Ntawm cov tshuaj tsaug zog ntau thiab cov tshuaj tua kab mob ntawm cov tshuaj narcotic, ib qho chaw tshwj xeeb yog nyob ntawm "Thiopental sodium". Cov lus qhia rau kev siv cov tshuaj muaj zog loj no yog qhov txaus siab rau ntau tus neeg mob. Tus kws tshuaj no yog dab tsi? Nyob rau hauv rooj plaub twg yog qhov kev teem caij ncaj ncees? Dab tsi yog cov txheej txheem ntawm kev ua ntawm sodium thiopental thiab yuav siv nws li cas? Cov tshuaj puas tuaj yeem ua rau muaj kev phiv thiab yuav ua li cas thaum noj ntau dhau? Cov lus teb rau cov lus nug no yog muab los ntawm cov lus qhia rau kev siv "Thiopental sodium".
Qhia txog tshuaj
Ua ntej koj yuav cov tshuaj, koj yuav tsum tau noj tshuaj Latin rau sodium thiopental los ntawm koj tus kws kho mob. Cov tshuaj no muaj cov nyhuv narcotic muaj zog, yog li nws tsis tuaj yeem yuav yam tsis muaj kws kho mob tshuaj.
Tshuaj yog dab tsi? Nyob rau hauv lub khw muag tshuaj, nws yog muag nyob rau hauv daim ntawv ntawm ib tug lub teeb hygroscopic hmoov, los ntawm cov kev daws rau intravenous tshuaj yuav npaj tau. Cov hmoov, ib los yog ib nrab ib gram, yog ntim rau hauv iav fwj nrog lub peev xwm ntawm kaumlos yog nees nkaum milliliters.
Cov khoom nquag ntawm tus neeg sawv cev ntawm kev txaus siab rau peb yog cov khoom ntawm tib lub npe - Thiopental sodium. Qhov no yog li cas lub npe yuav sau rau hauv daim ntawv qhia "Sodium Thiopental" hauv Latin.
Cov khoom xyaw nquag yog ib qho derivative ntawm barbituric acid. Nws yog siv los ua tshuaj loog uas tsis yog inhalation. Dab tsi ua tiav qhov xav tau ntawm cov tshuaj?
Nyob zoo rau lub cev
Yuav ua li cas thaum cov tshuaj nkag mus rau hauv cov hlab ntsha? sodium thiopental cuam tshuam li cas rau tib neeg lub cev? Cov pab pawg kws tshuaj ntawm cov tshuaj no yog tshuaj loog rau kev txhaj tshuaj rau hauv cov hlab ntsha nrog cov tshuaj loog luv luv thiab hypnotic effect.
Nkag mus rau hauv cov hlab ntsha, cov tshuaj nquag inhibits qhov chaw ua pa thiab vasomotor, nrog rau myocardium nws tus kheej. Maj mam, raws li cov txiaj ntsig no, tus neeg mob cov ntshav siab thiab mem tes txo qis, thiab cov leeg nqaij so yog hnov.
"Thiopental sodium" qeeb qeeb qhib cov channel uas nyob ntawm qhov cuam tshuam ntawm gamma-aminobutyric acid, thiab tseem ua rau lub sijhawm rau chloride ions nkag mus rau hauv cov hlab ntsha. Tsis tas li, cov tshuaj txo cov nyhuv stimulating ntawm cov amino acids xws li glutamate thiab aspartate.
Nws yog ib qho tseem ceeb uas cov tshuaj uas peb xav tau muaj cov nyhuv anticonvulsant. Qhov no yog ua tiav los ntawm kev nce qhov pib ntawm excitability ntawm neurons thiab thaiv cov conduction thiab propagation ntawm convulsive impulses thoob plaws hauv lub hlwb. Cov tshuaj kuj txoqhov kev siv ntawm qee cov txheej txheem tshwm sim hauv lub hlwb.
Nws siv sijhawm ntev npaum li cas rau Sodium Thiopental ua haujlwm? Cov tshuaj, thaum muab tso rau hauv cov hlab ntsha, pib ua hauv peb caug vib nas this, thaum siv rectally, tom qab yim mus rau kaum feeb.
