Monoinsulin CR, Monoinsulin hr

Qhov koob tshuaj thiab txoj hauv kev ntawm kev tswj hwm tshuaj yog txiav txim siab ntawm txhua tus neeg nyob rau hauv lub hauv paus ntawm cov piam thaj hauv cov ntshav ua ntej noj mov thiab 1-2 teev tom qab noj mov, thiab tseem nyob ntawm qhov ntsuas ntawm glucosuria thiab cov yam ntxwv ntawm chav kawm ntawm tus kabmob.

Cov tshuaj yog muab s / c, hauv / m, hauv / hauv, 15-30 feeb ua ntej noj mov. Txoj kev sib txawv ntawm kev tswj hwm yog sc. Nrog cov ketoacidosis uas mob ntshav qab zib, mob ntshav qab zib tsis xeev, thaum phais mob kev cuam tshuam - hauv / thiab / m.

Nrog kev kho mob monotherapy, qhov ntau zaus ntawm kev tswj hwm feem ntau yog 3 zaug hauv ib hnub (yog tias tsim nyog, txog li 5-6 zaug hauv ib hnub), qhov chaw txhaj tshuaj tau hloov pauv txhua lub sijhawm kom tsis txhob muaj kev txhim kho ntawm lipodystrophy (atrophy lossis hypertrophy ntawm subcutaneous rog).

Qhov nruab nrab txhua hnub koob tshuaj yog 30-40 IU, hauv cov menyuam yaus - 8 IU, tom qab ntawd qhov nruab nrab txhua hnub - 0.5-1 IU / kg lossis 30-40 IU 1-3 zaug hauv ib hnub, yog tias tsim nyog - 5-6 zaug ib hnub Cov. Hauv kev noj tshuaj ib hnub dhau ntawm 0.6 U / kg, tshuaj insulin yuav tsum tau txhaj rau 2 lossis ntau dua kev txhaj tshuaj hauv ntau qhov chaw ntawm lub cev. Nws yog qhov ua tau los ua ke nrog insulins ntev-coj.

Pharmacological kev txiav txim

Tib neeg siv tshuaj insulin DNA insulin. Nws yog cov insulin ntawm lub sijhawm ua haujlwm ntev. Regulates glucose metabolism, muaj cov nyhuv anabolic. Hauv cov leeg nqaij thiab lwm cov nqaij (muaj qhov tsis suav ntawm lub hlwb), cov roj ntsha insulin thauj cov ntshav qabzib thiab amino acids ntau dua, thiab txhim kho cov protein anabolism. Insulin txhawb kev hloov pauv ntawm cov piam thaj rau glycogen hauv lub siab, inhibits gluconeogenesis thiab txhawb kev hloov pauv ntawm cov piam thaj rau cov rog.

Sab sij huam

Los ntawm cov kab ke endocrine: hypoglycemia.

Kev mob ntshav qis heev tuaj yeem ua rau tsis nco qab thiab (tshwj tsis yog qee tus neeg tuag).

Ua xua: muaj kev fab rau lub cev yog ua tau - hyperemia, tawm pob lossis khaus ntawm qhov chaw txhaj tshuaj (feem ntau tso tseg li ntawm ob peb hnub mus rau ntau lub lis piam), kev tiv thaiv kab mob tsis haum (tshwm sim tsawg dua, tab sis muaj dua) - ua pob khaus, ua tsis taus pa, ua pa luv , txo cov ntshav siab, ntshav nce siab, nce hws. Cov uas muaj mob hnyav raug neeg lub cev tuaj yeem tas sim neej.

Cov lus qhia tshwj xeeb

Hloov chaw ntawm tus neeg mob mus rau lwm hom insulin lossis kev npaj tshuaj insulin nrog cov npe lag luam txawv yuav tsum tshwm sim nyob rau hauv kev saib xyuas mob nkeeg nruj.

Kev hloov pauv ntawm kev ua ub no ntawm insulin, nws hom, hom (kab mob, kab mob tib neeg, insulin ntawm tib neeg cov insulin) lossis cov txheej txheem tsim tawm (DNA recombinant insulin lossis insulin ntawm keeb kwm tsiaj) yuav xav tau kev hloov kho koob tshuaj.

