Diuretics: daim ntawv teev cov tshuaj, mechanism ntawm kev txiav txim

Cov tshuaj diuretic tshwj xeeb cuam tshuam rau lub raum kev ua haujlwm thiab kho qhov txheej txheem ntawm cov zis tsis ua haujlwm.

Lub tshuab ntawm kev ua ntawm feem ntau diuretics, tshwj xeeb tshaj yog tias nws yog potassium-sparing diuretics, yog ua raws li lub peev xwm los tiv thaiv kev thim rov qab nqus mus rau hauv lub raum, ntau dua qhov tseeb hauv cov hlaus rov qab, electrolytes.

Kev nce ntxiv ntawm cov roj ntsha tau tso tawm tshwm sim ib txhij nrog kev tso tawm ntawm qee qhov ntim ntawm cov kua.

Thawj lub diuretic tshwm sim nyob rau xyoo 19th, thaum pom cov tshuaj mercury, uas yog siv los kho mob syphilis. Tab sis hais txog ntawm tus kab mob no, cov tshuaj tsis tau muaj txiaj ntsig zoo, tab sis nws muaj zog diuretic nyhuv tau pom.

Tom qab qee lub sijhawm, kev npaj txhij txhua mercury tau hloov nrog cov khoom muaj kuab lom tsawg.

Tsis ntev, kev hloov kho ntawm cov qauv ntawm diuretics coj mus rau kev tsim cov tshuaj uas muaj zog heev, uas muaj lawv cov kev faib tawm.

Cov tshuaj cawm siav rau dab tsi?

Cov tshuaj Diuretic feem ntau siv rau:

• mob plawv tsis ua haujlwm,
• nrog edema,
• kom ntseeg tau cov zis nyob rau hauv cov ntaub ntawv ntawm impaired lub raum muaj nuj nqi,
• qis ntshav siab,
• Thaum raug lom, tshem tawm cov co toxins.

Nws yuav tsum raug sau tseg tias cov tshuaj diuretics zoo tshaj yog siv rau kev mob ntshav siab thiab lub plawv tsis ua haujlwm. Cov kab mob no cuam tshuam nrog kev qeeb ntawm lub cev sodium. Cov tshuaj diuretic tshem tawm ntau zuj zus ntawm cov khoom no thiab yog li txo qhov o.

Nrog rau cov ntshav siab, tshaj sodium muaj feem cuam tshuam rau cov leeg nqaij ntawm cov hlab ntshav, uas pib nqaim thiab sib cog lus. Cov tshuaj diuretic uas siv los ua antihypertensives ntxuav sodium tawm ntawm lub cev thiab txhawb vasodilation, uas ua rau txo qis ntshav siab.

Thaum lom, qee cov co toxins ua paug los ntawm lub raum. Yuav kom nrawm cov txheej txheem no, cov tshuaj diuretics tseem siv. Hauv kev siv tshuaj kho mob, txoj kev no yog hu ua "yuam diuresis."

Ua ntej, ntau qhov kev daws teeb meem yog muab tshuaj rau cov neeg mob, tom qab ntawd siv cov diuretic zoo heev, uas tshem cov kua tawm ntawm lub cev, thiab nrog nws cov co toxins.

Diuretics thiab lawv kev faib tawm

Txog rau ntau yam kabmob, kev qhia tshwj xeeb dhau los tau muab uas muaj cov txheej txheem sib txawv.

1. Cov tshuaj uas cuam tshuam rau kev ua haujlwm ntawm lub raum tubal epithelium, sau: Triamteren Amiloride, Ethacrylic acid, Torasemide, Bumetamide, Flurosemide, Indapamide, Clopamide, Metolazone, Chlortalidone, Methclothiazide, Bendroflumethiozide, Hydrochlorazoleid.
2. Osmotic diuretics: Saib xyuas.
3. Potassium-sparing diuretics: Veroshpiron (Spironolactone) yog hais txog cov antagonists ntawm mineralocorticoid receptors.

Kev faib tawm diuretics los ntawm kev ua haujlwm ntawm leaching ntawm sodium los ntawm lub cev:

• Kev ua tsis tau zoo - tshem tawm 5% sodium.
• Kev ua haujlwm nruab nrab - 10% sodium yog tawm.
• Ua tau zoo - tshem tawm ntau tshaj 15% sodium.

Tus txheej txheem ntawm kev txiav txim ntawm diuretics

Cov txheej txheem ntawm kev ua ntawm diuretics tuaj yeem kawm los ntawm cov piv txwv ntawm lawv cov teebmeem pharmacodynamic. Piv txwv, qhov txo qis hauv cov ntshav siab yog vim ob qhov system:

1. Kev ua rau sodium siab tsis zoo.
2. Qhov cuam tshuam ncaj qha ntawm cov hlab ntshav.

Yog li, txoj kev hloov ntshav ntawm txoj hlab ntshav tuaj yeem nres los ntawm qhov txo qis hauv cov kua hauv lub cev thiab kev ua haujlwm ntev ntawm cov leeg vascular.

Ib qho kev txo qis hauv cov pa oxygen xav tau ntawm cov leeg plawv thaum siv tshuaj diuretics yog cuam tshuam nrog:

• nrog kev ntxhov siab nyem los ntawm myocardial hlwb,
• nrog kev txhim kho microcirculation hauv ob lub raum,
• nrog tus txo hauv platelet adhesion,
• nrog rau kev txo qis hauv lub nra rau sab laug ventricle.

Qee qhov tshuaj tso ntshav tso ntshav, piv txwv li, Mannitol, tsis tsuas yog nce cov kua ntshav tawm hauv lub sij hawm edema, tab sis kuj tseem tuaj yeem nce osmolar siab ntawm cov kua dej interstitial.

Diuretics, vim yog lawv lub zog, so lub leeg ntawm cov hlab ntsha, bronchi, thiab kua tsib lub plab, muaj cov nyhuv antispasmodic.

Kev qhia rau kev teem caij kho tshuaj kho mob

Qhov qhia tseem ceeb rau kev teem caij kho mob diuretics yog kho cov hlab ntshav siab, feem ntau ntawm tag nrho cov no siv rau cov neeg laus laus. Cov tshuaj kho mob Diuretic yog raug kho rau sodium tuav tseg. Cov mob no suav nrog ascites, mob raum thiab mob plawv.

Nrog osteoporosis, tus neeg mob yog kws kho thiazide diuretics. Cov tshuaj poov tshuaj-sparing yog qhia rau kev mob raum ua kom tsis haum plab (tshem tawm cov khoom noj loj ntawm cov potassium thiab sodium khaws cia).

Loop diuretics muaj cov nyhuv cuam tshuam rau lub raum kev ua haujlwm, raug kho rau qhov mob siab intraocular, glaucoma, plhaw plawv, mob ntsws.

Txog kev kho thiab tiv thaiv kev mob ntshav siab, cov kws kho mob tau tshaj tawm cov tshuaj thiazide, uas hauv cov koob tshuaj me me muaj kev ntxim nyiam rau cov neeg mob uas muaj mob ntshav siab. Nws tau raug tseeb tias thiazide diuretics hauv koob tshuaj prophylactic tuaj yeem txo txoj kev pheej hmoo ntawm mob hlab ntsha tawg.

Noj cov tshuaj no hauv qib siab dua yog tsis pom zoo, nws yog fraught nrog txoj kev loj hlob ntawm hypokalemia.

Txhawm rau tiv thaiv cov mob no, thiazide diuretics tuaj yeem ua ke nrog cov tshuaj potassium-sparing diuretics.

Hauv kev kho mob ntawm diuretics, kev kho mob nquag thiab kev txhawb nqa kev txhawb nqa tau qhov txawv. Hauv cov theem nquag, cov koob tshuaj ntawm diuretics muaj zog (Furosemide) tau qhia. Nrog kev saib xyuas kev kho mob, kev siv cov tshuaj diuretics tsis tu ncua.

Cov kev txwv tsis pub siv rau diuretics

Cov neeg mob nrog decompensated cirrhosis ntawm daim siab, hypokalemia, kev siv tshuaj diuretics yog contraindicated. Ntxees diuretics tsis raug siv rau cov neeg mob uas tsis nkag rau qee yam sulfanilamide derivatives (hypoglycemic thiab tshuaj tua kab mob).

Rau cov neeg muaj mob ua pa thiab mob raum tsis ua hauj lwm, tshuaj kho tus mob ua ntej lawm. Diuretics ntawm thiazide pawg (Methiclothiazide, Bendroflumethiozide, Cyclomethiazide, Hydrochlorothiazide) yog cov kabmob sib kis ntawm hom 2 mob ntshav qab zib mellitus, vim tias tus neeg mob yuav ua kom cov ntshav qabzib nce siab.

Ventricular arrhythmias kuj tseem txheeb ze contraindications rau kev teem caij ntawm diuretics.

Rau cov neeg mob noj cov tshuaj lithium thiab cov tshuaj glycosides, voj diuretics raug kho nrog kev saib xyuas zoo.

Osmotic diuretics tsis kho rau lub plawv tsis ua hauj lwm.

Sab sij huam

Diuretics rau ntawm thiazide cov npe tuaj yeem nce cov ntshav uric acid ntau ntxiv. Vim li no, cov neeg mob kuaj pom tus mob gout yuav muaj tus mob phem dua.

Diuretics ntawm thiazide pawg (hydrochlorothiazide, hypothiazide) tuaj yeem ua rau cov kev tsis raug mob tsis zoo. Yog tias cov koob tshuaj tsis raug xaiv tau raug xaiv lossis tus neeg mob tsis qaug rau, cov kev mob tshwm sim tom qab no tuaj yeem tshwm sim:

• mob taub hau
• zawv plab yog tau
• xeev siab
• tsis muaj zog
• qhov ncauj qhuav
• tsaug zog

Qhov tsis txaus ntawm ions entails:

1. txo qis libido rau cov txiv neej,
2. ua xua
3. nce rau hauv cov ntshav qab zib,
4. mob pob txha pob leeg
5. leeg tsis muaj zog
6. arrhythmia.

Phiv los ntawm furosemide:

• txo cov poov tshuaj, magnesium, calcium,
• kiv taub hau
• xeev siab
• qhov ncauj qhuav
• nquag tso zis.

Nrog rau kev hloov pauv hauv ion pauv, theem ntawm uric acid, cov piam thaj, calcium ntxiv, uas ua rau:

• paresthesia
• daim tawv nqaij ua pob,
• hnov lus.

Kev phiv los ntawm aldosterone antagonists muaj xws li:

1. daim tawv nqaij ua pob,
2. gynecomastia
3. cramps
4. mob taub hau
5. raws plab, ntuav.

Rau cov poj niam uas tau teem tsis raug thiab noj ntau zaus yog:

Kev kho mob ntawm txoj hlab ntshav txhaws hauv ntshav qab zib. Kev tshuaj ntsuab

Diuretics (diuretics) yog ib qho ntawm cov muaj txiaj ntsig zoo tshaj plaws ntawm antihypertensives vim lawv lub siab, ua siab ntev ntawm tus nqi qis lossis nruab nrab. Txog tam sim no, nrog kev mob ntshav siab, feem ntau thiazide (hypothiazide, hydrochlorothiside, thiab lwm yam) thiab thiazide-zoo li (indapamide, chlortalidone, xipamide) diuretics raug siv, cov nyhuv ntawm uas cuam tshuam nrog nce ntxiv hauv cov zis ntawm sodium.

Voj diuretics (furosemide, thiab lwm yam) tau siv tsis siv rau kev kho mob ntev ntev ntawm txoj kev mob ntshav siab, tab sis lawv tau qhia rau cov neeg mob txo qis raum tsis siv thiazide diuretics. Potassium-sparing diuretics (triamteren, thiab lwm yam) feem ntau poob lawv qhov tseem ceeb rau kev kho mob tawg.

Txog thaum nyuam qhuav dhau los, thiazide diuretics rau kev kho mob ntawm txoj hlab ntshav hauv ntshav qab zib hom 2 tau siv qee yam vim lawv lub peev xwm los txo qhov rhiab ntawm cov hlwb rau insulin, nce piam thaj, ntxiv rau cov roj (cholesterol) thiab triglycerides hauv cov ntshav.

Txawm li cas los xij, nws tau pom tias cov kev mob tshwm sim tsuas yog siv sij hawm ntev ntawm kev siv ntau ntawm cov tshuaj, thiab hauv cov koob tshuaj me me lawv tsis cuam tshuam loj heev rau cov carbohydrate thiab lipid metabolism. Thiazide thiab thiazide-zoo li diuretics tshem tawm tsis tsuas yog sodium, tab sis kuj muaj cov potassium, ntxiv rau magnesium ntawm lub cev.

Kev noj ntau ntxiv ntawm cov zaub mov ntau nyob hauv cov poov tshuaj thiab magnesium (cov txiv hmab txiv ntoo tshiab thiab ziab thiab cov txiv, cov zaub, qos yaj ywm, oatmeal thiab buckwheat, thiab lwm yam) tiv thaiv lub cev tsis ua kom cov zaub mov no ploj mus. Thaum noj ua ke thiazide thiab potassium-sparing diuretics (triampur, triamco), cov piam thaj poob yog tsawg heev.

Thiazide-zoo li cov diuretics, uas cuam tshuam me ntsis ntawm cov carbohydrate thiab lipid metabolism, pom zoo rau kev sib xyaw ntawm kev kub siab thiab hom 2 mob ntshav qab zib mellitus, txawm hais tias insulin tswj hwm yuav ua rau me ntsis xav tau cov tshuaj insulin. Cov tshuaj ntawm cov kev xaiv thawj zaug yog indapamide retard (arifon), noj ib zaug ib hnub.

Txij li thaum kev tuav ntawm Na thiab kua dej thiab lub txiaj ntsig hypervolemia ua lub luag haujlwm tseem ceeb hauv kev sim keeb ntawm kev mob ntshav siab hauv hom 1 thiab ntshav qab zib hom 2, kev siv tshuaj diuretics los ua kom ntshav siab yog qhov tsim nyog. Txawm li cas los xij, tsis yog txhua pawg diuretic zoo sib xws thiab muaj txiaj ntsig zoo rau cov neeg mob ntshav qab zib.

Kev faib tawm ntawm diuretics

Thiazide diuretics Cov tshuaj no feem ntau ua rau lub hlwb ntawm qhov distal convoluted tubule los ntawm sab hauv, qhov chaw uas lawv thaiv diuretics tshwm sim 1-2 teev tom qab kev tswj hwm qhov ncauj thiab kav ntev, raws li txoj cai, 12-18 teev (hypothiazide) thiab mus txog 24 teev (chlortalidone). Thiazide diuretics yog cov muaj zog potassium-diuretics.

Lub tshuab ntawm cov ntshav qab zib ua tau ntawm thiazides yog vim lub suab nrov poov tshuaj excretory nyhuv ntawm cov tshuaj no. Kev ploj ntawm cov tshuaj tua kab mob ntxiv thiab cov kab mob txhab ntxiv hauv β-hlwb ntawm cov txiav ua qab ntawm thiazides ua rau cov tsis muaj peev xwm tiv thaiv cov tshuaj insulin secretion thiab hyperglycemia. Qhov ntau cov diuretic tshem cov poov tshuaj, qhov ntau dua nws cov nyhuv ntshav qab zib.

Hauv kev tshawb nrhiav ncauj lus kom ntxaws ntawm thiazide diuretics, nws muab tawm tias cov teebmeem ntawm potassium-excreting ntawm thiazides tsuas yog tshwj xeeb tshaj tawm cov tshuaj hauv qhov. Koob tshuaj dependence ntawm cov potassium-tshem tawm cov nyhuv ntawm hypothiazide (feem ntau siv dav thiazide diuretic hauv Russia) tau nthuav tawm.

Yog li ntawd, nrog ib koob tshuaj hypothiazide ntawm 12.5 mg / hnub los yog tsawg dua, nws cov nyhuv potassium-excreting yog qhov tsis lees paub.Yog hais tias lub zog ntawm cov potassium-tshem tawm cov nyhuv ntawm thiazides nyob ntawm qhov ntau ntawm cov tshuaj, tom qab ntawd cov nyhuv diabetogenic ntawm cov diuretics (ncaj qha ntsig txog cov ntsiab lus ntawm cov poov tshuaj) tseem yuav tsum yog koob tshuaj, i.e., yog qhov siab tshaj plaws ntawm qhov siab ntawm cov tshuaj thiab tsawg kawg ntawm qis.

Tseeb, ntau cov kev tshawb fawb pom tau tias qhov ntau dua me dua cov koob tshuaj thiazide noj, qhov tsawg dua nws cov nyhuv ntawm cov metabolism hauv kev ua kom yuag. Nrog rau ib qho koob tshuaj hypothiazide siab tshaj 50 mg / hnub, qhov kev pheej hmoo ntawm tus mob ntshav qab zib hom 2 nce mus txog 7% (kev kawm MRFIT), nrog qhov kev txhaj tshuaj 25 mg lossis tsawg dua, tsis muaj ib qho tseem ceeb ntxiv rau qhov kev pheej hmoo ntawm tus mob ntshav qab zib hom 2 (SHEP, TOMHS kev tshawb fawb).

Hauv kev tshawb fawb ntau ntawm cov pej xeem ARIC, uas suav nrog ntau dua 12,000 tus neeg tsis muaj ntshav qab zib, nws tau qhia tias kev noj thiazide diuretics ntawm 12,5-25 mg / hnub rau 6 xyoo tsis yog nrog los ntawm kev pheej hmoo ntawm tus mob ntshav qab zib hom 2 (OP = 0.91) Cov.

Yog li, cov kev tshawb fawb ntau tus neeg ua haujlwm tau lees tias qhov kev pheej hmoo ntawm kev tsim hom 2 de novo ntshav qab zib nrog kev siv thiazide diuretics tau ntev yog tsawg heev thaum lawv cov koob tsis siab tshaj 25 mg / hnub.

Cov nyhuv ntawm thiazide diuretics rau lipid metabolism ntau dua nyob ntawm lub sijhawm ntawm cov tshuaj thiab kom tsawg dua raws li nws cov koob tshuaj. Yog li, thaum noj thiazides rau 3-12 lub hlis. ntshiab ntshav theem nce ntxiv 5-7%.

Nyob rau tib lub sijhawm, kev soj ntsuam cov tshuaj placebo ua rau pom tias kev siv tshuaj ntev ntev (rau 3-5 xyoos) tsis cuam tshuam rau lipid metabolism. Hauv HAPPHY thiab EWPHE cov kev tshawb fawb, lub hauv paus hypercholesterolemia tau sau tseg (ntshiab qib OX tshaj 6.5 mmol / L).

Yog li, tsis muaj pov thawj txaus ntseeg tias cov thiazide diuretics tsis tuaj yeem raug kho rau cov neeg muaj dyslipidemia, yog tias lawv yuav tsum tau txo cov ntshav siab.

Nyob rau hauv muaj cov pathology, lub hauv paus ntsiab lus ntawm kev kho mob ntshav siab yog txawv me ntsis, vim kev ua txhaum ntawm cov khoom noj metabolism. Yog li ntawd, nrog kev kub siab thiab hom ntshav qab zib hom 2 uas muaj tam sim no, nws yog qhov tsim nyog thaum pib ua ke nrog kev kho mob antihypertensive.

Tam sim no, kev sib txuas ua ke uas tau ua raws li kev siv cov tshuaj angiotensin II thiab ACE inhibitors yog suav tias yog qhov zoo tshaj plaws. Nws raug nquahu los muab cov tshuaj no nrog beta-blockers thiab diuretics. Cov txiaj ntsig tau zoo yog muab los ntawm kev sib xyaw ntawm ACE inhibitors thiab calcium antagonists.

Rau cov neeg muaj ntshav qab zib, ntshav nce siab vim yog qhov nce ntxiv hauv lub cev ntshav mus ntxiv. Tsis tas li ntawd, cov neeg mob nyob rau hauv pab pawg no yog cov raug rau cov ntsev, yog li lawv tau sau tseg nyob rau ntau hom tshuaj lom:

• thiazide - chlortalidone thiab hypothiazide,
• thiazide-zoo li indapamide,
• rov qab - lasix thiab furosemide,
• poov tshuaj-sparing - veroshpiron.

Diuretics tuaj yeem txhim kho qhov kev txiav txim siab ntawm ACE inhibitor, vim tias lawv tau dav siv los ntawm cov kws kho mob rau kev kho mob nyuaj ntawm txoj kev mob ntshav siab. Tab sis, zoo li ib yam tshuaj twg, lawv muaj lawv qhov kev txwv hauv kev siv.

Tizoid diuretics rau cov ntshav qab zib hom 2 yog cov kev ceev faj, vim tias kev noj tshuaj ntau dhau pab txhawb kev nce ntxiv ntawm tus neeg mob cov ntshav muaj roj cholesterol thiab qab zib. Thiab nrog lub raum tsis ua haujlwm, qhov tshwm sim ntau dua hauv ntshav qab zib, cov tshuaj muaj peev xwm inhibit lub raum kev ua haujlwm. Tsis tas li ntawd ib tug contraindication rau tizoid diuretics yog gout.

