Ntau yam tshuaj lom neeg tshwm sim tas li tshwm sim hauv lub cev. Ntshav yog ib yam kua, uas yog yus muaj los ntawm tej yam txheej txheem: thrombus tsim thiab liquefaction ntawm cov hlab ntsha uas tau tshwm sim. Thaum lub cev reserves tau tag lawm, cov tshuaj thrombolytic tuaj cawm.
Cov no yog cov tshuaj muab tso rau hauv cov hlab ntsha los tiv thaiv cov ntshav txhaws los ntawm cov hlab ntsha. Thrombosis tuaj yeem tshwm sim hauv cov hlab ntsha lossis cov hlab ntsha. Nws cuam tshuam kev ua haujlwm ntawm lub cev tseem ceeb, thiab tuaj yeem ua rau muaj ntau yam teeb meem thiab ua rau tuag taus.
yam ntxwv
Lub hom phiaj tseem ceeb ntawm cov tshuaj thrombolytic yog kev sib cais ntawm cov ntshav txhaws uas cuam tshuam nrog microcirculation ib txwm. Cov tshuaj niaj hnub no pab rau cov xwm txheej nyuaj tshaj plaws.
Feem ntau, tib neeg tsis meej pem thrombolytics, anticoagulants thiab antiplatelet tus neeg sawv cev rau ib leeg. Thawj pab pawg tshuaj tshem tawm cov ntshav txhaws uas twb muaj lawm, thiab tus so tiv thaiv nws txoj kev tsim. Lawvsiv, raws li txoj cai, rau kev tiv thaiv.
Lawv thrombolytics yog enzymes uas nkag rau hauv cov kua hauv cov hlab ntsha puas. Twb tau li ib teev tom qab siv, cov tshuaj nquag ua haujlwm, uas ua rau muaj kev daws teebmeem sai.
Nws yuav tsum nco ntsoov tias txhua yam tshuaj thrombolytic tsuas yog siv thaum muaj kev hem thawj rau lub neej hauv tsev kho mob thiab nyob rau hauv kev saib xyuas ntawm kws kho mob.
How thrombolytics ua haujlwm
Thaum lub cev tsis tuaj yeem tiv nrog cov ntshav txhaws lawm, siv cov tshuaj kho tshwj xeeb. Fibrin yog cov protein uas muaj lub luag haujlwm rau viscosity. Nrog nws qhov tsis txaus, kev ua txhaum ntawm cov txheej txheem ntawm cov ntshav txhaws thiab los ntshav tshwm sim, thiab nrog cov ntsiab lus ntxiv, cov ntshav txhaws.
Rau qhov kev tawg ntawm fibrin clot, plasmin yog xav tau, uas yog nyob rau hauv cov ntshav tas li, tab sis nws yuav tsis txaus. Txhawm rau tshem tawm cov hlab ntsha, cov tshuaj enzymatic yog nchuav rau hauv cov hlab ntsha, uas ua rau kev puas tsuaj ntawm fibrin accumulations.
Lub spectrum ntawm kev ua ntawm cov tshuaj thrombolytic yog raws li kev nce ib ntus ntawm cov plasmin hauv cov ntshav. Muaj ntau txoj hauv kev ntawm kev tswj hwm tshuaj:
- Infusion yog qhov kev qhia qeeb ntawm cov tshuaj mus rau hauv cov leeg.
- bolus - ib qho tshuaj sai sai ntawm cov tshuaj loj rau kev tawm tsam tam sim ntawm lub cev.
- Txoj kev sib xyaw - thawj zaug txhaj tshuaj sai, thiab tom qab ntawd maj mam txhaj tshuaj.
Thaum twg thiaj tsim nyog siv thrombolytics
Cov nyiaj no yog siv rau ntau yam tshuaj. Raws li txoj cai, lawv raug pom zoo hauv kev kho mob ntawm cov kab mob uas cuam tshuam nrog ntshav txhaws. Cov tshuaj tsim nyog rau kev kho mob ntawm cov hlab ntsha, nrog rau cov hlab ntsha thiab cov kab mob ntawm cov kab mob thrombosis.
Indications:
- Ischemic stroke (kev puas tsuaj microcirculation ntawm lub hlwb nrog cov ntaub so ntswg puas).
- Myocardial infarction (ib hom mob plawv ischemia, uas tshwm sim nrog qhov tshwm sim ntawm ischemic necrosis ntawm ib feem ntawm lub plawv cov leeg, vim qhov tseeb lossis txheeb ze tsis txaus ntawm nws cov microcirculation).
