Nrog rau kev ua haujlwm ntawm cov coagulated thiab anti-coagulable ntshav systems, qhov sib npaug sab hauv ntawm lub cev yog normalized. Cov ntshav ntws los ntawm cov hlab ntsha tsis muaj teeb meem thiab kev txwv, thiab kev tsim cov thrombus yog nyob ntawm qhov tseeb. Thaum qhov sib npaug ntawm kev ua haujlwm ntawm lub tshuab raug cuam tshuam rau kev txaus siab ntawm cov ntshav txhaws, cov xwm txheej tshwm sim uas tuaj yeem ua rau muaj ntshav txhaws ntau dhau. Indirect anticoagulants yog ib pawg ntawm cov tshuaj siv los kho cov teeb meem sab hauv.
Dab tsi yog cov tshuaj tiv thaiv coagulants?
Anticoagulants yog cov tshuaj uas muaj cov nyhuv anticoagulant thiab ua kom cov ntshav thinning. Qhov no tso cai rau koj los kho cov yam ntxwv rheological thiab txo qhov kev loj hlob ntawm thrombosis.
txhais tau tias muaj nyob rau hauv cov ntawv ntsiav tshuaj, hauv daim ntawv ntawm cov tshuaj pleev, gels thiab txhaj tshuaj. Lawv raug sau tseg tsis yog rau kev kho mob ntawm cov kab mob, tab sis kuj rau kev tiv thaiv ntawm kev tsim cov ntshav ntau ntxivpob.
Feem ntau ntawm cov neeg sawv cev ntawm pawg tshuaj no tsis ua rau cov thrombus tsim, tab sis ntawm kev ua haujlwm ntawm coagulation system. Muaj cov txheej txheem ntawm kev cuam tshuam cov ntshav plasma thiab thrombin ntau lawm, uas ua rau qeeb thrombus tsim.
Tshuaj muab faib ua ob pawg nyob ntawm lawv qhov kev ua:
- ncaj qha anticoagulants;
- indirect anticoagulants.
tshuaj ncaj qha raws li heparin
Cov tshuaj no muaj kev cuam tshuam ncaj qha rau plasma cofactors uas inhibit thrombin. Tus neeg sawv cev tseem ceeb yog heparin. Raws li nws, muaj ntau cov tshuaj uas ua tau zoo sib xws thiab muaj lub npe consonant:
- Ardeparin.
- Nadroparin.
- Klivarin.
- Longiparin.
- YSandoparin.
Heparin lossis derivatives ua ke nrog antithrombin-III, uas ua rau muaj kev hloov pauv ntawm nws cov molecules. Qhov no ua rau kom qhov txuas ntawm cofactor mus rau thrombin thiab tom qab ntawd mus rau qhov tsis ua haujlwm ntawm cov txheej txheem txhaws.
Cov yam ntxwv ntawm kev siv "Heparin"
Qhov kev ua ntawm cov tshuaj no yog txhawm rau tiv thaiv kev loj hlob thiab kis ntawm cov ntshav txhaws. Heparin molecules tsim cov complex nrog antithrombin, uas yog ib qho inhibitor ntawm coagulation yam. Cov tshuaj yog cov saw ntawm glycosaminoglycans. Cov tshuaj tau txhaj tshuaj subcutaneously thiab pib ua haujlwm hauv ob peb teev.
Yog tias koj xav tau kev txiav txim sai "Heparin" raug tswj hwmlos ntawm kev txhaj tshuaj infusion kom ceev cov txiaj ntsig thiab ua kom bioavailability. Qhov kev xaiv ntawm ntau npaum li cas ntawm cov tshuaj nyob ntawm seb tus mob nyob rau hauv tus neeg mob. Tsis tas li ntawd, muaj cov kab mob sib xyaw ua ke, kev noj zaub mov zoo sib xws ntawm lwm pab pawg tshuaj, xav tau kev phais mob ntawm cov hlab ntsha raug coj mus rau hauv tus account.
Oligopeptides
Cov tshuaj uas ua ncaj qha rau ntawm qhov chaw ua haujlwm thrombin yog suav tias yog muaj zog tshwj xeeb inhibitors ntawm cov kab mob thrombus tsim. Cov tshuaj nquag ntawm cov tshuaj ntawm nws tus kheej khi rau coagulation yam, hloov lawv conformation.
Cov no yog Inogatran, Hirudin, Efegatran, Tromstop thiab lwm yam. Siv los tiv thaiv kev loj hlob ntawm lub plawv nres nyob rau hauv angina pectoris, varicose leeg, tiv thaiv thromboembolism, reocclusion nyob rau hauv vascular plasty.
