Captopril-STI (Captopril-STI)

Captopril-STI: cov lus qhia rau kev siv thiab tshuaj xyuas

Lub npe Latin: Captopril-STI

ATX Code: C09AA01

Tus nquag siv: Captopril (Captoprilum)

Chaw tsim tshuaj paus: РУС РУС, ОАО (Russia)

Qhia kho cov lus piav qhia thiab yees duab: 07/12/2019

Captopril-STI yog ib qho kev tiv thaiv angiotensin hloov ua enzyme (ACE) inhibitor.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Daim ntawv muab cov koob tshuaj - cov ntsiav tshuaj: biconvex, dawb lossis dawb nrog lub pob pleev lo zas, muaj lub teeb pom kev zoo, muaj tus cwj pwm tsis hnov ​​tsw, ntawm ib sab - nrog kev pheej hmoo (hauv cov ntim ntawm cov ntawv cardboard 1 yas tau lossis lub raj muaj 60 ntsiav tshuaj, lossis 2, 3, 4, 5 lossis 6 pob blister pob khoom uas muaj 10 ntsiav tshuaj txhua, thiab cov lus qhia rau kev siv Captopril-STI).

Kev Sau Ntawv 1 ntsiav tshuaj 25/50 mg:

• cov tshuaj nquag: captopril - 25/50 mg,
• Cov khoom siv pabcuam: talc - 1/2 mg, povidone K-17 - 1.975 / 3.95 mg, microcrystalline cellulose - 6.97 / 13.94 mg, hmoov nplej pob kws - 7.98 / 15.96 mg, magnesium stearate - 1 / 2 mg, lactose monohydrate - kom tau txais ib ntsiav tshuaj hnyav 100/200 mg.

Tso tawm daim ntawv, ntim thiab muaj pes tsawg leeg

10 Pcs. - blister packagings (2) - pob ntawv los ntawm cardboard.
10 Pcs. - blister packs (3) - pob ntawv ntawm cardboard.
10 Pcs. - hlwv pob (4) - pob khoom los ntawm cardboard.
10 Pcs. - blister pob (5) - pob ntawv ntawm cardboard.
10 Pcs. - blister packagings (6) - pob ntawv ntawm cardboard.

Cov Tshuaj Hauv Tshuaj

Captopril-STI yog ACE inhibitor uas txo cov kev tsim cov tshuaj angiotensin II los ntawm angiotensin I, uas ua rau txo qis ncaj qha rau kev tso tawm aldosterone. Tawm tsam cov keeb kwm yav dhau los no, tom qab- thiab preload rau lub siab, ntshav siab (BP), nrog rau txhua qhov kev tawm tsam ntawm cov leeg ntshav qis dua.

Pharmacological kev ua ntawm cov tshuaj, vim yog lub zog ntawm nws cov tshuaj nquag (captopril), kuj suav nrog:

• nthuav ntawm cov hlab ntsha (rau ntau dua li cov leeg),
• ib qho kev nce zuj zus hauv prostaglandin synthesis thiab txo qis hauv kev puas tsuaj ntawm bradykinin,
• nce raum thiab mob ntshav txaus,
• ib qho kev txo qis ntawm qhov hnyav ntawm hypertrophy ntawm phab ntsa ntawm myocardium thiab hlab ntsha ntawm cov tawv tiv thaiv (nrog rau kev siv lub sijhawm ntev ntawm cov tshuaj),
• txhim kho cov ntshav mov rau ischemic myocardium,
• tsawg dua platelet aggregation,
• txo hauv Na + hauv lub plawv tsis ua haujlwm,
• txo qis ntshav siab yam tsis muaj kev txhim kho ntawm reflex tachycardia (hauv kev sib piv rau cov vasodilators ncaj qha - minoxidil, hydralazine), uas ua rau txo qis ntawm myocardial oxygen xav tau.

Cov nyhuv ntshav cuam tshuam ntawm Captopril-STI tsis yog nyob ntawm ntshav ntshav kev ua si, thiab qhov txo qis rau ntshav tawm tsam cov keeb kwm yav dhau los ntawm nws qhov kev siv raug sau tseg ntawm qhov ib txwm thiab txawm tias txo qis ntawm cov tshuaj hormones, uas ua rau muaj kev cuam tshuam ntawm cov nqaij mos renin-angiotensin systems.

Hauv cov neeg mob uas muaj lub plawv tsis ua hauj lwm, noj angiotensin-hloov mus rau hauv cov tshuaj tiv thaiv enzyme hauv qhov tsim nyog tsis cuam tshuam txog ntshav siab.

Tom qab kev tswj hwm ntawm qhov ncauj, qhov siab tshaj plaws nyob rau hauv cov ntshav siab tau pom tom qab 1-1.5 teev Lub sijhawm ntawm cov nyhuv hypotensive nyob ntawm koob tshuaj Captopril-STI thiab nce mus txog qhov muaj txiaj ntsig zoo nyob rau ntau lub lis piam.

Pharmacological kev txiav txim

Antihypertensive tus neeg sawv cev, ACE inhibitor. Qhov kev ua haujlwm ntawm kev tawm tsam yog los cuam tshuam nrog kev sib tw inhibition ntawm ACE kev ua, uas ua rau kev txo qis ntawm tus nqi ntawm kev hloov pauv ntawm angiotensin I mus rau angiotensin II (uas muaj cov nyhuv vasoconstrictor thiab txhawb kev tso tawm ntawm aldosterone hauv adrenal cortex). Tsis tas li ntawd, captopril zoo nkaus li muaj qhov cuam tshuam rau lub zog kinin-kallikrein, tiv thaiv kev puas tsuaj ntawm bradykinin. Cov nyhuv antihypertensive tsis yog nyob ntawm kev ua si ntawm plasma renin, ib qho kev txo qis hauv cov ntshav siab tau sau tseg ntawm ib txwm thiab txawm tias txo cov tshuaj hormones ntau, uas yog vim muaj cov nyhuv ntawm cov nqaij mos RAAS. Ntau dua cov hlab ntshav khiav thiab cov ntshav khiav ceev.

Vim tias cov nyhuv vasodilating, nws txo qhov OPSS (afterload), jamming siab nyob rau hauv cov hlab ntsws capillaries (preload) thiab tawm tsam hauv cov hlab ntsws, ua rau lub plawv tawm thiab ua rau lub cev muaj zog. Nrog lub caij nyoog siv, nws txo qhov mob ntawm sab laug ventricular myocardial hypertrophy, txwv tsis pub muaj kev vam meej ntawm lub plawv tsis ua hauj lwm thiab txo qis kev loj hlob ntawm sab laug ventricular dilatation. Pab txo ntsev rau hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev. Nthuav cov hlab ntsha mus rau qhov ntau dua li cov leeg ntshav. Txhim kho cov ntshav xa mus rau ischemic myocardium. Txo platelet aggregation.

Txo lub suab ntawm cov hlab hlwb ua haujlwm ntawm glomeruli ntawm lub raum, txhim kho ntshav mob txha caj qaum, thiab tiv thaiv kev txhim kho ntshav qab zib nephropathy.

