Cov kua nplaum: cov lus qhia rau kev siv rau kev nqus ntshav

Glucose yog ib tus yeeb ncuab tseem ceeb ntawm tus mob ntshav qab zib. Nws cov lwg me me, txawm hais tias qhov sib txawv ntawm qhov loj me hauv kev sib piv rau cov lwg me me ntawm cov ntsev, muaj peev xwm tawm sai sai hauv cov channel ntawm cov hlab ntsha.

Yog li ntawd, los ntawm thaj chaw intercellular, dextrose hla mus rau hauv lub hlwb. Txoj kev no ua qhov loj tshaj plaws rau kev tsim cov tshuaj insulin ntxiv.

Raws li qhov kev tso tawm no, cov metabolism hauv dej thiab cov pa roj carbon dioxide tshwm sim. Yog tias muaj qhov ntau dhau ntawm cov dextrose hauv cov hlab ntshav, tom qab ntawd cov tshuaj dhau los uas tsis muaj teeb meem yog tawm ntawm lub raum.

Qhov muaj pes tsawg leeg thiab nta ntawm cov tshuaj

Cov tshuaj muaj rau txhua txhua 100 ml:

piam thaj 5 g lossis 10 g (tseem muaj tshuaj),
sodium chloride, dej rau txhaj 100 ml, hydrochloric acid 0.1 M (excipients).

Cov kua piam thaj yog cov xim tsis muaj kob lossis daj ua kua.

Glucose yog qhov tseem ceeb monosaccharide uas them rau ib feem ntawm lub zog siv nyiaj. Nws yog lub hauv paus tseem ceeb ntawm cov zaub mov carbohydrates yooj yim. Cov ntsiab lus caloric ntawm cov tshuaj yog 4 kcal ib gram.

Cov tshuaj sib xyaw ua ke tuaj yeem ua rau kom muaj ntau qhov sib txawv: txhim kho oxidative thiab txo cov txheej txheem, txhim kho antitoxic lub siab ua haujlwm. Tom qab kev tswj hwm kev siv tshuaj, cov tshuaj txuam rau qhov tseem ceeb txo qis ntawm nitrogen thiab cov protein, thiab tseem ua rau nrawm tsub zuj zuj ntawm glycogen.

Kev npaj isotonic ntawm 5% yog ib nrab muaj peev xwm sau cov dej tsis txaus. Nws muaj ib qho ua kom detoxifying thiab metabolic, yog tus neeg muag khoom ntawm cov khoom noj muaj txiaj ntsig thiab sai sai.

Nrog kev qhia txog 10% hypertonic kua nplaum:

osmotic ntshav nce siab
kom muaj dej txaus rau hauv cov hlab ntshav,
dab metabolic yog,
lub muaj nuj nqi tu ua kom zoo,
diuresis nce ntxiv.

Kev ntsuas rau siv

Dextrose (lossis piam thaj) yog ib yam tshuaj uas ua kom lub cev rov qab siv lub zog siv hluav taws xob.

Kev qhia ntawm cov tshuaj hypertonic rau hauv cov leeg ntshav pab ua kom lub siab osmotic ntawm cov ntshav, tso cai rau koj nce cov kua dej los ntawm cov ntaub so ntswg mus rau hauv cov ntshav, ua kom cov txheej txheem metabolic, txhim kho antitoxic kev ua haujlwm ntawm lub siab, nce kev ua haujlwm cog lus ntawm cov leeg mob plawv, nthuav cov hlab ntsha thiab nce diuresis.

Raws li cov lus qhia rau Dextrose, tsib feem pua isotonic tov yog qhia rau kev rov ua dua bcc (ntim ntawm cov ntshav ncig). Tsis tas li ntawd, Dextrose yog siv los ua qhov nruab nrab infusion lossis nruab nrab cov kuab tshuaj rau kev tswj hwm ntawm lwm cov tshuaj.

Tus ntsuas tsis muaj nuj nqis ntawm 1 litre ntawm 5% kev daws yog 840 kJ, 10% - 1680 kJ.

Muab cov khoom lag luam pharmacological ntawm dextrose, txoj kev daws teeb meem xav pom zoo thov thaum:

Carbohydrate tsis zoo
Kev Ntshav Qab Zib,
Cov kab mob lom
Hemorrhagic diathesis,
Intoxication,
Kab mob siab, uas yog nrog los ntawm intoxication ntawm lub cev,
Lub cev qhuav dej
Sua
Poob Siab.

Cov Yuav Tsum Muaj

Kev siv cov Dextrose yog contraindicated hauv:

Kev ua haujlwm tsis zoo
Kev mob qog ua kua hauv lub cev (nrog rau lub cev ua rau lub siab, suav nrog intracellular, uas tau ua kom pom los ntawm o, mob ntsws, mob plawv thiab / lossis lub raum tsis ua haujlwm, hyperosmolar coma),
Mob ntshav qab zib mellitus
Qog Ntshav,
Hyperlactacidemia,
Tsim kho tom qab kev phais mob, siv cov piam thaj tsis zoo.

Ua raws li cov lus pom zoo hauv cov lus qhia rau Dextrose, txoj kev daws teeb meem yuav tsum tau muab nrog ceev faj rau cov neeg mob uas muaj lub plawv tsis ua haujlwm thiab mob raum tsis zoo, nrog rau cov xwm txheej nrog los ntawm hyponatremia

Tsuas tshuaj thiab tswj hwm

Isotonic dextrose tov (5%) muab rau:

Muab me me 300-500 ml (lossis ntau dua),
Txoj kev nqus dej nrog dej (los ntawm 300 ml txog 1-2 litres ib hnub).