Thiazide-zoo li diuretics tsis tshua tau hais nrog ACE inhibitors. Hom kab no muaj cov nyhuv diuretic me me, thaum tsis cuam tshuam zoo rau lub raum thiab tsis pab txhawb rau kev nthuav tawm ntawm cov poov tshuaj.

Ntxees diuretics hauv kev kub siab, kev sib xyaw nrog hom ntshav qab zib hom 2 tsawg dua los ntawm kws kho mob vim hais tias ntawm kev ua kom nquag plias ntawm diuresis thiab potassium excretion. Txawm li cas los xij, lawv cov txiaj ntsig yog qhov zoo ua ke nrog ACE inhibitors, uas yog qhov tseem ceeb rau qhov tsis ua haujlwm raum. Thiab cov noj ntxiv poov tshuaj thaum noj cov tshuaj Lasix thiab Furosemide uas tau hloov pauv los ntawm kev noj cov poov tshuaj ntxiv.

Cov tshuaj potassium-sparing Veroshpiron qee zaum sau tseg rau kev kho mob ntshav siab, tab sis nws yuav tsum yug hauv siab tias yog tias lub raum tsis ua haujlwm, nws txoj kev siv yog contraindicated.

Txwv tsis pub noj tshuaj

Dab tsi antihypertensive ntsiav tshuaj muaj kev phom sij rau cov neeg mob ntshav qab zib? Kev txwv tsis pub, muaj teeb meem diuretics rau ntshav qab zib muaj xws li Hypothiazide (a thiazide diuretic). Cov tshuaj no tuaj yeem ua rau muaj ntshav nce siab thiab cov qib roj (cholesterol) phem. Thaum lub raum tsis ua haujlwm, tus neeg mob yuav ua rau muaj kev tsis zoo rau lub cev ua haujlwm. Cov neeg mob ntshav siab yog tawm tshuaj kho mob ntawm lwm pab pawg.

Cov tshuaj Atenolol (β1-adenoblocker) rau cov ntshav qab zib mellitus hom 1 thiab 2 ua rau kev nce lossis qis dua hauv qib glycemia.

Nrog kev ceev faj, nws yog tshuaj rau kev puas tsuaj rau lub raum, plawv. Nrog nephropathy, Atenolol tuaj yeem ua rau txo cov ntshav siab poob qis.

Cov tshuaj cuam tshuam rau cov txheej txheem hauv kev zom zaub mov, muaj ntau cov kev mob tshwm sim los ntawm cov hlab ntsha tawg, plab zom mov, lub plawv. Tawm tsam keeb kwm yav dhau los ntawm kev noj tshuaj Atenolol hauv hom 2 mob ntshav qab zib mellitus, tau pom tias ntshav siab qis heev.

Qhov no ua rau muaj kev cuam tshuam ntse nyob rau hauv kev muaj txiaj ntsig zoo. Kev noj cov tshuaj ua rau nws nyuaj rau kev kuaj ntshav ntawm cov ntshav qabzib.

Hauv cov neeg mob insulin, Atenolol tuaj yeem ua rau cov ntshav qis vim qhov ua rau cov piam thaj tso tawm los ntawm daim siab, thiab cov kua dej insulin ntau lawm. Nws yog qhov nyuaj rau kws kho mob kom paub tseeb, vim cov tsos mob tshwm sim tsawg dua.

Tsis tas li ntawd, Atenolol txo qhov rhiab ntawm lub cev nqaij mus rau insulin, uas ua rau lub cev tsis zoo hauv cov neeg mob ntshav qab zib hom 2, qhov tsis txaus ntseeg ntawm qhov sib npaug ntawm cov teeb meem thiab cov txiaj ntsig roj, thiab ua rau hyperglycemia.

Txais tos ntawm Atenolol tsis tuaj yeem nres sai sai; nws yog qhov yuav tsum tau sab laj nrog kws kho mob txog qhov hloov pauv thiab hloov mus rau lwm txoj kev. Kev tshawb fawb hauv kev tshawb fawb pom tseeb tias kev siv Atenolol ntev ntev hauv cov neeg mob ntshav siab maj mam ua rau kev loj hlob ntawm hom 2 mob ntshav qab zib mellitus, txij li qhov rhiab ntawm cov ntaub so ntswg mus rau insulin txo qis.

Ib qho tshuaj ntxiv rau Atenolol yog Nebilet, β-blocker uas tsis cuam tshuam rau cov metabolism thiab muaj cov txiaj ntsig vasodilating.

Cov ntsiav tshuaj rau cov ntshav siab hauv ntshav qab zib yuav tsum tau xaiv thiab cov kws kho mob koom nrog coj mus rau hauv tus account tus yam ntxwv ntawm tus neeg mob, muaj cov contraindications, qhov hnyav ntawm pathology. Nws tsis pom zoo siv β-blockers (Atenolol), lub voj diuretics, vim tias cov tshuaj no cuam tshuam rau cov txheej txheem hauv lub cev zom zaub mov, nce qib hauv glycemia thiab cov roj cholesterol tsawg.

Cov npe ntawm cov tshuaj muaj txiaj ntsig suav nrog sartans, thiazide-zoo li diuretics (Indapamide), ACE inhibitors.

Tshuaj ntsuab thiab cov hauv kev

Dab tsi yog cov tshuaj diuretics feem ntau nug koj tus kws kho mob. Diuretics yog diuretics ntawm qhov kev sib txawv ntawm kev ua nrog lub suab diuretic zoo. Hmoov tsis zoo, txhua tus muaj cov kev mob tshwm sim thiab kev siv lawv tus kws kho mob tsis muaj lus qhia yog qhov txaus ntshai rau kev noj qab haus huv. Cov tshuaj kho tau kab mob yog dab tsi?

Kev faib tawm - hom kev kuaj mob

Diuretics txhim kho qhov kev txiav txim ntawm ACE inhibitors, yog li ntawd, raug kho rau kev kho mob nyuaj. Thiazide-zoo li cov diuretics muaj qhov tsis tshua pom kev hauv hom 2 mob ntshav qab zib mellitus, tsis tshua muaj txiaj ntsig rau kev tshem tawm cov poov tshuaj, qib ntawm cov piam thaj thiab lipids hauv cov ntshav, thiab tsis cuam tshuam rau kev ua haujlwm ntawm lub raum.

Pab pawg no suav nrog Indapamide thiab Arefon Retard. Cov tshuaj muaj nephroprotective nyhuv rau ib theem ntawm kev ua haujlwm hauv nruab nrog cev.

Indapamide txhawb nqa vasodilation, txhawb kev tsim cov platelet aggregation blockers, vim qhov kev noj tshuaj rau cov ntshav qab zib hom 2, atrial load thiab ntshav siab poob qis.

Hauv kev siv tshuaj kho mob, indapamide ua rau tsuas yog muaj txiaj ntsig hypotensive yam tsis muaj teeb meem loj ntxiv rau cov zis.Thaj chaw tseem ceeb ntawm kev ua haujlwm ntawm Indapamide yog qhov system vascular thiab lub raum nqaij.

Kev kho mob nrog Indapamide tsis cuam tshuam rau cov txheej txheem hauv lub cev hauv lub cev, yog li nws tsis nce siab ntxiv cov piam thaj, lipoproteins tsawg hauv cov ntshav. Indapamide nrawm sai lawv lub plab zom mov, tab sis qhov no tsis txo nws cov hauj lwm zoo, noj me ntsis ua rau kom qis qis.

Indapamide ntev ntev tuaj yeem txo qhov noj tshuaj. Tus txheej txheem kho tau ua tiav los ntawm qhov kawg ntawm thawj lub lim tiam ntawm kev noj tshuaj. Nws yog ib qho tsim nyog kom haus ib qho tshuaj ntsiav ib hnub.

Kuv noj tshuaj ntshav qab zib dab tsi los ntawm ntshav siab rau ntshav qab zib?

Diuretic ntsiav tshuaj yog kho rau ntshav siab (tseem ceeb tawg) hauv ntshav qab zib hom 2. Tus kws kho mob uas koom nrog yuav tsum xaiv cov tshuaj, suav txog qhov mob hnyav, muaj cov kab mob hauv lub raum puas, thiab contraindications.

Furosemide thiab Lasix tau sau tseg rau ua rau muaj kev nrawm nrawm nrog ACE inhibitors. Ntxiv mus, hauv cov neeg mob kev txom nyem los ntawm lub raum tsis ua haujlwm, kev ua haujlwm ntawm lub cev hloov pauv. Cov tshuaj tau ntxuav tawm ntawm lub cev potassium, yog li koj yuav tsum ntxiv noj cov poov tshuaj uas muaj tshuaj (Asparkam).

Veroshpiron tsis leach potassium los ntawm tus neeg mob lub cev, tab sis yog txwv tsis pub siv rau hauv lub raum tsis ua haujlwm. Nrog rau ntshav qab zib, kev kho mob nrog cov tshuaj zoo li no tau kho tsawg tsawg.

Kev siab siab tuaj yeem kho nrog lwm txoj hauv kev rau cov ntshav qab zib tsuas yog kev saib xyuas ntawm tus kws kho mob nruj. Vim tias tsis yog txhua yam tshuaj ntsuab muaj txiaj ntsig zoo ib yam thiab muaj kev nyab xeeb kiag li.

Tshuaj ntsuab kho tus mob yog siv tau ntev heev, qee zaum yuav siv sijhawm los ntawm ntau lub hlis txog rau rau lub hlis los kho nws. Txawm li cas los xij, kev nkag ntawm cov tshuaj ntsuab thiab cov nqi them yuav tsum tau hloov nrog kev cuam tshuam, uas yuav tsum ntev li xya mus txog kaum hnub.

Ntxiv nrog rau cov tshuaj rau cov teeb meem nrog lub siab nyob hauv hom muaj ntshav qab zib hom 2 mob ntshav qab zib, kev noj zaub mov tshwj xeeb yuav tsum ua raws.

Yuav ua li cas xaiv cov tshuaj diuretic

Txog rau ntau yam kabmob thiab cov xwm txheej, qee chav kawm ntawm diuretics raug xaiv:

• Saluretics - diuretics, tshem tawm cov poov tshuaj thiab magnesium ions, ua rau muaj cov nyhuv diuretic:
  • loopback - furosemide, bumetanide, torasemide, lasix, ethacrylic acid
  • sulfonamides - chlortalidone, clopamide (feem ntau chlortalidone, clopamide yog siv ua ke nrog beta-adenoblockers, nrog cov tshuaj tiv thaiv kab mob), indapamide - ib qho tshuaj tiv thaiv hypotensive
  • thiazide - cyclomethiazide, hypothiazide
  • carbonic anhydrase inhibitors - acetazolamide, diacarb
• Potassium-sparing diuretics - ua haujlwm hauv qhov hluav taws xob tubule, tiv thaiv kev puas tsuaj potassium - amiloride, spironolactone, triamteren, veroshpiron, eplerenone
• Osmotic diuretics tiv thaiv kev thim rov qab nqus cov kua vim qhov txawv ntawm osmotic siab hauv cov tubules - mannitol, urea (kev tswj hwm ntshav).

Dab tsi thaum cov kws kho mob sau ntawv:

• Arterial hypertension (ntshav siab) - thiazides thiab indapamide
• Cov leeg ntshav siab thiab lub plawv tsis ua haujlwm yog lub voj kho mob. Tawm tsam keeb kwm ntawm lub plawv tsis ua haujlwm, mob khaus ceg txhais tau tias yog kev coj noj coj ua ntawm furosemide lossis lasix.
• Ntshav qab zib, kev mob plab zom mov - indapamide
• Ntxiv adrenal tso pa tawm ntawm aldosterone - spironolactone
• Kab mob hauv siab - Thiazides

Kev ua ntawm diuretics tuaj yeem faib ua:

Txog sijhawm

Kev ua haujlwm ntev (txog li 4 hnub)Eplerenone, Veroshpiron, Chlortalidone Sijhawm Nruab Nrab (txog 14 teev)Diacarb, Clopamide, Triamteren, Hypothiazide, Indapamide Kev ua yeeb yam luv luv (ntev txog 8 teev)Lures, Furosemide, Lasix, Torasemide, Ethacrine acid

Ntxees diuretics

Ntxees diuretics nce ntxiv excretion ntawm sodium los ntawm ob lub raum, thiab, raws li, thiab dej. Lawv ua rau muaj kev tawm dag zog, sai sai, tab sis cov sij hawm luv luv (tsis pub dhau 6 teev), yog li lawv feem ntau siv rau kev kho mob xwm txheej ceev.Hauv kev mob plawv tsis ua haujlwm nrog kev mob hnyav, lawv txoj siv tau hauv cov chav kawm luv.

Cov diuretics no ua tau zoo rau kev ua haujlwm tsis zoo hauv lub raum, tsis zoo li lwm tus. Tab sis txij li thaum noj lub voj diuretics, muaj qhov ua kom ploj ntawm magnesium thiab potassium hauv lub cev, qhov no cuam tshuam tsis zoo rau kev ua haujlwm ntawm lub plawv.

Cov tshuaj tiv thaiv: mob raum tsis ua haujlwm nrog anuria, mob siab rau lub siab tsis ua hauj lwm, mob siab tsis txaus, mob txhaws txhaws, mob txhaws qws nrog lub cev tiv thaiv kab mob nrog kev suav (pom lub raum pob zeb), kab mob pancreatitis, urethral stenosis, hyperuricemia, gout, mob myocardial myocardial infarction, mitral hypertrogen mob, mob rau , ua txhaum cov dej-electrolyte metabolism.

Cov kev mob tshwm sim: tachycardia, siab poob, arrhythmias, cev qhuav dej, tsis muaj zog, tsis meej pem, mob taub hau, tsaug zog, kiv taub hau, tsis hnov ​​lus thiab lub zeem muag, qhov ncauj qhuav, xeev siab, ntuav, nqhis dej, tsis qab los noj mov, exacerbation ntawm pancreatitis, mob tso zis ceev, poob qis muaj peev xwm, hematuria, interstitial nephritis, khaus tawv nqaij, kub taub hau, photosensitivity, erythema, dermatitis, anaphylactic ceeb, ceg mob plab, nqaij tsis muaj zog, thiab lwm yam.

Furosemide 40 mg. 50 pcs. 20-30 RUB.Lasix 40 mg. 45 pcs. 50 RUB Trigrim 10 mg. 30 pcs 500 rub. 5 mg 30 pcs 270 rub.Diuver 10 mg 20 pcs 450 rub., 5 mg 20 pcs. 320 rub

Sulfanamide diuretics

Cov no suav nrog Indapamide - cov tshuaj uas txo cov ntshav siab (diuretic, vasodilator), uas nyob ze hauv cov chaw muag tshuaj rau thiazides. Kev kho mob tshwm sim tom qab 1-2 lub lis piam ntawm kev tswj hwm, qhov siab tshaj plaws tau tiav tom qab 2-3 lub hlis thiab kav ntev txog 2 hlis.

Cov tshuaj tiv thaiv: mob siab rau daim siab tsis ua hauj lwm, ua kom lub cev tsis ua hauj lwm, cov menyuam tsis tau muaj 18 xyoo, cov poj niam thaum lactation, nrog lactose tsis haum, nrog ceev faj thaum cev xeeb tub, nrog kev ua txhaum ntawm cov dej-electrolyte metabolism, hyperuricemia, hyperparathyroidism.

Cov kev mob tshwm sim: poob hauv cov ntshav siab, palpitations, arrhythmia, ECG hloov, hnoos, mob ntsws, pharyngitis, kiv taub hau, tsaug zog, mob taub hau, poob siab, tsaug zog, pw tsis tsaug zog, mob leeg, malaise, kev nyuaj siab, txob taus, ntxhov siab, cem quav lossis zawv plab, xeev siab, ntuav, qhov ncauj qhuav, kab mob pancreatitis, nocturia, polyuria, urticaria, khaus ntawm daim tawv nqaij, thiab lwm yam.

Indapamide: Akuter-Sanovel, Arindal, Arifon, Indap, Indipam, Indiur, Ionik, Ipres-Ntev, Lorvas, Retapres, Tenzar, thiab tseem:

Arifon 2.5 mg 30 pcs 450 rub

Indap 2.5 mg 30 pcs 100 tshiav

Acripamide 2.5 mg 30 pcs 50 RUB

Indapamide 2.5 mg 30 pcs 100 tshiav

Ravel 1.5 mg 30 pcs 200 rub.

Thiazide diuretics

Lub ntsiab lus ntawm kev thov ntawm kev nqis tes ntawm thiazide diuretics yog distal tubules ntawm lub raum. Nws yog los ntawm qhov tseeb tias cov tshuaj tiv thaiv cov thim rov qab nqus ntawm sodium ions, tom qab los ntawm dej raws ib lub zog siab. Raws li qhov tshwm sim, sodium yog tawm nrog rau cov dej ntau dhau.

Raws li txoj cai, thiazide diuretics tso tawm ib qho diuretic nyhuv ntawm nruab nrab lub zog. Qee cov tshuaj hauv pawg no tseem muaj lub peev xwm ua kom ntshav cov hlab ntshav.

• Vim tias yuav txo qis kev o ntawm lub cev vascular phab ntsa, thiazide diuretic tshuaj kho mob yog siv dav hauv kev kho mob ntev ua ke ntawm txoj kev mob ntshav siab.
• Lub peev xwm tshem tawm cov tawv nqaij sab nraud thiab sab hauv ua rau cov tshuaj no cuam tshuam rau hauv kev kho mob ntawm lub plawv tsis ua haujlwm.
• Kuj tseem siv rau edema cuam tshuam nrog mob qog txha caj qaum thiab mob nephrotic.

Cov tshuaj tawm plaws nrawm thiab pib ua tom qab ib nrab ib teev lossis ib teev tom qab kev tswj hwm. Lub sijhawm ntawm lawv cov kev ua yog kwv yees 12 teev, uas tso cai rau koj mus noj tshuaj ib hnub ib zaug raws li tus neeg sawv cev hypotensive thiab txog 2 zaug thaum tshem tawm edema ntawm keeb kwm mob. Qhov zoo dua ntawm hom diuretic no yog qhov lawv tsis cuam tshuam cov acid-puag qhov sib npaug ntawm cov ntshav.

Nta ntawm kev noj thiazide diuretics:

• Yuav cuam tshuam nrog cov qib potassium thiab magnesium (nrog rau kev kho ntev)
• Nce qib uric acid (tsis xav ua rau mob gout)
• Nce qib qab zib (tsis xav ua rau ntshav qab zib)

Kev npaj Thiazide: Gigroton, Hypothiazide, Dichlothiazide, Oxodoline, Cyclomethazide.

25 mg 20 Pcs. 100 tshiav

100 mg 20 Pcs. 120 RUB

25 mg 20 Pcs. 50 RUB

100 mg 20 Pcs. 70 RUB

Diuretic poov tshuaj-sparing

Zoo li thiazide npaj, cov tshuaj potassium-sparing diuretics yog saluretics thiab ua haujlwm nyob rau theem ntawm qhov txawv ntawm cov tubules. Lub hauv paus ntsiab lus ntawm kev ua haujlwm yog zoo li thiazides (ua txhaum ntawm kev thim rov qab nqus dej ntawm sodium) thiab nws cov dej poob nrog dej (Amiloride, Triampur).

Spironolactone muaj cov nyhuv txawv rau aldosterone (ib yam tshuaj adrenal uas tiv thaiv sodium thiab dej). Txawm li cas los xij, cov txiaj ntsig ntawm potassium-sparing diuretics tsis muaj zog thiab nws pib qeeb (li 2-5 hnub txij li hnub pib kho).

• Raws li qhov tshwm sim, cov tshuaj potassium-sparing diuretics tsis haum rau kev kho tus kheej diuretic thiab feem ntau yog tshuaj kho ntxiv, piv txwv li, nrog hyperaldosteronism ntxiv, lub plawv tsis tuaj yeem tiv thaiv kev kho mob, nephrotic syndrome, mob ntsws.
• Tsis tas li, pab pawg no tau dhau los ua cov tshuaj xaiv rau kev tsis txaus siab rau cov tshuaj uas ntxuav cov poov tshuaj hauv kev kho cov kab mob plawv, xws li mob myocarditis, nrog edematous syndrome.
• Thaum ua ke nrog lub voj lossis thiazide diuretics, cov tshuaj muaj cov poov tshuaj tiv thaiv kev tiv thaiv tseem ceeb ntawm cov poov tshuaj hauv cov zis.
• Thawj hyperaldosteronism (qog mob qog ua ntshav) kuj yuav tsum tau teem sijhawm ntawm cov ntaub ntawv diuretic (veroshpiron). Cov tshuaj yog qhov tsim nyog hauv cov neeg mob ntshav qab zib mellitus thiab gout.