Cov tshuaj yuav kav ntev npaum li cas? Raws li cov lus qhia qhia, lub sijhawm ntawm kev siv tshuaj loog sib txawv ntawm nees nkaum mus rau peb caug feeb. Tom qab lub sijhawm no, tus neeg mob sawv. Raws li cov lus qhia, sodium thiopental tsis ua rau tsaug zog tom qab sawv. Lub sijhawm ntawm cov nyhuv analgesic xaus rau lub sijhawm tus neeg mob sawv.
Pharmacokinetic nta
Thaum muab tso rau hauv cov hlab ntsha, cov tshuaj nkag mus los ntawm cov hlab ntsha mus rau lub hlwb, cov ntaub so ntswg adipose, daim siab, cov leeg pob txha thiab ob lub raum hauv plaub caug txog rau caum vib nas this. Vim lub fact tias cov active tshuaj kis tau sai heev nyob rau hauv tag nrho cov ntaub so ntswg ntawm lub cev, nws cov nyhuv hnav sai sai.
Cov tshuaj plasma protein khi nruab nrab yog yim caum feem pua. Nrog rau ib qho kev tswj hwm, ib nrab-lub neej ntawm cov tshuaj nquag muaj nyob ntawm peb mus rau yim teev. Hauv cov menyuam yaus, cov txheej txheem no yog qhov ceev tshaj plaws - me ntsis ntau tshaj li ib teev. Lub sijhawm no nce rau cov poj niam nqa menyuam (txog 26 teev) thiab cov neeg rog rog (kwv yees li 27 teev).
Tus neeg sawv cev ntawm kev txaus siab rau peb yog metabolized nyob rau hauv daim siab, tawm los ntawm ob lub raum. Nws yog noteworthy tias cov tshuaj muaj ib tug cumulative nyhuv. Qhov no yog ua tau nrog rov hais dua cov tshuaj loog. Hauv qhov no, sodium thiopentalaccumulates nyob rau hauv cov ntaub so ntswg fatty.
Thaum twg qhov tshuaj loog no tau tsim nyog?
Cov lus qhia rau kev siv tshuaj
Feem ntau, cov tshuaj tau muab rau kev phais mob luv luv raws li kev siv tshuaj loog. Qee zaum, cov tshuaj ua raws li cov lus qhia lossis cov tshuaj loog. Qhov ntawd yog, tom qab nws qhia, nws yuav tsum tau siv lwm yam tshuaj muaj zog ntau dua rau kev siv tshuaj loog lossis tshuaj kho mob.
Qee zaum, Sodium Thiopental tuaj yeem siv los kho tus neeg mob uas muaj xwm txheej mob vwm lossis muaj zog intracranial. Qee zaum kev txhaj tshuaj yog muab los ua kev tiv thaiv ntawm cerebral hypoxia. Qhov no feem ntau yog kev ncaj ncees hauv kev ua haujlwm neurosurgical ua rau ntawm cov hlab ntsha ntawm lub hlwb, nrog cov khoom siv dag zog lossis carotid endarterectomy.
Tau kawg, cov tshuaj muaj contraindications.
Thaum tsis siv tshuaj
Ntawm cov contraindications tseem ceeb ntawm cov tshuaj, cov kws kho mob nco ntsoov loj pathologies ntawm lub raum thiab daim siab, ntshav qab zib mellitus, bronchial hawb pob, vau, qaug zog heev ntawm lub cev, inflammatory kab mob ntawm nasopharynx, kub taub hau, mob circulatory ntshawv siab, tawm tsam. ntawm mob porphyria hauv anamnesis ob leeg hauv tus neeg mob nws tus kheej thiab nws cov txheeb ze.
Ntxiv rau, cov tshuaj no yuav tsum tsis txhob siv los ua tshuaj loog rau cov poj niam uas pub niam mis, nrog rau cov neeg mob kuaj pom tias muaj kev tsis haum tshuajsodium thiopental lossis intoxication ntawm ntau lub hauv paus chiv keeb (vim kev haus cawv ntau ntxiv, tshuaj tsaug zog, tshuaj tua kab mob, thiab lwm yam).
