Xyoo 1930, Frey thawj zaug ua tiav kev siv tshuaj trasilol kallikrein inactivator los kho tus mob ua tiav pancreatitis. Thawj qhov kev tiv thaiv cov roj ntsha tiv thaiv kab mob tau los ntawm M. Kunitz thiab J. H. Norlrop hauv xyoo 1936 los ntawm cov tsiaj caj dab.

Ib qho cuab yeej ua ke ntawm cov tshuaj tiv thaiv kab mob (tshuaj tiv thaiv antienzyme) yog lub peev xwm los thaiv cov kev ua ntawm proteolytic enzymes los ntawm kev tsim cov chaw ruaj khov nrog lawv. Txog rau hnub tim, ntau tshaj 2,000 qhov kev ua haujlwm tau tshaj tawm txog kev siv cov tshuaj antienzyme rau kev kho mob ntawm tus mob voos, ob leeg hauv tsev kho mob thiab hauv kev sim. Txawm li cas los xij, tsis muaj kev pom zoo ntawm cov kab mob tseem ceeb ntawm lawv txoj kev siv, kev ua haujlwm, koob tshuaj, txoj kev ntawm cov thawj coj. Ntau tus kws phais neeg ntseeg hais tias kev siv tshuaj tiv thaiv kab mob tsis muaj kev cuam tshuam, hais txog qhov tseeb tias kev npaj tshuaj tua kab mob, txawm tias siv tshuaj ntau, tsis cuam tshuam cov txheej txheem necrotic nyob rau hauv caj pas thiab para-pancreatic fiber. Nrog rau kev tsim kho ntawm daim tawv nqaij ua paug ntawm pancreatitis, kev siv tshuaj trasilol thiab lwm yam kev siv tshuaj tiv thaiv kab mob tsis haum tsuas yog ob qho tib si los ntawm chaw kuaj mob thiab los ntawm qhov pom ntawm nyiaj txiag. Txawm li cas los xij, kev siv cov protease inhibitors yuav tsum tsis txhob tso tseg txhua yam.

Cov kev paub dhau los ntawm cov kws kho mob hauv tsev thiab txawv teb chaws tau qhia tias cov tshuaj tiv thaiv proteolysis inhibitors inhibit kinin tsim thiab autolysis los ntawm inactivating trypsin, kallikrein, chymotrypsin thiab plasmin. Peb tau sau tseg tias nrog kev pabcuam ntawm cov tshuaj tiv thaiv kab mob feem ntau nws tuaj yeem tshem cov neeg mob los ntawm kev poob siab, mob plab, txhawm rau txhim kho cov kab mob dav thiab ua kom ib txwm tsis ua qee yam tsis muaj kuab lom. Tsis tas li ntawd, nws paub tias antiferment npaj thawb inhibit esterase, proteolytic thiab kininogenase kev ua haujlwm ntawm ntshav thiab pancreatic kallikrein.

Tom qab tswj hwm ntawm kev siv tshuaj tiv thaiv antienzyme rau tus neeg mob li 5 feeb, ib qho kev tiv thaiv tsis ua hauj lwm-enzyme ua cov ntaub ntawv (Werle, 1963). 60 feeb tom qab lub sijhawm dhau los, cov ntsiab lus inhibitor hauv cov ntshav tau txo qis, thaum lub sijhawm no lub raum muaj me ntsis ntau dua 50% ntawm cov tshuaj txhaj inhibitor. Ua kom tiav kev cuam tshuam ntawm cov enzyme yog pom tsuas yog nyob ntawm qhov muaj tshaj ntawm inhibitor.

Nws tau sim hauv kev txhim kho tias txog li 98% ntawm antienzymes nyob rau hauv daim ntawv ntawm ib txoj hauv kev nyuaj yog tawm ntawm lub cev los ntawm lub raum. Nws ntseeg tau tias trasilol thiab nws cov analogues inhibit fibrinolysis, inhibit qhov kev ua haujlwm ntawm kininogenin (kallikrein) hauv cov qog nqaij hlav, inhibit tag nrho cov kev ua haujlwm ntawm lub cev ua haujlwm ntawm lub caj dab parenchyma, nquag cuam tshuam rau microcirculation thiab oxygen saturation ntawm cov ntaub so ntswg, inhibit elastase, chymotrypsin ncaj qha rau hauv cov hlab ntsws. Ib nrab-lub neej ntawm trasilol, kontrikal thiab lwm yam kev tiv thaiv los ntawm cov ntshav yog 2 teev. Yog li ntawv, cov tshuaj tiv thaiv antienzyme yuav tsum tau muab tshuaj kom ntau. Lub sijhawm nruab nrab ntawm kev tswj hwm yuav tsum tsis pub tshaj 3 teev, thiab theem ntawm kev tsis muaj zog yuav tsum ib txwm siab dua qib ntawm cov tshuaj tiv thaiv proteolytic enzymes. Hauv qhov no, kev tswj hwm lub sijhawm ntev ntawm cov tshuaj txhaj me me ntawm cov tshuaj tiv thaiv yog impractical thiab ua tsis tau zoo. Cov koob tshuaj txhua hnub ntawm cov tshuaj tiv thaiv kab mob yuav tsum txiav txim siab coj mus rau hauv tus account ib nrab-lub neej ntawm lawv los ntawm cov ntshav (2 teev). Qhov tseem ceeb ntawm cov tshuaj antienzyme yuav tsum tau muab rau thawj hnub ntawm tus kabmob.