Cov kab mob poov tshuaj-sparing: Spironolactone (Veroshpiron), Amiloride, Triamteren (Triampur).

Cov tshuaj ua kom nrov npe thiab lawv cov kev coj ntawm lub cev

Cov tshuaj diuretics uas cuam tshuam rau cov dej num ntawm lub raum hlab ntshav txwv kom tsis txhob sodium los rau hauv lub cev dua thiab tso zis. Diuretics ntawm nruab nrab ua hauj lwm Methiclothiazide Bendroflumethioside, Cyclomethiazide ua rau nws nyuaj rau nqus kom muaj chlorine, thiab tsis yog sodium xwb. Vim tias qhov kev txiav txim no, lawv tseem hu ua saluretics, uas txhais tau hais tias "ntsev".

Thiazide-zoo li cov diuretics (Hypothiazide) feem ntau yog kho rau edema, mob raum, lossis mob plawv. Hypothiazide tshwj xeeb tshaj yog nrov ua tus neeg saib xyuas hypotensive.

Cov tshuaj tshem tawm cov ntsev ntau tshaj thiab txo cov kev siab hauv cov hlab ntsha. Tsis tas li ntawd, thiazide tshuaj txhim kho cov nyhuv ntawm cov tshuaj, qhov ua haujlwm ntawm kev coj ua uas yog tsom rau txo qis ntshav siab.

Thaum sau ntawv yuav nce ntxiv ntawm cov tshuaj no, cov kua dej tawm hauv lub cev tuaj yeem nce ntxiv yog tias tsis muaj ntshav siab. Hypothiazide tseem raug xa tawm rau cov ntshav qab zib insipidus thiab urolithiasis.

Cov tshuaj yeeb dej caw uas muaj nyob hauv kev npaj txo qhov kev cia siab ntawm cov calcium ions thiab tiv thaiv kom tsis txhob muaj cov ntsev nyob hauv ob lub raum.

Cov tshuaj zoo tshaj plaws muaj xws li Furosemide (Lasix). Nrog kev tswj hwm ntawm cov tshuaj no, cov nyhuv tshwm sim tom qab 10 feeb. Cov tshuaj yog cuam tshuam rau

• mob tsis ua hauj lwm ntawm sab laug ventricle ntawm lub plawv, nrog mob ntsws ntsws los ntawm,
• peripheral edema,
• leeg ntshav siab
• tshem tawm cov co toxins.

Ethacrinic acid (Uregit) ze rau qhov nws ua rau Lasix, tab sis nws ua ntev me ntsis.

Qhov feem ntau cov tshuaj diuretic Zemol yog muab tshuaj pleev ib leeg. Cov tshuaj txhim kho osmotic siab ntawm ntshav thiab qis qis dua intracranial thiab intraocular siab. Yog li, cov tshuaj no ua tau zoo heev hauv oliguria, uas yog qhov ua rau kub hnyiab, raug mob lossis mob ntshav sai.

Aldosterone antagonists (Aldactone, Veroshpiron) tiv thaiv kev nqus ntawm sodium ions thiab txwv tsis pub muaj kev zais ntawm magnesium thiab potassium ions.Cov tshuaj ntawm pawg neeg no tau qhia rau tus mob edema, kub siab thiab mob plawv tsis ua hauj lwm. Poov tshuaj-sparing diuretics siv tsis txeem rau daim nyias nyias.

Tshuaj ntshav qab zib thiab ntshav qab zib hom 2

Ua tib zoo mloog! Nws yuav tsum tau yug hauv siab tias nrog hom 2 mob ntshav qab zib mellitus, tsuas yog qee tus diuretics tuaj yeem siv, uas yog, kev teem caij tshuaj diuretics tsis tau coj mus rau hauv tus kabmob no lossis kev siv tus kheej tuaj yeem ua rau muaj kev cuam tshuam tsis zoo hauv lub cev.

Thiazide diuretics rau hom 2 mob ntshav qab zib mellitus tau raug tshaj tawm los txo cov ntshav siab, nrog edema thiab rau kev kho mob plawv tsis txaus.

PEB COV NYEEM YUAV TSUM TAU TXAIS!

Txog kev kho mob pob qij txha, peb cov neeg nyeem tau siv DiabeNot siv tau zoo. Pom qhov nrov ntawm cov khoom no, peb tau txiav txim siab muab nws rau koj kom txaus siab.

Tsis tas li, thiazide diuretics siv los kho cov neeg mob feem ntau ntawm txoj kev mob ntshav ncig uas ua rau lub sijhawm ntev.

Cov tshuaj no ua rau txo qis qhov tsis haum xeeb ntawm cov hlwb rau cov tshuaj insulin, uas ua rau cov ntshav nce ntxiv hauv cov piam thaj, triglycerides thiab cov roj cholesterol. Qhov no txwv txoj kev txwv tseem ceeb rau kev siv cov tshuaj diuretics hauv ntshav qab zib hom 2 no.

Txawm li cas los xij, cov kev tshawb fawb soj ntsuam tsis ntev los no txog kev siv cov tshuaj diuretics rau cov ntshav qab zib hom 2 tau pom tias cov kev tsis zoo no feem ntau pom nrog qhov siab ntawm cov tshuaj. Ntawm kev noj tshuaj tsawg, phiv tawm tsis tshwm sim.

Tseem Ceeb! Hauv cov neeg mob uas muaj ntshav qab zib hom 2, thaum muab tshuaj thiazide diuretics, cov neeg mob yuav tsum noj zaub tshiab thiab txiv hmab txiv ntoo ntau li ntau tau. Qhov no yuav pab tshem tawm cov tseem ceeb ntawm cov piam thaj, sodium, thiab magnesium. Tsis tas li ntawd, qhov kev pheej hmoo ntawm kev txo qis ntawm lub cev rhiab rau insulin yuav tsum raug txiav txim siab.

Nrog hom 2 mob ntshav qab zib mellitus, feem ntau siv tshuaj yeeb tshuaj yog Indapamide, lossis theej, nws cov roj ntsha Arifon. Ob qho Indapamide thiab Arifon tsis muaj kev cuam tshuam zoo rau cov metabolism thiab cov lipid metabolism, uas yog qhov tseem ceeb heev rau cov ntshav qab zib hom 2.

Lwm txoj kev tso ntshav qab zib rau cov ntshav qab zib hom 2 tau sau tseg tsawg dua thiab tsuas yog muaj qee yam mob:

1. voj diuretics rau ntshav qab zib hom 2 feem ntau tsuas yog siv ib zaug hauv cov mob no thaum nws tsim nyog kom ua tiav sai ntawm ntshav nce siab,
2. ua ke thiazide thiab sib tov nrog cov tshuaj potassium-sparing diuretics - thaum nws yog qhov yuav tsum tau ua kom tsawg dua cov tshuaj potassium.

Cov neeg mob uas ua tsis tau cov ntshav qab zib cov kev cai yuav tsum to taub tias kev noj tshuaj diuretic tuaj yeem ua rau muaj kev cuam tshuam loj heev - qhov txo qis ntawm lub cev tsis txaus rau cov tshuaj insulin. Ntxiv mus, kev kho mob ntawm cov roj ntsha txhaws ntev yuav tsis ntev.

Sau cov tshuaj tiv thaiv mob ntshav qab zib rau hom 2 mob ntshav qab zib

Cov tshuaj antihypertensive rau hom 2 mob ntshav qab zib mellitus raug xaiv ib tus zuj zus, muab nws cov nyhuv rau kev ua haujlwm ntawm lub raum, thiab cov nyhuv ntawm cov metabolism ntawm fatty acids thiab carbohydrates. Arterial hypertension accompanies 80% ntawm cov neeg kev txom nyem los ntawm hyperglycemia. Cov kab mob sib xyaw ua rau kev ua haujlwm ntawm lub plab hnyuv siab raum, cuam tshuam rau kev ua haujlwm ntawm cov metabolism hauv lub cev.

Nta

Cov tshuaj ntawm cov tshuaj siab rau cov neeg mob ntshav qab zib yog qhov nyuaj los ntawm qhov tsis xav tau yam tsis txaus ntseeg, qhov kev cia siab uas tshwm sim los ntawm cov tshuaj tiv thaiv kab mob hauv lub cev.

Kev xaiv cov tshuaj rau kub siab nrog hyperglycemia yog raws li cov xwm txheej:

• Siab tshaj plaws, qhov kev cuam tshuam tsawg kawg,
• Cardio thiab nephroprotective effect (tiv thaiv lub plawv thiab lub raum),
• Tsis muaj dab tsi cuam tshuam rau kev mloog ntawm lipids thiab cov piam thaj hauv cov ntshav.

Ceev ua yeeb yam tshuaj

Yog tias koj nquag nquag dhia hauv ntshav siab, cov tshuaj uas haum rau cov ntshav qab zib mellitus yuav tsum nyob ntawm tes.

Yog tias xav tau kev pab thaum muaj xwm ceev, siv txhais tau tias nws cov txiaj ntsig ntawm lub cev kav ntev tsis tshaj 6 teev. Cov tshuaj muaj yees uas yog ib feem ntawm cov npe lag luam tshuaj:

Cov tshuaj kho rau siv kaw lus

Tus nyeem tas mus li sab saud 130/80 hli Hg. Kos duab. rau cov mob ntshav qab zib yog fraught nrog microvascular cov teeb meem, kev txhim kho ntawm atherosclerosis, qhov muaj tshwm sim ntawm cov mob ntshav qab zib angiopathies. Hauv qhov no, kev siv tshuaj tsis tu ncua tau pom zoo, thaum tib lub sijhawm ua raws li cov zaub mov noj ntsev thiab carbohydrate. Qhov cuam tshuam ntawm cov tshuaj tiv thaiv siab rau ntshav qab zib yuav tsum du. Kev poob rau hauv cov ntshav siab tom qab los ntawm kev dhia tawm yog ua kev puas tsuaj txawm tias cov kab mob plawv ntawm tus neeg noj qab haus huv.

Cov npe tshuaj nyob hauv Europe

Cov tshuaj hauv qab no yog tshwm sim hauv Tebchaws Europe:

• Lozol generic: indapamide
• Thalitone yuag: chlorthalidone
• Zaroxolyn ntau: metolazone
• Aquatensen cov yuag: methyclothiazide
• Aquazide h
• Diuril tsis tseem ceeb: chlorothiazide
• Diuril sodium tsis tseem ceeb: chlorothiazide
• Enduron cov yuag: methyclothiazide
• Esidrix tsis tseem ceeb: hydrochlorothiazide
• Microzide tsis tseem ceeb: hydrochlorothiazide
• Mykrox ntau: metolazone
• Naturetin tsis tseem ceeb: bendroflumethiazide
• Saluron tsis tseem ceeb: hydroflumethiazide
• Renese generic: polythiazide

Raws li qee cov ntaub ntawv sia mus thoob ntiajteb, cov tshuaj hauv qab no kuj tseem siv:

• metolazone
• hydroflumthiazide,
• benzthiazide
• polythiazide
• methicothiazide,
• bendroflumethiazide,
• trichloromethiazide,
• quinetasone
• thienyl acid, thiab lwm yam.

Sau cov tshuaj hauv Lavxias thiab Belarus

• Acripamide
• Acripamide retard
• Akuter-Sanovel
• Arindap
• Arifon
• Arifon Retard
• Vero-Indapamide
• Indapamide
• Indapamide Ntev Richter
• Indapamide MV Stad
• Indapamide retard
• Indapamide Retard-OBL
• Indapamide Retard Teva
• Indapamide Sandoz
• Indapamide-OBL
• Indapamide Werth
• Indapamide teva
• Indapres
• Indapsan
• Indap
• Indipam
• Indiur
• Inspra
• Ionik
• Jonik Retard
• Ipres Ntev
• Lorvas
• Lorvas SR
• Pam vov
• RavelSR
• Rov
• SR-Indamed
• Tenzar

Sau cov tshuaj nrog cov tshuaj kom nquag plias (Hydrochlorothiazidum) :

• Hydrochlorothiazide
• Hydrochlorothiazide
• Hydrochlorothiazide-ATS
• Kev Hypothiazide

Vim tias qhov tseeb hais tias cov tshuaj no tau siv dav dav los kho cov ntshav siab, daim ntawv no tsis tau tiav, tab sis muaj cov npe lag luam tseem ceeb rau cov sib txuas no.

Thiazide diuretics rau mob ntshav siab

Thiazide diuretics tau siv tsis tu ncua hauv kev kho mob ntshav siab vim lawv tau tshwm sim hauv khw. Chav kawm tshwj xeeb ntawm diuretics yog lub pob zeb nyob hauv kev kho kev kub siab. Tsawg cov tshuaj siv los kho ib yam kab mob tuaj yeem khav thev lub sijhawm ntev ntawm kev siv, thiab qhov no qhia tau hais tias ob qho tib si qhov ua tau zoo thiab kev nyab xeeb ntawm cov tshuaj lom neeg ntxiv. Piv txwv hydrochlorothiazide yog cov diuretic nrov tshaj plaws nyob hauv lub ntiaj teb rau kev kho mob ntshav siab. Thiazide diuretics txo cov kev pheej hmoo ntawm kev tuag, mob hlab ntsha tawg, myocardial infarction thiab lub plawv tsis ua haujlwm hauv ntshav siab.

Ntau cov lus qhia kho mob rau kev kho mob ntshav siab xav txog kev siv thiazide diuretics. Lawv raug siv los ua cov tshuaj kab thawj hauv tebchaws Asmeskas (JNC VII) thiab tau pom zoo siv rau hauv Tebchaws Europe (ESC / ESH). Txawm li cas los xij, xyoo 2011, National Institutes of Health hauv tebchaws Askiv (NICE) tau pom zoo calcium channel blockers (BCCs) ua thawj cov tshuaj nyob rau hauv lawv cov lus qhia rau kev kho mob ntshav siab. Txawm li cas los xij, lawv tseem ceeb toom tias thiazide diuretics tuaj yeem siv los ua thawj cov kab mob hauv cov xwm txheej uas CCL cuam tshuam, yog tias tus neeg mob muaj edema lossis muaj kev pheej hmoo siab ntawm lub plawv tsis ua haujlwm. Thiazide diuretics tau hloov pauv hauv Australia los ntawm angiotensin-hloov enzyme inhibitors (ACE inhibitors) vim tias lawv muaj lub siab xav ua kom tus mob ntshav qab zib hom 2 tsawg dua.

Thiazide diuretics rau edema ntawm ntau lub hauv paus pib

Thiazide diuretics nquag siv los kho hom mob edema li nram no:

• Edema ntawm mob keeb kwm,

Txawm li cas los xij, nws yuav tsum tau qhia hauv lub siab tias nyob rau hauv kev mob plawv mob hnyav (CHF), lub voj diuretics ua rau muaj kev cuam tshuam ntau dua.

• Edema ntawm hepatic keeb kwm (nrog mob hlab ntsws),
• Edema lub raum keeb kwm,

Txawm li cas los xij, lawv tsis muaj txiaj ntsig nyob rau hauv kev mob raum tsis ua haujlwm - nrog kev txo qis ntawm glomerular pom tsawg dua 30-40 millilitic ib feeb. Qhov uas tsis suav yog metolazone thiab indapamide vim yog lub xaib ntxiv ntawm kev nqis tes ua hauv qhov kwv yees sib luag.

• Edema nrog cov tswj hwm ntev ntawm glucocorticoids.

Thiazide diuretics thiab txha txha caj qaum

Cov nyhuv no tseem cuam tshuam nrog kev ua kom zoo ntawm calcium thiab qhov poob qis ntawm lub cev ntuag feem ntau hauv cov neeg mob txha osteoporosis. Tus txheej txheem rau kev txhim kho ntawm cov nyhuv no yog raws li hauv qab no: thiazide diuretics txhawb kev sib txawv ntawm osteoblasts thiab tsim pob txha nqaij. Tsaug rau qhov no lawv qeeb tus mob ntawm txha txha pob txha .

Vim yog lub peev xwm los khaws cov calcium hauv lub cev, thiazide diuretics siv rau hauv kev kho:

• Cov Kab Mob Hniav
• Ntshav Qab Zib,
• Tus mob Nerolrolithiasis,
• Bromide lom

Carbonic anhydrase inhibitors

Pab pawg no cov tshuaj suav nrog Diacarb. Nquag, cov carbonic anhydrase enzyme txhawb kev tsim cov carbonic acid nyob rau hauv lub raum los ntawm dej thiab cov pa roj carbon dioxide, uas ua kom rov qab tso ua ke ntawm alkaline cov ntshav. Los ntawm kev thaiv cov enzyme, Diakarb txhawb nqa kev ua kom muaj tshuaj sodium hauv cov zis, uas nqus dej nrog nws. Ib txhij nrog zis, ib qho kev nce poov tshuaj kuj poob. Diacarb muab cov nyhuv tsis muaj zog, uas muaj kev txhim kho sai txaus (tom qab ib teev thaum noj hauv cov ntsiav tshuaj, tom qab ib nrab teev nrog txoj hlab ntshav infusion). Lub sijhawm tiv thaiv yog li 10 teev (4 teev nrog niam txiv kev tswj hwm).

Cov tshuaj siv rau:

• intracranial tawg
• nce siab intraocular
• rau kev lom nrog salicylates thiab barbiturates rau alkalization ntawm cov zis
• hauv kev kho mob cytostatics
• nrog gout

Pharmacokinetics ntawm thiazide diuretics

Thiazide diuretics, tsis suav thiab chlortalidone zoo haus nyob rau hauv lub plab zom mov (GIT) thiab muaj ntau heev nyob rau hauv daim siab. Chlortiazide vim tias qhov nqus tsis zoo hauv txoj hnyuv plab, nws yog qhov tshuaj kho mob ntau npaum li cas thiab tsuas yog tus sawv cev ntawm thiazide diuretics pawg, uas tej zaum yuav raug tswj hwm niam txiv .

Nkaus chlortalidone los txog qeeb vim kev nqus qeeb. Cov diuretics khi ncaj qha rau cov ntshav plasma protein thiab yog li poob rau hauv lumen ntawm cov menyuam tsis dhau glomerular pom, tab sis los ntawm anion thauj mechanism .

Kev sib cuam tshuam yeeb tshuaj ntawm thiazide diuretics

Thiazide diuretics txhim kho cov nyhuv ntawm lub voj diuretics, Vitamin D, mob glycosides, diazoxide, lithium npaj, tshuaj loog. Thiab kev ua haujlwm ntawm insulin, piam thaj-txo qis kev sib txuas ntawm sulfanylurea, anticoagulants, uricosuric tus neeg sawv cev hauv kev kho mob ntawm gout ua rau thiazide diuretics.

Qhov thiazide uas muaj kev phom sij tshaj plaws ua ke nrog quinidine vim qhov tseeb tiv thaiv keeb kwm yav dhau los ntawm hypokalemia (ib qho kev phiv los ntawm thiazide diuretics, uas peb yuav tham txog hauv qab), quinidine tuaj yeem ua rau lub neej puas tsuaj ventricular arrhythmias.

Cov nyhuv ntawm thiazide diuretics raug txo qis thaum ua ke nrog cov tshuaj tsis-steroidal anti-inflammatory tshuaj (NSAIDs) thiab lipid-txo qis ion-pauv cationic resins.

Nrog kev sib xyaw ntawm thiazide diuretics nrog glucocorticoids, qhov pheej hmoo ntawm hypokalemia nce.

Tus txheej txheem ntawm kev ua ntawm thiazide diuretics

Cov tswv cuab ntawm cov hoob kawm ntawm diuretics yog benzothiadiazine derivatives. Lo lus "thiazide" feem ntau kuj siv rau cov tshuaj uas muaj cov nyhuv zoo sib xws uas tsis muaj thiazide tshuaj qauv. Piv txwv, chlortalidone thiab metolazone. Cov kab mob no muaj qhov hu ua thiazide zoo li diuretics.

Benzothiadiazine - niam txiv kev teeb tsa ntawm chav kawm ntawm cov lwg me me ntawm thiazide diuretics

Tus txheej txheem ntawm kev ua ntawm thiazide diuretics hauv kev txo cov ntshav siab yog tsis to taub tag nrho. Nrog cov lus qhia ntawm thiazides, lub siab poob qis vim tias qhov nce ntawm diuresis, txo qis hauv cov ntshav ntim thiab txo qis rau cov ntshav tawm. Qhov tseeb nthuav ntawd yog nrog kev siv tas mus li thiazide diuretics, txo siab kuj tseem ua tiav los ntawm kev txo qis peripheral tsis kam (i.e., ua rau vasodilation). Tus txheej txheem rau kev txhim kho ntawm cov nyhuv no tseem tsis tau paub. Thiazide diuretics tseem tswj ntshav siab hauv qee qhov los ntawm kev txwv tsis pub rov ua haujlwm ntawm Na, K, thiab Cl.