Nrog ceev faj, nws raug nquahu kom sau cov tshuaj no rau cov poj niam cev xeeb tub, cov menyuam yaus hnub nyoog qis dua kaum ob xyoos, nrog rau cov neeg muaj ntshav qab zib, cov leeg nqaij dystrophy, cov kab mob ua pa ntev ntev, rog rog, kab mob hnyav ntawm cov hlab plawv. (tsis ua haujlwm, kab mob myocardial) thiab lwm yam.
Ntxiv rau contraindications, cov tshuaj muaj ib tug xov tooj ntawm cov kev phiv, uas yuav tau tham nyob rau hauv lub subheading tom ntej.
Txoj kev tshuaj tiv thaiv tsis zoo
Ua ntej siv cov tshuaj no ua tshuaj loog, tus kws kho mob tuaj koom yuav paub tus neeg mob txog qhov tshwm sim tsis zoo uas yuav tshwm sim thaum siv Sodium Thiopental.
Ua ntej tshaj, peb tab tom tham txog kiv taub hau thiab qaug zog, nrog rau kev nco tsis zoo. Cov tsos mob no feem ntau pom nyob rau hauv lub sij hawm postoperative tom qab siv tshuaj loog. Qhov no yog vim koob tshuaj-nyob ntawm kev nyuaj siab ntawm lub hauv paus paj hlwb. Cov neeg mob hais li cas txog kev siv sodium thiopental? Hauv kev tshuaj xyuas ntawm cov tshuaj no, tib neeg nco ntsoov tias lawv tau ntsib cov xwm txheej tsis zoo xws li qaug dab peg, leeg nqaij, qaug zog thiab ntxhov siab. Tsis tshua muaj, cov neeg mob tau cuam tshuam los ntawm qhov tsis zoo tshwm sim rau kev siv tshuaj loog xws li kev hnov lus, mob nraub qaum, tsis meej pem, thiab lwm yam.
Kuj, raws li cov neeg mob, tom qab siv cov tshuaj, lawv tau txhawj xeeb txog kev cuam tshuam ntawm lub plawv dhia, txo qis, qaug zog.
Cov kab mob ua pa tuaj yeem cuam tshuam tsis zoo rau kev siv tshuaj loog nrog bronchospasms, ua pa nyuaj, txham lossis hnoos.
Tom qab siv tshuaj, tus neeg yuav muaj mob plab, xeev siab, thiab ntuav.
Ntawm lwm cov tsos mob tsis zoo, cov neeg mob nco ntsoov cov pob khaus tawv nqaij, urticaria, redness ntawm epidermis, hiccups.
Ncaj nraim nrog kev txhaj tshuaj, tus neeg yuav raug mob lossis kub hnyiab ntawm qhov chaw txhaj tshuaj, liab ntawm daim tawv nqaij hauv qhov chaw txhaj tshuaj, tev tawm, vasospasm.
Yuav siv tshuaj loog li cas thiaj txo tau tus lej thiab qhov hnyav ntawm cov tsos mob uas tau hais los saum no?
cov ntaub ntawv dav dav
Raws li tau hais los saum no, cov tshuaj tau muab tso rau hauv cov hlab ntsha. Manipulation yuav tsum tau ua kom zoo zoo thiab maj mam. Kev txhaj tshuaj yog nqa tawm tsuas yog hauv cov xwm txheej tshwj xeeb, uas yog, nyob rau hauv cov phab ntsa ntawm cov tsev kho mob, qhov chaw tsim nyog cov cuab yeej siv los tswj lub plawv thiab ua pa.
Cov menyuam yaus raug tso cai siv cov tshuaj rectally, uas yog, txhaj tshuaj rau hauv qhov quav.