Raws li peb cov ntaub ntawv (Mayat B.C. et al., 1976), raws li kev tshawb xyuas ntawm cov txiaj ntsig ntawm kev kho mob ntawm 107 tus neeg mob, kev tswj hwm kev siv tshuaj tiv thaiv antienzyme txawm nyob hauv cov koob tshuaj loj tsis nres qhov pib ntawm kev mob pancreatic necrosis. Nws yog ib qho tseem ceeb kom nco ntsoov tias qhov kev ua tau zoo ntawm cov tshuaj tiv thaiv yog txiav txim siab los ntawm ntau npaum li cas lub sijhawm tau dhau los ntawm qhov pib ntawm tus kab mob mus rau lub sijhawm ntawm lawv qhov kev siv thiab qhov ntau npaum li cas ntawm cov tshuaj. Raws li ntau tus kws kho mob, kev npaj tshuaj tiv thaiv antienzyme yuav tsum tau siv nyob rau hauv thawj 6 teev txij li pib ntawm tus kab mob. Tau txais txiaj ntsig zoo dua tau los nrog kev qhia ntawm inhibitors mus rau qhov siab ntawm pob txha caj dab. Saveliev B.C. (1983) pom zoo cia cov tshuaj tswj fwm ntawm cov tshuaj antienzyme ntawm 3-4 teev sib nrug.

G.P. Titova (1989) pom tias cov roj ntsha tiv thaiv kab mob hauv kev sim tshuaj tua kab mob hauv lub cev tsis txwv txiav txoj kev puas tsuaj ntawm lub qog thiab tsis tshem tawm cov mob hemorheological hauv zos.

Hauv cov kev xyaum ua, cov protease inhibitors hauv qab no muaj ntau thoob plaws: Cov khoom sib txuam, Trasilol (Lub Tebchaws Yelemees), Gordox (Hungary), Pantripin (Russia), Tsalol (Ltalis).

Contrical yog yeeb tshuaj cais tawm ntawm lub ntsws ntawm nyuj. Nws inhibits qhov kev ua si ntawm trypsin, kallikrein, plasmin. Nws yog siv cov tshuaj pleev thiab koob tshuaj rau hauv antitrypsin units (1 chav tsev inactivates 6 tryg ntawm trypsin). Koob tshuaj ib zaug rau tus mob vias hle tawv yog 20,000 units, ib hnub - 60,000 units. Lub chav kawm ntawm kev kho mob yog 500,000-700,000 units. Cov tshuaj yeeb yaj kiab tuaj yeem siv cov ntsiab lus los ntawm chipping parapancreatic fiber.

Trasilol yog tau los ntawm kev mob plab salivary ntawm cov tsiaj. Cov tshuaj inhibits cov kev ua ntawm plasmin, kallikrein, trypsin thiab lwm yam enzymes proteolytic. Ntxiv mus, nws cuam tshuam cov nquag trypsin 4 zaug tsis muaj zog tshaj qhov kev ua ntawm kallikrein. Lub sijhawm ib nrab ntawm nws cov ntshav ncig hauv ntshav yog 150 feeb. Nws siv nyob rau hauv ib koob tshuaj: 50,000-75,000 units, hauv cov xwm txheej hnyav - txog 100,000 chav nyob, yog muab tso dej rau hauv qhov qis hauv 250-500 ml ntawm 5% kua nplaum tov. Rau chav kawm ntawm kev kho mob - 400000-500000 units. Cov chav kawm ntawm kev kho mob antienzyme feem ntau xaus rau 7-10 hnub.

Gordox, zoo li trasilol, tau txais los ntawm salivary qog ntawm cov tsiaj. Thov tso dej khov. Raws li kev pib ua ntej, 500,000 units yuav tsum tau muab tshuaj maj mam, tom qab ntawd 50,000 units txhua teev nrog kua. Hauv ob peb hnub tom qab txhim kho, qhov tshuaj txhua hnub tuaj yeem maj mam txo mus rau 300,000-500,000 units.