Indirect anticoagulants (cov npe)
thawj cov tshuaj tiv thaiv kab mob tau txais nyob rau xyoo pua 20th hauv Tebchaws Meskas, thaum pom tus kabmob tshiab ntawm nyuj, ua rau muaj ntshav ntau. Thaum qhov ua rau ntawm cov kab mob pathological tau qhia meej, nws tau muab tawm tias cov kab mob ntawm cov tsiaj tau cuam tshuam los ntawm cov kab mob fungal pom nyob rau hauv pub. Los ntawm cov khoom siv raw no, thawj cov tshuaj tiv thaiv kab mob tsis ncaj, Dicumarol, tau ua ke.
Txog hnub tim, cov npe ntawm cov nyiaj uas yog analogues ntau tshaj li ib puas yam khoom. Tag nrho cov tshuaj no yog indirect anticoagulants. Cov txheej txheem ntawm kev ua ntawm ib pawg tshuaj yog raws li inhibition ntawm kev ua ntawm vitamin K.
Muaj cov ntshav txhaws uas nyob ntawm cov vitamin no. Indirect anticoagulants tiv thaiv kev ua kom cov coagulation proteins thiab vitamin-dependent cofactors. Kev txwv tsis pub siv cov tshuaj no, vim tias qhov kev pheej hmoo ntawm cov teeb meem hemorrhagic nce ntxiv.
Muaj ob pawg tseem ceeb rau hauv uas tag nrho cov tshuaj tiv thaiv tsis ncaj ncees tau muab faib. Kev faib tawm ntawm cov nyiaj yog nyob ntawm cov khoom nquag uas yog ib feem ntawm kev npaj. Qhov txawv:
- coumarin derivatives;
- Indandion raws cov khoom.
Indandione npaj
Tom qab ntau qhov kev tshawb fawb, cov kws tshawb fawb tau pom tias cov nyiaj raws li cov tshuaj nquag no yuav tsum tsis txhob siv los kho. Cov tshuaj muaj ib tug loj tus naj npawb ntawm kev phiv nyob rau hauv daim ntawv ntawm kev tsis haum tshuaj. Qhov kev ua tau zoo ntawm qhov cuam tshuam rau cov kab ke anticoagulation kuj tsis pom qhov tshwm sim ruaj khov.
Cov tshuaj no suav nrog tshuaj: Fenindione, Difenindione, Anisindione. Nws tau txiav txim siab tso tseg qhov kev xaiv tseem ceeb ntawm pawg thib ob ntawm cov tshuaj tiv thaiv kab mob, thiab ntawm cov tshuaj indandione derivatives, tsuas yog Phenylin tam sim no siv.
Cov tshuaj muaj tus nqi qis, muaj nyob rau hauv daim ntawv ntsiav tshuaj. Nws ua haujlwm rau 10 teev, thiab nws yog ib qho tseem ceeb heev kom tswj tau lub sijhawm ntawm kev kho mob. Cov nyhuv tshwm sim tsuas yog tom qab 24 teev txij li thawj zaug koob tshuaj. Kev siv cov nyiaj yuav tshwm sim nyob rau hauv kev saib xyuas ntawm tus neeg mob tus mob uas siv cov ntsuas ntshav kuaj (coagulogram, kuaj dav dav, biochemistry).
Scheme of application of "Phenilin":
- Hnub Ib - 1 txhuantsiav tshuaj 4 zaug.
- Hnub Ob - 1 ntsiav tshuaj 3 zaug.
- Txoj kev kho tas li - 1 ntsiav tshuaj ib hnub.
Cov khoom no tsis pom zoo kom noj ib txhij nrog cov tshuaj uas txo qis cov piam thaj hauv lub cev.
Coumarin derivatives
Coumarin yog ib yam khoom uas muaj nyob rau hauv cov nroj tsuag thiab tuaj yeem tsim cov hluavtaws hauv chav kuaj. Thaum xub thawj, tom qab nws tshem tawm, tus neeg sawv cev tau siv los ua tshuaj lom los tswj cov nas. Tsuas yog lub sijhawm dhau los, cov tshuaj tau pib siv los tiv thaiv cov hlab ntshav ntau dhau.
Indirect anticoagulants - tshuaj raws li coumarin - yog sawv cev los ntawm cov tshuaj hauv qab no:
- Warfarin (nws cov analogues yog Marevan, Warfarin Sodium, Warfarex).
- "Acenocoumarol" (analogue - "Sinkumar").
- "Neocoumarin" (analogue - "Ethylbiscumacetate").