Dab tsi yog qhov xav tau ntawm Sodium Thiopental txhawm rau txhawm rau txhawm rau tshuaj loog zoo? Raws li cov lus qhia rau kev siv, cov neeg laus tau muab tshuaj 2-2.5% tshuaj, tab sis qee zaum cov tshuaj tuaj yeem nce mus rau tsib feem pua. Cov neeg mob laus, cov neeg mob hnyav thiab cov menyuam yaus tau txais ib feem pua kev daws teeb meem.
Yuav ua li cas dilute Sodium Thiopental rau qhov xav tau ntau npaum li cas?
Cov lus qhia raukev daws teeb meem
Cov hmoov yog diluted nrog tshwj xeeb tsis muaj dej rau kev txhaj tshuaj, 5% qabzib tov los yog saline sodium chloride tov. Cov khoom npaj yuav tsum tau siv tam sim ntawd tom qab dilution. Nws tsis tuaj yeem khaws cia lossis khov nws.
Txhawm rau npaj cov tshuaj tsib feem pua, koj yuav tsum tau dilute ib gram ntawm hmoov hauv nees nkaum milliliters dej txhaj. Txhawm rau npaj 1.25% ntawm cov tshuaj, nws raug nquahu kom ntxiv plaub caug milliliters dej rau 0.5 grams hmoov.
txoj kev yug me nyuam nws tus kheej ua li cas? Nws yooj yim heev.
Cov kua dej uas xav tau yog rub mus rau hauv lub koob txhaj tshuaj, thiab tom qab ntawd ntxiv rau hauv lub vial ntawm cov hmoov, tom qab ntawd txhua yam sib xyaw kom huv si los ntawm kev co lub thawv nrog cov tshuaj. Cov tshuaj yuav tsum yaj tag thiab ua kom pom tseeb, txwv tsis pub nws siv tsis tau.
Kev noj tshuaj tshwj xeeb
Thiab tam sim no cia peb tham txog cov koob tshuaj tshwj xeeb ntawm cov tshuaj uas tuaj yeem sau los ntawm tus kws tshuaj loog. Raws li kev siv tshuaj loog rau cov neeg laus, thawj theem ntawm kev siv tshuaj loog, kev sim tshuaj yog siv - txog 25-75 milligrams. Tom qab ntawd, tom qab ib feeb, qhov koob tshuaj tseem ceeb yog muab los ntawm tus nqi ntawm peb mus rau tsib milligrams ntawm cov tshuaj ib kilogram ntawm tus neeg mob lub cev qhov hnyav. Qhov nruab nrab, qhov no yog ob puas mus rau plaub puas milligrams ntawm cov tshuaj. Feem ntau qhov koob tshuaj no tau muab faib ua ob mus rau plaub zaug thiab txhaj rau hauv cov hlab ntsha txhua peb caug mus rau plaub caug vib nas this kom txog thaum tau txais cov txiaj ntsig xav tau.
Txawm li cas los xij, raws li tau hais los saum toj no,"Thiopental sodium" tsis tsuas yog siv los ua tshuaj loog. Rau kev kho mob ntawm cov kab mob tshwj xeeb, cov tshuaj tau sau rau hauv cov tshuaj hauv qab no:
- Txhawm rau nres qhov qaug dab peg, txhaj tshuaj 75-125 milligrams ntawm kaum feeb.
- Rau qhov kev tshem tawm ntawm convulsions tshwm sim los ntawm cov tshuaj loog hauv zos, 125-250 milligrams kuj tau sau tseg rau kaum feeb.
- Nyob rau hauv cov ntaub ntawv ntawm lub paj hlwb hypoxia, cov tshuaj uas txaus siab rau peb yog muab nyob rau hauv tus nqi ntawm 1.5-3.5 milligrams ib kilogram ntawm tus neeg mob qhov hnyav. Kev txhaj tshuaj yog ua nyob rau hauv ib feeb, kom txog thaum lub circulatory nres ib ntus pib.
- Qee zaum, cov tshuaj tuaj yeem siv rau kev tshuaj xyuas tshuaj, thaum tus neeg raug muab tso rau hauv lub xeev ib nrab nco ntsoov kom nws teb cov lus nug tsim nyog. Nyob rau hauv cov xwm txheej zoo li no, ib puas milligrams ntawm sodium thiopental yog siv ntau tshaj ib feeb kom txog thaum lub xeev xav tau.