Pantripin tau txais los ntawm cov tsiaj nyeg txiav ntshav. Ib chav tsev ntawm nws sib raug mus rau 800 IU ntawm trasilol. Qhov koob tshuaj txhua hnub yog 300 units, hauv cov ntawv hnyav - txog 400-500 units ib zaug.

Tsalol tau txais los ntawm cov qog nqaij hlav tawm ntawm cov tsiaj txhu. Ib koob tshuaj - 25,000 units, txhua hnub - 50,000 units. Nkag mus rau hauv qhov dej num. Lub chav kawm ntawm kev kho mob yog 300000-400000 units.

Protease inhibitors tuaj yeem nkag mus rau hauv lub hnab khoom, rov qab thaum lub sijhawm phais.

Teeb meem nrog kev siv cov tshuaj tiv thaiv protease yog qhov tsis tshua muaj. Muaj qee cov ntaub ntawv hais txog kev saib xyuas qhov tsis haum thiab tawv nqaij ua xua, kev txhim kho ntawm thrombophlebitis raws cov leeg. P. Kyrle (1962) tau pom txog kev txhim kho cov ncauj lus thiab qog ntshav.

Thaum sau tshuaj tua kab mob kev kho mob rau cov neeg mob uas muaj tus kab mob pancreatitis, yuav tsum ua raws li cov hauv paus ntsiab lus: 1) xav txog lub sijhawm ua ntej (kev kuaj mob ntxov, tsev kho mob thiab kev kho mob), 2) kev saib xyuas ntawm kev soj ntsuam thiab morphological cov ntaub ntawv ntawm kev mob ntsig, 3) kev siv thaum ntxov ntawm kev txhaj tshuaj tiv thaiv antienzyme, 4) kev siv ua ke cov hau kev ntawm kev tswj hwm ntawm cov tshuaj tiv thaiv (Savelyev BC li al., 1976).

Kev nkag ncaj qha rau txoj kev tswj hwm ntawm cov tshuaj tiv thaiv protease inhibitors tsis tso cai los tsim kom muaj kev xav ntau ntawm lawv hauv cov txiav. Txhawm rau txhawm rau txhim kho kev kho mob tau ntawm B.C. pancreatitis Saveliev (1976), Yu.A. Nesterenko li al. (Xyoo 1978) pom zoo rau kev tswj hwm ntawm cov tshuaj tiv thaiv (protease inhibitors) rau hauv ntu lossis los ntawm kev xaiv catheterization ntawm txoj hlab ntsha hauv plab raws li Seldinger-Edman. Hauv tsev kho mob, hom txheej txheem no tau xub thov los ntawm K.N. Grozinger thiab Wenz (1965). Tsis nrov tam sim no.

B.C. Briskin li al. (Xyoo 1989) tau tso tshuaj rau hauv aortic hauv 92 cov neeg mob uas muaj tus mob pancreatitis. Catheterized lub plab txha caj qaum los yog leeg leeg cov leeg ntshav, tsawg dua ob leeg leeg. Cov tshuaj sib xyaw ua ke suav nrog cov tshuaj suav nrog: gelatin, polyglucin, albumin, ntxiv rau yam tsis muaj qhov ntxaws, papaverine, kev ua raws, tshuaj tua kab mob, gordox (600 000-800 000 units ib hnub). Qhov ntim ntawm qhov infusion nyob ntawm BCC thiab ncua txij li 2000 txog 3500 ml ib hnub. Yog tias tsim nyog, yuav tau ntxiv qhov kua thiab tshuaj ntxiv rau hauv dej khov dej. Tus sau phau ntawv ntseeg hais tias kev sib kis ntawm cov txheej txheem mob hauv cov nqaij mos retroperitoneal tuaj yeem nres los ntawm kev qhia txog cov kua thiab cov tshuaj ib txhij rau ob txoj hlab ntshav.

V.P. Grigoriev (1978) rau kev qhia txog cov tshuaj tiv thaiv catheterized txoj hnyuv daim siab. Qhov kom zoo dua ntawm daim ntawv lo tswj hwm ntawm cov tshuaj tiv thaiv protease inhibitors yog tias, ntxiv rau qhov kev txiav txim siab ncaj qha rau ntawm lub txiav, nws tso cai rau koj hla txoj cai kev lim dej hauv lub cev - lub siab thiab lub ntsws.

Hauv kev siv tshuaj, protease inhibitors tsis tau siv dav rau kev khwv nyiaj txiag, nrog rau vim tsis muaj txiaj ntsig hauv tag nrho cov pancreatic necrosis. Txawm li cas los xij, nrog rau cov mob toxicemia loj, kev kho ua ke nrog cytostatics thiab protease inhibitors yog qhov xav tau, uas tso cai rau koj los tiv thaiv cov txheej txheem thiab lub caj pas nws tus kheej thiab inactivate cov enzymes circulating hauv cov ntshav, nymph, thiab cov ntaub so ntswg.

