg hlwb poob nws lub peev xwm los cog lus.
Nrog rau kev raug tshuaj mus ntev"Pipecuronium bromide" cov leeg pob txha so. Xav tias cholinergic nicotinic receptors nyob tsis tau tsuas yog nyob rau hauv cheeb tsam ntawm kev sib cuag ntawm efferent fibers ntawm lub paj hlwb somatic nrog rau cov leeg hlwb ntawm cov pob txha pob txha, tab sis kuj nyob rau hauv lub ganglia ntawm lub autonomic paj hlwb, thaum loj npaum li cas ntawm cov tshuaj. raug tswj hwm, qhov tsis muaj zog ganglioblocking tshwm sim. Qhov no yog vim qhov kev txiav tawm ntawm cov hlab ntsha impulse mus rau postsynaptic daim nyias nyias ntawm cov neurons, uas ua rau txo qis hauv ob qho tib si sympathetic thiab parasympathetic teebmeem.
Cov lus qhia rau kev siv
Cov tshuaj "Pipecuronium bromide" yog qhia rau kev siv ntawm so ntawm cov leeg pob txha thaum muaj kev phais. Cov tshuaj muaj txiaj ntsig zoo rau tracheal intubation rau lub ntsws ua pa.
YContraindications
Raws li cov lus qhia hais rau cov tshuaj "Pipecuronium bromide", cov tshuaj yog kiag li contraindicated nyob rau hauv lub xub ntiag ntawm hypersensitivity, thiab nyob rau hauv lub xub ntiag ntawm myasthenia gravis (ib tug tsawg, genetic txiav txim kab mob, uas muaj nyob rau hauv kev ua txhaum cai. ntawm kev ua ntawm excitation nyob rau hauv lub neuromuscular synapse thiab kev loj hlob ntawm cov leeg tsis muaj zog).
Cov tshuaj yog contraindicated rau siv rau cov neeg mob thaum ntxov cev xeeb tub. Nyob rau theem tom ntej, kev siv tshuaj muaj peev xwm ua tau, vim nws nkag mus rau hauv lub placental barrier hauv me me.
Side effects
Cov tshuaj muaj peev xwm inhibiting kev ua haujlwm ntawm lub hauv nruab nrab paj hlwb,ua rau hyperesthesia phenomena.
Rau ib feem ntawm cov hlab plawv, cov kev mob tshwm sim yog vim inhibition ntawm kev sib kis hauv cholinergic synapses. Hauv qhov no, kev txo qis hauv lub plawv dhia, txo cov ntshav siab, ischemic myocardial puas, thiab mob hlwb cuam tshuam nrog kev txo qis hauv perfusion yog ua tau.
Thaum raug rau cov kab mob ua pa, ua pa nyuaj siab, ua pa nyuaj lossis apnea tuaj yeem tshwm sim (tshwj xeeb tshaj yog thaum cov tshuaj tom qab noj tshuaj).
Cov tshuaj cuam tshuam rau cov metabolism thiab tuaj yeem ua rau nce cov ntshav cov poov tshuaj, nce qib hauv endogenous creatinine thiab txo qis hauv cov ntshav qabzib.
Tshuaj "Pipecuronium bromide" - cov lus qhia rau kev siv
Cov tshuaj tsuas yog siv raws li kev saib xyuas ntawm tus kws tshaj lij. Ua ntej kev qhia txog cov tshuaj, nws yuav tsum tau ua kom paub tseeb tias muaj cov tshuaj anticholinesterase ("Neostegmine" lossis "Pyridostigmine") lossis anticholinergics ("Atropine").
Tom qab kev tswj hwm, kev soj ntsuam tas li ntawm tus neeg mob tau ua tiav thaum lub sijhawm rov zoo tag nrho tom qab tshuaj loog thiab kom txog thaum tus neeg mob cov leeg nqaij normalizes.
Cov tshuaj ntau npaum li cas yog ua los ntawm kev tshuaj xyuas zoo ntawm tus neeg mob thiab kev tshuaj xyuas cov ntaub ntawv los ntawm kev tshawb fawb hauv chav kuaj. Nyob rau hauv lub xub ntiag ntawm insufficiency ntawm lub excretory muaj nuj nqi ntawm lub raum, ua hauj lwm tsis txaus ntawm lub siab, rog - lub koob tshuaj ntawm cov tshuaj yuav tsum tau txo.
Cov tshuaj yog npaj ncaj qhaUa ntej kev qhia txog cov tshuaj "Pipecuronium bromide". Daim ntawv tso tawm ntawm cov khoom siv tshuaj yog vials nrog lyophilized hmoov uas muaj 0.004 g ntawm cov tshuaj nquag.