"Warfarin": daim ntawv thov nta
Indirect anticoagulants (cov npe nyob rau hauv tsab xov xwm) feem ntau yog sawv cev los ntawm "Warfarin". Cov ntsiav tshuaj no muaj nyob rau hauv 2, 5, 3 lossis 5 mg. Cov nyhuv ntawm tib neeg lub cev tshwm sim tom qab 1.5-3 hnub txij li thaum thawj ntsiav tshuaj tau noj. Cov txiaj ntsig siab tshaj plaws yuav tshwm sim thaum kawg ntawm thawj lub lim tiam.
Tom qab qhov kawg ntawm kev noj tshuaj, cov ntshav tsis zoo ntawm cov ntshav rov qab mus li qub tom qab 5 hnub txij li hnub "Warfarin" raug tso tseg. Txoj kev kho yog siv 2 zaug hauv ib hnub rau tib lub sijhawm. Hnub 5 los ntawm kev pib khoua kev kuaj ntshav txhawm rau txiav txim siab qhov tsim nyog thiab ua haujlwm tau zoo ntawm daim ntawv thov.
Cov kev kho mob yog xaiv los ntawm tus kws kho mob tshwj xeeb hauv txhua kis ntawm tus kheej. Qee cov kab mob pathological (piv txwv li, atrial fibrillation) yuav tsum tau siv tas li. Nrog rau txoj kev loj hlob ntawm PE (pulmonary embolism), tus neeg sawv cev antiplatelet raug tshuaj tsawg kawg rau lub hlis lossis rau lub neej.
Yog xav tau kev phais, Warfarin yuav tsum muab tso tseg 5 hnub ua ntej kev phais. Qhov no yuav ua rau cov ntshav suav rov qab mus rau qhov qub. Yog tias muaj kev xav tau ntau ntxiv rau kev siv cov tshuaj anticoagulant txuas ntxiv, tus neeg sawv cev no tau hloov los ntawm cov tsis yog feem ntau heparin. Qhov koob tshuaj kawg yog muab 4 teev ua ntej qhov kev cuam tshuam.
Tom qab ua haujlwm, tsis yog feem ntawm heparin rov pib dua 4 teev tom qab. Kev txais tos ntawm cov tshuaj tiv thaiv kab mob tsis ncaj tuaj yeem rov qab tau tom qab ob hnub, tom qab saib xyuas cov ntshav hauv lub xeev uas siv cov kev kuaj sim.
Thaum twg yog cov tshuaj tiv thaiv coagulants?
Direct and indirect anticoagulants yog siv los tiv thaiv kev loj hlob ntawm thromboembolism, mob thrombosis ntawm venous system, nyob rau hauv cov ntaub ntawv ntawm mechanical prosthetic lub plawv li qub thiab kev loj hlob ntawm atrial fibrillation.
Cov kab mob tseem ceeb, hauv kev txhim kho cov tshuaj tiv thaiv kab mob ntawm kev ncaj qha thiab tsis ncaj, tau muab faib ua pawg hauv qab no:
-
Thrombosis ntawm arterial system:
- myocardial infarction;
- pulmonary embolism;
- mob stroke nrog kev tshwm simischemia;
- kev puas tsuaj rau cov hlab ntsha vim yog atherosclerosis.
-
- shock xeev;
- raug mob;
- kev txhim kho ntawm sepsis.
-
mob hlab ntsha tawg:
- thrombosis tiv thaiv keeb kwm ntawm varicose leeg;
- thrombosis ntawm hemorrhoidal venous plexuses;
- Clot formation in inferior vena cava.
YDisseminated intravascular coagulation:
Lub ntsiab contraindications
Indirect anticoagulants yog cov tshuaj uas raug txwv nruj thaum muaj lactose tsis txaus, piam thaj lossis galactose malabsorption. Muaj ntau cov tshuaj uas tsis tuaj yeem siv ib txhij nrog cov tshuaj tiv thaiv tsis ncaj qha. Cov npe ntawm cov tshuaj muaj cov tshuaj uas tsis yog-steroidal anti-inflammatory tshuaj: Aspirin, Dipyridamole, Clopidogrel, Penicillin, Chloramphenicol, Cimetidine.
Cov xwm txheej uas ncaj qha thiab tsis ncaj qha tshuaj tiv thaiv tsis tuaj yeem siv:
- kab mob plab hnyuv;
- vascular aneuryms;
- kab mob siab;
- mob ntshav siab;
- thrombocytopenia;
- raum tsis ua haujlwm;
- Kuv lub peb hlis ntuj thiab lub hli kawg ntawm cev xeeb tub;
- siab creatinine.
Kev mob tshwm sim ntawm cov tshuaj tiv thaiv kab mob
Txhua yam tshuaj hauv pawg tshuaj no muaj cov kev mob tshwm sim zoo sib xws. Lawv tshwm sim nrog kev noj tshuaj rau tus kheej, noj tshuaj tsis raug, lossis ua txhaum cov lus pom zoo rau kev siv.