Cov me nyuam thiab tshuaj
Txawm hais tias lawv sim tsis txhob siv tshuaj los kho cov neeg mob me, yog tias tsim nyog tshuaj loog, cov tshuaj tau muab tshuaj ntawm ib koob ntawm peb mus rau tsib milligrams ib kilogram ntawm qhov hnyav. Cov tshuaj yog muab los ntawm dav hlau intravenously rau peb mus rau tsib feeb ib zaug. Qhov koob tshuaj no siv tau rau cov menyuam mos txog ib xyoos.
Cov menyuam yaus hnub nyoog ib txog rau kaum ob xyoos raug muab tshuaj ntawm tus nqi ntawm tsib mus rau yim milligrams ib kilogram ntawm lub cev qhov hnyav.
Ib tsib feem pua kev daws ntawm sodium thiopental yog muab tshuaj rectally. Qhov koob tshuaj ntawm cov tshuaj yog xam raws li hauv qab no: 0.04-0.05 grams rau ib xyoos ntawm lub neej ntawm tus neeg mob me (yog tias tus me nyuam lub hnub nyoog tsis yog.tshaj peb mus rau xya xyoo).
Siv ceev faj
Vim tias "Thiopental sodium" yog tus neeg sawv cev muaj zog rau kev siv tshuaj loog, tsuas yog cov kws tshaj lij yuav tsum tswj hwm nws raws li kev teem caij ntawm tus kws tshuaj loog. Tus kws kho mob tshwj xeeb txiav txim siab txog qhov ntau npaum li cas ntawm cov tshuaj tsis yog nyob ntawm lub sijhawm thiab qhov tob ntawm kev siv tshuaj loog, tab sis kuj yog nyob ntawm tus neeg mob rhiab heev.
Koj tsuas yog muab cov tshuaj tso rau hauv txoj hlab ntshav xwb. Kev nkag mus ntawm cov tshuaj rau hauv cov hlab ntsha tuaj yeem ua rau cov hlab ntsha thrombosis, necrosis thiab txawm gangrene.
Yuav ua li cas thiaj txiav txim siab lub sijhawm uas cov tshuaj nkag mus rau hauv cov hlab ntsha? Qhov no tuaj yeem kuaj tau yog tias tus neeg mob tsis nco qab yws txog qhov kub hnyiab hauv lub nkoj. Yog hais tias tus neeg tsis nco qab lawm, ces qhov darkening ntawm epidermis, ib ntus blanching los yog spotty cyanosis yuav qhia tau hais tias qhov tsis raug ntawm kev siv tshuaj loog. Nyob rau hauv rooj plaub no, nws yog ib qho tsim nyog yuav tsum ceev nrooj nres, thiab txhaj tshuaj "Heparin" rau hauv qhov chaw ntawm qhov txhab. Anticoagulant therapy thiab blockade ntawm brachial plexus yuav tsum tau ua.
Yog tias cov tshuaj nkag mus rau hauv qab ntawm daim tawv nqaij, ces nws yog ib qho tsim nyog yuav tsum tau ua kom pom cov tshuaj loog hauv zos, nrog rau kom sov rau saum npoo ntawm daim tawv nqaij. Qhov no activates ntshav ncig thiab txhawb lub resorption ntawm infiltrate.
Thaum muab tshuaj, ib tug yuav tsum coj mus rau hauv tus account qhov tseeb hais tias cov neeg haus cawv tsis teb zoo rau nws cov teebmeem, yog li cov tshuaj loog yuav ua tau luv luv.
Thaum lub sijhawm ua haujlwm ntawm cov tshuaj, uas yog, kev qhia txog kev siv tshuaj loog, yuav tsum ua kom tus neeg mob nkag mus rau oxygen.
Thaum siv tshuaj rau tshuaj, koj yuav tsum paub tias nws yog tshuaj.
tshuaj loog overdose
Qhov no tsis tshua muaj, tab sis tseem ceeb heev kom paub cov tsos mob tsis zoo uas nrog rau kev tswj hwm ntawm cov tshuaj ntau dhau. Kuv yuav tsum xyuam xim rau dab tsi?