Cov Tshuaj Pharmacokinetics

Tom qab lub qhov ncauj tswj hwm, tsawg kawg 75% yog nrawm los ntawm lub plab zom mov. Kev noj ib txhij kom txo tau kev nqus los ntawm 30-40%. C max hauv cov ntshav ntshav yog mus txog tom qab 30-90 feeb. Protein khi, feem ntau nrog albumin, yog 25-30%. Txaus siab nyob rau hauv niam cov mis. Nws yog metabolized hauv lub siab nrog kev tsim ntawm captopril disulfide dimer thiab captopril cysteine ​​disulfide. Metabolites yog tus tsis muaj tshuaj nyob hauv tsev muag tshuaj.

T 1/2 tsawg dua 3 teev thiab nce nrog lub raum tsis ua haujlwm (3.5-32 teev). Ntau tshaj 95% yog tawm los ntawm lub raum, 40-50% tsis pauv, qhov seem - nyob rau hauv daim ntawv ntawm metabolites.

Hauv mob raum tsis ua hauj lwm, nws tsub zuj zuj.

Tshuaj los qhia

Sab sij huam

Los ntawm sab hauv nruab nrab ntawm lub hauv nruab nrab lub paj hlwb thiab lub paj hlwb txhaws: kiv taub hau, mob taub hau, nkees, asthenia, paresthesia.

Los ntawm cov hlab plawv system: orthostatic hypotension, tsis tshua muaj - tachycardia.

Los ntawm lub plab zom mov: xeev siab, tsis qab los noj mov, ua txhaum ntawm lub siab saj, tsis tshua muaj - mob plab, raws plab los yog cem quav, nce kev ua haujlwm ntawm hepatic transaminases, hyperbilirubinemia, cov tsos mob ntawm hepatocellular puas (mob siab), nyob rau qee kis - cholestasis, nyob rau hauv cov neeg mob cais - kab mob txhaws.

Los ntawm cov kab mob hemopoietic: tsis tshua muaj - neutropenia, ua kom ntshav khov, mob thrombocytopenia, tsis tshua muaj neeg mob rau cov neeg mob autoimmune kab mob - agranulocytosis.

Los ntawm ib sab ntawm cov metabolism: hyperkalemia, acidosis.

Los ntawm cov kab mob urinary: proteinuria, lub raum khiav tsis zoo (nce concentration ntawm urea thiab creatinine hauv cov ntshav).

Los ntawm tus txheej txheem ua pa: hnoos qhuav.

Kev tsis haum tshuaj: ua pob rau daim tawv nqaij, tsis tshua muaj - Quincke's edema, bronchospasm, mob ntshav siab, lymphadenopathy, qee qhov - qhov tshwm sim ntawm cov tshuaj tiv thaiv kab mob hauv cov ntshav.

Cev xeeb tub thiab lactation

Nws yuav tsum tau yug los hauv lub siab tias kev siv cov captopril hauv II thiab III trimesters ntawm cev xeeb tub tuaj yeem ua rau kev txhim kho ntawm txoj kev loj hlob thiab kev tuag ntawm tus me nyuam hauv plab. Yog tias cev xeeb tub yog tsim los, captopril yuav tsum thim tawm tam sim ntawd.

Captopril ua tawm hauv cov kua mis. Yog tias tsim nyog, siv thaum lactation yuav tsum txiav txim siab txog kev txiav kev pub niam mis.

Siv rau lub raum tsis zoo muaj nuj nqi

Ceev faj yuav tsum siv rau hauv cov xwm txheej tom qab hloov raum, raum tsis ua haujlwm.

Yog tias muaj teeb meem tsis zoo rau lub raum, qhov tshuaj txhua hnub yuav tsum raug txo kom tsawg.

Kev siv cov pa tshuaj hu ua potassium-sparing diuretics thiab npaj tshuaj poov tshuaj hauv cov neeg mob raum tsis ua haujlwm yuav tsum zam.

Cov lus qhia tshwj xeeb

Kev ceev faj yuav tsum tau siv thaum muaj keeb kwm los ntawm angioedema hauv cov neeg mob ACE inhibitor txoj kev kho, mob caj ces lossis idiopathic angioedema, muaj mob aortic stenosis, mob hlwb-thiab cov hlab plawv (suav nrog tsis muaj kab mob cerebrovascular tsis txaus, mob plawv, mob ntshav tsis txaus), cov kab mob autoimmune ntawm cov nqaij mob sib txuas (nrog rau SLE, scleroderma), nrog kev txwv tsis pub mob pob txha hematopoiesis, nrog cov ntshav qab zib mellitus, hyperkalemia, ob tog raum leeg ntshav hlab ntsha, cov leeg ntawm ib lub raum, lub xeev tom qab hloov lub raum, lub raum thiab / lossis daim siab ua haujlwm, tawm tsam kev noj zaub mov nrog txoj kev txwv sodium, cov xwm txheej los ntawm kev txo qis hauv BCC (suav nrog raws plab, ntuav), hauv cov neeg laus.

Hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm ntev, captopril yog siv nyob rau hauv kev saib xyuas mob nkeeg.

Arterial hypotension uas tshwm sim thaum phais mob thaum noj captopril yog tshem tawm los ntawm rov ua kom tiav lub ntim dej.

Kev siv tib txhij ntawm cov tshuaj potassium-sparing diuretics thiab potassium npaj yuav tsum zam, tshwj xeeb tshaj yog nyob rau cov neeg mob raum tsis ua haujlwm thiab ntshav qab zib mellitus.

Thaum noj cov tshuaj captopril, qhov tseeb tshwm sim tsis zoo tuaj yeem pom thaum tshawb xyuas zis rau acetone.

Kev siv cov tshuaj captopril hauv cov menyuam yaus yog qhov ua tau yog tias lwm cov tshuaj tsis ua haujlwm zoo.

Cuam tshuam rau kev muaj peev xwm tsav tsheb thiab tswj cov tshuab

Yuav tsum ceev faj thaum tsav tsheb lossis lwm yam haujlwm uas yuav tsum tau saib xyuas kom ntau ntxiv, zoo li kiv taub hau yog ua tau, tshwj xeeb tshaj yog tom qab thawj zaug pib ntawm captopril.

Yeeb tshuaj sib cuam tshuam

Nrog rau kev siv ua ke nrog cov tshuaj tiv thaiv kab mob, cytostatics, qhov pheej hmoo ntawm kev txhim kho leukopenia nce.

Nrog rau kev siv ua ke nrog cov potassium-sparing diuretics (suav nrog spironolactone, triamteren, amiloride), cov tshuaj potassium, cov ntsev hloov thiab cov tshuaj noj rau cov zaub mov uas muaj cov tshuaj potassium, hyperkalemia yuav muaj (tshwj xeeb yog cov neeg mob uas lub raum tsis ua haujlwm), vim tias ACE inhibitors txo cov ntsiab lus ntawm aldosterone, uas ua rau muaj kev ncua sijhawm ntawm cov poov tshuaj hauv lub cev tiv thaiv keeb kwm yav dhau los ntawm kev txwv qhov tsis txaus ntawm cov poov tshuaj lossis nws cov dej ntxiv.

