Diuretics, uas ua rau ntawm ib feem ntawm nephron uas txuas cov tubules ze ze thiab qhov chaw, hu ua "loop diuretics". Lawv cuam tshuam rau kev lim dej ntawm lub raum, tso cai rau lub cev pov tseg cov kua thiab ntsev.
Cov tshuaj no muaj cov nyhuv diuretic sai thiab muaj zog, lawv tsis tsim cov txheej txheem ua ntej rau kev pib mob ntshav qab zib, thiab kuj tsis cuam tshuam rau cov roj cholesterol thiab yog cov tshuaj muaj zog nruab nrab.
Cov tshuaj tiv thaiv tsis zoo yog suav tias yog qhov rho tawm loj ntawm cov tshuaj no. Loop diuretics yog ib hom tshuaj diuretic uas tsom rau kev ua haujlwm ntawm lub raum nephron.
Thaum twg kuv yuav tsum noj kuv cov tshuaj?
siv tseem ceebLoop diuretics yog cov xeev hauv qab no:
- Puffiness tshwm sim los ntawm ntau tshaj sodium hauv lub cev.
- ntshav siab.
- mob plawv.
- nce qib calcium thiab potassium hauv cov ntshav.
- Kidney puas.
YContraindications
Cov kws kho mob sau tseg cov kev txwv hauv qab no rau kev siv lub voj diuretics:
- Tsis tso zis tso rau hauv lub zais zis.
- Kev cev xeeb tub.
- Ib yam mob uas ua rau muaj kev ua txhaum ntawm qhov zaus, nrog rau lub suab sib dhos thiab ua ntu zus ntawm excitation thiab contraction ntawm lub plawv.
- Kev tsis haum.
- Kev tsis zoo ntawm cov ntshav microcirculation.
- Lactation.
Lawv ua haujlwm li cas?
Loop diuretics pib ua haujlwm tom qab 30 feeb. Lub spectrum ntawm kev ua ntawm cov tshuaj diuretic yog raws li nyob rau hauv lub so ntawm cov hlab ntsha thiab ua rau kom cov ntshav khiav, cov tshuaj txhim kho kev sib txuas ntawm prostaglandins nyob rau hauv capillary endothelial hlwb.
Tshuaj pib ua haujlwm tom qab li 30-60 feeb, thiab ua tiav tom qab li ntawm rau teev. Loop diuretics ua rau muaj kev cuam tshuam nyob rau hauv cov txheej txheem countercurrent ntawm nephron thiab nce glomerular pom.
Ntxiv rau, cov txheej txheem ntawm kev ua ntawm lub voj diuretics yog txhawm rau txo qhov thim rov qab ntawm cov tshuaj chloride thiab sodium ions, thiab inhibition ntawm magnesium nqus tau tshwm sim hauv nephron, yog li ua kom qhov ntim ntawm nws cov kev sib koom ua ke nrog cov zis.
Cov tshuaj diuretic cuam tshuam rau lub raum cov ntshav khiav. Tsuas yogTsis tas li ntawd, lawv txo qis kev ua haujlwm ntawm lub plawv, nrog rau lub suab venous thiab nce zis ntim.
Cov tshuaj dab tsi ua rau lub voj diuretics cuam tshuam nrog?
Cov tshuaj diuretics yuav tsum tsis txhob ua ke nrog cov tshuaj tiv thaiv kab mob, nrog rau cov tshuaj tiv thaiv kab mob thiab lwm yam tshuaj.
Tus neeg mob uas tau pib siv lub voj diuretic yuav tsum tau xyuam xim rau nws txoj kev sib raug zoo nrog lwm pawg tshuaj. Feem ntau cov kev sib txuas ua ke muaj qee yam kev txwv thiab ua rau muaj qhov tsis zoo:
- tshuaj tiv thaiv kab mob ua rau txo qis cov teebmeem ntawm lub voj diuretics.
- ntshav nyias tuaj yeem ua rau los ntshav.
- Digitalis, uas suav tias yog tsob nroj tshuaj, tuaj yeem cuam tshuam rau lub plawv dhia.
- tshuaj lithium ua rau ntuav thiab raws plab.
- Probenecid txo cov teebmeem ntawm lub voj diuretics.
- "Inderal" slows lub plawv dhia.