Qhov xav tau koob tshuaj yuav tau siv nyob rau ntawm thawj coj thawj coj ntawm tib neeg cov tshuaj insulin tom qab npaj cov tshuaj insulin ntawm cov tsiaj keeb kwm los yog maj mam dhau ob peb lub lis piam lossis ntau lub hlis tom qab hloov.

Kev sib txuam

Hypoglycemic nyhuv txo qis los ntawm kev tiv thaiv kab mob hauv qhov ncauj, corticosteroids, thyroid hormone npaj, thiazide diuretics, diazoxide, tricyclic antidepressants.

Cov nyhuv hypoglycemic yog txhim kho los ntawm qhov ncauj hypoglycemic tshuaj, salicylates (e.g. acetylsalicylic acid), sulfonamides, MAO inhibitors, beta-blockers, ethanol thiab ethanol-muaj cov tshuaj.

Beta-blockers, clonidine, reserpine tuaj yeem npog qhov tsos ntawm cov tsos mob ntawm qog ntshav qab zib.

Txoj kev ntawm daim ntawv thov

Rau cov laus: Tus kws kho mob teeb tsa cov koob tshuaj ib lub zuj zus, nyob ntawm theem ntawm glycemia.
Cov kab ke ntawm cov thawj coj yog nyob ntawm hom insulin.

- mob ntshav qab zib mellitus nyob rau hauv muaj cov qhia rau kev kho mob,
- kab mob ntshav qab zib mellitus tshiab khiv,
- cev xeeb tub uas muaj hom 2 mob ntshav qab zib mellitus (tsis-insulin-dependant).

Daim ntawv tso tawm

Kev daws rau kev txhaj tshuaj tsis muaj xim, pob tshab.
1 ml insulin soluble (tib neeg kev tsim kho tshuab) 100 UNITS
Cov muaj mob: metacresol - 3 mg, glycerol - 16 mg, dej d / i - txog 1 ml.

10 ml - lub khob ntawm cov iav tsis muaj xim (1) - pob ntawv los ntawm cov duab los qhia

Cov ntaub ntawv ntawm nplooj ntawv koj tab tom saib yog tsim rau cov ntaub ntawv lub hom phiaj nkaus xwb thiab tsis txhawb nqa nws tus kheej kev noj tshuaj hauv txhua txoj kev. Cov peev txheej yog npaj los ua kom paub cov kws kho mob paub ntxiv txog qee yam tshuaj, yog li nce lawv qib kev tshaj lij. Siv cov tshuaj "Monoinsulin CR"tsis muaj qhov tsis ua tiav muab kev sab laj nrog ib tus kws tshaj lij, nrog rau nws cov lus pom zoo ntawm txoj kev siv thiab kev noj tshuaj uas koj xaiv.

Kev Sib Sau thiab daim ntawv ntawm kev tso tawm

• Cov tshuaj nquag: soluble insulin (tib neeg cov tshuaj lom neeg engineering) 100 PIECES,
• Cov muaj mob: metacresol - 3 mg, glycerol - 16 mg, dej d / i - txog 1 ml.

Tshuaj. 10 ml - ib fwj tsis muaj kob iav.

Kev daws rau kev txhaj tshuaj tsis muaj xim, pob tshab.

Tib neeg siv tshuaj insulin DNA insulin. Nws yog cov insulin ntawm lub sijhawm ua haujlwm ntev. Regulates glucose metabolism, muaj cov nyhuv anabolic. Hauv cov leeg nqaij thiab lwm cov nqaij (muaj qhov tsis suav ntawm lub hlwb), cov roj ntsha insulin thauj cov ntshav qabzib thiab amino acids ntau dua, thiab txhim kho cov protein anabolism. Insulin txhawb kev hloov pauv ntawm cov piam thaj rau glycogen hauv lub siab, inhibits gluconeogenesis thiab txhawb kev hloov pauv ntawm cov piam thaj rau cov rog.

Cov neeg ua yeeb yam luv luv.

Cov kab ke ntawm cov thawj coj yog nyob ntawm hom insulin.

Monoinsulin sp Cev xeeb tub thiab menyuam yaus

Thaum cev xeeb tub, nws yog ib qho tseem ceeb kom tswj tau glycemic zoo hauv cov neeg mob ntshav qab zib. Thaum cev xeeb tub, qhov xav tau rau cov tshuaj insulin feem ntau txo qis hauv thawj peb hlis thiab nce hauv qib thib ob thiab thib peb.