Nrog rau siv ACE inhibitors thiab NSAIDs tib lub sijhawm, qhov kev pheej hmoo ntawm kev txhim kho lub raum ua kom lub siab zuj zus, hyperkalemia tsis tshua pom.

Nrog rau kev siv ib txhij nrog "voj" diuretics los yog thiazide diuretics, tshaj tawm cov hlab ntsha hypotension yog ua tau, tshwj xeeb tshaj yog tom qab noj thawj koob ntawm diuretic, pom meej vim yog hypovolemia, uas ua rau muaj kev hloov pauv ntxiv hauv cov nyhuv antioppertil ntawm captopril. Muaj ib qho kev pheej hmoo ntawm hypokalemia. Ua rau muaj kev pheej hmoo ntawm kev txhim kho lub raum ua tsis tiav.

Nrog rau kev siv ua ke nrog cov tshuaj rau tshuaj loog, mob ntshav khov o tuaj yeem ua tau.

Nrog rau kev siv tib lub sijhawm nrog azathioprine, ntshav khov yuav tshwm sim vim kev txwv tsis pub erythropoietin kev ua si nyob rau hauv kev cuam tshuam ntawm ACE inhibitors thiab azathioprine. Cov kab mob ntawm kev txhim kho ntawm leukopenia tau piav qhia, uas tej zaum yuav cuam tshuam nrog kev tiv thaiv kab mob ntxiv hauv pob txha ua haujlwm.

Nrog rau kev siv tib lub sijhawm nrog allopurinol, qhov kev pheej hmoo ntawm kev tsim cov ntshav hematological nce ntxiv, cov xwm txheej ntawm kev txhim kho ntawm kev muaj qhov tsis haum lub cev, nrog rau Stevens-Johnson syndrome, tau piav qhia.

Nrog rau kev siv tib lub sijhawm ntawm txhuas hydroxide, magnesium hydroxide, magnesium carbonate, kev siv tsis tau ntawm kev ua kom qis ntawm captopril txo.

Acetylsalicylic acid nyob rau hauv cov koob tshuaj siab tuaj yeem txo cov txiaj ntsig antioppertensive ntawm captopril. Nws tsis tau pom meej tseeb tias seb acetylsalicylic acid txo cov kev kho mob ua tau zoo ntawm ACE inhibitors hauv cov neeg mob uas muaj mob rau cov hlab plawv thiab lub plawv tsis ua haujlwm. Qhov xwm ntawm cov kev sib cuam tshuam sib luag yog nyob ntawm chav kawm ntawm tus kab mob. Acetylsalicylic acid, inhibiting COX thiab prostaglandin synthesis, tuaj yeem ua rau vasoconstriction, uas ua rau txo qis hauv cov teebmeem ntawm lub plawv thiab lub cev tsis zoo hauv cov xwm txheej ntawm cov neeg mob plawv tsis ua haujlwm tau txais ACE inhibitors.

Muaj cov lus tshaj tawm txog kev nce siab hauv kev ua haujlwm ntawm digoxin hauv ntshav ntshav nrog kev siv captopril nrog digoxin tib lub sijhawm. Txoj kev pheej hmoo ntawm kev sib cuam tshuam yeeb tshuaj tau nce rau hauv cov neeg mob uas lub raum tsis ua haujlwm.

Nrog rau kev siv ib txhij nrog indomethacin, ibuprofen, cov nyhuv antihypertensive ntawm captopril poob qis, pom meej vim yog inhibition ntawm prostaglandin synthesis nyob rau hauv lub zog ntawm NSAIDs (uas ntseeg tias ua lub luag haujlwm hauv kev txhim kho hypotensive nyhuv ntawm ACE inhibitors).

Nrog rau kev siv ua ke nrog insulins, hypoglycemic agents, sulfonylurea derivatives, hypoglycemia yuav tshwm sim vim muaj kev tiv thaiv ntshav qabzib ntau dua.

Nrog rau kev siv ACE inhibitors tib txhij thiab interleukin-3, muaj kev pheej hmoo ntawm kev txhim kho arterial hypotension.

Nrog tib lub sijhawm siv cov interferon alpha-2a lossis interferon beta, cov xwm txheej ntawm kev loj hlob ntawm cov granulocytopenia ntau tau piav qhia.

Thaum hloov los ntawm kev noj clonidine rau captopril, cov nyhuv antihypertensive ntawm lub caij nyoog kawg hloov zuj zus. Nyob rau hauv cov ntaub ntawv ntawm kev tshem tawm sai ntawm clonidine hauv cov neeg mob uas tau txais captopril, muaj ntshav nce siab ntau yuav ua tau.

Nrog tib lub sijhawm siv cov lithium carbonate, cov concentration ntawm lithium hauv cov ntshav cov ntshav nce ntxiv, nrog rau cov tsos mob ntawm intoxication.

Nrog tib lub sijhawm siv nrog minoxidil, sodium nitroprusside, cov nyhuv antihypertensive yog kho dua.

Nrog rau kev siv tib lub sijhawm nrog orlistat, captopril tej zaum yuav ua rau muaj txiaj ntsig tsawg, uas tuaj yeem ua rau nce ntshav siab, teeb meem tawg, thiab ib qho teeb meem ntawm cov hlab ntshav tau piav qhia.

Nrog tib lub sijhawm siv ACE inhibitors nrog pergolide, ib qho kev nce ntawm cov txiaj ntsig antihypertensive yog ua tau.

Nrog rau kev siv ua ke nrog probenecid, lub raum tshem ntawm captopril poob qis.

Nrog rau kev siv ua ke nrog procainamide, ib qho kev pheej hmoo ntawm kev txhim kho leukopenia yog ua tau.

Nrog rau kev siv tib lub sijhawm nrog trimethoprim, muaj kev pheej hmoo ntawm kev tsim hyperkalemia, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas lub raum tsis ua haujlwm.

Nrog rau kev siv ua ke nrog chlorpromazine, muaj kev pheej hmoo los tsim orthostatic hypotension.

Nrog rau kev siv tib lub sijhawm nrog cyclosporine, muaj cov ntaub ntawv qhia ntawm kev txhim kho ntawm lub raum tsis ua haujlwm, oliguria.

Nws ntseeg tias qhov txo qis hauv kev ua tau zoo ntawm cov tshuaj tiv thaiv mob thaum siv tshuaj erythropoietins yog ua tau.

Sab sij huam

Cov kev mob tshwm sim> 10% - ntau zaus (> 1% thiab 0.1% thiab 0.01% thiab + hauv ntshav cov ntshav.) Thaum muaj ntshav qab zib mellitus, lub raum tsis ua haujlwm, noj cov tshuaj potassium-sparing diuretics, cov tshuaj muaj poov tshuaj lossis tshuaj uas nce ntxiv kev mloog lus ntawm cov poov tshuaj nyob rau hauv cov ntshav (piv txwv li, heparin) nce qhov kev pheej hmoo ntawm kev tsim hyperkalemia. Hauv no hais txog, nws raug nquahu kom tsis txhob ua ke nrog kev kho nrog potassium-sparing diuretics thiab potassium npaj.