- Pulmonary thromboembolism (kev thaiv ntawm cov hlab ntsha pulmonary lossis nws cov ceg ntoo nrog cov ntshav txhaws, uas tshwm sim ntau dua hauv cov hlab ntsha loj ntawm cov leeg qis lossis lub plab mog).
- Thrombosis ntawm cov hlab ntsha loj (ib kab mob tshwm sim los ntawm kev tsim cov ntshav txhaws ntawm cov phab ntsa sab hauv ntawm cov hlab ntsha thiab cov hlab ntsha, uas cov ntshav txhaws thaiv lub lumen ntawm cov hlab ntsha thiab cuam tshuam cov ntshav ncig).
- Clot formation in the heart.
Cov tshuaj thrombolytic dab tsi siv rau myocardial infarction?
txwv tsis pub siv
Qhov tsis zoo ntawm cov tshuaj thrombolytic yog qhov ua rau muaj kev pheej hmoo los ntshav, uas ua rau kev noj qab haus huv tsis zoo thiab tuaj yeem ua rau cov kab mob hnyav dua. Ua ntej siv cov tshuaj, koj yuav tsum paub koj tus kheej zoo nrog cov lus pom zoo, vim tias lawv muaj cov txheeb ze thiab cov kev txwv. Ua ntej kev kho mob, tus kws kho mob yuav tsum tau kuaj ntshav thiab electrocardiogram, thiab tsuas yog tom qab ntawv sau ntawvtshuaj.
Contraindications:
- Internal los ntshav.
- Kev phais plab plab.
- Kev phais mob hauv thaj tsam ntawm tus txha caj qaum thiab lub hlwb.
- Hypertension (ib kab mob uas muaj ntshav siab txaus).
- Kab mob hauv lub pericardium (qhov txhab ntawm lub hnab pericardial feem ntau yog kis mob, mob rheumatic lossis tom qab mob plab).
- Aortic aneurysm (kev nthuav dav ntawm thaj chaw txwv ntawm phab ntsa aortic, zoo li lub ntxaiv lossis lub hnab zoo li tsim nyob rau hauv cov duab, los yog qhov sib txawv ntawm nws cov lumen ntau dua 2 zaug piv rau thaj chaw tsis hloov pauv).
- mob pancreatitis (mob aseptic inflammatory lesion ntawm pancreas ntawm hom demarcation).
- Cov ntshav tsis txaus.
- kev tawm tsam tus kheej.
- noj tshuaj tiv thaiv kab mob.
- Daim ntawv mob diathesis (ib yam mob ntawm tus menyuam lub cev, uas yog tus cwj pwm los ntawm kev nyiam tsim cov kab mob, xws li kab mob ua pa).
- Kab mob ua rau los ntshav.
- Hloov pauv hauv cov qauv ntawm cov hlab ntsha hlwb.
- ntshav siab.
- Diabetic retinal disease.
- Thrombophlebitis (thrombosis nrog o ntawm phab ntsa ntawm cov hlab ntsha thiab tsim cov ntshav txhaws uas kaw nws cov lumen).
- Kev raug mob rau lub taub hau thiab qaum qaum.
- kub hnyiab heev.
- Txoj kev tawg ntawm ko taw.
- Ntshav plab lossis hnyuv.
Means of thisCov pab pawg tau raug tshem tawm sai sai ntawm lub cev, yog li tshuaj lom yog qhov tsawg kawg nkaus.
Kev faib cov tshuaj thrombolytic
Tam sim no muaj tsib tiam tshuaj:
- Thawj tiam yog cov enzymes uas muaj nyob hauv cov xwm txheej. Lawv hloov cov ntshav plasma thiab muaj txiaj ntsig zoo ntawm kev ua kom cov ntshav plasmagen ua rau plasmin. Cov tshuaj nquag raug cais tawm ntawm cov ntshav. Xws li cov tshuaj hloov ntshav txhaws, yog li provoking los ntshav hnyav. Cov tshuaj no ua txawv teb chaws rau lub cev, ua rau muaj kev tsis haum tshuaj. Lawv pab kom tau txais txiaj ntsig sai, tab sis vim muaj qhov tshwm sim los ntshav hnyav, lawv siv tsis tu ncua.