Nws raug nquahu kom cov neeg mob ntshav qab zib mellitus qhia tus kws khomob txog qhov pib lossis npaj lossis cev xeeb tub.

Hauv cov neeg mob uas mob ntshav qab zib mellitus thaum lactation (pub niam mis), yuav tsum tau txhaj tshuaj kho cov tshuaj insulin, zaub mov noj, lossis ob qho tib si yuav tsum tau ua.

Hauv kev tshawb fawb ntawm kev tshuaj lom neeg caj ces hauv cov tshuaj lom hauv vitro thiab hauv vivo, tib neeg cov tshuaj insulin tsis muaj qhov tshwm sim mutagenic.

Tsuas Tshuaj Monoinsulin

Tus kws kho mob teeb tsa cov koob tshuaj ib lub zuj zus, nyob ntawm theem ntawm glycemia.

Hloov chaw ntawm tus neeg mob mus rau lwm hom insulin lossis kev npaj tshuaj insulin nrog cov npe lag luam txawv yuav tsum tshwm sim nyob rau hauv kev saib xyuas mob nkeeg nruj.

Kev hloov pauv ntawm kev ua ub no ntawm insulin, nws hom, hom (kab mob, kab mob tib neeg, insulin ntawm tib neeg cov insulin) lossis cov txheej txheem tsim tawm (DNA recombinant insulin lossis insulin ntawm keeb kwm tsiaj) yuav xav tau kev hloov kho koob tshuaj.

Qhov xav tau koob tshuaj yuav tau siv nyob rau ntawm thawj coj thawj coj ntawm tib neeg cov tshuaj insulin tom qab npaj cov tshuaj insulin ntawm cov tsiaj keeb kwm los yog maj mam dhau ob peb lub lis piam lossis ntau lub hlis tom qab hloov.

Txoj kev xav tau cov tshuaj insulin tuaj yeem txo nrog adrenal tsis txaus ua haujlwm, pituitary lossis thyroid caj pas, nrog lub raum lossis hepatic tsis txaus.

Nrog rau qee qhov mob lossis kev ntxhov siab hauv lub siab, qhov xav tau rau insulin yuav nce.

Koob tshuaj yuav tau siv thaum nce ua si lossis thaum pauv noj zaub mov zoo.

Cov tsos mob ua ntej ntawm hypoglycemia thaum tswj hwm ntawm tib neeg cov tshuaj insulin hauv qee cov neeg mob tej zaum yuav tsawg dua los yog txawv ntawm cov uas tau pom thaum lub sijhawm saib xyuas insulin ntawm tsiaj keeb kwm. Nrog kev ua haujlwm ntawm cov ntshav qabzib hauv lub cev, piv txwv li, los ntawm kev kho mob insulin ntau dua, txhua yam lossis qee tus tsos mob ntawm cov xwm txheej ua ntej ntawm hypoglycemia yuav ploj, txog qhov uas cov neeg mob yuav tsum tau ceeb toom.

Cov tsos mob ua ntej ntawm lub qog ntshav qab zib tuaj yeem hloov lossis tsis tau hais tawm nrog lub sijhawm ntev ntawm mob ntshav qab zib mellitus, mob ntshav qab zib neuropathy, lossis siv cov beta-blockers.

Muaj qee kis, kev tsis haum tshuaj nyob hauv zos tuaj yeem yog los ntawm cov laj thawj tsis cuam tshuam nrog kev txiav txim ntawm cov tshuaj, piv txwv li, voos tawv nqaij nrog cov tshuaj ntxuav kom huv lossis kev txhaj tshuaj tsis zoo.

Muaj qee zaus, txaws kev tsis haum tshuaj, yuav tsum kho tamsid. Qee zaum, yuav tsum tau hloov cov insulin lossis desensitization.