Qhov siab tshaj plaws ntawm kev tswj hwm ntawm 5% kev daws teeb meem yog 150 tee (uas tau sib haum rau 7 ml ntawm dextrose) ib feeb lossis 400 ml ib teev.

Cov tshuaj hypertonic, raws li cov lus qhia, yuav tsum tau txhaj rau hauv cov hlab ntsha dav hlau. Ib koob tshuaj yog li ntawm 10 txog 50 ml. Muaj qee kis, thaum muaj kev kub ntxhov sai, nws raug tso cai kom muab cov tshuaj los tov nrog txoj kev nqus dej, tab sis hauv cov koob tshuaj tsis ntau tshaj 250-300 ml ib hnub.

Qhov siab tshaj plaws ntawm kev tswj hwm ntawm 10% Dextrose yog 60 dauv ib feeb (uas sib haum rau 3 ml ntawm kev daws). Qhov siab tshaj plaws txhua hnub rau cov neeg laus yog 1 liter.

Yog tias cov tshuaj daws tau siv rau kev noj zaub mov rau niam txiv ntawm cov neeg laus uas muaj cov metabolism hauv lub cev, qhov tshuaj txhua hnub feem ntau txiav txim siab coj mus rau hauv tus neeg mob qhov hnyav - los ntawm 4-6 g ib kilogram ntawm lub cev hnyav (qhov no sib piv txog li 250-450 g ib hnub). Rau cov neeg mob nyob rau hauv uas cov metabolic feem tsawg txo, kev siv Dextrose yog qhia hauv koob tshuaj qis dua (feem ntau nws yog 200-300 g). Qhov ntim ntawm cov kua txhaj tshuaj yuav tsum yog li 30 txog 40 ml / kg ib hnub.

Tus nqi ntawm kev qhia ntawm kev daws nyob rau hauv lub xeev ib txwm ntawm cov metabolism yog los ntawm 0.25 txog 0.5 g / h rau txhua qhov hnyav ntawm lub cev hnyav. Yog hais tias cov chav kawm ntawm cov txheej txheem metabolic qeeb, tus nqi ntawm kev tswj hwm yuav tsum tau txo qis ib nrab - txog 0.125-0.25 g / h rau txhua qhov hnyav ntawm lub cev qhov hnyav.

Rau cov khoom noj rau niam txiv, dextrose yog tswj hwm raws li hauv qab no:

6 g / kg ib hnub - nyob rau thawj hnub,
15 g / kg ib hnub - nyob rau hnub tom ntej.

Cov tshuaj yog tshuaj nrog rau cov amino acids thiab cov rog.

Thaum xam qhov txiav txim siab ntawm cov tshuaj Dextrose, cov tshuaj tso cai txhaj tshuaj yuav tsum tau muab rau hauv tus account. Rau cov menyuam yaus uas hnyav ntawm 2 txog 10 kg, nws yog 100-165 ml / kg ib hnub, rau cov menyuam yaus qhov hnyav txog 10 txog 40 kg - nyob ntawm lub xeev 45-100 ml / kg ib hnub.

Qhov siab tshaj plaws ntawm kev tswj hwm yog 0.75 g / h ib kilogram ntawm lub cev hnyav.

Sab sij huam

Yeej, cov tshuaj zoo tiv thaiv. Qee zaum infusions nrog dextrose tuaj yeem ua rau kev nthuav dav kub taub hau, cuam tshuam hauv dej-ntsev sib npaug (suav nrog hyperglycemia, hypervolemia, hypomagnesemia, thiab lwm yam), mob laug ventricular tsis ua haujlwm.

Cov tsos mob ntawm kev siv tshuaj ntau dhau ntawm dextrose yog glucosuria, hyperglycemia, ua tsis taus dej-electrolyte tshuav. Nrog lawv txoj kev loj hlob, Txoj kev lis ntshav yuav tsum nres thiab cov kua dej yuav tsum muab rau tus neeg mob. Cov kev kho ntxiv yog cov tsos mob.

Cov lus qhia tshwj xeeb

Txhawm rau txhawm rau txhim kho qhov nqus ntawm dextrose siv nyob rau hauv cov koob tshuaj siab, nws raug nquahu kom muab tshuaj insulin rau tus neeg mob tib lub sijhawm. Cov tshuaj raug muab nyob rau hauv cov feem ntau - 1 UNIT ntawm cov tshuaj insulin rau 4-5 grams dextrose.

Kev siv dextrose hauv kev sib xyaw nrog lwm cov tshuaj yuav tsum tswj kev sib raug zoo pharmacological.

Ob qho tsib-thiab kaum feem pua daws teeb meem rau Txoj kev lis ntshav tuaj yeem siv raws li kev qhia thaum cev xeeb tub thiab pub niam mis.

Tus mob ntshav qab zib rau dextrose yuav tsum tau muab tswj hwm nyob rau hauv kev tswj hwm ntawm nws cov ntsiab lus hauv cov zis thiab ntshav.

Tsis muaj cov ntaub ntawv uas yuav qhia tau qhov tsis zoo ntawm qhov tshuaj ntawm qhov ceev ntawm lub cev muaj zog thiab lub siab xav. Ntawd yog, txoj kev daws teeb meem tsis cuam tshuam rau tus neeg lub peev xwm los tsav lub tsheb lossis ua haujlwm uas muaj peev xwm tsis zoo rau kev noj qab haus huv thiab lub neej.

Cov Lus Txhais rau Dextrose - Qabzib thiab Glucosteril.