Thaum muaj mob hemodialysis thaum lub sijhawm saib xyuas Captopril-STI, nws yog qhov tseem ceeb los tiv thaiv kev siv cov qog ua kom ntshav txhaws nrog qhov siab permeability (piv txwv li AN69), txij li qee qhov xwm txheej zoo li no yuav ua rau muaj kev phiv tshuaj tsis zoo ntxiv.

Thaum angioneurotic edema zoo li, angiotensin-hloov enzyme inhibitor tau muab tso tseg, tus neeg mob tau ua tib zoo saib xyuas thiab cov tsos mob kho tau sau tseg.

Nws yuav tsum tau yug hauv siab tias qhov tshwm sim ntawm kev tshawb xyuas zis rau acetone thaum lub sijhawm noj captopril yuav yog qhov tsis zoo.

Cov neeg mob uas tsis muaj ntsev los yog noj ntsev ntau yuav tsum noj Captopril-STI nrog kev ceev faj, vim qhov pheej hmoo ua rau mob ntshav ntau dua.

Cov Yuav Tsum Muaj

Cov Hypersensitivity (suav nrog rau ACE lwm yam tshuaj tiv thaiv kab mob), angioedema (keeb kwm kev kho mob nrog ACE inhibitors lossis mob rwj), mob raum / mob siab tsis txaus, hyperkalemia, ob tog raum artery stenosis, stenosis ntawm ib lub raum nrog mob azotemia, mob tom qab hloov raum, IHSS, kab mob thiab mob uas muaj teeb meem tawm ntshav tawm los ntawm LV, cev xeeb tub, lactation, hnub nyoog qis dua 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb tsis tau tsim).

Yuav siv li cas: noj ntau thiab hom tshuaj kho

Sab hauv, 1 teev ua ntej noj mov, nrog kev mob ntshav siab, kho mob pib nrog kev siv tshuaj qis dua 12,5 mg 2 zaug hauv ib hnub. Yog tias tsim nyog, cov koob tshuaj tau maj mam nce nrog qhov luv ntawm 2-4 lub lis piam kom txog thaum pom zoo tshaj plaws. Nrog rau qhov mob sib khuav ntawm cov ntshav dhau mus txog qib qis, kev txij nkawm feem ntau yog 25 mg 2 zaug hauv ib hnub, qhov ntau kawg yog 50 mg 2 zaug ib hnub. Hauv kev mob ntshav siab heev, thawj koob tshuaj yog 12,5 mg 2 zaug hauv ib hnub, uas tom qab ntawd maj mam nce mus rau qhov siab tshaj plaws txhua hnub ntawm 150 mg (50 mg 3 zaug hauv ib hnub).

Hauv CHF, qhov pib txhaj thawj hnub yog 6.25 mg 3 zaug hauv ib hnub, yog tias tsim nyog, nce qhov koob tshuaj nrog lub sijhawm tsawg kawg 2 lub lis piam. Qhov nruab nrab ntawm kev saib xyuas txij nkawm yog 25 mg 2-3 zaug ib hnub. Qhov siab tshuaj ntau tshaj plaws txhua hnub yog 150 mg.

Thaum lub cev tsis ua haujlwm LV ua haujlwm tom qab raug mob myocardial infarction hauv cov neeg mob hauv lub xeev qhov chaw mob ruaj khov, captopril tuaj yeem pib ntxov li 3 hnub tom qab myocardial infarction. Thawj koob tshuaj yog 6.25 mg / hnub, tom qab ntawd lub koob tshuaj txhua hnub tuaj yeem nce ntxiv rau 37.5-75 mg nyob rau hauv 2-3 koob tshuaj (nyob ntawm kev kam ntawm cov tshuaj) txog ntau kawg yog 150 mg / hnub.

Hauv kev mob ntshav qab zib nephropathy, ib koob tshuaj 75-150 mg / hnub yog tau hais hauv 2-3 koob. Hauv hom 1 mob ntshav qab zib mellitus nrog macroalbuminuria (30-300 mg / hnub) - 50 mg 2 zaug ib hnub. Nrog kev txiav tawm ntawm cov protein ntau tshaj 500 mg / hnub - 25 mg 3 zaug ib hnub.

Nrog kev tswj hwm qhov tsis muaj zog ntawm lub raum lub ntsej muag (CC tsawg kawg 30 ml / min / 1.73 sq.m) - 75-100 mg / hnub. Nrog lub suab tshaj tawm ntawm lub raum ua haujlwm (CC tsawg dua 30 ml / min / 1.73 m), thawj qhov kev siv tshuaj tsis ntau tshaj 12,5 mg 2 zaug hauv ib hnub, tom qab ntawd, yog tias tsim nyog, koob tshuaj captopril yog maj nce nrog lub sijhawm ntev kom txog thaum kho tau zoo, tab sis cov koob tshuaj txhua hnub yuav tsum qis dua li ib txwm.

Hauv cov neeg laus cov neeg mob, thawj koob tshuaj yog 6.25 mg 2 zaug ib hnub.

Kev sib txuam

Cov nyhuv tshuaj tiv thaiv kab mob tsis muaj zog txaus los ntawm indomethacin thiab lwm yam tshuaj NSAIDs, suav nrog xaiv COX-2 inhibitors (ncua Na + thiab qhov txo qis hauv Pg synthesis), tshwj xeeb tshaj yog tiv thaiv keeb kwm ntawm qhov qis ntawm qis ntawm renin, thiab estrogens (ncua Na +).

Kev sib xyaw nrog thiazide diuretics, vasodilators (minoxidil) txhim kho cov kev mob hypotensive.

Kev sib xyaw nrog kev siv tshuaj potassium-sparing diuretics, K + kev npaj, cov tshuaj ntxiv potassium, ntsev hloov pauv (muaj cov K + tseem ceeb) ua rau muaj kev pheej hmoo ntawm hyperkalemia.

Ua kom qis qis ntawm kev tsis haum ntawm Li + cov tshuaj, nce nws cov ntsiab lus hauv cov ntshav.

Nrog rau kev teem sijhawm ntawm captopril thaum noj cov tshuaj allopurinol lossis procainamide, qhov kev pheej hmoo ntawm kev tsim mob Stevens-Johnson syndrome thiab neutropenia nce ntxiv.

Nrog rau kev siv ACE inhibitors thiab kev npaj kub (sodium aurothiomalate) tib txhij, muaj cov tsos mob piav qhia, suav nrog kev tso dej tawm ntsej muag, xeev siab, ntuav, thiab txo ntshav siab.

Cov tshuaj Insulin thiab lwm qhov ncauj tshuaj hypoglycemic - qhov kev pheej hmoo ntawm hypoglycemia.

Kev siv cov tshuaj captopril hauv cov neeg mob uas tau txais cov tshuaj tiv thaiv kab mob (suav nrog azathioprine lossis cyclophosphamide) ua rau muaj kev pheej hmoo ntawm cov ntshav tsis zoo.