Tsis zoo li lub voj diuretics, thiazide diuretics nce calcium reabsorption nyob rau hauv cov distal tubules ntawm nephron. Nrog rau qhov kev txo qis hauv cov concentration ntawm sodium hauv lub hlwb epithelial ntawm tubule, thiazides tsis ncaj qha nce cov kev ua ntawm Na-Ca cov neeg tawm tsam.

Cov tshuaj thaiv kab mob yog cov channel protein hauv cell cov qog ua dej uas thauj cov tshuaj los ntawm lub membrane.

Qhov no tswj kev hloov pauv ntawm Ca los ntawm epithelial hlwb rau lub raum interstitial ntaub so ntswg. Los ntawm nws tus kheej, Ca lub zog txo qis kev ua haujlwm ntawm intracellular Ca, uas tso cai rau Ca kom diffuse ntau dua los ntawm lumen ntawm tubules mus rau hauv cov hlwb epithelial los ntawm apical Ca xaiv channel (TRPV5). Hauv lwm lo lus, qhov poob qis hauv kev ua tau zoo ntawm Ca hauv lub xovtooj ntawm tes yuav ua rau lub zog muaj zog ntxiv rau nws qhov rov cuam tshuam los ntawm lumen ntawm tubule ntawm lub nephron.

Thiazide diuretics tseem nce Ca reabsorption siv tus txheej txheem uas reabsorption ntawm Na thiab Ca hauv cov tub ntxhais uas muaj feem cuam tshuam nrog teb rau qhov kev txo qis hauv Na concentration. Ib feem ntawm qhov kev tawm tsam no tshwm sim vim qhov nce ntawm parathyroid ntau ntau.

Cov nyhuv diuretic ntawm thiazide diuretics muaj zog ntau dua li ntawm lub voj diuretics, nws tshwm sim qeeb dua, tab sis ntev dua.

Cov kev txwv tsis pub siv rau thiazide diuretics

Thiazide diuretics yog muaj qhov pom tseeb hauv cov kab mob hauv qab no:

• Kev Ntshav
• Kev fab tshuaj tsis haum rau cov tshuaj,
• Tsis hlauv
• Kev kho mob lithium,
• Kev Hypokalemia
• Tej zaum yuav ua kom mob ntshav qab zib.

Thiazide diuretics txo uric acid tshem tawm, vim tias lawv sib tw nrog nws rau tib yam kev thauj khoom, yog li lawv nce uric acid ntau ntau hauv cov ntshav Cov. Yog li, lawv yuav tsum tau siv nrog ceev faj hauv cov neeg mob gout lossis hyperuricemia.

Kev siv txuas ntxiv ntawm thiazide diuretics tej zaum yuav ua rau hyperklycemia Cov. Thiazide diuretics tuaj yeem tshwm sim kom poob ntawm cov poov tshuaj los ntawm lub cev thaum tswj hwm cov ntsiab lus ntawm CA.

Thiazide diuretics tuaj yeem txo cov placental perfusion thiab cuam tshuam rau tus me nyuam hauv plab tsis zoo, yog li ntawd yuav tsum zam pov tseg thaum cev xeeb tub .

Kev phiv tshuaj ntawm thiazide diuretics

Thiazide diuretics ua rau muaj cov kev mob tshwm sim hauv qab no:

• Qog Ntshav,
• Hyperuricemia
• Hypokalemia (mechanism ntawm nws txoj kev txhim kho tau piav qhia hauv qab no),
• Ntshav Qab Zib,
• Cov Hypomagnesemia,
• Cov Tshuaj Siab Dub
• Hyperuricemia, Txawm hais tias gout tsis tshua muaj. Poj niam muaj feem tsawg dua li txiv neej
• Kev kho mob hauv lub plab zom mov: xeev siab, tsis mob hlwb, raws plab, cholecystitis, mob caj pas, mob plab, mob plab, cem quav,
• Hyperlipidemia. Kev nce hauv plasma cov ntshav puas los ntawm 5-15% thiab nce ntxiv ntawm cov qib ntawm cov lipoproteins tsawg heev (VLDL) thiab triglycerides (TG). Feem ntau, txoj kev pheej hmoo ntawm kev mob atherosclerosis yog me me,
• Kev tsis sib haum ntawm lub hauv nruab nrab lub cev (CNS): lub zog tsis muaj zog, xantopsia, muaj zog nkees, mob pob txha. Tsis tshua muaj
• Kev ua rau tsis tuaj yeem loj hlob hauv 10% ntawm tus txiv neej vim tias qhov txo qis hauv cov khoom hauv lub cev,
• Kev ua xua tsis haum. Hla kev ua xua cuam tshuam nrog pawg sulfonamide,
• Cov kab mob photosensitization thiab dermatitis feem ntau tsis tshua pom, thiab tsis tshua muaj tus mob thrombocytopenia, mob ntshav qab zib tsis txaus thiab mob leeg mob.

Cov tshuaj tiv thaiv ntawm hypokalemia

Thiazide diuretics yog paub tias ua rau hypokalemia.Nws muaj ntau lub tswv yim txhawm rau txhim kho hypokalemia thaum noj thiazide diuretics (i.e., txo cov ntsiab lus ntawm cov poov tshuaj hauv plasma):

Kev ua haujlwm ntawm renin-angiotensin-aldosterone system vim yog diuretic hypovolemia: lub cev teb rau qhov txo qis hauv cov kua dej hauv lub cev thiab pib tsim aldosterone ntau dua, uas ua rau Na / K metabolism hauv lub cev, uas ua rau lub cev poob lawm. Vim li no, ACE inhibitors uas inhibit angiotensin 2 feem ntau siv nrog thiazide diuretics los tiv thaiv hypokalemia. Qhov tsim nyog ntawm kev txhaj tshuaj tuaj yeem ua tiav lub hom phiaj no.

Kev txo qis hauv cov concentration ntawm K tso zis thaum tso zis ntxiv yuav nce tus lej K ntawm cell mus rau zis. Cov poov tshuaj tau ploj los ntawm cov kab xa xov xws li ROMK. Qhov no tshwm sim los ntawm kev mob siab dhau.

Diuretics yog ib pab pawg ib txwm ntawm cov tshuaj siv dav dav los kho txoj hlab ntshav siab (AH). Lawv nrov tshaj plaws nyob hauv Asmeskas thiab lwm lub teb chaws Askiv. Cov txiaj ntsig nce siab hauv kev kho mob ntshav siab tau pom tias muaj kev sim ntau hauv cov tshuaj uas kho tau lub hauv paus lossis tseem ceeb ntxiv rau ntau xyoo ntawm kev kho mob ntshav siab. Tus cwj pwm ntawm cov diuretics yog tam sim no tsis meej pem ntau. Ntau tus kws tshaj lij txuas ntxiv mus xav txog lawv, nrog rau cov tshuaj tiv thaiv kabmob ua kom zoo ntawm thawj kab. Lwm tus xav txog diuretics ua ib qho ntawm cov sib npaug pawg ntawm cov tshuaj tiv thaiv antihypertensive. Tseem tshuav lwm cov xav txog nag hmo lawv txhais tau tias. Nrog rau qhov tsis muaj qhov zoo qhov tsis zoo - muaj txiaj ntsig kev tshaj tawm, yooj yim ntawm kev noj tshuaj, tus nqi qis, ntau cov diuretics tseem muaj ntau yam tsis zoo cuam tshuam nrog cuam tshuam electrolyte tshuav nyiaj, lipid thiab carbohydrate metabolism thiab ua kom CAS.

Peb pawg ntawm diuretics paub tias muaj qhov sib txawv hauv cov qauv hauv tshuaj thiab hauv ib cheeb tsam ntawm kev nqis tes ua hauv nephron:

• thiazide
• rovqab
• poov tshuaj-sparing diuretics.

Cov nyhuv tshuaj ntawm thiazide thiab thiazide zoo li diuretics yog pom tau hais tias nyob rau theem ntawm distal tubules voj diuretics - nyob rau theem qaum qaum voj Henle, poov tshuaj-sparing - hauv feem ntau chaw saib xyuas cov chaw taws teeb distal tubules.

Txhua txoj kev kho mob, tshwj tsis yog spironolactone, "ua haujlwm" nyob rau saum npoo tig mus rau nephron lumen. Txij li cov diuretics xa mus rau hauv cov ntshav hauv daim ntawv uas muaj protein, lawv tsis dhau los ntawm cov lim glomerular, tab sis mus txog lawv qhov chaw ntawm kev ua los ntawm kev ua kom zais cov ntu ntawm cov nephron los ntawm epithelium. Qhov tsis muaj peev xwm ntawm lub raum epithelium mus cais ib lossis lwm pawg ntawm diuretics hauv qee yam mob pathological (piv txwv li, nrog acidosis) yog qhov tseem ceeb thiab txiav txim siab lawv cov kev xaiv.

Qhov zoo thiab qhov tsis zoo ntawm cov tshuaj

Kev siv cov tshuaj rau kev kho mob ntshav siab tau paub txog ntau dua 70 xyoo, lub sijhawm no lawv cov kev ua haujlwm thiab cov yam ntxwv ntawm kev teem sijhawm muaj kev nkag siab zoo. Cov txiaj ntsig ntawm thiazide diuretics muaj xws li:

• cov haujlwm nruab nrab
• ceev pib ntawm kev tshwm sim (30 - 60 feeb),
• ntev li profile (txog 11 teev),
• tsis ua rau tsis haum lossis acidification ntawm cov ntshav,
• tiv thaiv cerebral ntshav khiav tsis zoo nyob rau hauv kub siab.

Qhov cuam tshuam tseem ceeb ntawm kev siv diuretics ntawm pawg no yog:

• hypokalemia thiab hypomagnesemia, uas provokes cuam tshuam nyob rau hauv lub suab ntawm kev mob plab,
• uric acid retention thiab exacerbation ntawm gout,
• nce ntshav qab zib thiab decompensation ntawm ntshav qab zib,
• xeev siab, raws plab, kev ua kom tsis muaj zog,
• pancreatitis
• cov leeg mob hlwb.

Cov lus qhia rau kev teem caij

Thiazide diuretics tuaj yeem siv rau cov kab mob zoo li no:

• edema nrog cov hlab ntaws tsis ua haujlwm, mob ua paug rau daim siab, mob raum,
• thawj thiab theem nrab arterial tawg,
• mob ntsws
• ntshav qab zib insipidus
• kev tso dej tawm thaum lub cev rog dhau, ua ntej coj khaub ncaws,
• o ntawm ob txhais ceg nrog thrombosis,
• txuam nrog oxalates hauv lub raum.

Saib hauv daim vis dis aus hais txog kev nqis tes ua ntawm diuretics los yog diuretics:

Muaj kev phiv ntau

Kev noj tshuaj diuretics tuaj yeem ua rau muaj zog nce ntxiv, kiv taub hau, tsaus muag ntawm lub qhov muag, xeev siab thiab zawv plab, mob plab, pom qhov muag tsis zoo, cov plasma tsawg, cov qe ntshav dawb, nce siab ntawm uric acid, calcium.

Hauv thawj lub lim tiam ntawm kev siv thiazides, kev ceev nrawm ntawm cov tshuaj tiv thaiv thiab kev mloog zoo tuaj yeem ua tsis tau zoo, yog li nws tsis pom zoo kom tsav tsheb lossis ua haujlwm nrog cov txheej txheem nyuaj.

Txhawm rau kom tsis txhob muaj cov pa roj ntau ntau, cov tshuaj siv nrog nws cov ntsiab lus tau sau ua ke tib txhij - Panangin, Asparkam, Potassium normin, Caliposis. Kev noj haus yuav tsum muaj cov zaub, txiv hmab txiv ntoo thiab kua txiv kom txaus los ntawm lawv, zib ntab, apricots qhuav, txiv ntoo thiab txiv qaub yog qhov tseem ceeb.

Cov txiaj ntsig thiab kev phom sij ntawm diuretics

Cov khoom zoo ntawm diuretics yog siv los ntawm cov kis las (thiab koj thiab kuv tsis muaj kev zam, tom qab txhua yam). Noj cov tshuaj diuretics ua ntej kev sib tw, lawv tau yooj yim dua thiab sai dua kom tshem tawm qhov hnyav "tshaj". Cov poj niam kuj tseem siv cov tshuaj no rau qhov poob phaus. Lub cev tawm dag zog yog lub cev qhuav dej kom tsis txhob ua kua thiab cov leeg ua kom zoo dua.

Tab sis, zoo li txhua yam, muaj ob sab rau npib thiab, nrog rau cov txiaj ntsig, diuretics tuaj yeem muaj kev phom sij:

• Ua ke nrog zis, tsis tsuas yog muaj cov ntsev ntsev tawm hauv lub cev, tab sis kuj muaj cov tshuaj uas muaj txiaj ntsig, piv txwv li, potassium, qhov tsis muaj uas ua rau nrawm nrawm thiab poob ntawm lub zog,
• Lub ntuj tshem tawm ntawm cov calcium yog qeeb, uas ua rau kom qhov kev tso nyiaj ntawm ntsev,
• Kev tso zis ceev heev tuaj yeem ua rau pw tsaug zog ntxhov,
• Diuretics nce qib theem ntawm "phem" cov rog hauv cov ntshav,
• Cov tshuaj diuretic tuaj yeem ua rau kev ua me nyuam yaus hauv lub cev tsis ua haujlwm.

Txhawm rau kom tsis txhob muaj qhov tshwm sim tsis zoo ntawm cov tshuaj diuretics rau lub cev, kuv qhia koj kom tsis txhob siv tshuaj rau tus kheej, tab sis tseem sab laj nrog kws kho mob thiab xam seb cov diuretics zoo rau koj, yuav ua li cas siv lawv, uas koj tuaj yeem ua ke kom ua tiav tau zoo yam tsis muaj kev cuam tshuam.

Thiazide diuretics ua haujlwm li cas?

Thiazide diuretics muaj cov nyhuv hauv qhov epithelium meem qhov distal tubules ntawm nephron. Sodium cations muaj qhov kev ua haujlwm siab osmotic, uas ua rau kev txhim kho ntawm edema, suav nrog nrog kev kub siab ("sodium rub tawm dej nrog nws"). Thiazide thiab thiazide-zoo li diuretics inhibit (thaiv) cov qauv protein - ua haujlwm, uas yog tus choj rau thauj cov sodium thiab chlorine anions. Vim li no, lawv lub npe thib ob yog saluretics ("ua kom tsis qab ntsev"). Tus nqi ntawm sodium txo qis, osmolarity ntawm ntshav txo qis - edema regresses thiab lub hauv nruab nrab cov ntshav hauv cov hlab ntshav poob qis.

Ntxiv rau natriuretic kev ua si, thiazide diuretics muaj peev xwm tsawg rau inhibit cov carbonic anhydrase enzyme. Cov nyhuv no yog pom los ntawm kev txo qis hauv cov ntsiab lus ntawm phosphate anions thiab bicarbonate. Lub sijhawm ntev siv cov tshuaj ntawm thiazide diuretic pawg ua rau kev so ntawm cov leeg cov leeg ntawm cov hlab ntsha (tawm tsam lub txaj). Yog li, cov kws kho plawv siv thiazide-zoo li diuretics hauv kev kho mob ntshav siab hauv kev sib xyaw nrog cov tshuaj antihypertensive.

Cov nyhuv ntawm cov calcium reabsorption (thim rov qab nqus hauv cov ntshav) ua rau cov tshuaj ua tiav nrog cov mob txha caj dab, calcium nephrolithiasis. Nws ntseeg tau tias cov nyhuv ntawm cov channel ua cov calcium cations txo cov vascular kho dua tshiab.

Cov xwm txheej tsis zoo uas txwv kev siv tshuaj muaj feem cuam tshuam nrog cov nyhuv uricemic (nce ntxiv ntawm uric acid), qhov cuam tshuam rau cov metabolism carbohydrate (hyperglycemia).Ib qho kev hloov pauv ntawm cov roj lipid muaj peev xwm ua tau (tus naj npawb ntawm cov roj lipoproteins tsawg thiab cov roj cholesterol nce ntxiv).

Thiazide-zoo li diuretics muaj tib lub ntsiab lus thov, ntxiv rau kev thaiv cov kev ua ntawm cov carbonic anhydrase enzyme. Cov seem uas muaj los yeej zoo ib yam. Qhov sib txawv lus dag hauv qhov sib txawv hauv cov qauv tshuaj, cov yam ntxwv ua haujlwm zoo ib yam.

ACE inhibitors

Rau cov kev kawm tiav ncua zuj zus ntawm kev nthuav qhia kev mob ntshav siab, tshuaj thaiv angiotensin-hloov pauv enzyme (ACE) yog siv, uas ua rau cov synthesis ntawm angiotensin. Los ntawm kev txo qis ntawm cov tshuaj angiotensin, cov qog adrenal ua cov tshuaj hormones tsawg dua aldosterone, uas khaws cov ntsev thiab dej hauv lub cev. Vasodilation tshwm sim, kev ua kua ntau dhau thiab ua kom qab ntsev yog dhau los, cov nyhuv hypotonic yog manifested.

Yam tshuaj uas thaiv ACE:

• Enalapril
• Perindopril,
• Quinapril,
• Fosinopril
• Thrandolapril,
• Ramipril.

Qhov tsis zoo ntawm cov tshuaj tiv thaiv yog qhov muaj peev xwm ncua cov poov tshuaj tsis txaus thiab ua kom qeeb ntev. Qhov cuam tshuam hauv daim ntawv thov raug soj ntsuam tsis muaj ntxov tshaj ob lub lim tiam tom qab tau teem tseg.

Angiotensin Receptor Blockers (ARBs)

Lawv thaiv cov kev sib txuas ntawm cov renin, uas ua rau muaj qhov hloov pauv ntawm angiotensin, uas ua rau kom txoj kev ntshav ntawm lub phab ntsa kom tsawg. ARBs raug tshuaj yog tias tsis haum rau ACE inhibitors yog tsim los. Tus txheej txheem ntawm lawv cov kev siv tshuaj biochemical sib txawv, tab sis lub hom phiaj yog zoo ib yam - kom txo tau cov kev cuam tshuam ntawm angiotensin thiab aldosterone.

Cov pab pawg hu ua sartans ntawm qhov kawg ntawm cov npe ntawm cov tshuaj nquag:

Cov tshuaj kho ntshav qab zib muaj cov nyhuv hypotonic me me, yog raug kho tshwj xeeb hauv kev sib koom ua ke siv lwm yam tshuaj rau cov ntshav qab zib.

1. Voj diuretics (furosemide, lasex) ua ke zoo nrog ACE inhibitors, tsis txhob cuam tshuam rau theem ntawm cov piam thaj, lipids, thiab tsim nyog rau kev tswj hwm mus sij hawm luv luv kom tshem tawm qhov mob hnyav ntawm cov ntaub so ntswg. Kev tswj tsis siv siv provokes nrawm tshem tawm cov poov tshuaj, uas tuaj yeem ua rau kev nce hauv hypokalemia thiab mob plawv dhia tsis xwm yeem.
2. Vim tias cov nyhuv diuretic me me, thiazide-zoo li diuretics (indapamide) tsis mob siab qhov sib npaug ntawm cov piam thaj, rog rog, qib potassium, thiab tsis cuam tshuam rau lub cev ua haujlwm ntawm lub raum.
3. Thiazide diuretics (hypothiazide) hauv kev noj tshuaj txhua hnub ntau dua 50 mg tuaj yeem nce siab ntxiv thiab qib roj. Lawv tau txais kev ceeb toom nrog ceev faj hauv kev txhaj tshuaj tsawg kawg vim tias qhov tshwm sim ntawm qhov tsis zoo lub raum tsis ua haujlwm thiab mob gout.
4. Cov poov tshuaj-sparing tshuaj (Veroshpiron) tsis pom zoo siv rau hauv hom 2 mob ntshav qab zib mellitus, nrog los ntawm kev ua haujlwm tsis zoo hauv lub raum.

Beta blockers

Tus nab npawb ntawm cov tshuaj uas thaiv kev tsim kho ntawm adrenoreceptors los ntawm adrenaline thiab norepinephrine tau raug kho feem ntau rau kev kho mob ischemia, cardiosclerosis, lub plawv tsis ua haujlwm. Nrog hyperglycemia, ntsiav tshuaj rau kub siab yog xaiv nrog cov nyhuv ntxiv vasodilating:

Calcium antagonists

Cov calcium calcium blockers - ib pawg tshuaj uas txo cov tshuaj calcium calcium ions. So kom txaus thiab nthuav cov phab ntsa hauv cov hlab ntsha, cov hlab ntsha, cov leeg nqaij muaj pob. Conditionally muab faib ua pab pawg:

1. Verapamil, diltiazem. Cuam tshuam kev ua haujlwm ntawm myocardium thiab lub plawv mob hlwb, txo qis kev mob plawv. Ib txhij siv nrog beta-blockers yog contraindicated.
2. Cov khoom siv ntawm dihydropyridine - nifedipine, verapamil, nimodipine, amlodipine. Lawv so lub phab ntsa ntawm cov leeg hlwb txhim kho, ua kom lub plawv dhia.

