Anticholinergic tshuaj yog cov tshuaj uas thaiv qhov kev ua ntawm tus neeg nruab nrab - acetylcholine - ntawm cholinergic receptors. Nyob rau hauv cov ntaub ntawv txawv teb chaws, pawg tshuaj no hu ua "deliriants" vim muaj peev xwm ua rau delirium.
Qee keeb kwm tseeb
Thaum ntxov, nyob rau nruab nrab ntawm lub xyoo pua 20th, cov tshuaj anticholinergic tau siv los kho cov kab mob pulmonary obstructive pulmonary thiab bronchial hawb pob, tab sis lawv tau hloov los ntawm cov tshuaj niaj hnub ntau dua nrog cov kev mob tshwm sim tsawg dua. Nrog rau kev tsim kho tshuaj, cov kws tshawb fawb tau tsim cov tshuaj anticholinergics uas tsis muaj cov npe loj loj ntawm cov kev mob tshwm sim. Cov ntaub ntawv noj tshuaj tau raug txhim kho, thiab cov tshuaj anticholinergic tau rov siv dua hauv kev kho mob ntawm cov kab mob pulmonological. Cov txheej txheem ntawm kev txiav txim ntawm pawg tshuaj no yog qhov nyuaj, tab sis nws muaj peev xwm piav qhia txog cov txuas tseem ceeb.
Y Yuav ua li cas anticholinergics ua haujlwm?
Lub luag haujlwm tseem ceeb ntawm cov tshuaj anticholinergic yog los thaivcholinergic receptors thiab impossibility ntawm influencing lawv nrog ib tug neeg nruab nrab - acetylcholine. Piv txwv li, receptors nyob rau hauv cov nqaij ntshiv yog thaiv nyob rau hauv lub bronchi.
Kev faib tshuaj
Nyob ntawm seb cov receptors cuam tshuam los ntawm cov tshuaj anticholinergic, cov npe tau muab faib ua pawg loj:
- M-anticholinergics (atropine, scopolamine, ipratropium bromide).
- N-anticholinergics (pentamine, tubocurarine).
Nyob ntawm kev xaiv ntawm qhov kev txiav txim:
- Central, lossis tsis xaiv (atropine, pirenzepine, platifillin).
- Peripheral lossis xaiv (ipratropium bromide).
M-anticholinergics
Tus neeg sawv cev tseem ceeb ntawm pawg tshuaj no yog atropine. Atropine yog ib qho alkaloid pom hauv qee cov nroj tsuag xws li belladonna, henbane, thiab datura. Cov cuab yeej tshaj tawm ntawm atropine yog antispasmodic. Tawm tsam keeb kwm ntawm nws qhov kev ua, lub suab ntawm cov leeg ntawm lub plab hnyuv, zais zis, thiab bronchi txo.
Atropine yog siv rau qhov ncauj, subcutaneously thiab intravenously. Lub sijhawm ntawm nws qhov kev ua yog kwv yees li 6 teev, thiab thaum siv atropine hauv daim ntawv tee, lub sijhawm nce mus rau xya hnub.
tshuaj kho mob ntawm atropine:
- Kev nthuav dav ntawm cov menyuam kawm ntawv ntawm lub qhov muag vim muaj cov nyhuv stimulating ntawm cov leeg ncig ntawm iris - cov leeg ntawm iris so, feem, cov menyuam kawm ntawv nthuav dav. Qhov siab tshaj plaws tshwm sim tshwm sim 30-40 feeb tom qabinstillation.
- Kev pw tsaug zog - lub lens stretches thiab flattens, tshuaj anticholinergic kho lub qhov muag kom pom kev deb.
- Ntau lub plawv dhia
- Nyob ntawm cov leeg du hauv bronchi, plab hnyuv, zais zis.
- Kev txo qis ntawm cov qog hauv cov qog xws li bronchial, digestive thiab hws qog.
siv Atropine
- Nyob rau hauv ophthalmology: kev tshuaj xyuas ntawm lub fundus, kev txiav txim siab ntawm lub qhov muag refraction.
- Hauv plawv plawv, atropine yog siv rau bradycardia.
- Nyob rau hauv pulmonology, tshuaj anticholinergic yog siv rau bronchial hawb pob.