- tiam thib ob yog cov tshuaj fibrin tshwj xeeb uas tau tsim tawm nrog kev pab los ntawm cov kab mob E. coli. Lawv feem ntau cuam tshuam cov ntshav txhaws, thaum tsis muaj kev cuam tshuam sab nraud. Yam tsawg kawg ntawm qhov tsis zoo ua rau lawv nrov dua nyob rau lub sijhawm tam sim no.
- tiam thib peb yog recombinant activators. Lawv qhov zoo yog qhov kis tau ntev dua, nrog rau kev muaj peev xwm nrhiav tau cov ntshav txhaws.
- Tam sim no plaub yog cov tshuaj nyuaj uas nrawm nrawm thiab muaj txiaj ntsig zoo rau cov ntshav txhaws ntau dua piv rau cov tshuaj tiam dhau los. Hmoov tsis zoo, lawv tseem tsis tau kawm txaus rau lub sijhawm tam sim no.
- tiam thib tsib yog kev sib xyaw ntawm cov khoom xyaw ntuj thiab cov khoom xyaw ua ke.
Daim Ntawv Kho Mobthawj tiam
Tseem cov tshuaj uas nrov tshaj plaws:
- "Fibrinolysin".
- Y"Streptokinase".
- Y"Urokinase".
- "Streptodecaza".
- "Thromboflux".
"Fibrinolysin" yog lub ntuj enzyme uas cais tawm los ntawm cov ntshav pub dawb thiab tsim nyob rau hauv cov hmoov rau cov tshuaj txhaj. Nws ua rau cov protein (protein) threads, cuam tshuam lawv cov qauv thiab stabilizes ntshav microcirculation. Ntau yam kev ua xua tshwm sim tuaj yeem ua tau, txij li cov protein txawv teb chaws siv nyob rau hauv qhov muaj pes tsawg leeg. Txoj kev pheej hmoo ntawm hemorrhage nce raws li cov ntshav txhaws qis.
Y"Streptokinase"
Lub teb chaws keeb kwm ntawm cov tshuaj yog Belarus. Nws yog ib qho tshuaj zoo rau kev kho thrombolytic hauv myocardial infarction. Muaj nyob rau hauv daim ntawv ntawm cov hmoov, uas yog siv los ua ib tug tov. Siv nruj me ntsis hauv lub tsev kho mob. Qhov no yog vim nws qhov tsis zoo:
- Hemorrhage.
- Sudden hloov ntshav siab.
- Tachycardia (siab lub plawv dhia siab dua 90 neeg ntaus ib feeb).
- Bradycardia (arrhythmias uas tshwm sim los ntawm lub plawv qis).
Cov tshuaj zoo kawg nkaus yaj cov ntshav txhaws, txhim kho kev ua haujlwm ntawm sab laug ventricle ntawm lub plawv.
Urokinase
Qhov no yog cov tshuaj thrombolytic uas suav tias yog lub ntsiabplasmin stimulator. Nws txhawb nqa sab hauv thiab sab nraud dissolution ntawm cov ntshav txhaws. Lub teb chaws ntawm keeb kwm ntawm "Urokinase" yog Kauslim. Txhawm rau tsim nws, lub raum hlwb siv. Cov nyhuv ntawm cov tshuaj no yog pom zoo tom qab li peb mus rau rau teev. Hemorrhage yuav muaj, nrog rau los ntshav los ntawm kev lom.
Y"Streptodecaza"
Tshuaj nrog lub sijhawm ntev. Lub teb chaws ntawm keeb kwm - Russia. Cov tshuaj muaj feem xyuam rau cov ntshav txhaws. Cov kev mob tshwm sim hauv qab no yuav zoo li:
- kiv taub hau;
- tawv nqaij ua xua;
- nce hauv lub cev kub.
Thromboflux
Cov tshuaj yog siv rau theem siab ntawm tus kab mob. Cov tshuaj no pab txo qis fibrinogen hauv cov ntshav, uas tuaj yeem ua rau lub hlwb hemorrhage. Cov xwm txheej tsis zoo hauv qab no yuav zoo li:
- rashes;
- txo qis ntshav siab;
- nce plawv dhia;
- bradycardia.
Lub teb chaws - India.
tshuaj thib ob
Npe ntawm cov tshuaj thrombolytic hauv pawg no:
- "Alteplaza".
- "Actilise".
- Y"Prourokinase".
- "Gemaza".
- "Purolase".
- "Metalise".
"Alteplase" yog ib qho tshuaj uas txo qis kev pheej hmoo los ntshav. Cov tshuaj zom cov ntshav txhaws, txhim kho cov ntshav khiav. Nws yog siv nyob rau hauv thawj teev tom qab lub plawv nres los yog mob stroke, uas txo qhov yuav tshwm simteeb meem thiab txawm tuag.