Cov calcium antagonists tsis cuam tshuam nrog cov khoom noj carbohydrate, lipid metabolism. Thaum siv los ua tshuaj rau tswj siab, hom ntshav qab zib hom 2 txaus siab, tab sis muaj tus lej ntawm contraindications. Nifedipine yog contraindicated hauv angina pectoris, lub siab thiab lub raum tsis ua haujlwm, haum rau ib qho kev daws teeb meem ntawm kev nyuaj. Amlodipine yuav txhawb o.Verapamil muaj qhov ua tau zoo rau kev ua haujlwm ntawm lub raum, tab sis nws tuaj yeem ua rau bronchodilators.

Cov tshuaj tiv thaiv ib leeg

Antihypertensive tshuaj tau ua ke nrog txhua lwm yam, xaiv noj rau hauv tus account concomitant kab mob, tshuaj noj. Tawg ntshav, nrog ntshav qab zib ua txhaum cai ntawm cov metabolism hauv plab, ua rau muaj kev tsis haum tshuaj ntau yam.

Ua ntej siv, koj yuav tsum kawm cov npe ntawm cov kev mob tshwm sim, cov hau kev ntawm kev tshem tawm lawv.

Thaum noj, lub zog ntawm cov ntshav siab yog pom. Nyob rau tib lub sijhawm, qib ntawm glycated hemoglobin, cov roj cholesterol, triglycerides, yoo cov kua nplaum thiab tom qab noj tau soj qab. Undesirable deviations los ntawm qib txais yuav tsum tau hloov ntawm cov tshuaj.

Ntxees diuretics

Peb cov tshuaj raug xa mus rau lub voj diuretics - furosemide, ethacrylic acid thiab bumetanide. Voj diuretics muaj qhov ua kom muaj zog saluretic vim qhov thaiv ntawm Ma2 + / K + / Cl- co-thauj cov kab ke hauv qhov nce ntawm ntu Henle voj. Lub ntsiab tseem ceeb rau lawv txoj kev teem sijhawm thaum tawg yog concomitant lub raum tsis ua hauj lwm nyob rau hauv uas thiazide diuretics tsis ua hauj lwm zoo. Lub sijhawm teem ntawm lub voj diuretics rau cov neeg mob uas tsis mob qhov kub tsis ntau yog qhov tsis muaj qab hau vim lawv lub sijhawm luv luv ntawm lawv cov kev nqis tes thiab tshuaj lom. Tag nrho cov kev mob tshwm sim feem ntau ntawm thiazide diuretics tsis muaj tsawg dua qhov kev sib txuas hauv lub voj diuretics, uas tseem muaj cov nyhuv ototoxic.

Cov tshuaj nrov tshaj plaws los ntawm cov pab pawg ntawm lub voj diuretics yog furosemide Nws muaj lub zog, tab sis luv luv (4-6 teev) kev nqis tes ua, yog li nws yuav tsum tau ua ob zaug ib hnub. Hauv kev kub siab nrog mob raum tsis ua haujlwm, qhov koob tshuaj ntawm furosemide yog xaiv ib tus zuj zus, raws li txoj cai ntawm muab ob npaug tshuaj (40, 80, 160, 320 mg).

Poov tshuaj-sparing diuretics

Pawg tshuaj no spironolactone (Veroshpiron) amiloride thiab triamteren muaj tus txiaj ntsig tsis muaj txiaj ntsig hauv qhov ntshav siab. Triamteren thiab amiloride yog cov tshuaj tiv thaiv ncaj qha ntawm cov pa roj carbon monoxide tso pa tawm hauv cov tub luam thiab muaj cov diuretic uas tsis muaj zog thiab tsis ua haujlwm zoo. Lawv siv nrog kev sib xyaw nrog thiazide diuretics los tiv thaiv hypokalemia. Cov kws kho mob tau paub txog cov tshuaj triampur (kev sib xyaw ntawm 25 mg ntawm hypothiazide thiab 50 mg ntawm triamteren). Tsis tshua paub txog yog cov tshuaj moduretic, muaj 50 mg ntawm hypothiazide thiab 5 mg ntawm amiloride. Triamteren thiab amiloride yog contraindicated hauv kev mob raum tsis ua haujlwm vim muaj kev pheej hmoo siab ntawm hyperkalemia. Nws raug paub tias kev sib xyaw ua ke ntawm triamteren thiab indomethacin tuaj yeem ua rau muaj kev rov qab mob raum tsis ua haujlwm. Thaum kho nrog amiloride, cov kev mob tshwm sim xws li xeev siab, pom pob, thiab daim tawv nqaij puav tshwm sim.

Tus txheej txheem ntawm kev txiav txim ntawm spironolactone dag nyob rau hauv kev sib tw antagonism nrog aldosterone, tus yam ntxwv analogue ntawm nws yog. Hauv kev txhaj tshuaj txaus (100 mg rau ib hnub) spironolactone muaj cov lus tshaj tawm thiab cov nyhuv hypotensive. Txawm li cas los xij, spironolactone tsis muaj kev ywj pheej tseem ceeb hauv kev kho mob ntshav siab, vim nws txoj kev tswj hwm ntev yog feem ntau nrog kev loj hlob ntawm cov tshuaj hormonal phiv (gynecomastia hauv cov txiv neej thiab kev mob plab hauv poj niam). Thaum noj cov koob tshuaj qis dua (50 mg ib hnub), qhov ntau zaus ntawm cov kev mob tshwm sim poob qis, txawm li cas los xij, ob qho tib si diuretic thiab antihypertensive cuam tshuam tsis muaj zog txaus.

Dab tsi siv tshuaj diuretics los kho cov neeg mob ntshav siab?

Cov tshuaj tseem ceeb ntawm chav kawm no hauv kev kho mob tawg yog thiazides thiab thiazide-zoo li diuretics. Cov tshuaj siv feem ntau muaj xws li hydrochlorothiazide, chlortalidone thiab indapamide (Arifon-retard).

Thiazide diuretics tuaj yeem siv rau hauv cov neeg mob ntau, ob qho tib si nrog tsis yooj yim thiab tsis yooj yim AH. Cov chaw kho mob uas siv cov tshuaj kho mob kom zoo dua:

• Lub plawv tsis ua hauj lwm
• Mob ntshav qab zib mellitus
• Systolic tawg
• Kev Tiv Thaiv Kev Tiv Thaiv Mob Txheeb Rov Mob Dua
• Postmenopause
• Cerebrovascular kab mob
• Laus lub caij nyoog
• Khej dub

Kev siv ntawm thiazides yog suav hais tias yog kev siv tshuaj tiv thaiv nkaus xwb cev xeeb tub thiab hypokalemia Cov. Yuav tsum ceev faj thaum siv rau hauv cov neeg mob gout, dyslipidemia, ntshav qab zib mellitus thiab mob raum tsis ua haujlwm.

Qhov tshuaj twg los ntawm pawg no yog qhov zoo tshaj plaws?

Cov paj laum tseem ceeb hauv kev tiv thaiv diuretic, uas muaj cov nyhuv diuretic uas tsis muaj zog thiab muaj cov ntsiab lus vasoprotective, tam sim no tau nkag siab thiab pom tias yog - Arifon Retard (indapamide). Kev txhawj xeeb txog teeb meem hais txog thiazide diuretics tsis txhawj txog Arifon-retard, uas nyob hauv ib koob tshuaj txo kom tsawg dua 1.5 mg tsis ua kom tsis zoo rau cov tsis muaj teeb meem ntawm lipid thiab carbohydrate metabolism thiab yog li muaj ntau dua thaum xaiv cov tshuaj diuretic. Rau cov neeg mob ntshav siab ua ke nrog ntshav qab zib mellitus, kev siv tshuaj Arifon-retard rau kev kho mob sib xyaw ua ke yog qhov xav tau, muab cov phiaj xwm qis heev los txo cov ntshav siab (130/80) thiab kev tsis sib luag ntawm lub cev.

Txog rau tam sim no, tsis muaj kev faib tawm ntawm cov tshuaj diuretics, uas yuav coj mus rau hauv txhua qhov ntawm txhua qhov kev ua ntawm cov tshuaj no. Yog li, pab pawg tuaj yeem faib los ntawm:

• tshuaj qauv
• qhov xwm txheej
• mechanism ntawm kev txiav txim
• quab yuam ntawm kev txiav txim
• cov nqi zoo li cas,
• sijhawm ntev
• phiv.

Thawj qhov kev faib tawm ntawm diuretics tau raws li qhov sib txawv ntawm cov qauv tshuaj ntawm cov tshuaj. Tom qab ntawd muaj ib qho kev sim ua kom dav dav rau cov hom tshuaj diuretics raws qhov xwm ntawm lawv cov nyhuv ntawm lub raum. Txawm li cas los xij, qee qhov tshuaj diuretics muaj ib qho kev ntxim siab ntxiv. Ib qho kev sim rau kev faib cov tshuaj diuretics raws li ntu twg ntawm cov nephron lawv cuam tshuam kuj tseem tsis muaj txiaj ntsig, txij li cov tshuaj osmotic, ethacrine acid, furosemide, Xanthines thiab lwm tus tsis ua nyob rau qee ntu ntawm nephron, tab sis thoob plaws nws lub sijhawm. Hauv kev sib txuas nrog cov yam ntxwv ntawm diuretics, kev faib tawm los ntawm lub tshuab ntawm kev nqis tes ua yog qhov muaj kuab tshaj plaws.

Thaum kho tus neeg mob, los ntawm qhov chaw kuaj mob, qhov kev faib tawm ntawm cov tshuaj diuretics tsis muaj qhov tseem ceeb raws li lub sijhawm ua haujlwm, qhov pib ntawm qhov pib ntawm cov nyhuv, thiab tseem ua lub zog ntawm kev ua.

Npaj thiab lawv siv

Cov tshuaj tseem ceeb ntawm thiazide diuretics yog chlortiazide (hydrochlorothiazide). Thiazide-xws li cov tshuaj suav nrog Chlortalidone, Indapamide, Xipamide. Txog niaj hnub no, ntau cov tshuaj analog (“generics”) kuj tau rau npe.

Kev ntsuas rau kev siv saluretics:

• Kev kho mob edematous syndrome nrog mob nephrotic syndrome. Qhov kev ua tau zoo yog tsawg. Siv ua rau kev txiav txim zoo thaum tshuaj raws li ib feem ntawm ob-, qee zaum peb-txoj kev kho diuretic kho. Tsis muaj kev ua haujlwm thaum lub sijhawm hloov nephrotic yog piav qhia los ntawm lwm lub tshuab: hypoproteinemia thiab oncotically los ntawm edema. Thiazide diuretics yuav tsum tau titrated coj mus rau hauv tus account qhov tseem yuav raug hloov ntawm qhov electrolyte - hypokalemia, hyponatremia.
• Edema nrog cov mob ua rau daim siab ua paug. Kev Kho Mob raws li ib feem ntawm kev sib xyaw ua ke kho.
• Arterial tawg. Nws yog qhov tsim nyog los siv raws li kev kho mob monotherapy, tshwj xeeb tshaj yog nrog kev kho mob me (2 degree). Cov kev xaiv hauv kev pom zoo ntawm thiazide zoo li cov tshuaj hauv kev kho mob siab yog nqa tawm los ntawm cov kws kho plawv vim hais tias muaj lub cev ntev, qhov pib sai ntawm kev txo lub siab. Kev tswj hwm ntshav qis yuav pab tswj hwm ntshav siab, ntxiv cov koob tshuaj tsuas yog muaj qhov o nce ntxiv.
• Mob plawv tsis ua hauj lwm raws li European thiab Lavxias cardiological cov lus pom zoo yuav tsum tau teem caij ntawm saluretics. Chlortalidone muaj cov nyhuv antihypertensive rau 3 hnub. Indapamide thiab thiazide diuretics siv tau 24 teev. Lawv kuj tseem txo qhov kev pheej hmoo ntawm hyperkalemia. Qhov no tso cai rau koj siv lawv txhua txhua hnub, lossis tsawg dua.Ib qho ntxiv, cov txiaj ntsig so ntawm vascular du leeg cov leeg txaus nyiam siv cov tshuaj rau tawg thiab lub plawv tsis ua haujlwm.

Sab nraud thiab contraindications

Cov kev mob tshwm sim uas ua rau cov tshuaj hauv cov pab pawg no cuam tshuam nrog cov teeb meem metabolic thiab electrolyte cuam tshuam vim lub tshuab ntawm kev txiav txim.

1. Hypokalemia thiab nws cov nyhuv arrhythmogenic txog asystole. Nws yuav tsum tau tshem tawm cov tshuaj thiab kho cov ntsiab lus hauv cov poov tshuaj potassium.
2. Kev Hyponatremia.
3. Atherogenic pauv hauv ntshav nrog ib qho nyiam mus rau thrombosis. Kho los ntawm kev noj cov tshuaj statins.
4. Hyperuricemia nrog kev txhim kho gouty mob caj dab los yog mob raum los ntawm urate. Kev tshem tawm yeeb tshuaj ua rau muaj kev rov qab ua tiav ntawm txoj kev no.
5. Cov roj metabolism tsis zoo, tshwj xeeb tshaj yog thaum siv ua ke nrog beta-blockers.

Los ntawm cov kev mob tshwm sim ntawm cov tshuaj, ib daim ntawv teev contraindications tau tsim tsim:

• gouty mob caj dab, nephropathy,
• hypokalemia
• txo cov ntsev
• cev xeeb tub (siv Indapamide raws li kev kawm tshuaj tsawg kawg nrog kev cuam tshuam rau lub cev hauv plab yog qhov tshwj xeeb tshaj yog tsis xav tau), thaum noj Hypothiazide ua ib feem ntawm kev sib xyaw tshuaj (tsis siv tshuaj ACE inhibitors),
• kev fab tshuaj tiv thaiv.

Thiazides thiab lawv cov kev ua ntawm cov haujlwm

Thiazide diuretics yog suav tias yog tshuaj kho mob ntawm kev siv zog, cov nyhuv ntawm lawv tshwm sim tom qab li 1-3 teev thiab kav ntev txog 12 teev. Lub tshuab ntawm kev ua ntawm thiazide diuretics yog tsom rau cov tubules nyob ze ntawm lub raum, vim tias muaj qhov thim rov qab nqus ntawm sodium thiab chlorine thiab lawv cov kev nthuav tawm ntxiv nrog rau cov zis. Tsis tas li ntawd, thiazide-zoo li diuretic txo qis tso zis nrog calcium cov zis thiab txo qhov tsim ntawm uric acid.

Kev qhia rau kev siv thiazide diuretics

Thiazide diuretics siv los kho cov kev ua hauv qab no:

• Kev o, uas tau tsim vim yog mob raum, ua cim los ntawm kev ua txhaum ntawm cov dej-ntsev tshuav. Txawm li cas los xij, kev ua haujlwm ntawm thiazide diuretics rau kev kho mob ntawm tus kab mob no yog tsawg, yog li lawv tau kho nrog lwm cov tshuaj diuretics (lub voj voos diuretics zoo haum).
• Edema mob los ntawm kab mob ntsws. Feem ntau siv txuam nrog lwm cov tshuaj diuretics.
• Ntshav siab.
• Mob plawv thiab mob plawv tsis zoo.

Lub Cheebtsam nquag

Thiazide diuretics siv los kho ntau yam kabmob. Feem ntau, kev siv tshuaj kho yog siv, cov khoom tseem ceeb ntawm cov uas muaj hydrochlorothiazide thiab chlortiazide. Lawv pib ua haujlwm tom qab ob peb teev, thiab lawv cov ntsiab lus muaj zog tshaj plaws yog pom 3-4 teev tom qab kev tswj hwm. Qhov kev txiav txim kav ntev li 11-13 teev.

"Hydrochlorothiazide"

Nws belongs rau theem nrab diuretics thiab siv rau kev kho mob ntshav siab, mob plawv tsis ua haujlwm, mob ntsws thiab rau kev tiv thaiv pob zeb. Ib qho kev noj tshuaj yog tsim nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj uas yuav tsum tau noj tom qab noj mov thaum sawv ntxov. Txog kev kho mob ntshav siab, kws kho mob pom zoo kom haus 1 ntsiav tshuaj ib hnub ib zaug. Yog hais tias mob edema, koj yuav tsum haus 1-4 ntsiav tshuaj. Nws muaj tus lej ntawm cov kev mob tshwm sim, xws li xeev siab thiab ntuav, cramps, arrhythmias, thiab kev tsis haum daim tawv nqaij. Cov kws kho mob tsis pom zoo kom haus dej "Hydrochlorothiazide" thaum cev xeeb tub thiab thaum pub niam mis, nrog rau cov neeg laus. Nws yog ib qho tseem ceeb kom nco ntsoov tias thaum siv tshuaj, koj yuav tsum tsis txhob nyob hauv lub hnub ntev, vim tias cov tshuaj ua rau muaj kev cuam tshuam ntau dua ntawm daim tawv nqaij mus rau lub hnub ci.

Siv cov tshuaj rau kev kho mob ntshav siab. Haus cov tshuaj yog pom zoo thaum sawv ntxov, tsis hais txog pluas noj, 1 ntsiav tshuaj 1 zaug hauv ib hnub.Indapamide ua rau muaj kev phiv xws li: mob taub hau, nce ntxiv kev chim siab, kev nyuaj siab, qaug zog, mob plab. Yog hais tias noj ntau dhau, tus neeg mob tuaj yeem hnov ​​xeev siab, ntuav, mob taub hau thiab kiv taub hau, nkees thiab feeb tsis meej. Txhawm rau txo cov tsos mob ntawm kev noj ntau dhau, koj yuav tsum yaug koj lub plab thiab haus cov qhov tsim nyog ntawm cov hluav ncaig hluav taws xob. Koj yuav tsum tsis txhob noj cov tshuaj thaum cev xeeb tub thiab pub niam mis.

Nws yog kev ua thiazide ntev ntev, qhov kev ua haujlwm ntawm kev coj ua uas yog txhawm rau tshem tawm cov poov tshuaj thiab magnesium nyob hauv cov zis. Nws siv tau los txo qhov siab thiab txo qhov o ntawm ntau yam. Rau kev kho mob ntawm puffiness, nws raug nquahu kom siv cov tshuaj 1-2 ntsiav tshuaj 1 zaug ib hnub. Tom qab o tuaj yuav maj mam ploj mus, cov tshuaj yuav tsum raug txo kom tsawg. Haus tshuaj kom txo tau qhov siab yuav tsum muab rau 1 lub tshuaj ib hnub ib zaug. "Clopamide" muaj ntau cov kev mob tshwm sim: kev txo qis ntawm cov sodium thiab potassium hauv cov ntshav, ntuav, ua kom yuag, ua xua. Nws raug tso cai siv thaum cev xeeb tub thiab pub niam mis, tab sis koj yuav tsum haus cov tshuaj nrog ceev faj thiab tsuas yog thaum qhov kev cia siab tshwm sim muaj peev xwm ua kom muaj kev pheej hmoo ntawm kev muaj kab mob hauv lub cev xeeb tub.

Diuretics, los yog diuretics, yog cov tshuaj uas ua rau kom cov zis ntau ntxiv los ntawm lub cev thiab txo cov kua dej hauv cov ntaub so ntswg thiab cov kab noj hniav hauv lub cev. Qhov nce ntawm tso zis los ntawm diuretics yog cuam tshuam nrog lawv cov txiaj ntsig tshwj xeeb rau lub raum, uas feem ntau ua rau muaj kev txwv tsis pub rov qab tso cov sodium ions hauv cov hlaus rov qab, uas yog nrog los txo qis hauv dej reabsorption. Ib lub luag haujlwm me dua yog ua si los ntawm kev pom tawm hauv cov glomeruli.

Diuretics yog feem ntau sawv cev los ntawm cov pawg hauv qab no:

a) diuretics "voj" thiab ua yeeb yam ntawm ntu cortical ntawm lub voj ntawm Henle,

b) cov tshuaj diuretics ua kom nrov tshaj,

Diuretics muaj cov nyhuv sib txawv ntawm kev tsim cov zis, uas yog nyob ntawm lawv lub cev physicochemical cov yam ntxwv, mechanism ntawm kev txiav txim thiab nws cov chaw hauv cheeb tsam (txawv qhov chaw ntawm nephron).

Cov muaj zog tshaj plaws ntawm cov diuretics uas twb muaj lawm yog "loopback". Los ntawm lawv cov qauv hauv tshuaj lom neeg, lawv yog cov tsim los ntawm sulfamoylanthranilic thiab dichlorophenoxyacetic acids (furosemide, bumetanide, ethacrylic acid, thiab lwm yam). Voj diuretics khiav lag luam thoob plaws thaj chaw nce ntu ntawm nephron voj (Henle loop) thiab ua rau pom qhov rov qab hnyav dua ntawm chlorine thiab sodium ions, thiab kev tso tawm ntawm potassium ions kuj nce.