Cov lus piv txwv los ntawm cov txheej txheem ntawm kev ua: Aminoven, Aminodez, Aminokrovin, Aminoplasmal, Aminotrof, Hydramin, Hepasol, Dipeptiven, Intralipid, Infezol, Infuzamin, Infuzolipol, Nefrotect, Nutriflex, Oliklinomel, Omegaven, Poliolimidli, 8 8, SMOF Kabiven, Moriamin S-2.

Pharmacological kev txiav txim

Plasma hloov ntxiv, ua kom lub cev rov ua dua, kev ua kom lub cev zom zaub mov thiab tshem tawm cov ntshav. Lub tshuab ntawm kev ua yog vim muaj kev sib koom tes ntawm cov kua nplaum mus rau cov txheej txheem ntawm lub zog (glycolysis) thiab yas (kev hloov pauv, lipogenesis, nucleotide synthesis) metabolism.

Koom nrog ntau cov txheej txheem hauv lub cev hauv lub cev, txhim kho cov txheej txheem redox hauv lub cev, txhim kho antitoxic lub siab ua haujlwm. Cov piam thaj, nkag mus rau hauv cov ntaub so ntswg, phosphorylates, tig mus rau hauv qabzib-6-phosphate, uas koom tes nrog ntau yam ntawm lub cev metabolism. Nrog cov piam thaj hauv cov piam thaj, cov nyiaj tseem ceeb hauv lub cev yuav raug tso tawm hauv cov ntaub so ntswg uas tsim nyog rau lub neej ntawm lub cev.

Ib qho 100 mg / ml kua nplaum tov yog hypertonic hauv kev sib piv rau cov ntshav ntshav, muaj ntau ntawm kev ua si osmotic. Thaum muab cov tshuaj ua haujlwm rau nws, nws nce cov zis ntawm cov nqaij ua kua rau hauv lub txaj vascular, nce diuresis, nce ntxiv ntawm cov tshuaj lom rau hauv cov zis, thiab txhim kho lub siab ua haujlwm ntawm antitoxic.

Thaum diluted mus rau lub xeev isotonic (50 mg / ml tov), nws ua kom lub ntim ntawm cov kua dej uas ploj lawm, tswj qhov ntim ntawm lub cev ntshav.

Lub thevical osmolality ntawm cov kua nplaum ntawm 50 mg / ml yog 287 mOsm / kg.

Kev ua haujlwm osmolality ntawm cov kua nplaum 100 mg / ml - 602 mOsm / kg

Cov Tshuaj Pharmacokinetics

Nrog kev tswj hwm cov dej khov, cov kua nplaum tov sai sai tawm ntawm lub txaj vascular.

Kev thauj mus rau hauv tes yog tswj hwm los ntawm cov tshuaj insulin. Hauv lub cev peb hla biotransformation raws hexose phosphate pathway - txoj hauv kev tseem ceeb ntawm lub zog metabolism nrog kev tsim cov macroergic tebchaw (ATP) thiab pentose phosphate pathway - lub ntsiab

txoj hauv kev ntawm cov metabolism hauv yas nrog kev tsim ntawm nucleotides, amino acids, glycerol.

Cov kua nplaum kua roj (molecules) yog siv cov txheej txheem hauv lub zog ntawm lub cev. Cov kua nplaum nkag mus rau hauv cov ntaub so ntswg phosphorylates, tig mus rau hauv qabzib-6-phosphate, uas tom qab ntawd suav nrog cov khoom siv metabolism (cov khoom lag luam kawg ntawm cov metabolism yog carbon dioxide thiab dej). Nws yooj yim nkag mus los ntawm keeb kwm teeb meem rau hauv txhua yam plab hnyuv siab raum thiab cov ntaub so ntswg.

Nws yog nqus tag nrho los ntawm lub cev, nws tsis yog tawm los ntawm lub raum (qhov zoo li nyob hauv zis yog qhov kab pathological).

Tsuas tshuaj thiab tswj hwm

Ua ntej cov lus qhia, tus kws kho mob yog lub luag haujlwm los kuaj qhov muag pom ntawm lub raj tshuaj. Txoj kev daws teeb meem yuav tsum ua kom pob tshab, tsis muaj cov lus txwv lossis cov av poob. Cov tshuaj pom tau tias tsim nyog siv nyob rau hauv ib puag ncig ntawm daim ntawv lo thiab tswj qhov ceev ntawm lub pob.

Qhov kev txiav txim siab thiab qhov ntau thiab tsawg ntawm cov tshuaj pleev dej rau cov ntshav ua rau kev txiav ntshav yog txiav txim siab los ntawm ntau yam, suav nrog lub hnub nyoog, lub cev nyhav thiab kev kho mob ntawm tus neeg mob. Nws raug nquahu kom qee lub sijhawm txiav txim siab hais txog qib piam thaj hauv ntshav.

Cov tshuaj isotonic 50 mg / ml muab cov tshuaj txau nrog qhov kev pom zoo ntawm kev tswj hwm 70 tee / feeb (3 ml / kg lub cev qhov hnyav hauv ib teev).

Cov tshuaj hypertonic 100 mg / ml muab cov tshuaj txau nrog rau qhov kev pom zoo ntawm 60 tee / feeb (2.5 ml / kg lub cev qhov hnyav hauv ib teev).

Cov lus qhia ntawm kev daws teeb meem ntawm 50 mg / ml thiab 100 mg / ml ntawm cov kua nplaum yog ua tau los ntawm kev txhaj tshuaj tiv thaiv kab mob - 10-50 ml.