KCov kev mob tshwm sim muaj xws li kev txhim kho los ntshav, dyspeptic tshwm sim nyob rau hauv daim ntawv ntawm ntuav, xeev siab thiab raws plab. Muaj mob hnyav hauv plab, ua xua ntawm daim tawv nqaij ua pob khaus zoo li urticaria lossis eczema. Necrosis, plaub hau poob, khaus tawv nqaij tuaj yeem tsim.
Ua ntej pib kev kho mob, tus neeg mob yuav tsum xeem dhau ib qho kev sim los txiav txim siab seb yuav siv cov tshuaj li cas. Tus neeg mob muab kev kuaj ntshav dav dav, biochemistry, kev tso zis dav dav, tso zis raws li Nechiporenko, coagulogram. Nws tseem pom zoo kom ua ultrasound ntawm lub raum thiab pub cov quav rau cov ntshav occult.
Ntau dhau ntawm cov tshuaj tiv thaiv tsis ncaj qha
Cov neeg mob ntau dhau ntawm pawg tshuaj no tsis tshua muaj. Qhov no tuaj yeem tshwm sim yog tias tus menyuam me pom cov tshuaj hauv tsev thiab saj nws. Feem ntau cov concentration ntawm cov tshuaj yog tsawg, yog li ib koob tshuaj ntawm cov tshuaj tsis txaus ntshai. Nyob rau hauv rooj plaub tshwj xeeb lossis tsis txhob txwm siv cov tshuaj ntau ntau, coagulopathy thiab los ntshav tuaj yeem tshwm sim.
Lub chaw kho mob overdose tsis muaj cov tsos mob tshwj xeeb, yog li nws nyuaj rau kwv yees tias cov tshuaj tau noj ntau heev. Cov tsos mob ntawm kev tshwm sim yog zoo ib yam li ntau yam kab mob thiab pathological mob ntawm lub cev. Tus neeg mob tshwm:
- tuag nqaij tawv;
- ntshav tso zis los yog quav;
- uterine los ntshav;
- hematomas hauv caj dab;
- intracranial hemorrhage.
Kev mob stroke dhau los, hnub nyoog dhau los, keeb kwm ntawm plab hnyuv los ntshav thiab qis hematocrit yog ib qho ua ke uas tuaj yeem txo qis cov tshuaj tiv thaiv kab mob.
Tshuaj tiv thaiv kab mob ntau dhau
- Tsis muaj qhov cuam tshuam hauv kev nqus lossis yaug lub plab ob peb teev tom qab noj tshuaj.
- Tus neeg mob tau muab activated charcoal rau txoj hnyuv nqus.
- Yog tias muaj kev noj ntau dhau ntawm "Warfarin" lossis nws cov analogues, "Cholestyramine" raug sau rau ntawm qhov ncauj.
- Tus neeg mob tau muab tso rau hauv kev tiv thaiv kev raug mob kom tsis txhob pom cov hematomas tshiab thiab hemorrhages.
- Nrog kev poob ntshav tseem ceeb, kev hloov pauv ntawm cov qe ntshav lossis ntshav ntshav, qee zaum tag nrho cov ntshav, tau ua tiav. Erythrocyte loj, cryoprecipitate, prothrombin complex yog siv tau.
- Fitomenadione yog tshuaj, npaj raws li vitamin K.
- Yog tias tsis muaj qhov yuav tsum tau sau tshuaj tiv thaiv kab mob, ces Fitomenadione tau muab tshuaj raws li kev kho mob, thiab tsis yog kev pab thawj zaug.
Yog tias tus neeg mob tus mob tau rov zoo li qub, tab sis nws yuav tsum tau siv cov tshuaj tiv thaiv kab mob tsis ncaj, ces koj yuav tsum hloov Warfarin ib ntus nrog cov tshuaj heparin.
Zoo kawg
Kev siv cov tshuaj antiplatelet tso cai tsis tau tsuas yog ua kom cov ntshav rheological zoo li qub, tab sis kuj tseem txhim kho cov mob ntawm tus neeg mob thiabtiv thaiv kom muaj kab mob loj.
Ua tib zoo saib xyuas kev siv cov tshuaj tiv thaiv coagulants, xaiv ntau npaum li cas thiab saib xyuas tus neeg mob tus mob yuav pab txo qis kev pheej hmoo ntawm cov teeb meem thiab ua tiav. Cov kws kho mob tshwj xeeb uas siv cov tshuaj no hauv lawv txoj kev xyaum yuav tsum txhim kho lawv txoj kev paub thiab ua raws li cov lus pom zoo thoob ntiaj teb kev kho mob.
