Kev xa tawm ntawm impulses los ntawm neurons tau muab ua tsaug rau cov khoom tshwj xeeb - cov neeg sib kho. Ib qho ntawm cov neurotransmitters yog acetylcholine. Cov tshuaj no, nyob rau hauv synapses, cuam tshuam rau cell membranes, ua rau lawv inhibition los yog excitation thiab ua rau ntau yam teebmeem. Ntau cov neurotransmitters tau tawg los ntawm cov enzymes tshwj xeeb.
tshuaj Anticholinesterase: cov khoom thiab lub hom phiaj
tshuaj Anticholinesterase yog cov uas inhibit enzyme cholinesterase. Cov enzyme no tawg los ntawm hydrolysis cov neurotransmitter acetylcholine, uas ua kom cov kev sib kis ntawm impulses hauv synapses ntawm parasympathetic paj rhiab rau nws, ganglia thiab tag nrho cov somatic fibers. Anticholinesterase cov neeg ua haujlwm tau tsim los txhawm rau txhim kho qhov kev ua ntawm acetylcholine ntawm cov neurons thiab txhawb qee qhov ntawm lub paj hlwb. Kev siv cov tshuaj no cuam tshuam rau lub cev tag nrho.
Qhov kev ua ntawm cov tshuaj anticholinesterase zoo ib yam li cov txiaj ntsig ntawm kev txhawb nqa ntawm cov hlab ntsha cholinergic. Cov tshuaj no cuam tshuam nrog tib qhov chaw ntawm kev ua si ntawm qhov chaw receptor raws li acetylcholine, yog li tsim kom muaj lub paj hlwb xaus kev ua haujlwm. Cholinomimetics thiab cov tshuaj anticholinesterase yog, qhov tseeb, tib pab pawg kws tshuaj ntawm cov tshuaj. Muaj ntau ntau hom tshuaj no, uas txawv hauv cov qauv tshuaj thiab rov qab ua haujlwm. Cholinesterase blockers muab faib ua reversible thiab irreversible.
Means of reversible action
Anticholinesterase cov neeg ua haujlwm yog cov tshuaj ntawm kev thim rov qab, lawv yog cov tshuaj esters ntawm carbamic acid thiab ntau yam amino cawv. Cov kua qaub xaus dhau los ua ib feem ntawm cov tshuaj tiv thaiv uas thaiv cholinesterase, uas tsim kom muaj kev ruaj khov ntau dua nrog cov enzyme molecule tshaj qhov tsim thaum cuam tshuam nrog acetylcholine nws tus kheej. Kev puas tsuaj tag nrho ntawm cov tshuaj no tshwm sim los ntawm hydrolysis li ntawm 3-4 teev.
Cov tshuaj tiv thaiv rov qab tau muaj xws li Galantamine, Physostigmine, Prozerin (los yog Neostigmine), Pyridostigmine, Oksazil, Rivastigmine, Edrophonium.
Organophosphorus - tshuaj ntawm qhov ua tsis tau rov qab
Cov tshuaj tsis tuaj yeem ntawm pawg no yog cov tshuaj organophosphorus. Cov noCov tshuaj thaiv acetylcholinesterase rau lub sijhawm ntev. Phosphorus, uas yog ib feem ntawm lawv cov molecules, tsim ib qho chaw ruaj khov nrog cov enzyme, uas tuaj yeem muaj nyob hauv lub cev rau ob peb hnub thiab txawm lub lis piam. Kev kho dua tshiab ntawm qhov xav tau ntawm acetylcholinesterase tshwm sim los ntawm kev tsim cov molecules tshiab. Cov pab pawg no suav nrog "Phosfacol", "Armin", "Chlorophos", "Karbofos", "Dichlorvos", tshuaj lom neeg siv thaum ua tub rog - sarin thiab soman.
Organophosphate npaj muaj tshuaj lom heev. Lawv feem ntau siv nyob rau hauv lub neej txhua hnub raws li tshuaj tua kab; Cov tshuaj lom neeg tuaj yeem ua tau yog tias lawv siv tsis raug thiab ntsuas kev nyab xeeb tsis ua raws.
Cov tshuaj anticholinesterase
Nrog rau qee qhov zoo sib xws ntawm cov teebmeem uas cov tshuaj anticholinesterase tsim tawm ntawm lub cev, cov lus qhia rau kev tshuaj xyuas lawv txhua tus yuav tshwj xeeb. Koj tuaj yeem xav txog qhov ua tau zoo thaum nkag mus rau hauv lub cev siv cov piv txwv ntawm "Prozerin".