Hauv cov laus nrog rau cov metabolism hauv ib txwm, cov koob tshuaj txhua hnub ntawm cov dej qab zib yuav tsum tsis pub tshaj 1.5-6 g / kg ntawm lub cev qhov hnyav hauv ib hnub (nrog rau qhov txo qis ntawm metabolic, qhov kev noj tshuaj txhua hnub yog txo), thaum cov dej txhua hnub ntawm qhov hno dej yog 30-40 ml / kg.

Rau menyuam rau cov khoom noj rau niam txiv, nrog rau cov rog thiab cov amino acids, 6 g / kg / hnub yog muab rau thawj hnub, thiab tom qab ntawd txog li 15 g / kg / hnub. Thaum suav qhov tshuaj ntawm cov kua nplaum nrog kev qhia txog kev daws teeb meem ntawm 50 mg / ml thiab 100 mg / ml dextrose, nws yog ib qho tsim nyog yuav tsum tau coj mus rau hauv tus account kev tso cai ntawm cov kua txhaj: rau cov menyuam yaus lub cev hnyav ntawm 2-10 kg - 100-165 ml / kg / hnub, rau cov menyuam muaj lub cev qhov hnyav. 10-40 kg - 45-100 ml / kg / hnub.

Thaum siv cov kua nplaum dhau los ua cov kuab tshuaj, qhov koob tshuaj pom zoo yog 50-250 ml ib koob ntawm cov tshuaj yuav tsum yaj, cov yam ntxwv ntawm uas txiav txim xyuas tus nqi kev tswj hwm.

Sab sij huam

Cov nyom tsis zoo ntawm qhov chaw txhaj tshuaj: mob ntawm qhov chaw txhaj tshuaj, leeg ntshav kev daj ntseg, phlebitis, venous thrombosis.

Ua txhaum ntawm endocrine system thiab metkbolizma: hyperglycemia, hypokalemia, hypophosphatemia, hypomagnesemia, acidosis.

Kev mob plab zom mov: polydipsia, xeev siab.

Cov kev tawm tsam ntawm lub cev: hypervolemia, kev tsis haum tshuaj (ua npaws, tawm pob ntawm daim tawv nqaij, hypervolemia).

Yog tias muaj qhov tshwm sim tsis zoo, kev tswj hwm ntawm kev daws teeb meem yuav tsum tau txiav tawm, tus neeg mob kev tshuaj ntsuam thiab pab yuav tsum tau muab. Cov tshuaj uas yuav tsum tau yuav tsum khaws cia rau kev soj ntsuam tom qab.

Daim ntawv tso tawm

Cov tshuaj no yog nyob rau hauv daim ntawv ntawm kev daws rau infusion ntawm 5%.

Nws yog sawv cev los ntawm cov xim tsis muaj xim pob tshab ntawm 1000, 500, 250 thiab 100 ml hauv cov thawv ntim yas, 60 lossis 50 pcs. (100 ml), 36 thiab 30 pcs. (250 ml), 24 thiab 20 pcs. (500 ml), 12 thiab 10 pcs. (1000 ml) hauv cais cov hnab tiv thaiv, uas tau ntim rau hauv cov thawv ntawv thawv nrog rau cov naj npawb tsim nyog ntawm cov lus qhia rau kev siv.

Ib qho tshuaj pleev 10 feem pua yog cov xim tsis muaj kob, ntshiab ua kua ntawm 20 lossis 24 pcs. hauv cov hnab tiv thaiv, 500 ml txhua tus hauv cov thawv yas, ntim hauv thawv ntawv thawv.

Qhov nquag ua haujlwm ntawm cov tshuaj no yog dextrose monohydrate, ib qho tshuaj ntxiv yog cov dej haus.

Cov lus qhia rau kev teem caij

Dab tsi yog qhov khoom lag luam rau? Cov kua nplaum nyob rau Txoj kev lis ntshav yog siv:

raws li qhov ntawm carbohydrates,
raws li ib feem ntawm cov ntshav-hloov thiab tiv thaiv lub cev tiv thaiv kev poob siab (nrog tsaus muag, poob siab),
raws li lub hauv paus daws rau diluting thiab yaj cov tshuaj,
Thaum muaj mob ntshav nce hlwb tsawg (rau kev tiv thaiv lub hom phiaj thiab kho),
nrog rau txoj kev txhim kho lub cev qhuav dej (ua rau los ntawm ntuav, raws plab, ntxiv rau thaum lub sijhawm tom qab mob tas).

Dosage thiab txoj kev ntawm cov thawj coj

Cov kua nplaum ntawm kev ua kom ntshav qab zib yog muab tshuaj rau hauv qhov quav. Qhov siab thiab ntau npaum li cas ntawm cov tshuaj no yog txiav txim siab nyob ntawm qhov xwm txheej, hnub nyoog thiab qhov hnyav ntawm tus neeg mob. Nws yog ib qho tsim nyog yuav tau ua tib zoo soj ntsuam theem ntawm dextrose hauv cov ntshav. Raws li txoj cai, cov tshuaj yog txhaj rau hauv qhov nrug / nruab nrab txoj hlab ntshav coj mus rau hauv tus account osmolarity ntawm cov tshuaj txhaj. Kev tswj hwm ntawm 5% hyperosmolar qabzib cov tshuaj ua haujlwm tuaj yeem ua rau phlebitis thiab leeg ntshav voos. Yog tias ua tau, thaum siv tag nrho cov kev daws teeb meem, nws pom zoo kom siv cov ntxaij lim dej hauv cov kab khoom ntawm cov kev daws teeb meem.