"Actilyse" yog thrombolytic, uas yog siv rau kev puas tsuaj loj rau cov leeg thiab cov hlab ntsha. Nws qhia tau hais tias qhov ua tau zoo tshaj plaws nyob rau theem pib ntawm kev kho mob tshwm sim thawj zaug thiab ib nrab mus rau ob teev tom qab qhov pib tshwm sim ntawm lub plawv nres lossis mob stroke. Qhov yuav muaj teeb meem tsawg kawg nkaus.
"Prourokinase" yog ib yam tshuaj uas txawv ntawm qhov nws muaj qhov pheej hmoo los ntshav qis tshaj plaws. Thaum siv nws, cov hauv qab no ua tau:
- kev tsis haum;
- tachycardia;
- arrhythmia.
"Gemaza" yog ib hom tshuaj Lavxias teb sab uas tsim nyob rau hauv daim ntawv ntawm cov hmoov thiab feem ntau yog siv nyob rau hauv ophthalmology tom qab kev phais thiab nyob rau hauv cov ntaub ntawv ntawm lub plawv nres. Thaum siv, muaj kev pheej hmoo tsawg kawg los ntshav.
"Purolase" yog ib yam tshuaj uas ua rau muaj txiaj ntsig zoo tshaj plaws ntawm thrombosis ntawm peripheral hlab ntsha ntawm ob txhais ceg, caj npab thiab lub plawv nres hauv thawj feeb tom qab thawj cov tsos mob tshwm sim.
"Metalise" yog ib yam tshuaj uas muaj cov nyhuv xaiv thiab qhov ua rau los ntshav tsawg dua. Tsis tshua muaj siv vim tus nqi siab.
Tsev tiam thib peb tshuaj
Npe ntawm cov tshuaj thrombolytic:
- "Reteplase".
- "Lanoteplase".
- "Tenecteplaza".
- "Antireplaza".
"Reteplase" yog tus neeg sawv cev thrombolytic uas tau siv sijhawm ntev los txhim kho microcirculation. Txoj kev tshawb no qhia tau hais tias kev siv cov tshuaj qhia tau hais tias qhov kev pheej hmoo ntawm los ntshav qis tshaj plaws.
"Tenecteplase" yog ib qho tshuaj zoo uas tuaj yeem ua sai sai nrog kev pheej hmoo los ntshav tsawg. Lub ntuj plasminogen activator hloov nws mus rau hauv plasmin hauv cov hlab ntsha.
"Lanoteplase" yog tus neeg sawv cev thrombolytic, uas tau txais los ntawm kev tsim kho caj ces. Cov tshuaj tsis ua rau muaj kev fab tshuaj, muaj qee zaus, los ntshav thiab ntshav ntawm qhov mob hnyav heev.
"Antistreplaza" yog ib yam tshuaj uas muaj txiaj ntsig sai rau cov ntshav txhaws. Txhawm rau kom tau txais qhov xav tau, nws txaus los thov cov tshuaj ib zaug. Kev sib cais ntawm cov ntshav txhaws yog pom nyob rau hauv plaub caug-tsib feeb.
nyiaj txiag thib plaub thiab thib tsib
Cov no yog cov tshuaj thrombolytic niaj hnub ntawm ib tiam tshiab. Lawv ua sai sai, tsis zoo li daim ntawv thib peb ntawm plasminogen. Cov tshuaj muab cov khoom ntawm cov tshuaj ntawm cov tiam dhau los.
Kev xav
Kev tshuaj xyuas ntawm cov tshuaj thrombolytic yuav luag nrhiav tsis tau, thiab yog li nws tsis tuaj yeem txiav txim siab yam tshuaj twg zoo dua lossis phem dua raws li cov lus teb ntawm cov neeg mob thiab kws kho mob.
Raws li kev tshuaj xyuas ntawm cov kws kho mob tshwj xeeb, nws paub tias lub luag haujlwm ntawm cov tshuaj thrombolytic hauv cov tshuaj yog siab, lawv pab ntauneeg los daws qhov teeb meem. Cov tshuaj thib ob yog suav tias yog cov neeg nyiam tshaj plaws. Lawv tau dhau qhov kev xeem txaus, thiab kuj tau ua pov thawj lawv tus kheej zoo thiab tsis muaj cov ntsiab lus tsis zoo.