Pancreatitis noj tshuaj

Nws yuav tsum tau yug hauv siab tias mob pancreatitis yog hais txog qhov mob hnyav sai, thiab nws txoj kev kho yog nqa tawm hauv tsev kho mob xwb, uas cov neeg mob, feem ntau, tau mus pw hauv tsev kho mob tam sim ntawd. Hauv cov xwm txheej loj, uas tshwm sim hauv 20-25% ntawm cov neeg mob, ib qho xwm txheej ze ntawm lub plab mob hauv plab tuaj yeem pom, thiab yog tias muaj kua dej tsis txaus vim yog ntuav, thiab hypovolemia.

Yog li, cov tshuaj rau mob ua paug, txhawm rau thawj qhov chaw, yuav tsum daws qhov mob sai, nrog rau xeev siab, ntuav, nce lub plawv dhia thiab ntshav siab poob, thiab tseem rov qab kho cov dej-electrolyte sib npaug hauv lub cev. Kev mob siab ntxhov siab los ntawm kev coj noj coj ua ntawm analgesics (Novocaine nrog qabzib, Analgin, Ketanov) lossis antispasmodics: Tsis muaj-shpa, Papaverine hydrochloride, Platifillin hydroartate, Metacin lossis Ganglefen hydrochloride.

Nyob rau tib lub sijhawm, kua dej rov qab thiab hemodynamic stabilization yog nqa tawm: ib qho kev tso tawm rov qab rau tso rau tus neeg mob qa - nrog rau cov dej qab ntsev, kua nplaum thiab lwm yam uas txhawb rau kev ua haujlwm ntawm ntau lub nruab thiab kabmob. Cov kev mob tshwm sim ntawm lub cev tiv thaiv kab mob, sepsis thiab ntau yam hauv nruab nrog cev tsis ua haujlwm loj hauv cov neeg mob loj uas mob pancreatitis vim qhov ua kom tus mob pancreatic enzymes zom cov qog ua rau nws lub hlwb.

Yog li, cov kev saib xyuas kev mob siab ua ke nrog kev tiv thaiv kev sib kis ntawm cov nqaij hauv lub cev lossis kev tawm tsam los ntawm kev tua tus kab mob uas twb muaj lawm, thiab cov tshuaj tua kab mob tau siv rau hauv kev kho mob plab los daws qhov teeb meem no (feem ntau, qhov no yog Amoxiclav lossis peb-tiam cephalosporins). Ntawm cov yam ntxwv ntawm lawv siv hauv kev kho plab hnyuv plab pediatric, saib - Mob pob txha taub hau hauv cov menyuam yaus

Lwm txoj haujlwm yog txhawm rau txhawm rau zais cov haujlwm ntawm cov qog hauv kev txiav txim siab tsis yog tsuas yog txwv nws lub nra ntau li ntau tau, tab sis kuj tseem yuav tsum nres qhov tsis ua haujlwm ntawm kev puas tsuaj ntawm cov hlwb, uas ua rau rau mob rau leeg hlwb. Rau qhov no, muaj cov tshuaj uas inhibit cov synthesis ntawm pancreatic enzymes. Lawv lub npe tseem ceeb:

• Aprotinin (txhais lus - Kontrikal, Gordoks, Traskolan),
• Octreotide (Octrid, Octretex, Sandostatin, Seraxtal).

Raws li txoj cai, lawv tsuas yog siv rau mob ntsws qhuav rau cov neeg lausCov. Nyeem ntxiv txog lawv hauv qab no.

Cov tshuaj noj rau mob ntsws qhuav

Cov ntsiab lus tseem ceeb tshaj plaws, uas suav nrog kev kho mob rau kab mob pancreatitis nrog cov tshuaj, yog rau inhibit qhov kev ua haujlwm ntawm lub qhov quav, uas yog, txo kev tsim tawm ntawm nws cov enzymes. Nws feem ntau lees txais tias cov qog plab parenchyma cov hlwb raug puas tsuaj los ntawm cov khoom tsim kho los ua ke los ntawm nws, thiab kev puas tsuaj yog pib hauv acinar hlwb tom qab ntxov ntxov ua haujlwm ntawm cov enzymes digestive.

Hauv daim ntawv uas muaj mob mus ntev, Pirenzepine (Gastrocepin) los yog Profinia bromide (Riabal) tuaj yeem siv los txo qis ntawm cov tshuaj tiv thaiv proteolytic. Cov tshuaj no tseem tau sau tseg rau exacerbation ntawm pancreatitis: yog tias tus neeg mob mus pw hauv tsev kho mob, Pirenzepine yog siv niam txiv.

