Wessel Douai F txhaj tshuaj: cov lus qhia rau kev siv

Antithrombotic cov neeg sawv cev. Sulodexide.

PBX code B01A B11.

• Angiopathies nrog kev pheej hmoo ntawm thrombosis, incl. thrombosis tom qab mob myocardial infarction
• kab mob cerebrovascular: mob stroke (mob stroke sai thiab lub sij hawm rov kho kom zoo thaum tom qab mob stroke)
• discirculatory encephalopathy mob los ntawm atherosclerosis, mob ntshav qab zib mellitus, mob ntshav siab, thiab vascular dementia,
• occlusive kab mob ntawm cov hlab ntsha peripheral ntawm ob qho tib si atherosclerotic thiab ntshav qab zib keeb kwm
• phlebopathy thiab cov hlab ntsha sib sib zog nqus thrombosis
• microangiopathies (nephropathy, retinopathy, neuropathy) thiab macroangiopathies (mob ko taw mob ntshav qab zib, encephalopathy, cardiopathy) vim ntshav qab zib,
• thrombophilia, mob antiphospholipid mob
• heparin thrombocytopenia.

Tsuas tshuaj thiab tswj hwm

cov lus qhia dav dav

Feem ntau kev siv tshuaj kho mob suav nrog kev tswj hwm kev sib txuas ntawm cov tshuaj ua raws li tsiav tshuaj; hauv qee kis, kev kho nrog Sulodexide tuaj yeem pib ncaj qha los ntawm tsiav tshuaj. Cov txheej txheem kev kho mob thiab cov tshuaj uas siv tau tuaj yeem yoog raws li tus kws kho mob tau txiav txim siab rau ntawm qhov kev soj ntsuam thiab cov txiaj ntsig ntawm kev txiav txim siab ntsuas qhov ntsuas.

Feem ntau, cov tshuaj ntsiav tau pom zoo kom noj nyob nruab nrab ntawm cov pluas noj, yog tias qhov tshuaj txhua hnub hauv tshuaj ntsiav tau muab faib ua ob peb zaug, nws raug nquahu kom muaj 12-teev sib nrug ntawm cov koob tshuaj ntawm cov tshuaj.

Nyob rau hauv dav dav, tag nrho cov chav kawm ntawm kev kho yog pom zoo kom rov hais tsawg kawg 2 zaug hauv ib xyoos.

Angiopathies nrog kev pheej hmoo ntawm thrombosis, incl. thrombosis tom qab mob myocardial infarction

Lub sijhawm thawj lub hlis, txhaj tshuaj intramuscular ntawm 600 LO ntawm sulodexide (cov ntsiab lus ntawm 1 ampoule) raug tswj hwm txhua hnub, tom qab ntawd cov chav kawm ntawm kev kho mob txuas ntxiv, noj 1-2 tshuaj ntsiav qhov ncauj ob zaug ib hnub (500-1000 LO / hnub). Qhov txiaj ntsig zoo tshaj plaws tuaj yeem tau txais yog tias kev kho mob pib hauv thawj 10 hnub tom qab muaj mob ntawm cov mob myocardial infarction.

Cerebrovascular kab mob: mob stroke (mob stroke ischemic thiab rov tsim kho thaum ntxov tom qab mob stroke)

Kev kho mob pib nrog kev tswj hwm niaj hnub ntawm 600 LO ntawm sulodexide lossis bolus lossis drip infusion, rau cov ntsiab lus ntawm 1 ampoule ntawm cov tshuaj yaj yaj hauv 150-200 ml ntawm physiological saline. Lub sijhawm ntawm kev lis ntshav yog los ntawm 60 feeb (ceev 25-50 tee / min) mus rau 120 feeb (ceev 35-65 tee / min). Lub sijhawm pom zoo ntawm kev kho mob yog 15-20 hnub. Tom qab ntawd, txoj kev kho yuav tsum txuas nrog kev siv cov tshuaj ntsiav, uas tau noj qhov ncauj los ntawm 1 tshuaj ntsiav ib hnub ob zaug (500 LO / hnub) rau 30-40 hnub.