Tso cov ntaub ntawv thiab cov nyob ua ke

Qhov kev npaj yog dawb crystalline tshuaj, nkag yooj yim nyob rau hauv methyl, ethyl cawv thiab dej, nrog tsis muaj zog sulfur tsis hnov ​​tsw. Lub solubility ntawm cov tshuaj nyob rau hauv ethyl acetate thiab chloroform yog ib qho kev txiav txim ntawm qhov ntau zuj zus. Cov tshuaj yuav tsis yaj hauv ether.

Cov khoom muaj nyob rau hauv cov ntsiav tshuaj corrugated rau kev tswj hwm sab hauv lossis sab nrauv.

Ntxiv rau qhov tseem ceeb cov khoom xyaw rau hauv ib qho nyiaj ntawm 12.5-100 mg, cov ntsiav tshuaj muaj qee cov tshuaj pab: silicon dioxide, stearic acid, MCC, hmoov txhuv nplej siab, thiab lwm yam.

Nws yuav ua haujlwm li cas

Cov nyhuv pharmacological ntawm captopril tseem nyob hauv kev kawm.

Kev txhawb nqa ntawm renin-angiotensin-aldosterone (PAA) cov tshuaj nrog cov tshuaj ua rau nws muaj txiaj ntsig zoo hauv kev kho mob plawv thiab ntshav siab.

Qhov kev txiav txim ntawm Captopril yog kom tsis muaj zog tiv thaiv kev kub siab tag nrho peripheral vascular tsis kam (OPSS).

Renin synthesized los ntawm ob lub raum ua rau cov ntshav ntawm ntshav plasma globulin, ua rau kev tsim cov tsis muaj zog decapeptide thiab angiotensin. Tom qab ntawd, nyob rau hauv kev cuam tshuam ntawm ACE (angiotensin-hloov enzyme), vasoconstrictor khoom ntawm keeb kwm endogenous, angiotensin l yog hloov mus rau hauv angiotensin ll, uas txhawb cov synthesis ntawm aldosterone los ntawm adrenal cortex. Raws li qhov tshwm sim, dej thiab sodium tau khaws cia hauv cov ntaub so ntswg.

Qhov kev txiav txim ntawm Captopril yog kom tsis muaj zog tiv thaiv kev kub siab tag nrho peripheral vascular tsis kam (OPSS). Hauv qhov no, cov zis tawm los yog nce lossis tseem tsis hloov. Tus nqi pom nyob rau hauv lub raum glomeruli kuj tsis hloov.

Qhov pib ntawm hypotensive nyhuv ntawm cov tshuaj tshwm sim nyob rau hauv 60-90 feeb tom qab noj ib koob.

Cov tshuaj tau kho rau lub sijhawm ntev, vim hais tias ntshav siab hauv cov hlab ntsha nce qis hauv qab ntawm cawv ntawm yeeb tshuaj. Nrog rau kev siv Captopril nrog thiazide diuretics, kev sib ntxiv yog pom. Txais tos ua ke nrog beta-blockers tsis ua rau kev ua kom nrov loj ntawm cov nyhuv.

Ntshav siab nce mus txog cov lej ib txwm hloov zuj zus, tsis tas coj mus rau kev txhim kho tachycardia thiab orthostatic hypotension. Tsis muaj ntshav nce ceev thiab nrog kev thim tawm ntawm cov tshuaj.

Kev txo qis hauv lub plawv dhia, txo qis ntshav siab, mob plawv, mob ntshav naus laus zis, nce rau hauv cov zis hauv lub plawv, thiab cov cim ntawm kev tawm dag zog tawm tsam tag nrho pom nyob hauv cov neeg mob uas muaj kab mob ntawm cov hlab plawv thaum kho captopril. Ntxiv mus, cov teebmeem no tau pom hauv cov neeg mob tom qab noj thawj koob, txuas ntxiv thoob plaws hauv kev kho mob.

Cov tshuaj ua kom yaj zom hauv cov kua txiv thiab nkag mus rau hauv cov hlab ntshav los ntawm txoj hnyuv. Qhov siab tshaj plaws hauv cov ntshav tau mus txog hauv ib teev twg.

Cov tshuaj yog npaj rau kev kho mob ntshav siab.

Los ntawm cov ntshav, cov tshuaj ua rau ntawm ACE enzyme hauv lub ntsws thiab lub raum thiab inhibits nws. Cov tshuaj raug tawm hauv ntau dua li ib nrab hauv lub xeev tsis hloov. Nyob rau hauv daim ntawv ntawm qhov tsis muaj zog metabolite, nws tawm los ntawm lub raum nrog zis. 25-30% ntawm cov tshuaj nkag mus rau hauv kev sib txuas nrog cov ntshav protein. 95% ntawm cov tshuaj tau tawm los ntawm lub raum tom qab 24 teev. Ob teev tom qab kev coj noj coj ua, qhov kev nkag siab hauv cov ntshav txo qis li ntawm ib nrab.

Cov hlwv tsis ua hauj lwm hauv cov neeg mob noj cov tshuaj ua rau nws qeeb hauv lub cev.

Dab tsi pab

Cov tshuaj yog npaj rau kev kho mob ntawm:

1. Arterial hypertension: cov qauv tshuaj ntsiav tau siv los ua kev kho mob thawj zaug hauv cov neeg mob uas tau khaws cia lub raum. Cov neeg mob uas lub raum khiav tsis zoo, tshwj xeeb tshaj yog cov uas muaj cov kab mob collagenosis, yuav tsum tsis txhob siv nws yog tias muaj kev cuam tshuam lwm yam tshwm sim los ntawm lwm cov tshuaj. Cov cuab yeej tuaj yeem siv los ua kev kho mob tshuaj pleev ib ce lossis hauv kev sib xyaw nrog lwm cov tshuaj muaj zog.
2. Qhov ua kom lub plawv tsis ua haujlwm: Txoj kev kho lub hlwb kom zoo siv nrog digitalis thiab diuretics.
3. Kev ua txhaum tom qab ua txhaum ntawm sab laug ventricular muaj nuj nqi: txoj kev muaj sia nyob ntawm cov neeg mob ntawd yog nce vim qhov txo qis ntawm cov txiaj ntsig lub plawv tawm mus rau 40%.
4. Mob ntshav qab zib nephropathy: qhov xav tau lim ntshav thiab lub raum hloov qis yog txo los ntawm kev txo qis ntawm qhov muaj tshwm sim ntawm cov mob nephrotic. Nws siv rau cov tshuaj insulin-ntshav qab zib mellitus thiab nephropathy nrog proteinuria ntau dua 500 mg / hnub.
5. Hlawv tawg.

Hauv kev ua kom lub siab tsis haum, Captopril txoj kev kho yog siv nrog digitalis thiab diuretics.

Yuav ua li cas coj captopril

Nrog ntshav siab, noj sublingually lossis hais lus tom qab noj mov.

Nws yog ib qho tsim nyog kom haus cov tshuaj ib teev ua ntej noj mov, raws li cov ntsiab lus ntawm lub plab tuaj yeem txo qhov nqus ntawm cov quav tshuaj kom tsawg li 30-40%.