Ib qho xwm txheej ntawm kev tsis txaus ntawm cov plab zom mov pancreatic enzymes muaj feem ua rau mob mob thiab ua rau lub hlwb zais ntawm cov txiav. Yuav kom npog nws, tus kws kho mob tsaj tshuaj tawm muaj enzyme npaj muaj cov khoom tiv thaiv (cais cov protein), amylase (rau hydrolysis ntawm complex carbohydrates) thiab lipase (kom lub cev tuaj yeem nqus tau cov rog). Cov no suav nrog Pancreatin, uas muaj ntau lub npe ua lag luam: Pancitrate, Pangrol, Pancreasim, Penzital, Mikrazim, Creon, Mezim, Gastenorm forte, Vestal, Hermitage, thiab lwm yam Ntxiv rau pancreatitis, kev qhia txog kev siv cov enzymes suav nrog teeb meem nrog lub plab zom mov ntawm ntau etiologies, dyspepsia , flatulence, cystic fibrosis, kev noj haus yuam kev.

Txhawm rau txhawm rau txhim kho cov tshuaj hydrochloric acid nyob rau hauv lub plab, ntau ntau lawm uas ua kom lub zog ntawm cov kua txiv quav yeeb, nyob rau hauv kev kho mob regimen. mob txha taub hau tshuaj ntawm peb ntau pawg pharmacological tau qhia:

• antisecretory H2 antihistamines: Ranitidine (Ranigast, Atzilok, Zantak, thiab lwm yam) lossis Famotidine (Pepsidin, Kvamatel, Gastrosidin),
• inhibitors ntawm cov enzyme hydrogen-potassium ATPase (proton twj tso kua mis): Omeprzazol (Omez, Gastrozole, Promez), Rabeprazole lossis Lansoprol (Lanzol, Clatinol, thiab lwm yam),
• antacids nrog aluminium thiab magnesium hydroxides - Almagel (Alumag, Gastratsid, Maaloks), uas ua rau cov kua qaub hauv lub plab ua kom tsis muaj zog.

Tus txheej txheem ntawm kev nqis tes ua, daim ntawv ntawm kev tso tawm, txoj kev ntawm daim ntawv thov thiab koob tshuaj thiab lwm cov yam ntxwv pharmacological ntawm cov tshuaj ntawm peb pawg no tau piav qhia meej hauv cov khoom - Plab pob tsam plab nyhuv

Txog cov tshuaj dab tsi uas xav tau rau kev mob ua paug rau menyuam yaus, thiab hais txog cov yam ntxwv ntawm kev siv rau lawv thaum yau, nyeem daim ntawv tshaj tawm - Kev kho mob ntawm kev mob ntsig ua leeg

Thiab cov tshuaj rau pancreatitis, uas tiv thaiv kev tsim cov kabmob ntawm pancreatic enzymes (Aprotinin, Octreotide, Pirenzepine, Prifiny bromide) thiab ua rau lawv cov tsis muaj peev xwm tom qab tshwm sim (Pancreatin), tau tham txog hauv kev qhia hauv qab no.

Kev siv cov protease inhibitors rau kev kho ntawm tus txiav

Nrog rau cov kab mob pancreatitis, kev ua kom cov proteases ua rau ua rau muaj kev puas tsuaj rau cov kabmob thiab kev txhim kho ntawm thaj chaw necrotic.

Txhawm rau tiv thaiv cov txheej txheem pathological no, cov kws tshaj lij sau ntawv rau Contrical, Trasilol, Gordox lossis Antagozan. Kev siv cov tshuaj no rau kev tswj hwm qhov quav yog qhov tseem ceeb ntawm thawj hnub ntawm kev mob tuaj yeem ua mob siab rau tus kabmob hnoos qeev.

Hom ntawm pancreatic enzymes

Lub luag haujlwm tseem ceeb ntawm tus txiav yog ua kom endocrine (sab hauv) thiab exocrine (sab nraud) txoj haujlwm. Kev ua haujlwm ntawm endocrine muaj nyob rau hauv kev tsim cov tshuaj hormones - insulin, uas txo cov piam thaj, thiab glucagon, uas ua rau kom qhov chaw nyob hauv qab zib.

Lub exocrine muaj nuj nqi ntawm lub qhov quav yog tsim cov enzymes tshwj xeeb (enzymes) tsim los zom cov zaub mov. Lawv yuav tsum tau muab faib ua ntau pawg - lipolytic, amylolytic thiab enzymes proteolytic. Cia peb xav txog hauv kev piav qhia txhua ntu.

Lipolytic cov enzymes. Pab pawg no yog lub luag haujlwm rau qhov tawg ntawm cov rog rau cov roj ntsha thiab glycerol. Prolipase yog qhov muaj zog lipase enzyme uas, thaum nws nkag rau hauv duodenum, sib xyaw nrog colipase.