"Prozerin" muaj nyob rau hauv ampoules raws li 0.05% kev daws teeb meem thiab muab tshuaj subcutaneously lossis intravenously. Thaum tso tawm rau hauv cov ntshav, nws yooj yim rau kev nkag mus ntawm impulses nyob rau hauv lub neuromuscular kis tau tus mob thiab ganglia ntawm lub autonomic paj hlwb. Nyob rau hauv tus neeg mob tus mob, qhov no manifests nws tus kheej raws li nram no:
- vim kev sib cog lus ntawm cov leeg ntawm lub iris, cov menyuam kawm ntawv nqaim;
- chaw pw spasm tshwm sim, lub lens yuav siv sij hawm ntau convex zoo vimso ntawm zinn ligament, lub hom phiaj ntawm lub zeem muag yog teem rau ze ze, muaj peev xwm paub qhov txawv ntawm cov khoom nyob deb yog sharply txo;
- lub plawv dhia;
- lub suab ntawm cov leeg du ntawm cov kab mob hauv nruab nrog cev nce ntxiv - cov kab mob ua pa, plab thiab hnyuv, tsev menyuam, zais zis;
- ntxiv dag zog rau pob txha pob txha pob txha vim kev txhim kho kev sib kis ntawm impulses hauv synapses;
- nce tso tawm ntawm cov qog exocrine - tawm hws, salivary, bronchial, gastric.
Daim ntawv thov
Cov teebmeem uas tau teev tseg txiav txim siab siv cov tshuaj no hauv cov tshuaj hauv ntau qhov xwm txheej. Cov lus qhia rau kev siv cov tshuaj anticholinesterase tsis txwv rau cov kab mob tshwj xeeb, vim tias lawv muaj kev cuam tshuam rau hauv nruab nrab thiab peripheral paj hlwb, uas ua rau muaj kev cuam tshuam rau tag nrho lub cev. Feem ntau lawv raug sau tseg rau kev ua txhaum cai ntawm innervation thiab lub suab ntawm cov pob txha lossis cov leeg du.
Xav txog qhov muaj peev xwm ntawm kev kho mob nrog cov tshuaj anticholinesterase siv cov piv txwv ntawm "Prozerin". Cov tshuaj thim rov qab no yog siv rau myasthenia gravis, tus kab mob autoimmune uas tau hais tawm hauv qhov tsis muaj zog ntawm cov leeg pob txha. Tus kab mob no tshwm sim thawj zaug los ntawm kev txo qis ntawm cov leeg ntawm cov leeg nqaij, tom qab ntawd los ntawm kev qaug zog ntawm cov leeg ntawm caj dab, sab sauv thiab sab qis; Hauv qhov xwm txheej hnyav, muaj kev ua txhaum ntawm kev ua pa vim kev ua haujlwm tsis txaus ntawm lub diaphragm. "Prozerin" muaj cov tsos mob ntawm lub cev, khokis tau tus mob impulses nyob rau hauv neuromuscular kis tau tus mob, yog li ua kom cov leeg nqaij tone thiab ua kom lub cev muaj zog ua si.
Tsis tas li, cov tshuaj no tau sau tseg rau lub sijhawm tom qab phais nrog atony ntawm lub plab hnyuv lossis zais zis. Hauv ophthalmology, nws yog qee zaus muab tshuaj rau glaucoma kom txo qis intraocular siab. Raws li ib tug antagonist, nws yog siv nyob rau hauv overdose ntawm cov leeg nqaij relaxants thiab antidepolarizing tshuaj. Qee zaum, "Prozerin" yog siv los txhawb cov leeg nqaij nrog kev ua haujlwm tsis muaj zog.
Alzheimer's disease
Cov tshuaj thim rov qab tau pom daim ntawv thov hauv kev kho mob ntawm cov hlab ntsha hauv nruab nrab, nyuaj kho. Hauv Alzheimer's tus kab mob, "Galantamine" yog tshuaj - ib tug alkaloid tau los ntawm snowdrop tubers ntawm lub genus Galantus ("Rivastigmin", aka "Exelon"), tab sis Donepezil tau los ua tus kws kho mob zoo tshaj plaws, uas xaiv blocks acetylcholinesterase nyob rau hauv lub synapses ntawm lub hlwb. thiab xyaum tsis cuam tshuam nws nyob rau hauv periphery ntawm lub paj hlwb.
YContraindications
Raws li cov teebmeem ntawm cov tshuaj anticholinesterase thim rov qab, qaug dab peg, mob ntsws asthma, angina pectoris, Parkinson's kab mob thiab ntau yam kab mob ntawm lub plawv system yog contraindications rau lawv siv.