Ua ntej tshaj plaws, tus neeg mob yuav muaj kev poob qis hauv cov ntshav siab, tachycardia, ua pa nyuaj siab, bronchospasm. Txawm tias pulmonary edema thiab plawv nres tuaj yeem ua tau.
Nyob rau hauv cov xwm txheej zoo li no, raws li cov kws paub txog tshuaj loog hais tias, nws yog ib qho tseem ceeb kom paub txog bemegride, uas yog cov tshuaj tiv thaiv ntawm sodium thiopental, raws sijhawm. Kev kho kom tsim nyog yog siv los tshem tawm cov tsos mob tsis zoo. Piv txwv li, thaum ua tsis taus pa, pa oxygen los yog cua tshuab cua ntawm lub ntsws yog muab, nrog convulsions, diazepam yog siv, thiab hais txog. Qee qhov tshwj xeeb, cov leeg nqaij yuav xav tau.
Kev sib tham nrog lwm cov tshuaj
Raws li cov lus qhia, "Thiopental sodium" tuaj yeem txo cov nyhuv ntawm cov tshuaj tiv thaiv kab mob, coumarin derivatives (indirect anticoagulants), glucocorticosteroids thiab griseofulvin. Nws yog txwv tsis pub noj cov tshuaj no nrog rau cov leeg nqaij, ascorbic acid, atropine, tshuaj tua kab mob, tranquilizers, tubocurarine chloride, scopolamine, ephedrine, thiab lwm yam.
Yog tias siv tshuaj loog ua ke nrog cov tshuaj tiv thaiv ntshav siab, ganglionic blockers lossis diuretics, nws tuaj yeem ua taukev poob siab hauv siab. Qhov no kuj tseem ua tau nrog kev teem caij sib luag ntawm cov tshuaj txaus siab rau peb thiab diazoxide.
Kev noj cov tshuaj tiv thaiv kev ntxhov siab thiab tshuaj loog txo qis cov txiaj ntsig ntawm "Sodium Thiopental". H1-histamine blockers thiab cov tshuaj uas thaiv tubular secretion (qhov no tej zaum yuav yog, piv txwv li, probenecid) ua kom cov nyhuv ntawm cov tshuaj loog.
Kev tshuaj xyuas ntawm "Sodium Thiopental"
Ntau tus neeg pom zoo tias cov cuab yeej no ua tau zoo thiab muaj txiaj ntsig, tshwj xeeb tshaj yog thaum nws los tshuaj loog rau lub sijhawm phais. Cov tshuaj xyaum tsis ua rau muaj kev phiv, tau zam tau yooj yim txawm tias menyuam yaus.
Txawm li cas los xij, muaj cov xwm txheej thaum siv cov tshuaj ua rau muaj kev phiv thiab tsis zoo ntawm lub cev rau kev qhia txog tshuaj loog. Nws yog ib qho nyuaj kom paub tias qhov no yog vim li cas: kev tsis saib xyuas ntawm cov kws kho mob, tus neeg mob rhiab heev ntawm tus neeg mob, lossis qhov tsis zoo ntawm cov tshuaj loog nws tus kheej.
Ua li ntawd, cov tshuaj no tsuas yog siv rau kev kho mob thiab tsuas yog hauv cov chaw kho mob tshwj xeeb xwb.
Analogues ntawm "Sodium Thiopental"
Ntawm cov kev hloov pauv tseem ceeb rau cov tshuaj uas peb xav tau, nws yog ib qho tsim nyog yuav tsum tau ua ib leeg xws li Pentotal thiab Thiopental KMP. Cov nyiaj no muaj tib yam khoom muaj txiaj ntsig thiab yog cov hmoov rau kev npaj cov tshuaj txhaj tshuaj. Yog li ntawd, nws tsis yog qhov xav tsis thoob tias cov lus qhia rau kev siv cov tshuaj no yuav luag zoo ib yam.