Kev kho mob mus ntev yog nrog nws los noj cov tshuaj hauv. Yog tias cov tshuaj siv rau kev kho mob kub ntxhov nrog kev nce ntxiv hauv cov ntshav siab los ntawm kev mob siab lossis lub cev txav, nws raug muab nyob hauv qab tus nplaig.

Twb tau 15 feeb tom qab kev tswj hwm ntawm qhov ncauj, cov tshuaj zom hauv cov ntshav.

Nrog kev tswj hwm sublingual, bioavailability thiab tus nqi ntawm cov tshwm sim ntawm cov nyhuv nce.

Qhov pib ntawm txoj kev kho yog nrog los ntawm kev tswj hwm ntawm cov tshuaj muab faib rau noj thaum yav tsaus ntuj thiab noj thaum sawv ntxov.

Qhov pib ntawm txoj kev kho yog nrog los ntawm kev tswj hwm ntawm cov tshuaj muab faib rau noj thaum yav tsaus ntuj thiab noj thaum sawv ntxov.

Kev kho ntawm lub plawv tsis ua hauj lwm koom nrog kev siv tshuaj ib hnub peb zaug. Yog tias lub hom phiaj ntawm Captopril ib leeg tsis muaj peev xwm txo tau qhov siab kom txaus, hydrochlorothiazide raug tshuaj yog qhov tshuaj tiv thaiv thib ob. Muaj qee tus qauv tshwj xeeb muab tshuaj uas suav nrog ob qho tib si ntawm cov tshuaj (Caposide).

Kev kho mob nrog ntshav siab yog pib nrog kev siv tshuaj txhua hnub ntawm 25-50 mg. Tom qab ntawd cov koob tshuaj tau nce siab, raws li kws kho mob sau, maj mam kom txog thaum ntshav siab yog qhov tsis sib xws. Txawm li cas los xij, nws yuav tsum tsis txhob siab tshaj tus nqi siab tshaj plaws ntawm 150 mg.

Kev kho mob ntawm lub plawv tsis cuam tshuam nrog pib nrog kev siv cov tshuaj ntau npaum li ntawm 6.5-12.5 mg nrog nce ntxiv yog tsim nyog.

Kev kho mob ntawm lub plawv tsis cuam tshuam nrog pib nrog kev siv cov tshuaj ntau npaum li ntawm 6.5-12.5 mg nrog nce ntxiv yog tsim nyog.

Lub sijhawm pib nkag yog tshwm sim rau hnub peb tom qab kev puas tsuaj rau cov leeg plawv. Cov tshuaj yog qaug cawv raws li cov txheej txheem:

1. 6.25 mg ob zaug ib hnub rau thawj 3-4 hnub.
2. Hauv ib lub lis piam, 12,5 mg 2 zaug ib hnub.
3. 2-3 lub lis piam - 37,5 mg, muab faib ua 3 koob.
4. Yog tias cov tshuaj muaj peev xwm zam tau yam tsis muaj qhov tshwm sim, qhov koob tshuaj txhua hnub tau hloov kho rau 75 mg, nce ntxiv raws li qhov tsim nyog rau 150 mg.

Captopril pib rau hnub thib peb tom qab kev puas tsuaj rau cov leeg plawv hauv siab.

Mob ntshav qab zib mellitus nrog cov ntsiab lus siab ntawm albumin hauv cov zis yuav tsum tau siv ob koob tshuaj ib zaug tshuaj ib hnub, sib npaug ntawm 50 mg. Yog tias cov protein ntau tshaj 500 mg hauv kev tso zis txhua hnub - 25 mg peb zaug.

Nrog rau kev sib xyaw nrog cov ntshav qab zib mellitus hom l nephropathy, qhov koob tshuaj 75-100 mg / hnub tau muab faib ua 2-3 koob.

Noj ntau dhau

Kev noj cov koob tshuaj ntau tshaj ntawm cov koob tshuaj pom zoo tuaj yeem ua rau txo ntshav nce siab. Tsis tas li ntawd, tej zaum yuav muaj kev cuam tshuam nyob rau hauv daim ntawv ntawm thromboembolism ntawm cov hlab ntsha loj ntawm cov hlab ntsha, cov hlab ntsha ntawm lub plawv thiab lub hlwb, uas, nyeg, tuaj yeem ua rau lub plawv nres thiab mob hlab ntsha tawg.

Nrog kev siv tshuaj ntau dhau ntawm Captopril, hemodialysis tseev kom muaj.

Cov kev ntsuas hauv qab no yog ua los ntawm kev kho:

1. Yaug lub plab tom qab tshem tawm lossis txo cov tshuaj ntau npaum li cas.
2. Rov qab ua kom ntshav siab, muab tus neeg mob pw txoj hauj lwm nrog ceg tsa ceg, thiab tom qab ntawd nqa tawm txoj leeg ntshav qab ntsev, Reopoliglyukin lossis ntshav ntshav.
3. Qhia Epinephrine rau tshuaj pleev ib ce lossis subcutaneously kom ntshav nce siab. Raws li cov tshuaj tiv thaiv kab mob, siv cov tshuaj hydrocortisone thiab antihistamines.
4. Ua haujlwm hemodialysis.

So haujlwm rau kev ntes captopril los ntawm lub tsev muag tshuaj

Tsuas yog raws li daim ntawv qhia sau rau hauv daim ntawv tshwj xeeb hauv Latin, piv txwv:

1. Rp. Captoprili 0.025.
2. D.t.d. N 20 nyob rau hauv tabulettis.
3. S. 1 lub ntsiav tshuaj ib nrab ib teev ua ntej noj mov thaum sawv ntxov thiab yav tsaus ntuj.

Tus nqi ntawm cov tshuaj txawv ntawm 9-159 rubles.

Kev tshuaj xyuas ntawm cov kws kho mob thiab cov neeg mob txog Captopril

Oksana Aleksandrovna, Pskov, tus kws kho mob txog poj niam: “Kuv siv Captopril ua lub tsheb thauj neeg mob rau kev nyuaj. Feem ntau ua tsis tau, yog li nws yog qhov zoo dua rau kev saib xyuas: nws puas yog qhov muaj tshuaj lossis cov tshuaj qub. "

Maria, 45 xyoo, Moscow: “Kuv haus cov tshuaj raws li kev pom zoo ntawm tus kws kho plawv thaum mob siab. Cov nyhuv tsis zoo dua li los ntawm Moxonidine li ib txwm. Nws ua nws txoj haujlwm "pabcuam pabcuam" zoo kawg nkaus, thiab ntawm tus nqi zoo ntawd. "

Vitaliy Konstantinovich, Krasnodar, kws kho plawv: “Yog tias tus neeg mob ntsib nrog kev xaiv, npaj nrog Kapoten lossis Captopril, Kuv xav pom zoo ua ntej. Yog lawm, cov tshuaj yeeb tshuaj nyob hauv ob qho tshuaj yeeb tshuaj yog qhov zoo ib yam, tab sis ib qho yog qhov qub, thiab qhov thib ob yog daim ntawv theej. Cov neeg mob feem ntau yws yws txog cov nyhuv tsis muaj zog ntawm cov tshuaj, txawm hais tias nws siv rau hauv cov xwm txheej uas pab yuav tsum tau nrawm thiab ua haujlwm zoo. Kuv pom zoo kom Kapoten rau cov neeg mob uas muaj kev kub siab, vim rau kuv tus kheej Kuv tseem yuav siv cov tshuaj no. Ntxiv mus, tus nqi tso cai rau nws. "

UKPDS kev kawm

Ib qho pov thawj ntawm kev nyab xeeb thiab kev ua haujlwm ntawm kev siv BB hauv ntshav qab zib hom 2 yog qhov ua tiav ntawm UKPDS txoj kev tshawb nrhiav, uas piv rau kev mob plawv thiab tuag, nrog rau cov teeb meem mob microvascular (MD, DR) hauv cov neeg mob ntshav qab zib hom 2 uas muaj ntshav siab uas tau txais ib qho ACE inhibitor captopril ntawm ib koob ntawm 25-50 mg 2 zaug hauv ib hnub (400 tus neeg), lossis xaiv atenolol BB ntawm ib koob ntawm 50-100 mg / hnub (358 tus neeg).