Cov tshuaj pom zoo rau cov kua nplaum ntev rau cov neeg laus Txoj kev lis ntshav:

nyob rau hauv daim ntawv ntawm ib qhov chaw ntawm carbohydrates thiab nrog tshem tawm isotopic lub cev qhuav dej: nrog lub cev qhov hnyav ntawm 70 kg - los ntawm 500 txog 3000 ml ib hnub,
rau diluting parenteral npaj (nyob rau hauv daim ntawv ntawm ib qho kev daws teeb meem) - los ntawm 100 txog 250 ml rau ib zaug tshuaj.

Cov tshuaj noj uas pom zoo rau cov me nyuam (nrog rau cov menyuam yug tshiab):

nrog rau cov isotopic ua kom lub cev qhuav dej thiab ua kom muaj cov carbohydrates: nrog rau qhov hnyav txog 10 kg - 110 ml / kg, 10-20 kg - 1000 ml + 50 ml ib kg, ntau dua 20 kg - 1600 ml + 20 ml ib kg,
rau kev thiav tshuaj (npaj daws): 50-100 ml ib koob tshuaj.

Tsis tas li ntawd, muaj 10% ntawm cov tshuaj siv rau hauv txoj kev kho thiab txhawm rau tiv thaiv kom tsis txhob mob ntshav qab zib thiab thaum lub sijhawm rov ua dej nrog kua dej. Kev siv tshuaj ntau dua txhua hnub tau txiav txim siab ntawm tus kheej, suav txog hnub nyoog thiab lub cev qhov hnyav. Tus nqi ntawm kev tswj hwm cov tshuaj yog xaiv nyob ntawm qhov kev kuaj mob thiab tus mob ntawm tus neeg mob. Txhawm rau tiv thaiv hyperglycemia, nws tsis pom zoo kom tshaj li qhov pib ntawm kev dextrose kev ua haujlwm, yog li ntawd, tus nqi rau kev tswj hwm ntawm cov tshuaj yuav tsum tsis txhob siab tshaj 5 mg / kg / feeb.

Sab sij huam

Qhov feem ntau cov nyom phiv rau infusion yog:

Kev ua haujlwm tsis zoo.
Hypervolemia, hypomagnesemia, hemodilution, hypokalemia, lub cev qhuav dej, hypophosphatemia, hyperglycemia, electrolyte tsis txaus.
Anaphylactic kev xav.
Cov tawv nqaij ua pob, tawm hws ntau dhau.
Venous thrombosis, phlebitis.
Polyuria
Kev mob hauv zos ntawm qhov chaw txhaj tshuaj.
Ua daus no, kub taub hau, tshee tshee, ua npaws, febrile tshua.
Glucosuria.

Cov kev mob tshwm sim zoo li no muaj peev xwm ua tau rau cov neeg mob uas muaj kev fab tshuaj rau pob kws. Lawv kuj tuaj yeem tshwm sim hauv daim ntawv ntawm cov tsos mob ntawm lwm yam, xws li hypotension, cyanosis, bronchospasm, pruritus, angioedema.

Cov lus qhia tshwj xeeb rau kev siv nyiaj

Nrog rau kev txhim kho cov tsos mob lossis cov paib tiv thaiv tsis nco qab, tswj hwm yuav tsum tau nres tam sim ntawd. Cov tshuaj tsis tuaj yeem siv yog tias tus neeg mob ua xua nrog pob kws thiab nws cov khoom ua tiav. Muab cov kev mob soj ntsuam ntawm tus neeg mob, cov yam ntxwv ntawm nws cov metabolism (pib rau kev siv dextrose), qhov nrawm thiab ntim ntawm Txoj kev lis ntshav, kev tswj hwm kev mob ntshav tuaj yeem ua rau muaj kev tiv thaiv ntawm electrolyte tsis txaus (xws li, hypophosphatemia, hypomagnesemia, hyponatremia, hypokalemia, hyperhydration thiab congestion), suav nrog cov tsos mob ntawm hyperemia thiab pulmonary edema), hyperosmolarity, hypoosmolarity, osmotic diuresis thiab lub cev qhuav dej. Cov mob hypomotic hyponatremia tuaj yeem ua rau mob taub hau, xeev siab, tsis muaj zog, tu cev, cerebral edema, tsis nco qab thiab tuag. Nrog rau cov tsos mob hnyav ntawm hyponatremic encephalopathy, kev kho mob xwm txheej ceev yog tsim nyog.

Kev pheej hmoo ntawm kev txhim kho hypoosmotic hyponatremia yog pom hauv cov menyuam yaus, cov neeg laus, poj niam, cov neeg mob tom qab thiab cov neeg mob hlwb polydipsia. Qhov ntxim nyiam ntawm kev muaj mob encephalopathy yog me ntsis dua rau cov menyuam yaus hnub nyoog qis dua 16 xyoo, cov poj niam tsis muaj zog, cov neeg mob nruab nrab hauv cov hlab ntsha tsis zoo thiab cov neeg mob hypoxemia. Nws yog ib qho tsim nyog yuav tsum tau ua hauv kev ntsuas hauv tsev kuaj ntsuas txhawm rau soj ntsuam kev hloov pauv ntawm cov kua dej, electrolytes thiab kua qaub sib npaug thaum lub sijhawm kho niam txiv ntev thiab kev ntsuas kev siv koob tshuaj.