Atherosclerosis-induced discirculatory encephalopathy, ntshav qab zib mellitus, mob ntshav siab, thiab vascular dementia

Nws raug nquahu kom noj 1-2 tshuaj ntawm ob zaug ib hnub (500-1000 LO / hnub) ntawm qhov ncauj li 3-6 lub hlis. Cov chav kawm ntawm kev kho mob tuaj yeem pib nrog kev qhia txog 600 LO sulodexide ib hnub rau 10-30 hnub.

Occlusive kab mob ntawm cov hlab ntsha peripheral ntawm ob qho tib si atherosclerotic thiab ntshav qab zib keeb kwm

Kev kho mob pib nrog kev siv tshuaj intramuscular txhua hnub ntawm 600 LO sulodexide thiab txuas ntxiv rau 20-30 hnub. Tom qab ntawd qhov kev kawm txuas ntxiv, noj 1-2 tshuaj ntsiav ntawm ncauj ob zaug ib hnub (500-1000 LO / hnub) rau 2-3 hlis.

Phlebopathy thiab txoj hlab ntshav sib nqus

Feem ntau siv tshuaj rau qhov ncauj ntawm sulodexide tsiav tshuaj ntawm 500-1000 LO / hnub (2 lossis 4 tsiav tshuaj) rau 2-6 hlis. Cov chav kawm ntawm kev kho mob tuaj yeem pib nrog kev qhia txhua hnub ntawm 600 LO sulodexide ib hnub rau 10-30 hnub.

Microangiopathies (nephropathy, retinopathy, neuropathy) thiab macroangiopathies (mob ntshav qab zib ko taw, encephalopathy, cardiopathy) vim ntshav qab zib

Kev kho mob ntawm cov neeg mob kev txom nyem los ntawm micro- thiab macroangiopathies tau pom zoo nyob hauv ob theem. Ua ntej, 600 LOs ntawm sulodexide muab tshuaj rau txhua hnub rau 15 hnub, thiab tom qab ntawd ces kev kho mob txuas ntxiv, noj 1-2 tsiav tshuaj ib hnub ob zaug (500-1000 LO / hnub). Txij li nrog kev kho lub sijhawm luv luv nws cov txiaj ntsig tuaj yeem ploj mus rau qee yam, nws raug nquahu kom nce lub sijhawm rau theem ob ntawm kev kho mus rau tsawg kawg 4 lub hlis.

Thrombophilia, antiphospholipid syndrome

Cov tshuaj kho zoo ib txwm suav nrog kev tswj hwm qhov ncauj ntawm 500-1000 LO sulodexide ib hnub (2 lossis 4 tsiav tshuaj) rau 6-12 hlis. Sulodexide tsiav tshuaj feem ntau yog tshuaj tom qab kho nrog tsawg molecular phaus heparin hauv kev sib xyaw nrog acetylsalicylic acid, thiab kev noj tshuaj ntawm cov tom kawg tsis tas yuav hloov pauv.

heparin thrombocytopenia

Xws li heparin, thrombocytopenia, kev qhia ntawm heparin lossis qis molecular hnyav heparin hloov qhov hnyav ntawm sulodexide. Txhawm rau ua qhov no, cov ntsiab lus ntawm 1 ampoule ntawm cov tshuaj (600 LO sulodexide) yog diluted hauv 20 ml ntawm 0.9% sodium chloride tov thiab muab ua kom qeeb li 5 feeb (ceev 80 tee / min). Tom qab ntawd, 600 LOs ntawm sulodexide yog diluted hauv 100 ml ntawm 0.9% sodium chloride tov thiab txhaj rau hauv cov txheej txheem ntawm 60-feeb kua txau (ceev 35 tee / min) txhua 12:00 txog thaum muaj qhov xav tau tshuaj tua kab mob.

Kev phiv tshuaj

Cov hauv qab no yog cov lus qhia txog kev phiv tshuaj pom nyob rau hauv kev soj ntsuam sim nrog 3258 cov neeg mob siv cov koob tshuaj thiab cov qauv kho mob.