Cuam tshuam rau lub peev xwm tsav tsheb thiab tswj cov tswv yim:

Thaum lub sij hawm hypoglycemia, tus neeg mob lub peev xwm los mloog zoo yuav txo qis thiab tus lej ntawm psychomotor cov tshuaj tiv thaiv yuav tsawg. Qhov no tuaj yeem txaus ntshai nyob rau hauv qhov xwm txheej uas qhov peev xwm no tshwj xeeb tshaj yog (tsim nyog tsav tsheb los yog siv tshuab ua haujlwm). Cov neeg mob yuav tsum qhia rau lawv kom ceev faj kom tsis txhob mob ntshav qab zib thaum tsav tsheb. Qhov no tseem ceeb tshwj xeeb tshaj yog rau cov neeg mob uas cov tsos mob me lossis tsis tuaj-ua ntej-ntawm cov ntshav lub qog lossis nrog kev loj hlob ntawm hypoglycemia nquag. Hauv cov xwm txheej zoo li no, tus kws kho mob yuav tsum soj ntsuam qhov ua tau ntawm tus neeg mob tsav tsheb.

Cov Tshuaj Pharmacokinetics

Qhov nqus thiab pib ntawm cov nyhuv ntawm cov tshuaj insulin nyob ntawm txoj kev ntawm cov thawj coj (subcutaneously, intramuscularly), qhov chaw ntawm cov thawj coj (plab, ncej, pob tw) thiab qhov ntim ntawm kev txhaj tshuaj. Hauv nruab nrab, tom qab kev tswj hwm subcutaneous, Monoinsulin CR pib ua nyob rau hauv 1/2 teev, muaj cov nyhuv siab tshaj plaws ntawm 1 mus rau 3 teev, qhov tshuaj tau ntev tshaj li 8 teev.

Nws tau faib qhov tsis sib luag thoob plaws cov ntaub so ntswg, tsis txeem rau hauv qhov chaw nres thiab nkag mus rau niam mis. Nws yog rhuav tshem los ntawm insulinase, feem ntau yog nyob hauv daim siab thiab lub raum. Qhov kev tshem tawm ib nrab-lub neej ua rau ob peb feeb. Nws yog tawm los ntawm lub raum (30-80%).

Kev ntsuas rau siv

Yam 1 ntshav qab zib mellitus (insulin-dependant),

Hom 2 mob ntshav qab zib mellitus (non-insulin-dependant): theem ntawm kev tawm tsam cov tshuaj tiv thaiv kab mob hauv lub qhov ncauj, tiv taus ib feem los ntawm cov tshuaj no (thaum kho sib txuam), cov kab mob sib kis, cev xeeb tub,

· Qee yam mob xwm txheej ceev hauv cov neeg mob ntshav qab zib mellitus.

Cev xeeb tub thiab lactation

Tsis muaj kev txwv dab tsi rau kev kho mob ntshav qab zib mellitus nrog cov tshuaj insulin thaum cev xeeb tub, txij li thaum cov tshuaj insulin tsis hla lub cev placental. Thaum npaj kev cev xeeb tub thiab thaum nws, nws yog ib qho tsim nyog yuav tsum tau ua ntu zus ntawm kev kho mob ntshav qab zib. Qhov kev xav tau rau insulin feem ntau poob qis hauv thawj peb lub hlis thaum cev xeeb tub thiab maj mam nce ntxiv hauv qib thib ob thiab thib peb. Thaum lub sijhawm thiab yug tom qab yug, insulin yuav tsum poob ntau. Tsis ntev tom qab yug los, xav tau cov tshuaj insulin sai sai rau qib uas yog ua ntej cev xeeb tub. Tsis muaj kev txwv rau kev kho mob ntshav qab zib mellitus nrog tshuaj insulin thaum pub niam mis, txij li kho tus niam nrog insulin yog qhov muaj kev nyab xeeb rau tus menyuam. Txawm li cas los xij, txo qis hauv cov tshuaj insulin tej zaum yuav tsum tau, yog li ntawd yuav tsum ua tib zoo saib xyuas kom txog thaum qhov xav tau ntawm insulin.

Sab sij huam

Feem ntau cov kev tshwm sim tsis zoo nrog cov tshuaj insulin yog hypoglycemia. Cov tsos mob ntawm tus mob ntshav qab zib feem ntau pib dheev. Cov no suav nrog: hws txias, pallor ntawm daim tawv nqaij, poob siab lossis tshee tshee, ntxhov siab, nkees nkees lossis tsis muaj zog, tsis nco qab, ua rau lub siab tsis tuaj yeem, kiv taub hau, mob siab tshaib plab, tsis pom kev ib ntus, mob taub hau, xeev siab, tachycardia. Kev mob ntshav nce siab ntau tuaj yeem ua rau tsis nco qab, ib ntus lossis rov qab tsis tau ntawm lub hlwb, lossis tag txoj sia.