Yuav tsum ceev faj thaum siv cov tshuaj no

Nrog rau qhov ceev faj, cov tshuaj no tau sau ntawv rau cov neeg mob uas muaj kev phom sij ntawm lub cev hluav taws xob thiab dej tsis txaus, uas yog qhov kev txom nyem los ntawm kev nce rau hauv kev thauj cov dej dawb, yuav tsum siv tshuaj insulin lossis hyperglycemia. Qhov loj ntau yog tso rau hauv kev tswj hwm hauv cov neeg mob uas muaj cov tsos mob ntawm lub plawv, mob ntsws lossis lwm yam tsis txaus, thiab ntxiv ntshav. Nrog kev qhia ntawm kev noj tshuaj ntau lossis ncua sijhawm siv hauv kev siv tshuaj, nws yog ib qho tsim nyog los tswj cov kev xav ntawm cov poov tshuaj hauv cov ntshav thiab, yog tias tsim nyog, noj cov tshuaj potassium.

Nrog kev ceev faj, kev tswj hwm ntawm cov dej qab zib daws tau ua nyob rau hauv cov neeg mob uas muaj kev mob nkees heev, mob taub hau, thiamine tsis muaj peev xwm, kev tiv thaiv qis tsis txaus, electrolyte thiab dej tsis txaus, mob hlab ntsha ischemic mob thiab hauv cov menyuam tshiab. Hauv cov neeg mob uas lub cev tsis muaj zog ntau, kev qhia txog kev noj zaub mov zoo tuaj yeem ua rau muaj kev txhim kho ntawm kev noj zaub mov tshiab syndromes, tus cwj pwm los ntawm kev nce siab ntawm cov khoom noj muaj zog ntawm magnesium, phosphorus thiab potassium vim tias cov txheej txheem ntau ntawm anabolism. Ntxiv rau, thiamine tsis muaj peev xwm thiab ceev cov dej yog tau. Txhawm rau tiv thaiv kev txhim kho ntawm cov teeb meem no, nws yog ib qho tsim nyog yuav tsum ua tib zoo saib xyuas thiab nce cov khoom noj muaj txiaj ntsig, zam kev noj zaub mov ntau dhau.

Cov tshuaj qhia rau leej twg?

Ib qho 5% kev daws teeb meem muab cov tshuaj ua haujlwm koom rau:

rov qab nrawm nrawm nrawm ntawm cov dej ploj (nrog rau dav dav, ntxiv ntawm lub cev thiab lub cev qhuav dej ntawm lub cev),
tshem tawm cov kev ua kom poob siab thiab cev qhuav dej (raws li ib qho ntawm cov khoom ntawm cov tshuaj tiv thaiv poob siab thiab ntshav hloov ntshav).

10% daws tau cov cim qhia txog kev siv tshuaj thiab kev tuav dej num:

nrog lub cev qhuav dej (ntuav, plab zom mov, hauv lub sijhawm postoperative),
Thaum muaj tshuaj lom nrog txhua yam tshuaj lom lossis tshuaj (arsenic, tshuaj, carbon monoxide, phosgene, cyanides, aniline),
nrog cov ntshav qog ntshav qab zib, kab mob siab, mob ua paug, mob ntshav siab, mob hlab ntsha hlwb, mob hlwb thiab lub ntsws txhaws ntshav, mob ntshav tawm, mob plawv tsis muaj teeb meem, muaj mob plawv, kis mob, kis mob rau lub cev,
thaum lub sijhawm npaj cov tshuaj daws teeb meem rau kev tswj hwm cov quav (tshuaj lom 5% thiab 10%).

Kuv yuav siv qhov tshuaj siv li cas?

Ib qho tshuaj isotonic ntawm 5% yuav tsum tau dripped ntawm qhov siab tshaj plaws ntawm 7 ml ib feeb (150 tee hauv ib feeb lossis 400 ml ib teev).

Rau cov laus, cov tshuaj muaj peev xwm muab tshuaj rau hauv lub ntim ntawm 2 liv ib hnub. Nws yog qhov ua tau kom noj cov tshuaj subcutaneously thiab hauv enemas.

Cov tshuaj hypertonic (10%) yog qhia rau kev siv xwb los ntawm kev tswj kav dej hauv ib lub ntim ntawm 20/40/50 ml ib lub lis ntshav. Yog tias muaj ntawv pov thawj, tom qab ntawd txau nws tsis kub tshaj 60 tee ib feeb. Qhov muab tshuaj ntau tshaj rau cov neeg laus yog 1000 ml.

Qhov txhaj tshuaj rau lub cev muaj pes tsawg yuav yog nyob ntawm tus neeg cov kev xav tau ntawm txhua yam kab mob muaj sia. Cov neeg laus uas tsis hnyav dhau hnub ib hnub tuaj yeem noj tsis tshaj 4-6 g / kg ib hnub (kwv yees li 250-450 g ib hnub). Hauv qhov no, qhov ntau npaum li cas ntawm cov tshuaj txhaj yuav tsum yog 30 ml / kg ib hnub.

Nrog rau qhov txo qis ntawm cov txheej txheem metabolic, muaj kev taw qhia kom txo cov tshuaj txhua hnub rau 200-300 g.

Yog tias yuav tsum tau muaj kev kho mob ntev ntev, tom qab ntawd yuav tsum ua qhov no los ntawm kev saib xyuas cov ntshav qab zib kom ntau.

Rau qhov nqus sai thiab ua tiav kev nqus ntawm cov piam thaj hauv qee kis, kev tswj hwm ntawm insulin ib txhij.

Qhov ntxim nyiam ntawm kev phiv tshuaj tiv thaiv cov teeb meem

Cov lus qhia rau kev siv lub xeev hais tias qhov muaj pes tsawg leeg lossis cov khoom tseem ceeb hauv qee kis tuaj yeem ua rau muaj kev tsis zoo ntawm lub cev mus rau cov kua nplaum ntawm 10%, piv txwv:

npaws
hypervolemia
hyperglycemia
mob tsis ua hauj lwm hauv seem ventricle.