Rau cov neeg mob uas muaj cov tshuaj electrolyte tsis txaus lossis acid-base tsis txaus, kev hloov tshuaj kuj tseem tsim nyog. Qhov tseem ceeb txo qis hauv cov ionic concentration hauv cov ntshav plasma, hypothermia thiab kev siv lub plawv glycosides (thaum lub sijhawm digitalization) tuaj yeem ua rau lub sijhawm ua haujlwm ntawm cov tshuaj. Nyob rau hauv cov ntaub ntawv ntawm cov nqaij ntshiv nyob rau hauv xws li ib pab pawg neeg ntawm cov neeg mob, nws yog tsim nyog los normalize cov ntshav electrolyte tsis, thiab ces yuav tsum tau ua kom cov leeg nqaij so. Yog tias cov neeg mob muaj lub plawv tsis ua haujlwm ntev, ua rau cov ntshav khiav qeeb, nws tuaj yeem ua rau lub sijhawm latent ntawm cov tshuaj (nce ntxiv rau lub sijhawm ntawm kev tswj hwm thiab qhov pib ntawm cov nyhuv).
Nws tuaj yeem siv tshuaj rau cov menyuam yaus txij li 1 xyoos. Hauv qhov no, nws yuav tsum nco ntsoov tias tus menyuam lub cev tsis tshua nkag siab txog cov teebmeem ntawm cov leeg nqaij, thiab raws li, kom ua tiav cov txiaj ntsig xav tau, koob tshuaj yuav tsum tau nce ntxiv.
Drug dispensing
Txawm tus kws kho mob tuaj yeem sau ntawv tsis tuaj yeem sau cov tshuaj "Pipecuronium bromide" hauv Latin. Lub tsev kho mob tau txais cov tshuaj muaj zog los ntawm cov npe A tsuas yog ntawm kev thov thiab raws li tsoomfwv. Nyob rau hauv ib rooj plaub, tus kws kho mob tshwj xeeb tuaj yeem sau ntawv tshuaj "Pipecuronium bromide" siv daim ntawv "liab",Txawm li cas los xij, tsis yog txhua lub tsev kho mob hauv tsev kho mob muaj cai muag tshuaj yeeb thiab tshuaj muaj zog, suav nrog cov leeg nqaij.
npe lag luam
Nyob rau hauv khw muag tshuaj, cov tshuaj muaj nyob rau hauv cov npe lag luam xws li Arduan, Vero-pipecuronium, Aperamide, Pipecuronium bromide. Lub npe lag luam ntawm cov tshuaj nyob ntawm cov chaw tsim khoom uas muab cov tshuaj rau lub khw muag tshuaj.
Ntau tshaj
Kev noj tshuaj ntau dhau ntawm cov tshuaj thiab txo qis hauv cov nyhuv yog ua tau vim yog kev qhia txog cov tshuaj anticholinesterase. Cov tshuaj no ua rau kom cov concentration ntawm acetylcholine mediator, yog li sib tw nrog cov leeg nqaij so rau kev khi qhov chaw ntawm receptor.
Tsis tas li, kev ntsuas kev kho mob thaum noj ntau dhau yog txhawm rau nce ntshav siab, tswj hwm lub luag haujlwm tseem ceeb ntawm lub cev, suav nrog kev ua pa tawm ntawm lub ntsws.
Kev Sib Tham Tshuaj
Cov tshuaj yuav tsum tsis txhob tov nrog ntau yam kev daws teeb meem, tshwj tsis yog cov tshuaj isotonic ntawm sodium chloride thiab dextrose. Kev loj hlob ntawm cov nyhuv ntawm cov tshuaj qeeb qeeb, cov tshuaj kho tau zoo nce nyob rau hauv cov xwm txheej ntawm kev tswj hwm ua ntej ntawm cholinesterase inhibitors rau hauv tus neeg mob lub cev.
Thaum siv cov leeg nqaij so ua ke nrog cov tshuaj loog, qhov chaw ua pa nyuaj siab nrog kev txhim kho ntawm apnea yog ua tau.
Daim ntawv thovtshuaj nrog cov leeg nqaij relaxants ntawm depolarizing hom kev txiav txim tuaj yeem txhim kho thiab tsis muaj zog tag nrho cov leeg nqaij so. Qhov xwm txheej no yog vim kev siv tshuaj, lub sijhawm ntawm kev tswj hwm thiab tus kheej rhiab heev rau cov tshuaj.
Zoo kawg
Miorelaxation thaum lub sij hawm kev phais yog ib feem tseem ceeb ntawm txoj kev siv tshuaj loog. Cov tshuaj "Pipecuronium bromide" tau siv zoo hauv kev kho mob rau cov laj thawj no.
Nws yuav tsum nco ntsoov tias kev tswj hwm ntawm cov tshuaj tsis yog tsuas yog ua rau kom cov leeg pob txha muaj lub luag haujlwm rau kev yeem txav, tab sis kuj ua rau tuag tes tuag taw ntawm cov leeg ua pa. Muab qhov no, cov tshuaj tsuas yog siv nyob rau hauv cov xwm txheej ntawm kev phais thiab cov chaw kho mob hnyav.