Kev siv tshuaj kho zoo heev muaj xws li thiazides - derivatives ntawm benzothiadiazine (hydrochlorothiazide, cyclopentiazide, thiab lwm yam). Lawv cov txiaj ntsig ua tau zoo nyob rau hauv ntu cortical ntu ntawm lub voj voos nephron, qhov twg thim rov qab siv cov cations (sodium thiab potassium) yog txhaws. Lawv tsiag ntawv los ntawm hypokalemia, qee zaum txaus ntshai heev.

Ob lub voj voos diuretics thiab benzothiadiazines siv rau hauv kev kho kab mob siab thiab mob plawv tsis ua haujlwm. Nce diuresis, lawv txo BCC, ntsig txog, nws cov leeg rov qab mus rau lub siab thiab lub nra rau ntawm myocardium, txo qhov daig hauv lub ntsws. Thiazides, ntxiv rau, ncaj qha so lub vascular phab ntsa: cov txheej txheem hauv kev zom zaubmov hauv lub cell daim nyias nyias ntawm txoj hlab ntsha hloov, tshwj xeeb, kev ua kom cov sodium ions tsawg zuj zus, uas ua rau txo qis o thiab muaj kev tawm tsam peripheral vascular tsis kam. Nyob hauv kev cuam tshuam ntawm thiazides, kev hloov pauv ntawm cov vascular hloov pauv, cov pa tshuaj tiv thaiv rau vasoconstrictor tshuaj (adrenaline, thiab lwm yam) txo qis thiab qhov cuam tshuam tsis haum rau laib laib thaiv cov tshuaj ntxiv.

Potassium-sparing diuretics kuj nce kev tso tawm sodium ions, tab sis tib lub sij hawm txo kev tso tawm cov potassium ions. Lawv coj ntawm cov tubal distal hauv cov chaw uas sodium thiab potassium potassium sib pauv.Los ntawm lub zog thiab lub sijhawm ntev ntawm cov nyhuv, lawv ua tsis tau zoo rau "lub voj", tab sis tsis ua rau hypokalemia. Cov neeg sawv cev tseem ceeb ntawm pawg tshuaj no - spironolactone, triamteren - sib txawv hauv cov txheej txheem ntawm kev ua. Spironolactone yog antagonist ntawm aldosterone, thiab nws cov kev ua haujlwm kho yog qhov siab dua, qib siab dua thiab ntau lawm hauv lub cev ntawm aldosterone. Triamteren tsis yog antagonist ntawm aldosterone, nyob rau hauv kev cuam tshuam ntawm cov tshuaj no, permeability ntawm daim nyias nyias ntawm cov hlwb epithelial ntawm distal tubules xaiv tau poob qis rau sodium ions, tom kawg tseem nyob hauv lub lumen ntawm tubule thiab khaws cov dej, uas ua rau muaj kev nce ntxiv hauv cov zis.

Kev npaj cov tshuaj osmodiuretic yog qhov tsuas yog qhov ua tsis thaiv “thaiv” tso zis. Xaj, lawv nce osmotic siab ntawm "thawj zis" (glomerular filtrate), uas txwv tsis pub cov dej reabsorption hauv qhov menyuam tub ze. Kev siv ntau tshaj plaws osmotic diuretics (mannitol, thiab lwm yam) yog siv los ua yuam kev diuresis nyob rau hauv kev lom neeg mob hnyav (barbiturates, salicylates, thiab lwm yam), mob raum tsis ua haujlwm, thiab tseem ua rau lub plawv tsis ua haujlwm hauv cov neeg mob uas txo qis raum. Raws li lub cev qhuav dej, lawv tau raug xaj rau lub hlwb txha caj dab.

Kev siv cov carbonic anhydrase inhibitors (saib Enzymes thiab antifermenta) raws li diuretics yog vim yog qhov inhibition ntawm kev ua ub no ntawm enzyme hauv ob lub raum (feem ntau nyob hauv qhov siab raum tubules). Raws li qhov tshwm sim, kev tsim thiab kev cuam tshuam tom qab ntawm carbonic acid txo, qhov kev rov ua haujlwm ntawm bicarbonate ions thiab Na + ions los ntawm tubular epithelium poob qis, thiab yog li ntawd cov dej tsis ua haujlwm nce ntxiv (diuresis nce). Nyob rau tib lub sijhawm, tso zis pH nce thiab qhov yuav tsum tau them rov qab, nyob rau hauv kev teb rau H + ions ncua sijhawm, nce metabolic secretion ntawm K + ions. Tsis tas li ntawd, qhov kev tawm ntawm ammonium thiab chlorine tsawg dua, hyperchloremic acidosis kev loj hlob, tawm tsam uas cov tshuaj tsis ua.

Osmotic

Lub hauv paus ntsiab lus ntawm kev ua haujlwm ntawm osmotic diuretics yog tias lawv nce osmotic siab hauv cov ntshav ntshav, ua tsaug uas, los ntawm cov ntaub so ntswg uas tau o, cov kua dej tau tawm thiab qhov ntim ntawm cov ntshav uas circulates nce.

Qhov no txo ​​cov reabsorption ntawm sodium thiab chlorine. Thaum sau cov tshuaj diuretics no, yuav tsum tau them rau cov tib neeg cov kab mob, vim tias lawv tuaj yeem ua rau tsis zoo rau cov kab mob ntawm daim siab thiab lub raum.

Cov kws kho mob tsis txwv tsis pub cov neeg mob xaiv cov tshuaj diuretics ntawm lawv tus kheej: txhua pawg ntawm diuretics muaj cov yam ntxwv raug, nws tus kheej contraindications thiab phiv. Kev siv cov haib sib txuas ua rau pov thawj tshem tawm cov poov tshuaj lossis cov tsub zuj zuj ntawm ib qho khoom, lub cev qhuav dej, mob taub hau heev, kub ntxhov. Nrog kev siv ntau dhau ntawm lub voj lub zog kho, tus kheej ntawm tus kheej tuaj yeem xaus hauv qhov tsis ua hauj lwm.

Zaub

• palpable diuretic nyhuv,
• "Mos" cuam tshuam rau lub raum, lub siab, cov hlab ntshav,
• tshem cov kua ntau dhau, ntxuav cov zais zis thiab lub raum,
• ua rau pom qhov mob ua kom loog me me,
• saturate lub cev nrog cov khoom siv tseem ceeb: cov ntsev ntxhia pob zeb, cov vitamins, cov kev ua haujlwm biologically,
• haum rau kev siv mus sij hawm ntev (kev kawm).

Kev ntsuas rau kev siv lub voj kev tshuaj kho: lub tshuab ntawm kev coj ua thiab contraindications

Qhov qhia tseem ceeb rau kev teem caij kho mob diuretics yog kho cov hlab ntshav siab, feem ntau ntawm tag nrho cov no siv rau cov neeg laus laus. Cov tshuaj kho mob Diuretic yog raug kho rau sodium tuav tseg.

Nrog osteoporosis, tus neeg mob yog kws kho thiazide diuretics. Cov tshuaj poov tshuaj-sparing yog qhia rau kev mob raum ua kom tsis haum plab (tshem tawm cov khoom noj loj ntawm cov potassium thiab sodium khaws cia).

Loop diuretics muaj cov nyhuv cuam tshuam rau lub raum kev ua haujlwm, raug kho rau qhov mob siab intraocular, glaucoma, plhaw plawv, mob ntsws.

Txog kev kho thiab tiv thaiv kev mob ntshav siab, cov kws kho mob tau tshaj tawm cov tshuaj thiazide, uas hauv cov koob tshuaj me me muaj kev ntxim nyiam rau cov neeg mob uas muaj mob ntshav siab. Nws tau raug tseeb tias thiazide diuretics hauv koob tshuaj prophylactic tuaj yeem txo txoj kev pheej hmoo ntawm mob hlab ntsha tawg.

Noj cov tshuaj no hauv qib siab dua yog tsis pom zoo, nws yog fraught nrog txoj kev loj hlob ntawm hypokalemia.

Hauv kev kho mob ntawm diuretics, kev kho mob nquag thiab kev txhawb nqa kev txhawb nqa tau qhov txawv. Hauv cov theem nquag, cov koob tshuaj ntawm diuretics muaj zog (Furosemide) tau qhia. Nrog kev kho kom zoo, kev siv cov tshuaj diuretics tsis tu ncua.

Cov neeg mob nrog decompensated cirrhosis ntawm daim siab, hypokalemia, kev siv tshuaj diuretics yog contraindicated. Ntxees diuretics tsis raug siv rau cov neeg mob uas tsis nkag rau qee yam sulfanilamide derivatives (hypoglycemic thiab tshuaj tua kab mob).

Rau cov neeg muaj mob ua pa thiab mob raum tsis ua hauj lwm, tshuaj kho tus mob ua ntej lawm. Diuretics ntawm thiazide pawg (Methiclothiazide, Bendroflumethiozide, Cyclomethiazide, Hydrochlorothiazide) yog cov kabmob sib kis ntawm hom 2 mob ntshav qab zib mellitus, vim tias tus neeg mob yuav ua kom cov ntshav qabzib nce siab.

Ventricular arrhythmias kuj tseem txheeb ze contraindications rau kev teem caij ntawm diuretics.

Rau cov neeg mob noj cov tshuaj lithium thiab cov tshuaj glycosides, voj diuretics raug kho nrog kev saib xyuas zoo.

Hauv kev kho mob ntawm diuretics, kev kho mob nquag thiab kev txhawb nqa kev txhawb nqa tau qhov txawv. Hauv cov theem nquag, cov koob tshuaj ntawm diuretics muaj zog (Furosemide) tau qhia. Nrog kev saib xyuas kev kho mob, kev siv cov tshuaj diuretics tsis tu ncua.

Cov tshuaj diuretic tshwj xeeb cuam tshuam rau lub raum kev ua haujlwm thiab kho qhov txheej txheem ntawm cov zis tsis ua haujlwm.

Lub tshuab ntawm kev ua ntawm feem ntau diuretics, tshwj xeeb tshaj yog tias nws yog potassium-sparing diuretics, yog ua raws li lub peev xwm los tiv thaiv kev thim rov qab nqus mus rau hauv lub raum, ntau dua qhov tseeb hauv cov hlaus rov qab, electrolytes.

Kev nce ntxiv ntawm cov roj ntsha tau tso tawm tshwm sim ib txhij nrog kev tso tawm ntawm qee qhov ntim ntawm cov kua.

Thawj lub diuretic tshwm sim nyob rau xyoo 19th, thaum pom cov tshuaj mercury, uas yog siv los kho mob syphilis. Tab sis hais txog ntawm tus kab mob no, cov tshuaj tsis tau muaj txiaj ntsig zoo, tab sis nws muaj zog diuretic nyhuv tau pom.

Tom qab qee lub sijhawm, kev npaj txhij txhua mercury tau hloov nrog cov khoom muaj kuab lom tsawg.

Tsis ntev, kev hloov kho ntawm cov qauv ntawm diuretics coj mus rau kev tsim cov tshuaj uas muaj zog heev, uas muaj lawv cov kev faib tawm.

Cov tshuaj kho mob ua kom haum rau cov mob thiab cov kab mob nrog los ntawm kev tuav dej:

• cov tsos mob nephrotic
• txha txha caj qaum
• cov lus o ntawm qis qis kawg nrog kev mob plawv,
• ntshav siab (arterial hypertension),
• kev tso dag ntev dhau ntawm cov tshuaj hormones aldosterone,
• mob ntsws
• pathology ntawm lub raum thiab mob siab,
• congestive plawv tsis ua haujlwm,
• o ntawm cov ntaub so ntswg.

Kawm paub txog cov laj thawj ntawm kev mob qog cell hauv cov poj niam thiab cov cai ntawm kev kho mob rau kev kawm ntawv.

Cov lus qhia rau kev siv ntawm urological sau Fitonephrol tau piav qhia rau ntawm nplooj no.

Thaum xaiv cov tshuaj diuretic, cov kws kho mob xav txog qhov kev txwv no. Txhua cov tshuaj muaj cov npe tshwj xeeb ntawm contraindications (qhia hauv cov lus qhia). Tsis yog txhua yam tshuaj tua hluavtaws tau sau tseg rau lub sijhawm cev xeeb tub:

• cov me nyuam muaj hnub nyoog
• kev pub mis
• cev xeeb tub
• lub cev tsis haum rau phytoextracts lossis cov khoom siv hluavtaws diuretics,
• mob ntshav qab zib mellitus
• hom mob raum tsis ua haujlwm.

Ua ntej txiav txim siab cov txheej txheem ntawm kev txiav txim ntawm thiazide-zoo li siv yeeb tshuaj, nws yog qhov yuav tsum tau nkag siab dab tsi thiazide diuretics yog.

Hauv qhov hauv kev txiav txim, qhov no yog pab pawg ntawm cov diuretics hluavtaws nrog cov nyhuv hypotensive ntev.

Thiazide diuretics yog dav vim lawv cov hauj lwm zoo hauv kev kho mob ntshav siab thiab lub plawv tsis ua haujlwm. Qhov kom zoo dua ntawm thiazide thiab thiazide-zoo li diuretics piv rau lwm cov tshuaj diuretics yog qhov kev txwv tsawg dua kev siv ntsev nrog zaub mov.

Ntxiv rau, thiazide (thiazide-like) diuretics yog txuag tshuaj calcium, yog li cov tshuaj no yuav yog qhov kev xaiv thib 1 hauv kev kho mob ntshav siab thiab lub plawv tsis ua haujlwm rau cov neeg mob txha.

Thiazide-type diuretics siv rau kev yws, ntshav siab, mob plawv.

• Kev o, uas tau tsim vim yog mob raum, ua cim los ntawm kev ua txhaum ntawm cov dej-ntsev tshuav. Txawm li cas los xij, kev ua haujlwm ntawm thiazide diuretics rau kev kho mob ntawm tus kab mob no yog tsawg, yog li lawv tau kho nrog lwm cov tshuaj diuretics (lub voj voos diuretics zoo haum).
• Edema mob los ntawm kab mob ntsws. Feem ntau siv txuam nrog lwm cov tshuaj diuretics.
• Ntshav siab.
• Mob plawv thiab mob plawv tsis zoo.

Feem ntau, cov tshuaj ntawm cov pab pawg no yog siv los kho cov kab mob pathology ntawm lub chaw tso zis thiab zis. Cov tshuaj no ua nrog quab yuam nruab nrab, cov nyhuv tshwm sim nws tus kheej tom qab ib mus rau peb teev, thiab lub sijhawm ncua ntev li ib nrab ntawm ib hnub.

Lub tshuab ntawm kev ua yog kev txwv tsis pub rov qab thim rov qab ntawm sodium thiab dej hauv qhov ze ntawm lub raum plab, vim tias lawv tau tawm hauv cov zis ntawm qhov nrawm nrawm. Tsis tas li ntawd, thiazide diuretics txo qhov kev pom zoo ntawm calcium, ntxiv rau tus nqi thiab kev siv ntau ntawm kev tsim cov uric acid hauv lub raum.

Hom diuretics zoo qhia rau cov kab hauv qab no:

• edematous mob siab
• arterial hypertension, uas tsis yog tso tseg los ntawm txoj kev pom zoo, txo cov nuj nqis siab,
• mob plawv thiab mob plawv tsis ua hauj lwm.

Cov tshuaj tseem ceeb ntawm cov pab pawg no suav tias yog chlortiazide thiab hydrochlorothiazide, qhov pib ntawm qhov kev ua tau zoo uas tshwm sim hauv thawj teev, thiab lawv cov nyhuv kav ntev li ib teev.

Cov kev mob tshwm sim muaj xws li qee qhov kev cuam tshuam ntawm cov metabolism hauv lub cev, nrog rau cov kev hloov pauv hauv cov metabolism hauv cov hauv paus ntsiab lus thiab cov vitamins. Tsis tas li, hypokalemia (ib qho kev txo qis hauv kev suav ntawm cov poov tshuaj hauv cov ntshav) qee zaum pom los ntawm kev mob tshwm sim, thaum cov tshuaj tsis cuam tshuam mus ib ntus thiab cov tshuaj muaj cov ntsiab lus tseem ceeb ntawm cov kab kawm no (panangin, asparkum) tau raug xaj.

Koj tseem tuaj yeem sau cia ib qho kev txo qis ntawm cov sodium hauv plasma ntau ntxiv, nrog rau kev nce ntxiv ntawm cov concentration ntawm uric acid. Qhov kawg, nyeg, ua rau mob caj dab ntawm cov pob qij txha, thiab tseem cuam tshuam rau lub raum parenchyma. Tom qab nres kev siv cov tshuaj no, tag nrho lub cev ua haujlwm li qub.

Yog tias cov neeg mob nrog rau cov tshuaj diuretics noj beta-blockers, tom qab ntawd lwm cov txiaj ntsig tuaj yeem yuav yog cov metabolism hauv cov piam thaj.

Ntawm lub contraindications, hauv qab no yuav tsum tau sau tseg:

• inflammatory sib koom tes kab mob
• glomerular pom kev sib txawv hauv ob lub raum,
• qhov txo qis hauv cov qib ntawm cov potassium thiab sodium hauv cov ntshav ntshav,
• cev xeeb tub thiab lub sijhawm pub mis niam,
• kev tsis haum tshuaj lossis qhov tsis haum rau ib qho twg ntawm cov tshuaj.

Niaj hnub no, ib lub tsev muag tshuaj twg muaj cov tshuaj tiav ntawm cov tshuaj no, uas koj tuaj yeem yuav nqi tsawg me ntsis yam tsis muaj kws kho mob sau ntawv. Txawm li cas los xij, nws yog ib qho tseem ceeb heev uas kev teem sijhawm ntawm cov tshuaj mob hnyav no yog kws kho mob tsim nyog sau tseg, qhia tias muaj pes tsawg, tsawg zaus thiab lub sijhawm siv. Tom ntej no, peb yuav qhia koj luv luv txog cov tshuaj tseem ceeb los ntawm pab pawg no.

Kev npaj ntawm cov pawg me no muaj cov diuretic zoo vim qhov kev txwv tsis pub rov tso cov sodium ions hauv lub voj ntawm Henle, uas yog hauv nws lub hauv caug nce mus.Hauv qhov no, qhov nce ntxiv ntawm kev nthuav tawm ntawm cov calcium, bicarbonates, magnesium thiab phosphates tshwm sim.

Voj diuretics tseem muaj cov nyhuv veno-nthuav dav vim qhov hloov pauv ntawm prostaglandins los ntawm lub raum. Qhov kev ua no txo ​​lub siab hauv cov leeg seem ntawm lub plawv thiab pab txo cov hlab ntsws.

Ntawm tag nrho cov tshuaj no, furosemide loop diuretic feem ntau siv.

Voj diuretics ua txoj hauv kev uas cov tshuaj nquag ntawm cov tshuaj tshem tawm cov sodium ions thiab dej los ntawm ob lub raum. Feem ntau siv los ua kev pab sai, vim qhov kev tshwm sim feem ntau tshwm sim tsis pub dhau 6 teev.

Lub sijhawm ntev lossis tsis siv sijhawm ntawm lub voj diuretics tuaj yeem ua rau lub plab tsis zoo hauv lub plawv vim poob ntawm magnesium thiab potassium. Yuav siv tau yog tias lub raum tsis ua haujlwm.

Ntawm cov kab mob sib kis, cov xwm txheej hauv qab no tuaj yeem sau tseg:

• myocardial infarction
• mob raum tsis ua haujlwm
• mob siab hnyav ua haujlwm
• pancreatitis
• raum pob zeb
• mob gout
• txoj hlab zis,
• kev tiv thaiv tsis haum
• aortic stenosis,
• kev ntxhov siab hauv cov dej-electrolyte tshuav,
• tsis muaj ntshav siab (lub voj diuretic tuaj yeem txo cov ntshav siab).

Cov txheej txheem:

• los nplij puffiness,
• nyem ntawm cov hlab plawv tsis ua haujlwm,
• tso zis tawm vim lub raum mob thiab cov diuretic muaj nuj nqi cuam tshuam,
• kho mob ntshav siab
• tshem tawm ntawm co toxins thiab tshuaj lom.

Sab nraud thiab contraindications.

Cov txheej txheem:

• Edema ntawm raum thiab mob plawv keeb kwm kom tshem tawm cov kua dej ntau dhau.
• Hepatic tsis muaj txhij txhua nyob rau hauv kev txiav txim kom txo intoxication thiab kev hloov pauv ntawm cov dej-ntsev tshuav.
• Urolithiasis kom tshem tawm cov calcium ntau ntxiv thiab tiv thaiv lub raum pob zeb.
• Neesrogenic (ntshav qab zib insipidus) mob ntshav qab zib kom hloov pauv pathological cuam tshuam nrog dej ncig.
• Tawg raws li ib feem ntawm txoj kev kho mob nrog cov tshuaj antihypertensive los txhim kho thiab ua kom ntev ntev ntawm cov nyhuv.
• Qhov xav tau yuav tsum ua kom ntev ntev cov cuam tshuam ntawm cov tshuaj voj.