Kev siv lub sijhawm ntev (lossis los ntawm kev tswj hwm sai heev ntawm cov dej ntim ntau) ntawm cov tshuaj tuaj yeem ua rau o tuaj, dej intoxication, kev ua haujlwm tsis zoo hauv lub siab ntawm lub siab lossis kev ua haujlwm ntawm cov kab mob ntxig rau ntawm cov txiav.

Hauv cov chaw uas cov kab ke rau kev tswj hwm mob tau txuas nrog, kev txhim kho ntawm kev kis mob, mob thrombophlebitis thiab cov nqaij mos necrosis yog ua tau, raug rau hemorrhage. Zoo sib xws rau cov kua nplaum npaj hauv ampoules tuaj yeem tshwm sim los ntawm cov khoom decomposition lossis nrog cov kev coj ua tsis raug.

Nrog kev tswj hwm intravenous, ib qho kev ua txhaum ntawm electrolyte metabolism tuaj yeem sau tseg:

Txhawm rau kom tsis txhob muaj kev phiv tshuaj rau cov tshuaj hauv cov neeg mob, nws yuav tsum ua tib zoo saib xyuas qhov kev pom zoo ntau npaum li cas thiab cov txheej txheem ntawm kev tswj hwm kom zoo.

Rau leej twg cov piam thaj tom qab?

Cov lus qhia rau kev siv muab cov ntaub ntawv hais txog lub ntsiab contraindications:

mob ntshav qab zib mellitus
mob hlwb thiab mob ntsws ntsws,
hyperglycemia
hyperosmolar coma,
hyperlactacidemia,
circulatory tsis ua haujlwm, hem teeb meem kev txhim kho ntawm txoj hlab ntsws thiab lub hlwb.

Kev cuam tshuam nrog lwm yam tshuaj

Cov kua nplaum ntawm 5% thiab 10% thiab nws muaj pes tsawg leeg ua rau kom muaj kev nqus tau cov dej qab ntsev los ntawm cov hnyuv. Cov tshuaj tuaj yeem pom zoo ua ke nrog ascorbic acid.

Kev koom tes ib txhij ntawm kev tswj hwm yuav tsum yog nyob ntawm tus nqi ntawm 1 chav tsev ib 4-5 g, uas muaj kev txhawb nqa qhov siab tshaj plaws ntawm kev nqus tshuaj.

Hauv kev pom txog qhov no, piam thaj 10% yog ib qho muaj zog oxidizing tus neeg sawv cev uas tsis tuaj yeem siv nrog ib leeg nrog hexamethylenetetramine.

Glucose yog qhov zoo tshaj plaws zam nrog:

cov kev daws teeb meem alkaloids
kev ua kom loog
cov tshuaj tsaug zog.

Kev daws yog tuaj yeem ua kom tsis muaj zog ntawm cov tshuaj loog, adrenomimetic tshuaj thiab txo cov nyhuv ntawm nystatin.

Ib co nuances ntawm kev taw qhia

Thaum siv cov tshuaj no tso ntshav siab, ntshav qab zib cov ntshav yuav tsum saib xyuas txhua lub sijhawm. Qhov qhia txog ntawm cov kua roj ntau hauv cov piam thaj tuaj yeem ua rau cov neeg mob ntshav qab zib uas muaj qhov tsis txaus electrolyte. Ib qho kev daws teeb meem ntawm 10% tsis tuaj yeem siv tom qab muaj kev tawm tsam sai ntawm ischemia nyob rau hauv daim ntawv mob vim qhov cuam tshuam tsis zoo ntawm hyperglycemia ntawm tus txheej txheem kho.

Yog tias muaj cov cim qhia, tom qab ntawd cov tshuaj tuaj yeem siv rau hauv kev kho menyuam yaus, thaum cev xeeb tub thiab lub sijhawm pub mis.

Cov lus piav qhia ntawm cov tshuaj no qhia tias cov piam thaj tsis tuaj yeem cuam tshuam rau lub peev xwm los tswj cov tshuab thiab thauj.

Ntau tus neeg mob

Yog tias tau muaj ntau dhau los noj, cov tshuaj yuav muaj cov cim ntawm cov kev mob tshwm sim. Txoj kev loj hlob ntawm hyperglycemia thiab coma yog qhov muaj feem ntau.

Kev txuam nrog rau kev nce siab ntxiv hauv cov piam thaj, kev poob siab yuav tshwm sim. Hauv lub pathogenesis ntawm cov mob no, lub zog osmotic ntawm cov kua thiab electrolytes ua lub luag haujlwm tseem ceeb.

Kev daws rau Txoj kev lis ntshav tuaj yeem tsim hauv 5% lossis 10% siab hauv qhov ntim ntawm 100, 250, 400 thiab 500 ml.

Kev cuam tshuam nrog lwm yam tshuaj

Thaum muab sib xyaw nrog lwm cov tshuaj, nws yog ib qho tsim nyog yuav tsum tau soj ntsuam saib xyuas lawv qhov ua rau kev tsis sib xws (pom tsis tau tshuaj los yog pharmacodynamic tsis sib xws yog ua tau).

Cov kua nplaum hauv lub qab zib yuav tsum tsis txhob tov nrog cov alkaloids (lawv yuav ploj mus), nrog cov tshuaj loog (txo qis kev ua si), nrog cov tshuaj tsaug zog (lawv cov kev ua si tsawg dua).

Cov kua nplaum ua rau cov kev ua haujlwm ntawm analgesic, adrenomimetic tshuaj, inactivates streptomycin, txo cov kev ua haujlwm ntawm nystatin.