Tom qab lub sijhawm soj ntsuam (8.4 xyoo) hauv ob pawg, tib theem kev tswj ntshav siab tau ua tiav: 144/83 mmHg. Kos duab. hauv cov pab pawg ntawm captopril thiab 143/81 hli RT. Kos duab. hauv pawg atenolol. Nyob rau tib lub sijhawm, tsis muaj qhov sib txawv tseem ceeb ntawm cov ntsiab lus kwv yees zaum kawg (kev tuag muaj feem cuam tshuam nrog ntshav qab zib, zaus ntawm cov xwm txheej mob plawv, cov teeb meem microvascular) ntawm cov pab pawg. Hauv lwm lo lus, captopril thiab atenolol ua rau tib qho kev tiv thaiv zoo tiv thaiv micro- thiab macrovascular cov teeb meem hauv cov neeg mob uas muaj ntshav qab zib hom 2.

Raws li kev tawm tswv yim, Kuv xav nco ntsoov tias UKPDS txoj kev tshawb nrhiav pib txij li xyoo 1970, thaum captopril tsuas yog ACE inhibitor ntawm lub ntiaj teb ua lag luam. Hauv cov xyoo ntawd, ib qho kev faib tawm thaj tsam ntawm 25-100 mg 2 zaug hauv ib hnub tau saws. Txawm li cas los xij, nws tom qab tau lees paub tias xws li kev siv tshuaj yeeb tshuaj tsis tuaj yeem ua rau muaj kev tawm tsam tsis pom kev zoo thaum nruab hnub, vim tias cov tshuaj no muaj lub sijhawm luv (4-6 teev).

Txhawm rau kom tswj tau cov ntshav siab ruaj khov, yuav tsum tau noj 3-4 koob ntawm cov tshuaj hauv ib koob tshuaj txhua hnub 150 mg yuav tsum ua. Yog li, qhov sib piv ntawm luv luv-kev ua si captopril nrog kev ua yeeb yam ntev ntawm atenolol tsis tau muaj tseeb hauv kev tshuaj ntau npaum li cas. Txawm li cas los xij, ob qho tshuaj muaj cov tiv thaiv zoo ib yam. Tom qab tau txais txiaj ntsig ntawm UKPDS txoj kev tshawb nrhiav, nws tau pom meej tias kev siv cov kev xaiv BB hauv cov neeg mob uas muaj ntshav qab zib hom 2 thiab AT yog kev nyab xeeb thiab siv tau.

Kev tshawb nrhiav GEMINI (Cov teebmeem Glycemic nyob rau hauv Ntshav Qab Zib Mellitus: Carvedilol-Metoprolol Sib Piv hauv Hypertensives)

Hauv kev kawm txog ob lub qhov muag tsis pom tseeb, lub hom phiaj yog ua qhov kev sib piv ncaj qha ntawm ob lub BBs hauv kev kho kev mob ntshav siab nyob rau hauv cov neeg mob uas muaj ntshav qab zib hom 2: metoprolol, ib qho kev xaiv BB1-BB, thiab carvedilol, tsis tau xaiv BB, uas muaj cov cuab yeej ntxiv ntawm kev thaiv α1-AR. Cov kws tshawb nrhiav tau hais tias vim α1-AR blockade, carvedilol yuav muaj qhov ua tau zoo dua metoprolol tsis yog vim nws twb tau tshaj tawm vasodilator kev ua haujlwm, tab sis kuj, muaj, vim muaj ntau dua cov txiaj ntsig rau cov teeb meem metabolic (dyslipidemia, IR), txij li α1-AR blockade nce kev ua haujlwm ntawm lipoprotein lipase uas tawg rau TG.

Txoj kev tshawb no suav nrog 1235 tus neeg mob uas kub siab thiab hom 2 mob ntshav qab zib. Ib pab pawg (n = 737) tau txais tshuaj metoprolol tartrate nyob rau hauv ib koob ntawm 50-200 mg 2 zaug hauv ib hnub, thib ob (n = 498) tau txais carvedilol hauv koob tshuaj 6.25-25 mg 2 zaug hauv ib hnub rau 35 lub lis piam. Tib lub sijhawm, txhua tus neeg mob txuas ntxiv noj cov tshuaj uas tau hais txog RAS blockers (ACE inhibitors lossis ARA) ntawm koob tshuaj dhau los. Thaum piv cov glycemic tswj kev ntsuas, nws tau muab tawm tias thaum kho nyob rau hauv pab pawg carvedilol, qhov nruab nrab HbAlc qhov tseem ceeb tsis tau hloov, thaum nyob hauv pawg metoprolol lawv tau nce 0.15%, insulin rhiab heev (txiav txim los ntawm NOMA Performance index) zoo dua ntawm carvedilol, tab sis tsis nyob rau metoprolol ( qhov ntsuas poob qis 9.1 thiab 2, feem). Kev pheej hmoo ntawm UIA tau txo qis dua carvedilol dua li ntawm metoprolol (6.4 thiab 10.3%, feem).

Yog li, qhov kev tshawb fawb no tau tso cov lus dab neeg hais txog qhov txaus ntshai ntawm kev siv BB hauv ntshav qab zib thiab ua pov thawj tias carvedilol tsis tsuas yog tsis cuam tshuam txog kev tswj cov khoom noj hauv ntshav qab zib hom 2, tab sis tseem txhim kho cov nqaij mos rhiab rau insulin. Tau kawg, cov txiaj ntsig ntawm qhov kev tshawb fawb no tsis tuaj yeem xa mus rau tag nrho BB pawg, vim carvedilol muaj cov yam ntxwv ntxiv ntawm an1-blocker, uas piav qhia txog cov teeb meem hauv metabolic tau. Hauv txoj kev tshawb no, carvediol (Dilatrend) tau siv los ntawm Hoffman - la Roche.