Cov tsos mob ntawm overdose thiab AChE lom
Tshuaj lom nrog cov tshuaj anticholinesterase muab cov tsos mob ncaj qha ntsig txog kev txhawb nqa ntau dhau ntawm receptors rhiab rauacetylcholine tshuaj. Muaj qhov nqaim ntawm cov menyuam kawm ntawv, lub plawv dhia qeeb (bradycardia), bronchospasm thiab - vim li ntawd - cov tsos mob ntawm kev ua tsis taus pa, nce plab hnyuv peristalsis mus rau ntuav thiab raws plab, tso zis ntau zaus. Arterial siab maj mam txo qis raws li qhov tshwm sim ntawm inhibitory nyhuv ntawm lub paj hlwb. Muaj chaotic contractions thiab twitches ntawm skeletal nqaij thiab tus nplaig vim impaired conduction nyob rau hauv neuromuscular transmissions.
FOS lom
Kev noj cov tshuaj organophosphorus ua rau daim duab kho mob zoo ib yam li kev lom nrog cov tshuaj anticholinesterase rov qab. Cov tsos mob yuav qhia tau ntau dua vim yog tshuaj toxicity ntau dua. Rau cov tsos mob ntawm kev lom nyob rau theem somatic, cov teebmeem tau ntxiv rau theem ntawm lub hauv nruab nrab lub paj hlwb - tsis meej pem, tsis meej pem, ua pa nyuaj siab.
Organophosphorus tebchaw ua rau mob miosis loj, qhov muag tsis pom kev, ua tsis taus pa, tawm hws, ntuav hnyav, kev ntxhov siab psychomotor - tus neeg mob pib ntshai, nws tuaj yeem tswj tsis tau. Vim spasms ntawm cov leeg du, muaj qhov mob ntawm lub plab. Thaum tus mob hnyav zuj zus, convulsions tshwm sim, ntshav siab poob, thiab coma tshwm sim. Kev tuag tuaj yeem tshwm sim vim tuag tes tuag taw ntawm qhov chaw ua pa.
Cov tsos mob zoo sib xws tau pom thaum muaj yoov agaric lom. Qhov no yog vim cov ntsiab lus ntawm muscarine hauv lawv, muaj tshuaj lom nrog cov nyhuv cholinomimetic.
Kev ua phem phem
Kev kho mobpab thaum muaj tshuaj lom nrog cov tshuaj anticholinesterase tsuas yog muab los ntawm tus kws kho mob tshwj xeeb. Nyob rau hauv cov ntaub ntawv no, ib tug daws ntawm "Atropine" yog txhaj subcutaneously, lub sij hawm ntawm "Metacin" los yog lwm yam anticholinergics yog ua tau. Nws yog ib qho tsim nyog los tswj kev ua pa ntawm qib kom zoo. Tracheotomy, mechanical ventilation thiab oxygenation yuav siv tau.
Nyob rau hauv rooj plaub ntawm tsev neeg lom nrog FOS, lub hauv paus ntawm cov tshuaj lom nkag mus rau hauv lub cev yog txiav txim. Yog hais tias cov khoom tau nkag mus rau ntawm daim tawv nqaij, nws yog ntxuav tawm nrog ib tug 3-5% soda tov los yog xab npum thiab dej. Nyob rau hauv rooj plaub thaum cov tshuaj tau noj ntawm qhov ncauj, plab hnyuv plab yog ua, muab ntau yam enemas, adsorbents los yog laxatives. Yog hais tias lub organophosphorus compound twb tau tswj kom nkag mus rau hauv cov ntshav mus rau ntau dua, yuam diuresis raug muab tshuaj nrog kev pab los ntawm diuretics. Qee zaum, lawv siv txoj hauv kev pom cov ntshav siv hemodialysis thiab hemosorption.
Tsis tas li ntawd, nyob rau hauv rooj plaub ntawm FOS lom, cholinesterase reactivators raug sau tseg, uas, thaum noj thawj zaug tom qab qaug cawv, muaj peev xwm rov qab los thaiv cov enzymes. Nws tuaj yeem yog "Isonitrozin", "Trimedoxime", "Dipiroxime". Yog tias cov ntshav siab nce siab, cov tshuaj antihypertensive tau muab tshuaj kho. Kev nyiam yuav tsum tau muab rau cov uas tsis cuam tshuam rau hauv nruab nrab paj hlwb. Thaum ua pa tsis muaj zog, kev ua pa ntawm lub ntsws thiab cov pa oxygen tau qhia.