Vim tias qhov tseeb tias cov piam thaj yog qhov muaj zog txaus ua rau tus neeg sawv cev, nws yuav tsum tsis txhob siv rau hauv tib lub koob txhaj nrog hexamethylenetetramine.

Raws li kev cuam tshuam ntawm thiazide diuretics thiab furosemide, kev ua kom lub ntsej muag txo qis.

Cov kua nplaum ua kom txo cov tshuaj lom los ntawm pyrazinamide ntawm daim siab. Kev qhia ntawm lub ntim loj ntawm cov kua nplaum ua rau muaj kev txhim kho hypokalemia, uas ua rau kom lub cev tsis muaj zog ntau ntawm cov tshuaj tiv thaiv digitalis npaj txhij.

Cov kua nplaum tsis sib haum hauv kev daws teeb meem nrog aminophylline, soluble barbiturates, erythromycin, hydrocortisone, warfarin, kanamycin, soluble sulfanilamides, cyanocobalamin.

Cov kua dej qab zib yuav tsum tsis txhob siv nyob rau hauv tib lub ntshav infusion system vim tias qhov kev pheej hmoo ntawm tsis tseem ceeb nkees.

Txij li thaum dhau los ntawm cov kua nplaum ua rau kev ua kom ntshav ntau ntxiv muaj cov tshuaj tiv thaiv acidic (pH

Kev tiv thaiv kev nyab xeeb

Rau ib qho kev ua tiav ntxiv ntawm cov piam thaj tau muab rau hauv cov koob tshuaj loj, cov tshuaj insulin yog tib lub sijhawm ua ke nrog nws ntawm tus nqi ntawm 1 pawg ntawm insulin rau 4-5 g ntawm qabzib. Rau cov neeg mob ntshav qab zib, qabzib yog tswj hwm nyob rau hauv kev tswj hwm ntawm nws cov ntsiab lus hauv cov ntshav thiab zis. Thaum kho, nws yog ib qho tsim nyog yuav tau soj ntsuam cov ionogram.

Kev siv cov kua nplaum nyob rau hauv cov neeg mob uas muaj ischemic mob stroke tuaj yeem ua rau cov kev kho zoo dua.

Txhawm rau kom zam dhau hyperglycemia, qib ntawm cov piam thaj oxidation tsis tuaj yeem ua dhau.

Cov kua nplaum ntawm cov kua nplaum yuav tsum tsis txhob muab rau kom sai lossis siv sijhawm ntev. Yog tias muaj daus txias tshwm sim thaum lub sijhawm tswj hwm, pawg tswj hwm yuav tsum nres tam sim ntawd. Txhawm rau tiv thaiv thrombophlebitis, nws yuav tsum tau muab maj mam los ntawm txoj hlab ntshav loj.

Nrog lub raum tsis ua haujlwm, decompensated lub plawv tsis ua hauj lwm, hyponatremia, tshwj xeeb yuav tsum tau saib xyuas tshwj xeeb thaum sau cov piam thaj, saib xyuas ntawm central hemodynamics.

Cuam tshuam rau lub peev xwm tsav tsheb thiab lwm yam uas muaj peev xwm txaus ntshai. Tsis cuam tshuam dab tsi.

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Tom qab kev tswj hwm, nws tau faib sai sai hauv cov nqaij hauv lub cev. Txaus siab los ntawm ob lub raum.

Cov Tshuaj Hauv Tshuaj

Ib qho kua nplaum 5% isotonic nrog rau cov ntshav plasma thiab, thaum muab cov tshuaj pleev ib ce, rov qab ntim cov ntshav ntau, thaum nws ploj, nws yog qhov khoom noj khoom haus, thiab tseem pab

lom los ntawm lub cev. Cov kua nplaum muab lub zog ntxiv rov ua kom zoo rau lub zog siv. Nrog kev txhaj tshuaj rau cov ntshav, nws ua kom cov txheej txheem metabolic, txhim kho antitoxic lub siab ua haujlwm, txhim kho qhov kev sib cog lus ntawm myocardium, dilates cov hlab ntsha, thiab nce diuresis.

Cov Khoom Qhiasiv

- hyper thiab isotonic lub cev qhuav dej

- txhawm rau tiv thaiv kev ua txhaum ntawm cov dej-electrolyte sib npaug thaum phais me nyuam

- raws li ib kuab tshuaj rau lwm yam tshuaj siv tau yooj yim.

Cov tshuaj sib cuam tshuam

Nrog rau kev siv ua ke nrog thiazide diuretics thiab furosemide, lawv lub peev xwm los cuam tshuam cov ntshav qabzib yuav tsum raug txiav txim siab. Cov tshuaj insulin pab rau tso cov piam thaj rau hauv cov ntaub so ntswg. Cov kua nplaum ua kom txo cov tshuaj lom los ntawm pyrazinamide ntawm daim siab. Kev qhia ntawm lub ntim loj ntawm cov kua nplaum ua rau muaj kev txhim kho hypokalemia, uas ua rau kom lub cev tsis muaj zog ntau ntawm kev siv digitalis npaj txhij.

Cov kua nplaum tsis sib haum hauv kev daws teeb meem nrog aminophylline, soluble barbiturates, erythromycin, hydrocortisone, warfarin, kanamycin, soluble sulfanilamides, cyanocobalamin.

Vim tias qhov ua rau pseudoagglutination, nws tsis tuaj yeem siv cov kua nplaum 5% hauv ib qhov system tib lub sijhawm, ua ntej lossis tom qab hloov ntshav.