Kev ua kom lipase tshwm sim nrog kev them nyiaj txaus ntawm cov kua tsib thiab trypsin. Qhov rhuav tshem cov lipolytic xyaw ua hauv 7-14 teev. Lub raum glomeruli yog lub luag haujlwm rau lawv cov pom: lawv txhawb kev nqus ntawm lipase hauv cov qauv ntaub so ntswg, yog li ntawd cov khoom ntawm lipolytic tsis pom nyob hauv cov zis. Cov tshuaj zoo li lipase kuj tseem ua los ntawm lub siab, lub ntsws thiab txoj hnyuv.

Cov ntshav enzyme Amylolytic. Muaj ntau ntau yam - alpha, beta thiab gamma amylase.Pab pawg ntawm cov enzymes no tseem hu ua cov hmoov txhuv nplej siab. Hauv cov txheej txheem kev zom, tsuas yog alpha-amylase nkaus xwb.

Nws kuj tseem ua tawm me me ntawm cov qog ua kua qaub ncaug, tshwj xeeb tshaj yog thaum zom zaub mov. Yog li, peb xav tias qab qab cov khoom qab zib thaum zom cov zaub mov muaj hmoov nplej - mov lossis qos yaj ywm ci. Ua tsaug rau amylase, txoj kev hais kom ua paug ntawm cov hmoov txhuv nplej siab thiab lwm cov kev ua kom thoob tsib yuav yooj yim.

Cov Proteolytic enzymes. Lub luag haujlwm tseem ceeb ntawm pawg neeg no yog qhov tawg ntawm cov nqaijrog. Proteolytic enzymes pab txhawb kom tawg ntawm cov amino acids uas muaj nyob hauv peptides thiab cov protein. Nws muaj ob yam sib txawv ntawm cov protease hauv cov kua txiv quav yeeb:

1. Peptidase, lossis exopeptidase, lub luag haujlwm rau lub hydrolysis ntawm cov tebchaw sab nraud ntawm peptides.
2. Proteinase, lossis endopeptidase, uas tawg rau hauv cov sib txuas sab hauv ntawm peptides.

Yog li, lipase, amylase thiab protease tsim cov kua txiv pancreatic, uas, thaum nws nkag rau hauv duodenum, zom cov khoom noj khoom haus molecules rau hauv cov sib txuas yooj yim.

Ua rau thiab pom tshwm sim ntawm pancreatitis

Hauv cov neeg noj qab nyob zoo, kev ua kom muaj zog ntawm pancreatic enzymes tshwm sim hauv duodenum.

Yog tias kev ua haujlwm ntawm amylase, protease thiab lipase pib tshwm sim hauv lub nqus ntshav nws tus kheej, peb tuaj yeem tham txog qhov tsis ua haujlwm ntawm cov khoom nruab nrog.

Pancreatitis yog to taub hais tias muaj kev nyuaj ntawm cov mob sib kis thiab cov kab mob nrog los ntawm kev ua kom cov enzymes hauv lub qog, uas ua rau cov txheej txheem ntawm "kev zom tus kheej". Raws li qhov tshwm sim, lawv tsis nkag mus rau hauv duodenum, thiab kev zom plab tau cuam tshuam.

Muaj ntau qhov laj thawj uas ua rau lub luag haujlwm ntawm pathological:

• nquag haus
• tsis ua raws li kev noj haus zoo,
• ntev li ntawm kev noj khoom kib thiab roj,
• noj zaub mov zoo ntau dhau tom qab noj zaub mov nruj lossis yoo mov,
• kev tswj tsis tau ntawm qee yam tshuaj
• lub plab zom mov raug mob
• pathology ntawm qhov kis tau.

Nrog kev ua kom ntev ntawm cov enzymes hauv cov txiav, mob tshwm sim: nws nce loj, thiab thaj chaw necrotic tshwm sim. Xws li tus txheej txheem tsis tuaj yeem yog asymptomatic, ntxiv rau, muaj kev ua txhaum ntawm txoj hnyuv plab.

Nrog lub cev tsis tuaj yeem ua mob ntawm pancreatic enzymes hauv duodenum thiab mob ntawm lub txiav, cov tsos mob hauv qab no tau pom:

1. Kev mob nyob rau hauv sab laug hypochondrium, feem ntau ntawm cov mob pob qhov muag.
2. Kev txo qis hauv kev tsis taus, qhov tsis txaus ntseeg thiab tsis muaj zog.
3. Dyspeptic tsis meej - tsam plab, xeev siab lossis ntuav, tsis qab los noj mov, tso quav tsis hnov ​​lus.