- Gastroenterology: nrog peptic rwj ntawm lub plab thiab duodenum, hyperacid gastritis (los ntawm kev txo qis qis ntawm hydrochloric acid los ntawm cov qog nqaij hlav). Cov tshuaj no zoo rau plab hnyuv colic.
- Nyob rau hauv anesthesiologists, atropine yog siv raws li ib tug premedication ua ntej ntau yam kev phais.
Cov teebmeem ntawm atropine
Tus yam ntxwv los ntawm qhov ncauj qhuav thiab larynx, photophobia, tsis pom kev nyob ze, cem quav, tso zis nyuaj.
Atropine yog categorically contraindicated rau siv nyob rau hauv glaucoma vim cov nyhuv ntawm intraocular siab. Anticholinergic tshuaj yog contraindicated rau urinary incontinence, raws li lawv so cov leeg ntawm lub zais zis. Cholinolytics xav tau qhov tseebxaiv koob tshuaj. Thaum cov koob tshuaj ntau dhau, kev lom ntawm lub cev tshwm sim, uas yog lub cev muaj zog thiab lub siab lub ntsws, cov menyuam kawm ntawv dilated, hoarseness, nyuaj rau nqos, thiab tej zaum yuav muaj qhov kub thiab txias. Nrog rau kev lom neeg hnyav dua, cov neeg mob pib poob lawv txoj kev taw qhia hauv qhov chaw, tsis paub txog cov neeg nyob ib puag ncig lawv, kev xav tsis thoob thiab kev xav tshwm sim. Tej zaum txoj kev loj hlob ntawm convulsions uas tig mus rau hauv lub coma, thiab vim tuag tes tuag taw ntawm qhov chaw ua pa, kev tuag sai sai. Cov menyuam yaus feem ntau nkag siab txog kev noj tshuaj ntau dhau - lawv qhov koob tshuaj tuag yog 6-10 mg.
Scopolamine zoo ib yam hauv cov qauv rau atropine, tab sis tsis zoo li nws, nws muaj feem cuam tshuam rau cov hlab ntsha hauv nruab nrab, ua haujlwm zoo li sedative. Nws yog cov cuab yeej no uas siv rau hauv cov tshuaj siv tswv yim - scopolamine yog siv rau ntau yam kev mob ntawm lub vestibular apparatus - kiv taub hau, gait thiab tshuav nyiaj li cas, los tiv thaiv kev loj hlob ntawm hiav txwv thiab huab cua.
Cov tshuaj Anticholinergic suav nrog hauv Aeron, uas feem ntau siv ua ntej yuav mus ncig ua si ntawm dav hlau thiab nkoj. Qhov kev txiav txim ntawm cov ntsiav tshuaj kav li 6 teev. Muaj ib daim ntawv uas tsis yog ntsiav tshuaj - ib tug transdermal kev kho mob system - ib thaj uas yog glued qab pob ntseg thiab tso cov tshuaj rau 72 teev. Cov tshuaj anticholinergic no - tshuaj tiv thaiv kev nyuaj siab, tshwj xeeb tshaj yog cov neeg mob siab, pab txhawb nqa lub siab ntawm tus neeg mob uas muaj kev nyuaj siab ntev.
Ipratropium bromide ("Atrovent") yog ib qho bronchodilator. Thaum nqus tau, nws yog xyaum tsis absorbed rau hauv cov ntshav thiab tsis muaj ib tug systemic nyhuv. Vim qhov blockade ntawm cholinergic receptors ntawm cov leeg nqaij ntawm lub bronchi, nws nthuav lawv. Cov tshuaj anticholinergics no muaj nyob rau hauv cov tshuaj inhaler lossis metered-dose aerosol thiab zoo rau mob hawb pob thiab COPD. Cov kev mob tshwm sim muaj xws li xeev siab thiab qhov ncauj qhuav.
Tiotropium bromides yog cov tshuaj anticholinergic zoo ib yam li cov khoom rau ipratropium bromide. Muaj ua hmoov rau nqus tau pa. Ib qho tshwj xeeb ntawm cov tshuaj no yog tias nws ua rau cholinergic receptors rau lub sijhawm ntev, yog li nws muaj txiaj ntsig zoo dua li ipratropium bromide. Siv rau COPD.