- tshuaj tiv thaiv kab mob ntshav qab zib ua rau txo qis ntshav qab zib.
Cov tshuaj twg - voj lossis thiazide diuretics - yog qhov zoo tshaj los noj?
Cov tshuaj thiazide yog suav tias yog qhov zoo tshaj plaws. Feem ntau, cov tshuaj no tau muab rau cov neeg mob uas muaj qhov sib txawv me ntsis hauv kev ua haujlwm ntawm lub raum, nrog rau lub siab thiab lwm yam kabmob. Loop thiab lwm yam tshuaj diuretics raug txwv nyob rau hauv cov ntaub ntawv no. Qhov tsis zoo yog qhov tsis muaj zog kho mob pharmacology, ib tus neeg yuav tsum tau mus ntevchav kawm ntawm kev kho kom tshem tawm cov ntshav siab. Loop diuretics tuaj yeem ua kom cov txheej txheem kho kom zoo, tab sis tsis yog txhua tus neeg raug tso cai coj lawv.
kev tawm tsam tsis zoo
Muaj ntau qhov tshwm sim tsis zoo:
- Dehydration (maj mam lub cev qhuav dej, uas yog, poob dej, uas tuaj yeem ua rau tus neeg mob tuag).
- Txo qis hauv cov ntshav chloride.
- Txo qis hauv cov tshuaj insulin.
Cov npe tshuaj diuretics
Cov tshuaj ua kom sai tshaj plaws yog:
- "Britomar" yog ib ntsiav tshuaj uas muaj cov nyhuv diuretic, tus nqi ntawm cov khoom xyaw uas yog 5 lossis 1 mg. Koj tuaj yeem siv tshuaj txhua lub sijhawm yooj yim rau ib tus neeg, tsis hais noj mov. Siv cov tshuaj diuretic thaum muaj mob edema hauv lub plawv yuav tsum yog 10-20 mg ib hnub ib zaug. Yog tias o tshwm sim vim mob raum, nws raug nquahu kom noj 20 mg ib hnub ib zaug. Yog tias edema tshwm sim nrog kab mob siab, cov kws tshaj lij tau sau 5-10 mg ib hnub (ua ke nrog lwm cov tshuaj). Rau ntshav siab - 5 mg ib hnub twg.
- "Furosemide" yog muag ob qho tib si hauv daim ntawv ntsiav tshuaj (40 mg) thiab ua tshuaj rau kev txhaj tshuaj (10 mg). Qhov ncauj, cov tshuaj yog noj thaum sawv ntxov, pib nrog 40 mg ib hnub twg, yog tias tsim nyog, noj txhua hnub yog nce mus rau 160 mg. Cov txiaj ntsig zoo tshwm sim tom qab ib nrab teev thiab kav ntev txog 4 teev. Kev dawsNws yog siv ob leeg intramuscularly thiab intravenously ntawm 20-40 mg ib hnub twg thiab pib ua tom qab 4 feeb.
- "Ethacrynic acid" yog tsim nyob rau hauv ntsiav tshuaj daim ntawv thiab nyob rau hauv kev daws. Qhov ncauj, cov tshuaj pib noj nrog ib koob ntawm 50 mg, maj mam nce cov concentration ntawm cov tshuaj (yog tias tsim nyog). Intravenously (kom ua tiav cov txiaj ntsig sai tshaj plaws) xaiv 50 mg. Cov txiaj ntsig zoo tuaj yeem pom hauv li 30 feeb thiab tuaj yeem kav ntev txog yim teev.
Ntxiv rau, voj diuretics yog:
- "Bufenox".
- "Diver".
- "Lasix".
Cov tshuaj no yuav tham ntxiv hauv qab no.
Bufenox
Cov tshuaj muaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj (1 mg) thiab tshuaj rau txhaj tshuaj (0.025%). Cov ntsiav tshuaj yuav tsum tau noj thaum sawv ntxov ntawm lub plab khoob, 1 daim rau tsib hnub, thiab tom qab ntawd ob daim rau peb hnub.
Cov tshuaj yog siv rau hauv cov hlab ntsha lossis intramuscularly, ntawm 0.5-1.5 mg, txhaj tshuaj tuaj yeem ua tau kwv yees li plaub mus rau yim teev. Lub sijhawm kho yog plaub hnub. Qhov txiaj ntsig zoo tshwm sim hauv ob teev.