Vim tias tau nce ntxiv diuresis thiab kev hloov pauv ntawm cov dej-ntsev sib npaug, thiazide npaj rau kev siv tshuaj lom thiab intoxication nrog hnyav hlau ntsev.

• Kab mob ntawm cov pob qij txha cuam tshuam nrog kev cuam tshuam cov metabolism hauv uric acid.
• Hloov pauv dej-ntsev ntsev cov roj, nrog rau kev ua kom muaj zog ntawm uric acid.
• Lub hnub nyoog laus, cev xeeb tub thiab lactation. Kev kho mob nrog tshuaj diuretics ntawm hom no kuj tsis haum rau menyuam yaus.
• Tsis muaj raum thiab mob siab ua haujlwm hauv daim ntawv mob.
• Cov tsos mob Asthenic.
• Mob ntsws antihypertensive syndrome.
• Cov kab mob ntawm cov qog adrenal nrog cov tshuaj hormonal tsis zoo.

Cov kev txwv tsis pub noj thiazide diuretics txhais tau hais tias koj yuav tsum ua kom tau cov diuretic nyhuv lwm txoj kev, feem ntau siv voj thiab osmotic cov neeg sawv cev siv.

Cov tshuaj uas txhim kho lawv lub peev txheej pom zoo hu ua loop diuretics.

Cov tshuaj no txhawb cov kev tawm dag zog ntawm cov leeg nqaij muaj zog, nce ntshav siab rau lub plawv, txhawb kev tsim khoom ntawm prostaglandins E2 thiab I2 hauv cov hlwb vascular, thiab nce siab txhaws txhaws.

Vim tias tag nrho cov txheej txheem no, ib qho nce ntawm diuretic nyhuv tau pom.

Cov tshuaj kho mob raug pom zoo rau kev kuaj mob ntawm tus mob pathological thiab cov txheej txheem xws li:

1. Mob plawv, mob rau daim tawv thiab mob hlab ntsws. Lawv kho sai tom qab kuaj tus kab mob no.
2. Mob raum tsis ua hauj lwm. Txhais tau hais tias tau txais txiaj ntsig nrog kev muaj peev xwm los txhim kho lub raum ntshav thiab khiav tawm ntawm cov zis hauv anuria.
3. Hypercalcemia. Pab txhawb lub excretion ntawm calcium los ntawm lub cev kab noj hniav.
4. Tawg siab, tab sis tsuas yog tias tus neeg mob lub plawv tsis ua haujlwm.Hauv txhua lwm yam mob, kev teem sijhawm thiazide diuretics yog suav hais tias yog neeg ncaj ncees.

Lawv tseem siv rau lub hom phiaj ntawm kev ua cov diuresis yuam thaum muaj tshuaj lom, nrog rau kev pab thaum muaj xwm ceev hauv kev kuaj mob ntsws txhaws lossis lub hlwb.

• txwv qhov kev tso zis txaus rau hauv lub zais zis,
• kev txawv txav ntawm lub plawv
• ua xua rau cov tshuaj uas yog pab pawg sulfonamide,
• cev xeeb tub thiab lactation.

Cov zaub mov txawv

Cov nqi them los ntawm cov tshuaj ntsuab rau cov kab mob ntshav siab thiab hom ntshav qab zib hom 2 muaj txiaj ntsig thiab txhim kho kev mob ntawm ib tug neeg.

Qhov feem ntau hypotensive, zoo heev tshuaj rau ntshav qab zib yog diuretics. Ua tsaug rau lawv, cov txheej txheem tsim dag zog ntawm cov zis ntau ntxiv hauv lub cev tau tsim, uas ua rau kev nce qib ntawm cov txheej txheem tom qab tau tso tseg, nrog rau kev tso tawm sai sai ntawm tib neeg lub cev los ntawm dej thiab dej qab ntsev.

Yog li ntawd, tag nrho cov ntshav tso ntshav tawm mus tsis txaus, cov ntshav siab poob qis thiab tib cov hlab ntsha nqaim.

Txauv kev tsis sib haum

Kev ua txhaum ntawm cov protein metabolism ua ke nrog qhov tsis muaj poov tshuaj, ua rau muaj kev ua txhaum ntawm nitrogen tshuav nyiaj. Nws tshwm sim feem ntau hauv cov menyuam yaus thiab cov neeg laus uas muaj cov protein tsawg hauv cov zaub mov noj. Txhawm rau txhim kho cov mob no, nws yog qhov tsim nyog los txhawb cov khoom noj uas muaj cov protein thiab sau cov tshuaj anabolic steroids.

Thaum siv thiazide thiab voj diuretics hauv cov ntshav, cov concentration ntawm cov roj cholesterol, beta-lipoproteins, triglycerides nce. Yog li no, thaum sau tshuaj diuretics, lipids hauv cov khoom noj yuav tsum tau txwv, thiab yog tias tsim nyog, diuretics yuav tsum tau ua ke nrog angiotensin hloov kho enzyme inhibitors (ACE inhibitors).

Thiazide diuretic txoj kev kho tuaj yeem ua rau nce ntshav qabzib (hyperglycemia), tshwj xeeb tshaj yog rau cov neeg mob ntshav qab zib mellitus lossis rog rog. Txhawm rau tiv thaiv cov mob no, ib qho kev txwv hauv kev noj zaub mov ntawm cov khoom noj tau yooj yim zom zom (suab thaj), kev siv ACE inhibitors thiab cov tshuaj potassium npaj pom zoo.

Hauv cov neeg muaj ntshav siab thiab lub cev tsis zoo purine metabolism, kev nce siab ntawm cov uric acid hauv cov ntshav yuav tshwm sim (hyperuricemia). Tshwj xeeb yog qhov muaj feem ntau qhov tshwm sim hauv txoj kev kho cov voj thiab thiazide diuretics. Rau kev kho mob, kev noj zaub mov purine-txwv tsis pub noj, allopurinol, yog tshuaj, diuretics yog ua ke nrog ACE inhibitors.

Nyob rau hauv cov ntaub ntawv ntawm lub sijhawm ntev siv ntau ntawm cov tshuaj diuretic, lub raum kev ua haujlwm zoo li yuav cuam tshuam nrog kev txhim kho ntawm azotemia (kev nce ntxiv hauv cov concentration ntawm nitrogenous pov tseg hauv cov ntshav). Hauv cov rooj plaub no, nws yog ib qho tsim nyog yuav tsum tau soj ntsuam kom tsis tu ncua cov ntsuas azotemia.

Diuretic intolerance yog tsawg. Nws yog feem ntau cov yam ntxwv ntawm thiazide thiab voj diuretics, feem ntau hauv cov neeg mob uas muaj kev fab tshuaj rau sulfonamides. Kev ua xua tuaj yeem tshwm sim nrog daim tawv nqaij ua pob xoo, vasculitis, ua kom lub cev, kub cev, ua kom lub siab thiab lub raum ua haujlwm.

Txoj kev kho rau kev tawm tsam tsis haum yog ua tiav raws li cov txheej txheem ib txwm muaj nrog kev siv tshuaj antihistamines thiab prednisone.

Kev siv cov carbonic anhydrase inhibitors yuav nrog cov kev ua haujlwm tsis zoo rau lub cev. Mob taub hau, insomnia, paresthesia, tsaug zog tshwm.

Nrog kev tswj hwm kev siv tshuaj ethacrine acid, muaj tshuaj lom rau hauv lub rooj sib hais.

Yuav luag txhua pawg ntawm cov tshuaj diuretic nce qhov kev pheej hmoo ntawm kev tsim urolithiasis.

• hypovolemia,
• hypokalemia (nws ua rau lub cev puas lom ntxiv ntawm lub plawv glycosides),
• kev npau suav,
• hyperuricemia (tuaj yeem ua rau muaj mob ntawm gout),
• ua kom nrov nrov,
• hyperglycemia
• hypomagnesemia - qhov tsis nco qab ntawm magnesium yog suav tias yog qhov ua rau mob pseudogout (chondrocalcinosis),
• kiv taub hau
• tsaus muag
• hypotension.

Vim li cas siv cov tshuaj diuretics rau cov ntshav qab zib

Feem ntau, ntau yam tshuaj diuretic raug kho nyob rau hauv kev rau siab kho kub siab. Tab sis kws kho mob kuj tseem pom zoo cov tshuaj no rau mob qog nqaij thiab o o. Thiab qhov no tsis yog kev sib tsoo, vim hais tias cov kab mob no tuaj yeem qhia qhov pom ntawm lub plawv tsis ua haujlwm.

Hauv cov ntshav qab zib mellitus, cov lus qhia tshuaj tso rau hauv nqe lus nug yuav tsum tau siv nrog kev ceev faj, vim tias tsis yog txhua tus diuretics zoo rau qhov no lossis qhov muaj sia. Yog li, nws yog qhov yuav tsum tau mus ntsib kev sab laj ua ntej nrog kws kho mob tshwj xeeb uas tuaj yeem qhia tau yam tshuaj twg koj tuaj yeem haus rau tus neeg mob ntshav qab zib.

Raws li koj paub, cov tshuaj diuretic rau cov ntshav qab zib tuaj yeem muaj ntau hom. Piv txwv li, potassium-sparing thiab loopback pawg ntawm cov tshuaj tsis haum nyob rau hauv thiaj li yuav kho tau kub siab mob ntshav qab zib mellitus.

Nws yog ib qho tseem ceeb kom nco ntsoov tias cov kev faib tawm no yog qhov tsim nyog rau kev siv ib zaug, uas yog, txhawm rau tshem tawm qhov mob sai sai uas hnov ​​mob. Qhov tsawg tshaj plaws nyiam nyob rau lub sijhawm ntawm lo lus nug yog potassium-sparing diuretics, txij li nyob rau lub sijhawm tam sim no lawv raug txiav txim siab tshaj plaws thiab tau txais txiaj ntsig nrog ntau qhov tsis zoo lub siab.

Thiazide-xws li thiab thiazide tus neeg sawv cev

Thiazide-zoo li thiab thiazide tus neeg sawv cev raug lees paub tias yog cov neeg nyiam tshaj plaws hauv kev kho mob ntshav qab zib mellitus, nrog rau kev mob ntshav siab. Xav tias yuav tso cov tshuaj diuretic rau cov kab mob ntawm hom ob tuaj yeem ua rau hauv qhov ntau tsawg.

Cov no suav nrog Poithiazide thiab Dichlothiazide. Lawv qhov tsis zoo yog vim muaj lub peev xwm los txo qis ntawm qhov rhiab ntawm hlwb mus rau lub dag zog insulin xa.

Feem ntau feem ntau, qhov xwm txheej no tshwm sim vim yog cov li niaj zaus thiab kev siv tshuaj ntau. Yog lawm, cov xwm txheej zoo li no yuav tshwm sim ua ntej dhau los hauv ntau hom phiv.

Thiazide-zoo li tshuaj diuretic tuaj yeem noj los ntawm cov neeg mob ntshav qab zib uas tsis muaj kev ntshai tshwj xeeb. Cov sawv cev xws li indapamide yog cov tshuaj tsis haum tshaj plaws.

Siv cov ntsiab lus no, koj tuaj yeem tshem cov poov tshuaj, sodium, magnesium ntawm lub cev. Yog li, nrog kev kho mob nquag, ib tus neeg mob ntshav qab zib yuav tsum noj cov zaub mov uas muaj cov ntsiab lus saum toj no.

Qhov no thiab buckwheat porridge, oatmeal, Berries, txiv ntoo thiab, ntawm chav kawm, cov txiv hmab txiv ntoo tshiab.

Mob ntshav qab zib, tshuaj ntsuab los kuj tseem siv tau. Txawm li cas los xij, ua ntej siv ncaj qha, nws tsim nyog sab laj nrog koj tus kws kho mob txhawm rau tsim cov tshuaj ntau npaum li cas thiab tshawb xyuas cov khoom ua haujlwm kom sib haum nrog cov tshuaj muaj txiaj ntsig.

Tus neeg mob ntshav qab zib yuav tsum tau saib xyuas yog tias nws tau raug kho rau kev tiv thaiv cov kab mob sib kis, vim tias xav tau cov tshuaj insulin nyob rau hauv cov ntaub ntawv no tuaj yeem hloov tshwj xeeb tshaj yog nyob rau hauv cov tshuaj uas cuam tshuam rau cov metabolism ntawm carbohydrates (corticosteroids, salicylates).

Beta-adrenergic blockers cuam tshuam txog kev tso ntshav qab zib los ntawm lub siab thaum kev txhim kho hypoglycemia, uas tau sib kho los ntawm beta2-adrenergic receptors, thiab txo cov tsos mob ntawm cov ntshav qog, nrog rau kev tshwj tsis yog tawm hws. Yog li, hypoglycemia provoked los ntawm cov tshuaj insulin yog aggravated thiab ua tsawg tshaj tawm suab.

Hauv kev hais txog qhov no, yog tias tus neeg mob ntshav qab zib yuav tsum tau siv tshuaj beta-adrenergic receptor, cardioselective beta-1-blockers, piv txwv li, atenolol, yuav tsum siv. Sympatolytic tshuaj kuj potentiate ua hauj lwm ntawm insulin.

Thiazide diuretics tuaj yeem ua rau mob ntshav qab zib, yog li ntawd, ib txwm muaj, kev txhim kho kev mob ntshav siab ntshav qab zib mellitus yuav tsum muaj kev tshwj xeeb.Kev ua ntawm sulfonylurea derivatives yog txhim kho los ntawm loj dua ntawm sulfanilamides, thiab qee qhov lawv nce qib ntawm dawb butamide, tej zaum yog los ntawm kev sib tw rau kev sib txuas lus nrog plasma protein.

Monoamine oxidase inhibitors potentiate cuam tshuam ntawm cov tshuaj hypoglycemic, thiab tejzaum insulin. Lawv tuaj yeem txo qhov qab los noj mov, yog li hloov qhov xav tau ntawm insulin. Nws kuj tseem muaj kev cuam tshuam nrog kev sib xyaw nrog kev noj tshuaj ntshav nrog kev txhim kho hypoglycemia, nrog anticoagulants yog qhov txiaj ntsig ntawm kev sib tw rau daim siab enzymes, thiab lwm yam.

Inducers ntawm hepatic microsomal enzymes tuaj yeem nrawm cov metabolism ntawm sulfonylurea derivatives metabolized hauv lub siab, piv txwv, butamide. Lawv txoj kev khiav tawm ntawm kev sib txuas lus nrog plasma protein tshwm sim nrog kev kho mob nrog clofibrate, qee qhov tsis yog tshuaj steroidal anti-inflammatory tshuaj thiab sulfonamides.

Cov koob tshuaj loj ntawm acetylsalicylic acid muaj qhov teebmeem hypoglycemic. Tag nrho cov qauv no qhia tias qhov ntxim nyiam ntawm kev sib txuam yeeb tshuaj hauv kev kho cov neeg mob ntshav qab zib yog qhov pom tseeb.

Pharmacokinetics ntawm cov tshuaj rau ntshav qab zib

Kab mob hauv lub raum ua rau mob ntshav qab zib nrog rau kev hloov pauv hauv feem ntau ntawm cov tshuaj. Kev nqus Penicillin thaum lub sijhawm tswj hwm intramuscular yog qeeb qeeb rau cov neeg mob laus uas mob ntshav qab zib mellitus dua li ntawm cov neeg hauv pawg tswj hwm.

Qhov no ua rau txo qis hauv qhov theem siab tshaj plaws ntawm cov tshuaj hauv ntshav. Qhov ua kom tsawg dua ntawm kev nqus yog tej zaum vim muaj tus kab mob ntshav qab zib mob ntshav qab zib. Cov kev hloov zoo sib xws hauv kev nqus ntawm lwm cov tshuaj kuj tsis cais thiab tuaj yeem tsis muaj qhov tshwm sim tsis tseem ceeb.

Tshuaj muaj ntshav qab zib

Tom qab qhia txog thiazide diuretics rau kev coj ua, nws tau pom tias, nrog kev siv lub sijhawm ntev, lawv exacerbate hyperglycemia hauv cov neeg mob ntshav qab zib mellitus, thiab tom qab ntawd nws tau muab tawm tias kev tso ntshav qabzib yog qhov tsis zoo hauv qee tus neeg noj qab haus huv. Nrog rau kev kho mob ntev, lawv nce tus naj npawb ntawm cov neeg mob uas tsis muaj peev xwm txo cov piam thaj.

Lub tshuab ntawm cov kev ua no tsis tiav tsim. Lawv tawm tswv yim txog qhov ua tau los ntawm kev txuas nrog cov poov tshuaj tsis txaus. Thaum txiav tawm kev kho mob, cov piam thaj rov qab mus rau qhov pib ua ntej, tsuas yog cov neeg mob uas tau nyob hauv lub xeev kev mob ntshav qab zib ua ntej kev kho mob.

Txoj kev pheej hmoo ntawm kev tsim muaj cov ntshav qab zib yuav tsum raug txiav txim siab thaum kho cov neeg mob uas mob sib khuav thiab tsis mob ntshav qis, vim tias qhov kev pheej hmoo ntawm kev tsim tus mob loj thib ob tsis tshua nco qab txo tus nqi ntawm cov nyhuv hypotensive ntawm thiazide diuretics.

Poov tshuaj-sparing diuretics

Txhawm rau tswj cov ntshav khov mus ntev (BP), tshuaj kho ntshav qab zib kom ntshav tau. Lawv raug kho thaum muaj qhov hnyav rau ntawm txoj hlab plawv (CCC) lossis thaum muaj kev ua txhaum ntawm kev ua haujlwm ntawm cov zis ua haujlwm los ntawm lub raum.

Lub hom phiaj kev kho mob tseem ceeb yog ua raws cov txheej txheem ntawm kev txiav txim siab, ntawm qhov kev xaiv ntawm cov tshuaj hauv ib qho kev soj ntsuam cov duab ntawm tus kabmob.

Thaum muaj ntshav qab zib mellitus (DM), lwm yam tshuaj tseem raug kho rau kev kho mob, yog li cov tshuaj kho mob tsuas yog kho los ntawm tus kws kho mob kom ua raws li cov tshuaj hauv daim ntawv. Lawv muaj ntau cov kev mob tshwm sim.

Kev xaiv tshuaj los txo cov ntshav siab hauv cov ntshav qab zib yuav tsum yog raws li cov duab hauv chaw kuaj mob, tus neeg mob lub neej zoo, hnub nyoog thiab hom phiaj ntawm kev siv. Tus kws kho mob txiav txim siab qhov ua rau muaj kev txuam nrog cov kua thiab, ntawm lub hauv paus ntawm no, ib qho tshuaj tua kab mob tso tawm.

Nrog tus mob ntshav qab zib hom 1, ib qho kev tsis ncaj ncees yog muab rau ntawm thiazide pawg tshuaj ntawm cov tshuaj me me. Qee cov tshuaj cuam tshuam rau cov metabolism hauv qab zib, uas yuav tsum tau txiav txim siab thaum haus dej. Kev txo ntshav siab sai yog ua siv cov diuretics.

Cov Hom Tshuaj Diuretics

Txhua tus kab mob yuav tsum tau kho nrog ib hom tshuaj tshwj xeeb uas ua ncaj qha rau tus ua kom muaj tus mob. Diuretic tshuaj muaj cov txheej txheem sib txawv ntawm kev ua. Raws li kev faib tawm no, txhua tus diuretic belongs rau qee pawg:

• cov tshuaj uas cuam tshuam rau kev ua haujlwm ntawm lub raum muaj xws li: "Chlortalidone", "Clopamide", "Cyclomethiazide",
• diuretics uas muaj cov nyhuv osmotic (piv txwv li, "Saib Xyuas"),
• poov tshuaj-sparing diuretics: Veroshpiron.

Tsis tas li, tag nrho cov tshuaj tso tawm tau faib ua pawg raws li kev ua tau zoo ntawm sodium excretion:

• nrog kev ua tau zoo los ntawm 15% thiab ntau dua,
• nrog tus txiaj ntsig nruab nrab ntawm 5-10%,
• qhov ua tau zoo tshem tawm 5% lossis tsawg dua ntawm lub cev.

Txhua lub diuretic nws muaj nws lub hom phiaj tshwj xeeb. Diuretics nrog kev ua tsis tau zoo txhawb lub cev kom sib xyaw nrog lwm cov tshuaj. Hauv kev tshawb fawb, nws pom tias qib siab ntawm cov protein ntau hauv cov zis, qhov siab yuav ua rau nrog tawg.