Cov tsos mob ntawm tus kab mob tuaj yeem sib txawv raws qhov tsis muaj ib qho enzyme tshwj xeeb:

• Amylase deficiency ua rau lub plab zom mov, vitamin tsis txaus, poob ceeb thawj poob. Cov quav ua kua, cov tsis muaj quav cais ntawm cov zaub mov nyob hauv nws.
• Qhov tsis txaus ntawm lipase uas zom cov rog ua rau steatorrhea - kev nce ntxiv ntawm cov roj ntau hauv cov quav. Nrog kev mob pancreatitis, txoj hnyuv plab hnyuv mus ua daj lossis txiv kab ntxwv, ib qho admixture ntawm hnoos qeev yog pom hauv lawv.
• Nrog lub plab zom mov vim li cas, cov protein tsis tau txais kev pab muaj nyob hauv cov quav. Cov yam ntxwv ntawm tus yam ntxwv yog kev loj hlob ntawm lub cev tsis muaj ntshav.

Yog tias ib tug neeg paub txog cov phiajcim no, nws yuav tsum nrhiav kev pab kho mob sai li sai tau. Tus kws kho mob yuav sau ntawv hla dhau ntawm kev sim thiab kev kho txaus.

Pancreatic Ntuj Enzyme Inhibitors

Lub cev tsim tawm tsis tsuas yog cov enzymatic tshuaj uas pab txhawb kev puas tsuaj ntawm cov lwg me me, tab sis kuj txwv tsis pub ua kom tsis muaj kab mob, ua rau lub cev tsis ua haujlwm ntawm lub cev, i.e. Cheebtsam uas tiv thaiv kom tsis txhob muaj sijhawm ntau dhau ntawm cov kua txiv pancreatic.

Enzyme blockers suav nrog pancreatic polypeptide (PPP), YY peptide, somatostatin, pancreatic glucagon, pancreastatin thiab neuropeptides.

Cov islets ntawm Langerhans, feem ntau nyob hauv tus Tsov tus tw ntawm lub tsev pheebsuab, tsim cov tshuaj hormones tshwj xeeb, PPP, uas inhibits pancreatic ntau lawm dej, enzymes thiab bicarbonates. Nws tseem inhibits zus ntawm acetylcholine.

PPP kev zais ntxiv nyob rau hauv cov xwm txheej zoo li no:

1. nrog kev xav hauv siab los noj mov lossis noj zaub mov,
2. tom qab tsa ntawm qhov chaw mos,
3. nrog duodenal acidification,
4. thaum kis mus rau gastrin thiab gastrin-tso peptide,
5. thaum kis mus rau secretin, cholecystokinin thiab VIP.

Lub distal ileum thiab hnyuv tso tawm YY peptide sai li sai tau cov rog nkag mus rau hauv lub plab zom mov. Cov peptide no pab txo qis kev muaj peev xwm ntawm lub qog rau qhov cuam tshuam ntawm cholecystokinin thiab secretin.

Pancreatic D hlwb thiab cov roj ntsha ntawm lub plab zom zaub mov ua kom somatostatin. Qhov cov tshuaj no qhov tshuaj tiv thaiv kev tsim cov enzymes thiab bicarbonates. Lub autonomic lub paj hlwb siv sijhawm hauv kev tsim cov tshuaj somatostatin, sai li sai tau cov rog thiab amino acids tuaj ntawm cov zaub mov.

Lwm qhov kev txiav txim siab pancreatic yog sawv cev los ntawm cov tshuaj hormones no:

• Pancreatic glucagon, uas nres qhov kev tsim ua kua, bicarbonates thiab enzymes.
• Pancreastatin, inhibiting kev tso tawm ntawm acetylcholine. Nws yog tsim nyob rau ntawm qhov kawg ntawm efferent kawg ntawm lub paum ntawm lub paum.
• Neuropeptides, uas muaj cov calcitonin-peptide-cov ntaub ntawv peptide (txhawb kev somatostatin) thiab enkephalins (txo cov khoom ntawm acetylcholine).

Nrog rau cov txheej txheem ua rau lub qog, lub zais ntawm pancreatic enzyme inhibitors tuaj yeem ua tsis taus, yog li koj yuav tsum tau noj tshuaj.

Cov hauv paus ntsiab lus ntawm kev kho mob rau pancreatitis

Ob lub ntsiab lus tseem ceeb ntawm kev kho mob rau tus mob yog kev noj haus thiab tshuaj kho. Cov txheej txheem kev kho mob yog tsim kho ib tus zuj zus nyob ntawm qhov mob hnyav ntawm tus kab mob thiab kev puas tsuaj rau ntawm lub txiav.

Kev noj haus tshwj xeeb rau kab mob pancreatitis yog ua raws li kev noj haus No. 5 raws li Pevzner. Nws tshem tawm ntau dhau los ntawm kev noj cov khoom noj uas muaj cov carbohydrate thiab cov rog, thiab tseem ua rau noj cov zaub mov muaj protein ntau.