Raws li kev ntsuas prophylactic, kev noj zaub mov uas muaj cov poov tshuaj yog tshuaj los tiv thaiv hypokalemia. Cov neeg mob uas tau txais koob tshuaj ntau ntawm Bufenox yuav tsum tsis txhob txwv kom tsis txhob muaj qhov tshwm sim ntawm hyponatremia thiab hypochloremic alkalosis.ntsev rau hauv lub cev. Cov neeg muaj lub raum tsis ua haujlwm feem ntau yuav muaj cov kua dej thiab cov electrolyte tsis txaus.
Thaum lub sijhawm kho, nws yuav tsum tau saib xyuas cov ntsiab lus ntawm plasma electrolytes, nrog rau cov nitrogen seem. Yog hais tias azotemia thiab oliguria tshwm sim los yog nce rau cov neeg uas muaj mob raum mob hnyav, Bumetanide yuav tsum raug ncua.
Tsis tas li ntawd, yuav tsum tau saib xyuas tshwj xeeb thaum haus cawv, nrog rau thaum sawv ntsug ntev lossis tawm dag zog, thaum muaj cua sov thiab hloov pauv mus rau qhov chaw ntsug los ntawm kev pw tsaug zog vim muaj zog orthostatic hypotensive..
Diver
Cov tshuaj muaj nyob rau hauv daim ntawv teev cov tshuaj diuretic voj voog. "Diuver" yog ib ntsiav tshuaj nrog ib koob ntawm 5 thiab 10 mg. Nrog rau ntau yam edema, cov tshuaj yuav tsum tau siv ntawm 5 mg ib hnub ib zaug, yog tias tsim nyog, nce koob rau 40 mg. Rau ntshav siab, noj ib nrab ib ntsiav tshuaj (2.5 mg) ib hnub ib zaug.
Hypokalemia, nrog rau hyponatremia thiab metabolic alkalosis, tau nce ntxiv thaum noj Diuver siab ntau lub sijhawm ntev, thiab yog li kev noj zaub mov yuav tsum ua raws.
Kev xaiv cov tshuaj kom raug rau cov neeg mob ascites, uas tshwm sim los ntawm kev mob siab rau daim siab, yuav tsum tau ua nyob rau hauv lub tsev kho mob. Tsis tas li ntawd, cov neeg mob no yuav tsum tsis tu ncuatswj cov qib ntawm electrolytes hauv cov ntshav plasma.
Cov zis thiab cov ntshav qabzib yuav tsum tau kuaj ntau zaus hauv cov neeg mob ntshav qab zib. Vim muaj qhov ua rau mob urinary retention, diuresis yuav tsum tau saib xyuas hauv cov neeg mob uas nqaim ntawm cov ureters thiab prostatic hyperplasia, nrog rau cov neeg mob uas tsis nco qab.
Lasix
Cov tshuaj yog tsim nyob rau hauv daim ntawv ntawm cov tshuaj rau txhaj tshuaj thiab ntsiav tshuaj. Cov tshuaj yog infused infused. Nrog edema, cov tshuaj tau muab rau hauv tus nqi ntawm 20-40 mg ib hnub, nrog rau kev mob ntsws ntsws - 40 mg. Rau ntshav siab - 80 mg ib hnub twg (ob koob). Rau ntshav siab - 80 mg ib hnub twg (ob koob). Cov diuretic pib "ua haujlwm" ob teev tom qab noj.
Ua ntej pib txoj kev kho diuretic, ib tus neeg yuav tsum tau soj ntsuam rau lub raum tsis ua haujlwm, tshwj xeeb tshaj yog tias cov zis tso zis txhua hnub raug txo qis heev. Qhov tseeb yog tias cov txheej txheem ntawm lub voj diuretics yog ua raws li kev so ntawm cov hlab ntsha thiab nce lub raum cov ntshav khiav.
Thaum lub sijhawm kho tshuaj, nws tseem yuav tsum tau tswj kev ua haujlwm ntawm cov kabmob tseem ceeb, tshwj xeeb tshaj yog tias tus neeg mob raug yuam kom siv Lasix hauv qhov siab. Kev noj tshuaj ntau ntxiv uas tsis tau tso cai tuaj yeem ua rau muaj cov tsos mob lom thiab mob hnyav hypovolemia.