Platifillin - hla alkaloid. Tsis zoo li lwm cov tshuaj anticholinergics, platifillin tuaj yeem ua rau cov hlab ntsha. Vim yog cov cuab yeej no, muaj qhov txo qis hauv cov ntshav siab. Cov tshuaj yog tsim nyob rau hauv daim ntawv ntawm kev daws thiab qhov quav suppositories. Nws yog siv rau spasms nyob rau hauv cov nqaij ntshiv ntawm lub hauv nruab nrog cev, lub siab thiab lub raum colic, bronchial hawb pob, raws li zoo raws li rau mob los ntawm spasm thaum exacerbation ntawm gastric ulcer thiab duodenal rwj. Hauv kev xyaum ophthalmic, platifillin yog siv nyob rau hauv daim ntawv ntawm qhov muag te rau dilate cov menyuam kawm ntawv.
Pirenzepine - feem ntau thaiv cov hlwb ntawm lub plab uas tso tawm histamine. Los ntawm kev txo qhov tso tawm ntawm histamine, qhov tso tawm ntawm hydrochloric acid txo. Hauv cov koob tshuaj ib txwm siv, cov tshuaj no tsis tshua muaj txiaj ntsigntawm cov menyuam kawm ntawv thiab lub plawv contractions, yog li pirenzepine feem ntau yog noj qhov ncauj rau kev kho mob plab thiab duodenal ulcers.
N-anticholinergics (ganglion blockers)
Cov txheej txheem ntawm kev txiav txim yog tias cov tshuaj anticholinergic ntawm pab pawg no thaiv kev sib haum xeeb thiab parasympathetic innervation ntawm qib ntawm cov hlab ntsha, txo qis kev tso tawm ntawm adrenaline thiab norepinephrine, thiab tiv thaiv kev ua pa ntawm lub pa thiab vasomotor chaw. Tsis tas li ntawd, qhov ntau dua qhov cuam tshuam ntawm kev xav lossis parasympathetic innervation, qhov cuam tshuam ntau dua yuav tshwm sim.
Piv txwv li, qhov loj ntawm cov menyuam kawm ntawv feem ntau cuam tshuam los ntawm parasympathetic innervation - raws li txoj cai, cov menyuam kawm ntawv feem ntau raug txwv. Hauv qhov no, anticholinergics yuav cuam tshuam rau lub paj hlwb parasympathetic - vim li ntawd, cov menyuam kawm ntawv yuav nthuav dav. Yuav luag tag nrho cov hlab ntsha yog nyob rau hauv kev cuam tshuam ntawm lub sympathetic paj hlwb - cov tshuaj tshem tawm nws cov cawv thiab dilate cov hlab ntsha, li no yuav txo tau siab.
H-cholinergic blockers muaj cov nyhuv bronchodilatory thiab siv rau bronchospasm, txo cov suab nrov ntawm lub zais zis, yog li cov tshuaj anticholinergic no tuaj yeem muab tshuaj rau cov zis nyuaj. Tsis tas li ntawd, cov tshuaj no txo qis kev tso tawm ntawm cov qog, thiab tseem ua rau cov peristalsis ntawm lub plab zom mov. Hauv kev xyaum kho mob, cov nyhuv hypotensive uas cov tshuaj anticholinergic muaj feem ntau yog siv. Daim ntawv teev cov kev mob tshwm simnthuav dav:
- plab hnyuv: qhov ncauj qhuav thiab cem quav.
- Cov kab mob ua pa: hnoos, muaj peev xwm hnov mob hauv zos.
- Los ntawm CCC: arrhythmias, pronounced palpitations. Cov tsos mob no tsis tshua muaj thiab tswj tau yooj yim.
- Lwm yam cuam tshuam: txo qhov pom kev pom, kev loj hlob ntawm mob glaucoma, edema.
Contraindications rau kev siv cov tshuaj anticholinergics
- Ntaus rhiab heev rau atropine derivatives thiab lwm yam tshuaj tivthaiv.
- Kev xeeb tub (tshwj xeeb yog lub peb hlis ntuj 1).
- Lactation.
- Childhood (kwv tij contraindication).
- Kev siv tshuaj nyob rau hauv lub kaum sab xis kaw glaucoma yog kiag li contraindicated, nyob rau hauv cov neeg mob uas lub raum tsis txaus nws yuav tsum tau ua tib zoo saib xyuas cov ntshav thiab zis.