Nrog rau qhov pib ntawm mob caj dab ntev, 3-4 hnub ntawm kev yoo mov yog kho. Nyob rau lub sijhawm no, koj yuav tsum kiag li tsis kam noj thiab haus dej sov ua kua alkaline, piv txwv li, Borjomi.

Tom qab tshaib plab nrog pancreatitis, cov zaub mov txawv txawv tau nkag mus rau hauv kev noj haus uas yuav tsis tsim txom cov plab zom mov. Cov neeg mob uas muaj mob pancreatitis tau pub siv:

• kev noj haus ntau yam ntawm cov nqaij thiab ntses,
• zaub kua zaub thiab ntxim nyiam cov kua zaub,
• nag hmo cov mov ci thiab cov mov ci,
• khoom noj siv mis nyuj,
• cov txiv ntoo tshiab, tshuaj ntsuab thiab zaub,
• cereals tau hau hauv dej lossis mis tsis muaj roj,
• qe hauv tsawg tus naj npawb,
• rosehip broth, zib ntab los yog jam (txwv).

Nrog rau mob ntawm tus txiav, nws yog ib qho tsim nyog yuav tsum tsis kam noj cov zaub mov uas ua rau kev zom zaub mov ntxiv:

1. Cov khoom qab zib, ncuav qab zib, ncuav qab zib.
2. Mov tshiab.
3. Fried zaub mov.
4. Khaws cia, nqaij nqaij thiab pickles.
5. Rog tej nqaij thiab ntses.
6. Rog rau khoom noj siv mis.
7. Si haus.
8. Cov txuj lom.
9. Cov nplua nuj kua zaub.
10. Muaj ntau lub qe.
11. Lub zog tshuaj yej thiab kas fes.
12. Nqaij tawv.
13. Legumes thiab txiv lws suav.

Nrog exacerbation ntawm kev mob caj dab ntev, nws yog ib qhov tsim nyog yuav tsum tau ua raws li lub txaj so.

Cov tshuaj noj rau cov txiav ua kab mob nrog:

• enzyme inhibitors kom txo qis kev ua haujlwm ntawm pancreatic proteases (proteinases),
• cov kab mob tua kab mob kom tsis txhob muaj cov kab mob ua rau lub plab ua kom plab, purulent mob ntawm lub plab bursa, kev txhim kho ntawm pancreatic necrosis thiab rotul cellulitis cellulose ntawm qhov chaw tom qab peritoneum,
• Cov H2 blockers kom txo qis cov kua txiv hydrochloric acid,
• tshuaj tua kab mob kom thim cov tshuaj hydrochloric acid hauv cov hnyuv,
• antispasmodics rau cov leeg txhawm rau ua kom cov leeg nqaij txuas nrog qhov tsis ua haujlwm ntawm lub cev ua haujlwm hauv tus kab mob pancreatic,
• anticholinergic tshuaj txhawm rau txhawm rau thaiv cov txheej txheem ua haujlwm tsis txaus ntseeg hauv ganglia thiab cerebral cortex,

Ntxiv rau, cov tshuaj tiv thaiv enzymatic yog siv los txhim kho kev zom zaub mov thiab tshem tawm dyspeptic tsis txaus ntseeg.

Tshuaj kho mob zoo

Thawj hnub ntawm exacerbation ntawm daim ntawv ntev, kev siv ntawm protease inhibitors rau kev kho mob ntawm pancreatitis yog yam. Cov tshuaj no tshem tawm qhov ua rau ntawm qhov tshwm sim ntawm inflammatory foci thiab kev sib kis ntawm thaj chaw necrotic.

Cov tshuaj noj tau txais los ntawm kab mob ntsws pulmonary parenchyma thiab nyuj rawm.

Hauv qab no yog cov tshuaj zoo tshaj plaws, qhov ntau npaum ntawm tau txiav txim siab ib tus zuj zus los ntawm tus kws kho mob koom nrog. Lawv tsis muaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj, tab sis nyob rau hauv daim ntawv ntawm mloog zoo los yog lyophilisate rau Txoj kev lis ntshav.

Kev kho ntawm pancreatitis nrog inhibitors nrog kev tswj hwm ntawm lub cev yog nqa tawm tsuas yog hauv txoj haujlwm supine. Ntxiv mus, tus kws tu mob thiab kws kho mob yuav tsum ua tib zoo saib xyuas tus neeg mob lub sijhawm. Kev noj haus No. 5, uas, ua ke nrog kev siv tshuaj kho mob, yuav ua kom ntseeg tau tias tus neeg mob rov qab ua tiav yam tsis muaj kev cuam tshuam dab tsi, yuav tsum ua raws cai.

Yuav kho tus mob pancreatitis li cas yuav qhia los ntawm cov kws txawj hauv video hauv tsab xov xwm no.