BB thiab lub siab tsis ua haujlwm

Txoj kev tshawb no ntawm kev ua tau zoo ntawm BB hauv kev mob plawv tau hais txog ntau yam kev tshawb fawb, suav nrogMERIT-HF (Metoprolol CR: XL Randomized Kev Pabcuam Tiv Thaiv hauv kev ua rau lub plawv tsis ua haujlwm), CIBIS-II (Kev Tshawb Fawb Ntshav Ntshav Bisoprolol Kev Tshawb Fawb) thiab SENIORS (Kev Tshawb Fawb ntawm Nebivolol Kev cuam tshuam ntawm cov txiaj ntsig thiab Rehospitalisation hauv cov neeg laus nrog lub plawv tsis ua haujlwm).

Lub hom phiaj ntawm txoj kev tshawb MERIT-HF yog los txiav txim siab kev nyab xeeb thiab kev ua tau zoo ntawm BB hauv cov neeg mob plawv. 3991 cov neeg mob uas muaj hnub nyoog nruab nrab ntawm 63 xyoo tau suav nrog HYHA qib II-IV lub plawv tsis ua haujlwm. Kwv yees li 25% ntawm cov neeg mob suav nrog cov neeg mob ntshav qab zib hom 2. Siv txoj kev ntsuas ob-qhov muag tsis pom, cov neeg mob tau muab faib ua 2 pawg: tau txais metoprolol CR (ua ntev ntev) ntawm koob tshuaj 25 txog 200 mg lossis placebo. Tib lub sijhawm, cov neeg mob txuas ntxiv siv cov tshuaj diuretics (90%), ACE inhibitors (89%) thiab digitalis (63%). Txoj kev tshawb no tau txiav tawm ib xyoos ib zaug tom qab pib kho vim cov txiaj ntsig zoo ntawm cov tshuaj metoprolol. Tag nrho thiab cov mob plawv tuag yog cov qis dua nrog metoprolol los ntawm 34 thiab 38%.

Cov txiaj ntsig zoo sib xws tau nyob rau hauv CIBIS-II txoj kev tshawb nrhiav, uas kawm txog cov tshuaj bisoprolol hauv cov neeg mob zoo sib xws. Hauv txoj kev tshawb fawb no, tus naj npawb ntawm cov neeg mob uas muaj ntshav qab zib hom 2 yog 12%. Kev mob plawv rau ntawm bisoprolol tsawg dua 34%.

Tsis ntev los no, txoj kev tshawb CIBIS-III tau ua tiav, lub hom phiaj uas yog los qhia tias pib kev kho mob monotherapy nrog bisoprolol ua raws li kev hloov pauv ntawm cov neeg mob uas muaj lub plawv tsis ua haujlwm mus rau kev sib xyaw ntawm BB bisoprolol thiab ACE inhibitors enalapril tsis yog qhov qis dua rau kev coj ua qub kev kho mob (ACE inhibitors enalapril ua raws li kev koom tes ntawm BB bisoprolol) tus nqi ntawm kev tuag thiab tsev kho mob. Cov txiaj ntsig ntawm 6 lub hlis ntawm kev kho mob monotherapy nrog txhua yam ntawm cov tshuaj, tom qab ntawd hloov mus rau kev kho mob sib xyaw (18 lub hlis) rau thawj zaug tau lees tias qhov kev xav tias qhov kev xaiv ntawm kev pib kho mob rau lub plawv tsis ua haujlwm (BB nrog bisoprolol lossis ACE inhibitors enalapril) tsis cuam tshuam rau lub hauv paus ntsiab lus (kev suav ntawm kev tuag thiab tsev kho mob los ntawm qhov kawg ntawm kev soj ntsuam ) thiab yuav tsum ua raws li kev txiav txim siab ntawm tus kws kho mob hais txog txhua tus neeg mob.

Hauv kev cais tawm ntawm pawg me me ntawm cov neeg mob ntshav qab zib nyob rau hauv ob qho kev tshawb fawb, nws tau nthuav tawm tias kev pheej hmoo ntawm kev tuag ntawm cov neeg mob ntshav qab zib hom 2 uas tau txais BD tau 46% qis dua hauv cov neeg mob ntshav qab zib tsis kho nrog BD.

Ob qhov muag dig, ua rau xaiv qhov chaw, tshuaj ntsuam xyuas los ntawm SENIORS tsom rau kev soj ntsuam qhov ua tau zoo ntawm kojivolol (xaiv BB nrog vasodilator kev ua ub no) hauv kev kho mob plawv tsis ua haujlwm. Txoj kev tshawb fawb no muaj ntau tshaj 2,000 tus neeg mob laus (> 70 xyoo), uas 26 feem pua ​​muaj mob ntshav qab zib hom 2. Lub sijhawm tshuaj xyuas tau ntev li 2 xyoos. Raws li qhov tshwm sim, nebivolol ua pov thawj nws cov hauj lwm zoo thiab kam rau ua siab ntev hauv kev kho mob rau pawg neeg no, suav nrog cov neeg mob ntshav qab zib hom 2: kev mob plawv tuag thiab tsev kho mob tus nqi tsawg dua piv nrog pab pawg placebo.

Yog li, cov kev tshawb fawb tau ua pov thawj pom qhov pom tseeb ntawm kev siv BB hauv cov neeg mob ntshav qab zib nrog mob plawv tsis zoo.

BB hauv kev kho mob tom qab lub sijhawm ntu tas

Tseem siv BB thaum ntxov post-infarction lub sijhawm tau kawm nyob rau hauv cov kev tshawb fawb MIAMI (Metoprolol In Acute Myocardial Infarction), ISIS-1 (First International Txoj Kev Tshawb Nrhiav Kab Mob Ciaj Tuag), CAPRICORN (Carvedilol Post Infarct Survival Control in LV Dysfunction).

Hauv tag nrho cov kev tshawb fawb no, nws tau qhia tias kev siv BB hauv lub sijhawm tom qab lub sijhawm dhau los (thawj 3 lub hlis tom qab mob myocardial infarction) muaj txiaj ntsig zoo dua rau cov neeg mob ntshav qab zib ntau dua li cov neeg mob tsis muaj ntshav qab zib.

Yog li, tag nrho cov kev tshawb fawb no ua pov thawj qhov tsis tau pom zoo ntawm kev siv BB hauv cov neeg mob ntshav qab zib nrog mob plawv thaum lub sijhawm tom qab lub sijhawm tiv thaiv. Ntxiv mus, raws li qhia hauv Bezafibrate Infarction Prevention (B1P) txoj kev kawm, tso tseg BD nyob rau hauv cov neeg mob ntshav qab zib nrog mob plawv ua ob txog kev tuag.

Txawm hais tias muaj txiaj ntsig zoo ntawm kev siv BB hauv ntshav qab zib, raws li ua ntej, tsuas yog 40-50% ntawm cov neeg mob ntshav qab zib tau txais BB hauv lub sijhawm tom qab lub sijhawm tiv thaiv. Tej zaum, qhov no tuaj yeem piav qhia qhov tseeb hais tias, nrog rau tus qauv dav dav yuav txo qis kev mob plawv hauv cov pej xeem tag nrho, rau cov neeg mob ntshav qab zib hauv xyoo tsis ntev los no, qhov ntau zaus ntawm cov kab mob ntsig txog mob tsis tsuas yog tsis tau txo qis, tab sis tseem nce ntxiv.