Cov kev phiv tsis zoo uas cuam tshuam nrog kev siv sulodexide, txwv kom raug raws li cov chav kawm ntawm cov kab ke hauv nruab nrog cev thiab ntau zaus. Cov ntsiab lus hauv qab no yog siv los txiav txim siab qhov nquag ntawm qhov tshwm sim tsis zoo: ntau zaus (≥ 1/10), feem ntau (ntawm ≥ 1/100 txog

Noj ntau dhau

Kev noj tshuaj ntau dhau yuav ua rau txoj kev loj hlob ntawm cov tsos mob hemorrhagic, xws li hemorrhagic diathesis lossis los ntshav. Thaum los ntshav, ib qho kev daws teeb meem 1% ntawm protamine sulfate yuav tsum raug tswj hwm. Feem ntau, nrog kev noj ntau dhau, kev siv cov tshuaj yuav tsum tsis ua txuas ntxiv thiab tsim nyog kev kho mob uas tsim nyog yuav tsum tau pib.

Siv thaum cev xeeb tub lossis lactation

Txij li thaum tsis muaj kev paub dhau los ntawm kev siv tshuaj nyob rau thawj peb lub hlis thaum cev xeeb tub, cov poj niam yuav tsum tsis txhob raug tshuaj nyob rau lub sijhawm no, tshwj tsis yog, raws li kws kho mob, cov kev cia siab tau txais txiaj ntsig ntawm kev kho mob rau leej niam outweighs qhov muaj feem yuav ua rau muaj menyuam hauv plab.

Muaj tsawg qhov kev paub nrog kev siv cov sulodexide hauv kev txiav thib ob thiab thib peb ntawm cev xeeb tub rau kev kho mob vascular cov teeb meem tshwm sim los ntawm hom I thiab hom II mob ntshav qab zib thiab mob toxicosis lig. Nyob rau hauv cov xwm txheej zoo li no, sulodexide tau txais tshuaj txhua hnub intramuscularly ntawm koob tshuaj 600 LOs ib hnub rau 10 hnub, tom qab ntawd cov tshuaj noj ntawm qhov ncauj tau npaj rau 1 tshuaj ntsiav ib hnub ob zaug (500 LOs / hnub) rau 15-30 hnub. Tus mob toxicosis, txoj kev kho mob no tuaj yeem ua ke nrog cov txheej txheem ntawm kev kho mob.

Thaum lub caij II thiab III txiav tawm cev xeeb tub, cov tshuaj yuav tsum tau siv nrog ceev faj, nyob rau hauv kev saib xyuas ntawm kws kho mob.

Nws tseem tsis tau paub meej tias sulodexide lossis nws cov metabolites raug nthuav tawm hauv cov kua mis. Yog li, rau kev nyab xeeb, nws tsis pom zoo kom tsa cov poj niam thaum lactation.

Muaj tsawg tsawg tus paub nrog kev siv cov sulodexide npaj rau kev kho tus mob ntshav qab zib nephropathy thiab glomerulonephritis rau cov tub ntxhais hluas hnub nyoog 13-17 xyoo. Hauv cov xwm txheej zoo li no, 600 LO ntawm sulodexide tau txais tshuaj intramuscularly ib hnub rau 15 hnub, thiab tom qab ntawd 1-2 tshuaj ntawm cov tshuaj tau muab qhov ncauj noj ob zaug ib hnub (500-1000 LO / hnub) rau 2 lub lis piam.

Cov ntaub ntawv hais txog kev ua tau zoo thiab kev nyab xeeb ntawm cov tshuaj hauv cov menyuam yaus hnub nyoog qis dua 12 xyoos tsis muaj nyob.

Daim ntawv thov nta

Thaum lub sijhawm ua haujlwm ntawm kev kho, hemocoagulation tsis (txiav txim siab ntawm coagulogram) yuav tsum tau saib xyuas tsis tseg. Thaum pib thiab tom qab ua tiav ntawm kev kho, qhov kev sim hauv qab no yuav tsum tau txiav txim siab: ua kom lub sijhawm thromboplastin sijhawm, ntshav sijhawm / coagulation sijhawm, thiab qib III antithrombin. Thaum siv cov tshuaj, qhov ua kom tiav ib nrab thromboplastin lub sijhawm nce ntxiv txog li 1.5 npaug.