Thaum kho nrog insulin, kev tsis haum tshuaj hauv zos (liab, lub zos o, khaus ntawm daim tawv nqaij ntawm qhov chaw txhaj tshuaj) tuaj yeem pom. Cov kev mob tshwm sim no feem ntau yog ib ntus, thiab lawv dhau mus thaum kho ntxiv.

Cov kev tsis haum suav daws hnyav tuaj yeem tshwm sim qee zaum. Lawv muaj ntau dua thiab tuaj yeem ua rau tawv nqaij ua pob khaus, ua pob khaus rau ntawm daim tawv nqaij, tawm hws ntau ntxiv, mob plab hnyuv, mob caj dab, ua pa nyuaj, tachycardia, mob ntshav qis. Cov kev tsis haum siab dav dav muaj kev phom sij txog lub neej, yuav tsum tau kev kho mob tshwj xeeb.

Yog tias koj tsis hloov qhov chaw txhaj tshuaj nyob rau thaj tsam anatomical, lipodystrophy ntawm qhov chaw txhaj tshuaj yuav pib txhim kho.

Noj ntau dhau

Nrog rau kev siv tshuaj ntau dhau, ua rau lub ntsej muag ntshav qab zib yuav pib ua.

Kev Kho Mob: tus neeg mob tuaj yeem tshem tawm qhov mob ntshav qab zib me me los ntawm kev noj cov suab thaj lossis cov khoom noj uas muaj carbohydrate. Yog li, nws tau pom zoo rau cov neeg mob ntshav qab zib kom nqa cov piam thaj, qab zib, ncuav qab zib lossis kua txiv qab zib nrog lawv.

Thaum muaj mob hnyav, thaum tus neeg mob poob siab, 40% kua nplaum daws cov tshuaj ua kua tshuaj, mob plab cev, subcutaneously, mob ntshav qab zib - glucagon. Tom qab nws rov qab nco qab, tus neeg mob tau pom zoo kom noj cov khoom noj uas muaj cov khoom noj carbohydrate kom tiv thaiv kev rov qab txhim kho hypoglycemia.

Kev tiv thaiv kev nyab xeeb

Tawm tsam keeb kwm yav dhau los ntawm kev kho mob insulin, kev tshuaj xyuas cov ntshav qabzib ntau yog tsim nyog. Vim li cas ntshav qog Ntxiv nrog rau kev noj tshuaj ntau dhau ntawm insulin, tej zaum yuav muaj: hloov tshuaj, hla zaub mov, ntuav, raws plab, kev ntxhov siab ntawm lub cev, cov kab mob uas txo qis qhov xav tau rau insulin (kev mob siab rau lub siab thiab lub raum kev ua haujlwm, kev ua haujlwm ntawm adrenal cortex, pituitary lossis thyroid caj pas), hloov chaw txhaj tshuaj, nrog rau kev cuam tshuam nrog lwm yam tshuaj.

Kev noj tshuaj tsis yog lossis cuam tshuam rau hauv cov tshuaj insulin, tshwj xeeb tshaj yog nyob rau cov neeg mob ntshav qab zib hom I, tuaj yeem ua rau mob hyperglycemia. Feem ntau, thawj cov tsos mob ntawm hyperglycemia pib maj mam dhau ob peb teev lossis hnub. Cov no suav nrog kev nqhis dej, ntxiv tso zis, xeev ntuav, ntuav, kiv taub hau, liab thiab ntawm daim tawv nqaij, qhov ncauj qhuav, tsis qab los, tsis hnov ​​ntxhiab ntawm cov acetone hauv cov pa tawm. Yog tias tsis kho, hyperglycemia hauv hom I mob ntshav qab zib tuaj yeem ua tus kab mob ntshav qab zib ketoacidosis muaj sia.

Cov koob tshuaj insulin yuav tsum raug kho rau kev ua haujlwm ntawm cov thyroid tsis zoo, Addison's disease, hypopituitarism, ua rau lub siab thiab lub raum tsis ua haujlwm thiab mob ntshav qab zib hauv cov neeg muaj hnub nyoog 65 xyoos.

Cov kab mob sib xyaw tshwj xeeb, tshwj xeeb tshaj yog kis mob thiab cov kab mob nrog kub taub hau, nce ntxiv qhov xav tau ntawm insulin.