Lub peev xwm los cuam tshuam cov tshuaj tiv thaiv tus nqi thaum tsav tsheb lossis ua haujlwm nrog lwm cov txheej txheem.

Yog hais tias kiv taub hau yog pom thaum kho, ib tug yuav tsum tsis txhob tsav tsheb thiab ua haujlwm nrog cov txheej txheem.

Cov chaw muag tshuaj

Kws tshuaj. Wessel Douay F yog kev npaj sulodexide, ntuj sib xyaw ntawm glycosaminoglycans cais los ntawm plab hnyuv mucosa ntawm npua, muaj cov heparin zoo li feem nrog molecular phaus txog 8000 Da (80%) thiab dermatan sulfate (20%).

Sulodexide yog txais tau antithrombotic, anticoagulants, profibrinolytic thiab angioprotective cov nyhuv.

Qhov ua rau anticoagulants ntawm sulodexide yog vim nws txoj kev sib raug zoo nrog cofactor heparin II, inhibits thrombin.

Cov nyhuv antithrombotic ntawm sulodexide yog kev sib kho los ntawm inhibition ntawm Xa kev ua si, txhawb kev sib txuas thiab kev zais ntawm prostacyclin (PGI2) thiab txo qis plasma fibrinogen.

Cov txiaj ntsig profibrinolytic yog vim muaj kev nce ntxiv hauv cov kev ua ntawm cov nqaij mos plasminogen activator thiab ib qho kev txo qis hauv kev ua ntawm nws cov inhibitor.

Cov nyhuv angioprotective yog txuam nrog kev kho dua tshiab ntawm cov txheej txheem thiab kev ua haujlwm ntawm lub hlwb endothelial thiab nrog cov normalization ntawm lub cev ntom ntom rau cov tsis zoo lub luag hauj lwm ntawm vascular qab daus puas.

Ntxiv rau, sulodexide normalizes rheological yam ntxwv ntawm cov ntshav los ntawm kev txo qib triglycerides (uas cuam tshuam nrog kev ua haujlwm ntawm lipoprotein lipase, lub enzyme lub luag haujlwm rau lub hydrolysis ntawm triglycerides).

Qhov ua tau zoo ntawm cov tshuaj hauv cov ntshav qab zib nephropathy yog txiav txim siab los ntawm kev muaj peev xwm ntawm sulodexides kom txo cov tuab ntawm cov hauv qab daus thiab kev ua haujlwm ntawm cov sib txuam sib npaug los ntawm kev txo cov kev loj hlob ntawm cov hlwb mesangium.

Cov Tshuaj Pharmacokinetics Sulodexide yog nqus hauv cov hnyuv me. 90% ntawm kev muab tshuaj ntawm sulodexide accumulates hauv vascular endothelium, qhov twg nws cov ntsiab lus yog 20-30 lub sijhawm siab dua qhov cia siab hauv cov ntaub so ntswg ntawm lwm yam kabmob. Sulodexide yog metabolized los ntawm daim siab, thiab feem ntau yog tawm los ntawm lub raum. Nyob rau hauv kev sib piv rau qhov tsis sib xws thiab tsis tshua muaj molecular hnyav heparin, desulfate da dej, uas yuav ua rau txo qis hauv antithrombotic kev txiav txim siab thiab qhov tseem ceeb ntawm cov zis sulodexides, tsis tshwm sim. Hauv kev tshawb fawb txog kev faib tawm sulodexide, nws tau qhia tias nws tau tawm los ntawm lub raum nrog ib nrab-lub neej uas mus txog 4:00.

Incompatibility

Txij li sulodexide yog polysaccharide nrog me ntsis acidic khoom, thaum muab los ua extemporal ua ke, nws tuaj yeem tsim cov khoom tawg yooj yim nrog lwm cov tshuaj uas muaj cov yam ntxwv yooj yim. Cov tshuaj yeeb dej hauv qab no uas tau siv dav rau extemporal kev txhaj tshuaj sib xyaw yog tsis sib xws nrog sulodexide: vitamin K, ib qho nyuaj ntawm B vitamins, hyaluronidase, hydrocortisone, calcium gluconate, quaternary ammonium ntsev, chloramphenicol, tetracycline thiab streptomycin.