Kev kho tshuaj ntawm cov tshuaj insulin kuj tseem xav tau yog tias tus neeg mob nce qib qoj ib ce lossis hloov cov zaub mov ib txwm muaj.

Txoj kev hloov ntawm ib hom lossis hom tshuaj ntshav dej rau lwm qhov yuav tsum tau ua nyob rau kev saib xyuas ntawm tus kws kho mob nruj. Kev hloov pauv hauv kev xav, lub npe lag luam (tus tsim khoom), hom (luv luv, nruab nrab, ua haujlwm ntev insulin, thiab lwm yam), hom (tib neeg, tsiaj keeb kwm) thiab / lossis hom kev tsim tawm (tsiaj keeb kwm lossis kev tsim kho caj ces) yuav xav tau kho muab koob tshuaj insulin. Qhov xav tau tshuaj no ntawm cov tshuaj insulin tuaj yeem tshwm sim tom qab thov thawj zaug, thiab thawj ob peb lub lis piam lossis ob hlis.

Thaum hloov tawm ntawm tsiaj los ntawm cov tshuaj insulin mus rau CR Monoinsulin, qee cov neeg mob tau sau tseg qhov kev hloov lossis kev ua kom tsis muaj zog ntawm kev kwv yees hypoglycemia.

Thaum raug mob zoo rau kev noj haus metabolism hauv kev lom zem, piv txwv li, vim tias muaj kev cuam tshuam los ntawm cov tshuaj insulin ntau dua, cov tsos mob li ib txwm muaj ntawm kev txo qis ntawm hypoglycemia kuj tuaj yeem hloov pauv, hais txog tus neeg mob twg yuav tsum ceeb toom.

Cov neeg muaj mob plawv tsis txaus siab tau tshaj tawm nrog kev siv cov tshuaj insulin thiab thiazolidinediones, tshwj xeeb tshaj yog nyob rau cov neeg mob uas muaj feem cuam tshuam rau lub plawv tsis ua haujlwm. Qhov no yuav tsum tau ris hauv siab thaum muab qhov kev sib xyaw no.

Yog tias qhov sib xyaw ua ke saum toj no tau sau tseg, nws yog qhov yuav tsum tau ua kom paub tseeb cov cim thiab cov tsos mob ntawm lub plawv tsis ua hauj lwm, hnyav, edema. Kev siv cov pioglitazone yuav tsum nres yog tias cov tsos mob ua rau ntu ntawm cov kab mob hauv lub plawv.

Kev tswj cov thauj thiab ua haujlwm nrog cov tshuab

Lub peev xwm ntawm cov neeg mob kom pom tseeb thiab tus nqi tshuaj tiv thaiv tej zaum yuav raug mob thaum lub cev tsis muaj ntshav qab zib thiab hyperglycemia, uas tuaj yeem ua rau txaus ntshai, piv txwv li, thaum tsav tsheb lossis ua haujlwm nrog cov tshuab thiab tshuab. Cov neeg mob yuav tsum tau qhia rau kev ntsuas kom tiv thaiv kev txhim kho hypoglycemia thiab hyperglycemia thaum tsav tsheb thiab ua haujlwm nrog cov txheej txheem. Qhov no yog qhov tshwj xeeb tshaj yog rau cov neeg mob uas tsis muaj los yog ploj zuj zus ntawm cov tshwm sim ntawm kev muaj ntshav qab zib lossis kev txom nyem los ntawm kev pheej muaj ntshav tsis txaus. Hauv cov xwm txheej zoo li no, kev tsim nyog ntawm kev tsav tsheb yuav tsum xav txog.

Khaws cov tshuaj insulin uas siv rau hauv chav sov (txog 25 ° C) tsis pub dhau 6 lub lis piam.

Tiv thaiv cov tshuaj ntawm lub teeb. Txav deb ntawm cua sov, tshav ntuj ncaj qha thiab khov. Khaws tsis ncav cuag ntawm cov menyuam yaus.

Tsis txhob siv Monoinsulin CR yog tias qhov kev daws teeb meem tsis ua kom zoo, tsis muaj kob lossis yuav luag tsis muaj xim.

Tsis txhob siv tom qab hnub tas sij hawm luam tawm ntawm pob.