Diuretic pawg

Diuretics tau muab faib ua pab pawg raws li cov txheej txheem ntawm lawv cov kev coj ua ntawm lub cev:

1. Loopback - zoo tshem tawm cov kua dej ntau dhau hauv lub sijhawm luv. Cov no suav nrog: "Furosemide", "Ethacrylic acid" thiab lwm yam.
2. Thiazide diuretics - feem ntau siv rau cov ntshav qab zib thiab raug suav hais tias yog ib qho ntawm cov tshuaj siv tau zoo tshaj plaws. Sai sai txo qhov siab thiab pab daws o. Cov no suav nrog: "Hypothiazide", "Indapamide", "Dichlothiazide".
3. Osmotic diuretics - tshem cov kua hauv lub sijhawm luv heev. Siv thaum muaj xwm ceev. Kev Txwv tsis pub siv ntev. Cov no suav nrog: Urea, Mannitol, Potassium Acetate.
4. Potassium-sparing diuretics tiv thaiv kev puas tsuaj rau cov ntshav hluav taws xob tshuav nyiaj, pab txhawb rau kev nthuav tawm ntawm cov poov tshuaj thiab sodium los ntawm lub cev. Cov no suav nrog: Triamteren, Spironolactone.

Cov kev mob tshwm sim los ntawm kev siv tshuaj diuretics kho mob ntshav qab zib tau ntev. Yog li, txhawm rau kom siv cov tshuaj kom zoo nrog kev ua haujlwm siab tshaj plaws, tus kws kho mob yuav tsum sau nws tom qab txhua yam kev tshuaj ntsuam thiab kev kuaj mob tau ua tiav.

Ib qho diuretic yog siv dav hauv kev kho mob ntshav qab zib, uas zwm rau ntawm thiazide lossis thiazoid pawg. Diuretics uas yog rau thiazide sawv daws yuav (Dichlothiazide, Poithiazide) thiab raug coj mus rau ntshav siab nrog hom 1 mob ntshav qab zib mellitus ua tau zoo tshaj rau kev txhaj tshuaj me me.

Feem ntau, cov diuretics siv tau nrog rau lwm cov tshuaj.

Ib qho diuretic xws li Hypothiazide feem ntau siv rau hauv txoj kev kho mob ntshav qab zib mellitus thiab ntshav siab. Ib qho ntawm cov cwj pwm tsis zoo yog cov yam ntxwv ntawm cov tshuaj, uas cuam tshuam rau kev sib pauv ntawm cov piam thaj thiab roj cholesterol.

Tshuaj diuretics rau cov ntshav qab zib hom 2 tsis pom zoo nyob rau hauv ntau. Diuretics uas zwm rau hauv thiazide pawg muaj cov khoom ntiag tug uas cuam tshuam nrog cov tshuaj insulin thiab nce qib ntau ntxiv.

Tsis pub siv cov tshuaj diuretic rau cov ntshav qab zib, zwm rau hauv cov potassium-sparing los yog loop pawg, tsis pom zoo. Qhov kev zam yog kev tswj hwm ib-zaug rau kev coj ua haujlwm tam sim thaum muaj xwm ceev.

Diuretics yog qhov ua tau zoo tshaj plaws antihypertensives. Lawv tso dag ntau ntxiv hauv cov zis hauv tib neeg lub cev, uas ua rau cov txheej txheem ua kom lub zog ntxiv mus thiab ua kom lub cev tawm sai dua los ntawm kev muaj teeb meem ntsev thiab dej. Yog li, txoj kev thauj khoom ntawm txoj kev ncig, vasoconstriction thiab txo qis ntawm lub siab tshwm sim.

Diuretics kho mob feem ntau yog nyob rau hauv kev kho mob ntshav siab, tab sis qee zaus lawv kuj tau noj los ntawm cov neeg mob qog mob siab thiab cov neeg muaj kev txom nyem los ntawm o ntawm ob txhais ceg (qhov no yuav yog ib qho ntawm cov tsis qhia ntawm lub plawv tsis ua haujlwm).

Tab sis rau cov neeg muaj ntshav qab zib, cov tshuaj diuretics yuav tsum tau siv nrog kev ceev faj, nyob rau hauv kev saib xyuas nruj ntawm tus kws kho mob, thiab nco ntsoov tias tsis yog txhua tus diuretics zoo rau lawv.

Voj thiab potassium-sparing diuretics yog nyob rau hauv txoj kev tsis haum rau kev kho mob tag nrho ntawm kev mob ntshav qab zib mellitus, tab sis lawv tuaj yeem siv ib zaug, rau kev kho mob sai sai ntawm qhov mob.

Qhov nrov tshaj plaws hauv kev kho mob ntshav siab hauv ntshav qab zib niaj hnub no yog thiazide thiab thiazide-li diuretics. Thiazide diuretics, xws li dichlothiazide thiab poithiazide, yog siv rau hauv qhov ntau tsawg hauv kev kho mob ntshav siab hauv hom II mob ntshav qab zib mellitus.

Qhov tseeb yog tias lawv txo qhov rhiab ntawm cov hlwb rau insulin. Feem ntau qhov no tshwm sim tsuas yog nrog lub caij nyoog thiab siv cov tshuaj, tab sis qee zaum qhov no tshwm sim ua ntej, nyob rau hauv daim ntawv ntawm qhov tshwm sim.

Cov tshuaj kho ntshav qab zib rau cov ntshav qab zib mellitus tsuas yog kho mob txhawm rau txhawm rau txhawm rau txhawm rau, txo kev o thiab kho lub plawv tsis ua haujlwm. Nws yuav tsum tau yug hauv siab tias tsis yog txhua txoj kev kho mob ntshav qab zib rau cov ntshav qab zib siv tau, uas txhais tau tias kev siv tshuaj kho tus kheej lossis kev teem caij kho tshuaj, tsis suav nrog qhov mob hnyav no, yuav ua rau muaj kev cuam tshuam rau lub cev.

Txog kev kho mob ntawm cov neeg mob feem ntau uas tau mob tawm los ntawm txoj hlab ntshav ntev ntev, thiazide diuretics siv, qhov nqus ntawm qhov ntawd ua rau kom muaj zog ntawm sodium los ntawm lub cev. Nyob rau tib lub sijhawm, lawv txo qis rhiab heev ntawm cov cell mus rau insulin, uas txhais tau tias cov ntshav ntawm triglycerides, piam thaj thiab roj cholesterol yuav nce, uas yuav ua rau qee qhov kev txwv ntawm kev siv cov diuretics rau cov ntshav qab zib hom 2.

Txawm li cas los xij, cov kev tshawb fawb tsis ntev los no ntawm kev siv cov tshuaj diuretics hauv ntshav qab zib mellitus tau tsim tias cov kev tsis zoo no feem ntau pom nrog kev siv tshuaj ntau. Thaum qis - cov kev mob tshwm sim yuav luag tsis pom.

Tsis tas li ntawd, cov neeg mob uas muaj ntshav qab zib hom 2, thaum noj thiazide diuretics, raug pom zoo kom noj cov txiv hmab txiv ntoo thiab zaub tshiab kom ntau, uas yuav tsum tau them nyiaj rau qhov ua kom poob ntawm magnesium, sodium thiab potassium.

Txoj kev pheej hmoo ntawm kev txo qis rhiab ntawm cov hlwb rau insulin yuav tsum tau coj mus rau hauv tus lej. Thaum kho ntshav siab, nws yog ib qho tsim nyog los tswj cov qib ntawm cov piam thaj hauv cov ntshav ntau dua thiab, yog tias tsim nyog, ua kom nws cov khoom noj ntau ntxiv.

Ntsaim Vaj

Daim ntawv txhaj tshuaj ntawm diuretics feem ntau muaj nyob rau hauv cov mob loj, thaum nws yog qhov tsim nyog tias cov txiaj ntsig zoo tshwm sim sai li sai tau lossis thaum tus neeg mob tsis tuaj yeem noj cov tshuaj ntsiav tshuaj. Cov tshuaj ntawm kev xaiv yog:

1. Cov tshuaj tiv thaiv bufenox yog siv rau kev tso tshuaj thiab tshuaj intramuscular. Cov koob tshuaj tuaj yeem yog li 0.1 txog 1.5 mg, qhov kev txhaj tshuaj tom ntej tuaj yeem ua tau, saib xyuas qhov sib cuam tshuam ntawm 4-6 teev. Txoj kev kho kom zoo yuav tsum nyob ntev li ntawm peb mus rau plaub hnub.
2. Ethacrylic kua qaub. Daim ntawv txhaj tshuaj yog npaj rau cov tshuaj txhaj, cov koob tshuaj yog 50 mg. Qhov pib ntawm kev kho mob nyhuv tuaj yeem xav pom tom qab 30 feeb, nws kav mus rau 8 teev.
3. Furosemide. Txoj kev daws teeb meem tuaj yeem siv rau ob qho tib si ntawm intramuscular thiab kev tso ntshav tshuaj, nrog ib koob li ntawm 20 txog 40 mg. Cov nyhuv tshwm sim hauv ob peb feeb thiab kav rau 8 teev.
4. Xas Las. Nws muab xeem rau leeg lossis intramuscularly. Nrog rau kev nce ntxiv hauv cov ntshav siab, cov tshuaj tuaj yeem noj ob zaug ib hnub.

Raws li rau qhov tsis zoo ntawm kev txhaj tshuaj ntawm cov pab pawg no, lawv suav hais tias yog qhov kev xav hnov ​​mob uas tshwm sim nrog kev qhia ntawm cov tshuaj thiab qhov ua tsis tau ntawm kev tswj hwm tus kheej.

Thov nco ntsoov tias hom tshuaj thiab nws cov koob tshuaj yuav tsum yog kws kho mob tau hais tseg tsuas yog tus kws kho mob, coj mus rau hauv tus account tus yam ntxwv ntawm tus neeg mob, hom thiab qhov mob ntawm chav kawm ntawm tus kab mob.

Lub voj voos uas siv tau ntev tshaj plaws yog torsemide - 2 lub sijhawm ntev dua li ntawm furosemide (yog li ntawd, nws yog qhov zoo tshaj plaws ntawm pab pawg ntawm lub voj diuretics rau kho kho kub siab).

Lub zog diuretic muaj zog tau piav qhia los ntawm qhov tseeb tias nws yog nyob rau hauv ntu ntawm ntu ntawm Henle lub voj voos uas feem ntau ntawm cov sodium, thiab yog li ntawd cov dej, rov kho dua. Voj diuretics los ntawm kev ua kom nquag plias nkag mus rau lumen ntawm qhov sib thooj tubule thiab sib tw nrog uric acid rau kev nthuav tawm, uas ua rau nws qeeb thiab hypercuricemia.

Voj diuretics muaj cov nyhuv theem nrab. Qhov kev cuam tshuam thib ob ntawm pawg tshuaj no yog qhov nce ntxiv ntawm kev tsim cov tshuaj prostaglandins, uas ua rau cov vasodilation thiab txhim kho cov ntshav mus rau lub raum.

• dyslipidemia,
• kom cov ntshiab si muaj tswv yim ntau ntxiv,
• ua kom nrov nrov,
• ua pob.

Ototoxicity (pob ntseg puas) yog qhov mob tab sis tsis tshua muaj kev cuam tshuam ntawm lub voj diuretics. Tinnitus thiab kiv taub hau tej zaum yuav tshwm sim, tab sis nyob rau hauv cov mob loj heev nws tseem tuaj yeem ua rau lag ntseg.

Txij li thaum lub voj diuretics xws li furosemide, torasemide thiab bumetanide yog cov tshuaj loog uas muaj cov thev naus laus zis (saib cov duab hauv cov qauv tshuaj ntawm lub voj diuretics rau ib qho duab), muaj qhov kev pheej hmoo uas cov neeg mob nkag mus rau sulfanilamides yuav rhiab rau cov diuretics.

Qhov kev pheej hmoo no yog qhia ntawm cov tshuaj pob. Txawm li cas los xij, qhov tseeb, qhov kev pheej hmoo ntawm cov kev ua tsis taus zoo tsis muaj leej twg paub, thiab muaj qee qhov chaw uas muaj kev tsis sib haum xeeb ntawm qhov kev hla ntawd.

Ib txoj kev tshawb nrhiav tau pom tias tsuas yog 10% ntawm cov neeg mob ua xua rau cov tshuaj sulfonamide yog cov tshuaj tiv thaiv khaub thuas rau cov diuretics. Txawm li cas los xij, nws tseem tsis tau paub meej tias qhov no yog qhov tseeb ntawm kev sib thim tshuaj tiv thaiv lossis seb qhov xwm txheej ntawm qhov kev xav no txawv li cas.

Ethacrylic acid yog cov tshuaj nkaus xwb hauv cov hoob kawm ntawm diuretics uas tsis yog sulfanilamide. Txawm li cas los xij, nws muaj cov lus tshaj tawm uas cuam tshuam nrog kev phiv tshuaj rau ntawm lub plab zom mov.

Ntxig diuretics thaum ua ke nrog aminoglycoside cov tshuaj tua kab mob ua rau muaj kev pheej hmoo ntawm ototoxicity loj (tsis hnov ​​lus tsis zoo), anticoagulants nce kev pheej hmoo ntawm los ntshav, mob glycosides nce kev pheej hmoo ntawm arrhythmias,

tshuaj tiv thaiv kab mob ntshav los ntawm pab pawg ntawm sulfonylurea derivatives - ua kom qhov kev pheej hmoo ntawm ntshav qog, NSAIDs - txo cov nyhuv ntawm tom kawg. Voj diuretics nce cov nyhuv ntawm propranolol thiab lithium npaj.

Sib txuas ua ke

Kev tso tshuaj tso zis ib txhij muaj cov nyhuv diuretic thiab txo qis ntshav siab. Qhov tseem ceeb ntawm cov tshuaj no yog tias cov nyhuv tshwm sim 1-3 teev tom qab kev tswj hwm thiab kav ntev li ntawm 6 txog 9 teev.

Cov tshuaj lom ua ke ua nto moo tshaj plaws muaj xws li: "Amirtid Mite", "Triamtezid", "Diazide", "Isobar". Siv rau toxicosis thaum cev xeeb tub, ntshav siab thiab mob plawv tsis ua haujlwm ntev.

Pab pawg me no tuaj yeem txiav txim siab txog piv txwv ntawm Apo-Triazide. Cov tshuaj no muaj cov thiazide diuretic - hydrochlorothiazide thiab cov potassium-sparing diuretic - triampteren. Ua tsaug rau qhov kev sib xyaw ua ke no, cov nyhuv diuretic uas muaj zog tau tiav thiab tsis tas yuav muaj cov tshuaj potassium ntxiv.

Hom tshuaj sib xyaw feem ntau ua ke ob lossis ntau cov tshuaj yeeb dej caw kom ob leeg txhawm rau txhim kho qhov ua tau zoo ntawm ib leeg, thaum txo cov kev mob tshwm sim.Piv txwv li, cov tshuaj Apo-Azid muaj ob qho khoom xyaw nquag - potassium-sparing triampteren (txhawm rau kom tsis muaj qhov ploj ntawm cov kab mob no) thiab thiazide diuretic hydrochlorothiazide (kom muaj txiaj ntsig zoo ntawm kev kho).

Diuretics siv dav hauv kev kho mob ntshav siab los ntawm kev txo qis ntawm cov dej hauv lub cev hauv cov hlab ntsha. Kev faib tawm ntawm cov diuretics xav txog cov tshuaj uas sib txawv hauv cov muaj pes tsawg leeg, txoj ntsiab cai ntawm kev ua thiab cov khoom.

Nws tsis pom zoo kom coj lawv yam tsis muaj kws kho mob sau, vim tias qhov no tuaj yeem ua rau muaj kev phom sij. Qhov kev xaiv ntawm diuretic yog txiav txim siab los ntawm cov xwm txheej tam sim no ntawm tus neeg mob thiab nws lub siab rau ib qho zuj zus ntawm cov tshuaj. Thiazide diuretics yog tshwj xeeb tshaj yog.

Lub ntsws diuretics

Lub teeb diuretics tau siv dav hauv kev kho mob rau cov poj niam thiab cov kws kho mob hauv kev tiv thaiv kev tawm tsam ntawm tes thiab taw hauv cov poj niam cev xeeb tub, nrog qhov ib txwm ua rau ntshav nce siab me ntsis hauv cov menyuam yaus thiab hauv kev kho mob ntawm cov neeg laus. Hauv thawj kis, ua cov diuretic muag, tshuaj osmotic tuaj yeem siv, vim tias lawv cov nyhuv tseem ceeb yog tsom tshwj xeeb ntawm kev tshem tawm cov kua dej los ntawm cov nqaij mos edematous. Cov menyuam yaus thiab cov neeg laus feem ntau kho cov tshuaj potassium-sparing diuretics ua cov tsis muaj zog diuretic, uas feem ntau muaj txaus thaum nws tsim nyog txhawm rau txo cov ntshav siab ntawm cov menyuam los ntawm 10-20 hli. Hauv cov neeg laus, vim muaj kev hloov pauv hauv cov txheej txheem ntawm cov txheej txheem biochemical, uas nyob rau hauv txhua txoj kev cuam tshuam nrog cov tshuaj tiv thaiv kab mob me, lawv muaj peev xwm muab cov txiaj ntsig siab tshaj plaws.

Nws yuav tsum raug sau tseg tias nws yog qhov zoo dua los muab qhov kev nyiam rau cov tshuaj uas poob rau qhov kev faib tawm "ntsws" thiab tsis muaj kev phiv ntau ntawm cov phiaj xwm hormonal, uas yog tshwj xeeb tshaj yog thaum nws hais txog cov menyuam yaus thiab cov poj niam cev xeeb tub. Tsis tas li, ntau yam infusions ntawm tshuaj ntsuab tuaj yeem raug ntaus nqi rau lub teeb diuretics.

Lub zog tshuaj

Tsis zoo li lub teeb diuretics, uas nyob rau hauv pej xeem cov tshuaj nyob rau hauv daim ntawv ntawm infusions los ntawm ntau yam tshuaj ntsuab tau siv ntev, muaj zog diuretic hluav taws xob cov tshuaj tau tsim muaj tsis ntev los no, tab sis tau dhau los ua dav hauv kev kho mob ntawm ntau yam kab mob.

Txog rau tam sim no, cov diuretics haib tshaj yog cov tshuaj:

Lasix tuaj yeem siv tau rau niam txiv thiab hais tawm. Qhov tsis muaj tseeb qhov ua tau zoo ntawm qhov cuab yeej no yog qhov pib nrawm ntawm qhov muaj txiaj ntsig zoo tom qab nws siv. Piv txwv, yog tias Lasix tau noj ntawm qhov ncauj, ces kev txhim kho yuav tshwm sim hauv ib teev, thiab nrog kev tswj hwm hauv tsoomfwv tsis dhau ob peb feeb. Nyob rau tib lub sijhawm, lub sijhawm ntawm kev ua ntawm no diuretic thaum coj qhov ncauj mus txog 8 teev, thiab nrog kev tswj hwm mob ntshav - tsuas yog peb.

Cov nyhuv diuretic ntawm lwm cov tshuaj uas muaj zog diuretic - Spironolactone, siv rau edema ntawm ntau lub hauv paus, suav nrog lub siab edema, feem ntau tshwm sim rau hnub 3 ntawm kev noj tshuaj. Txawm li cas los xij, lub sijhawm no tuaj yeem txo qis los ntawm kev sau ntawv ntawm Flurosemide lossis Hypothiazide nrog Spironolactone.

Lure muaj nyob rau hauv daim ntawv ntawm cov hmoov qhuav thiab suav hais tias yog ib qho tseem ceeb tshaj plaws siv hauv edema ntawm lub hlwb, ntsws, lub siab thiab lom nrog barbiturates.

Sib txuas ua ke

Cov kev npaj ua ke ntawm diuretics muaj xws li:

1. Vero-Triamtezid,
2. Diazide
3. Diursan
4. Diursan Mite
5. Isobar
6. Lazilactone
7. Qauv Zog
8. Thialoride
9. Triam Co
10. Triampur pawg,
11. Triamtezid,
12. Triamtel
13. Furesis puas,
14. Furo Aldopur
15. Lub Ecodurex
16. Aldactone Saltucin,
17. Amyloside
18. Amyloretic,
19. Amiloride + Hydrochlorothiazide,
20. Amitrid,
21. Amitrid Mite
22. Apo triazide.

Tag nrho cov tshuaj sib txuam no muaj ob qho kev tiv thaiv hypotensive thiab diuretic zoo.Qhov zoo ntawm cov tshuaj sib xyaw ua ke yog qhov ceev ntawm qhov pib ntawm qhov hloov pauv zoo tom qab noj lawv (ntawm 1 mus rau 3 teev) thiab tswj kev ua tiav rau 7 txog 9 teev.

Cov tshuaj kho ua ke yog siv rau cov mob txha caj qaum tsis txaus, mob toxicosis nyob rau lub lim tiam dhau los ntawm kev xeeb tub, kab mob siab, mob nephrotic, lub plawv tsis ua hauj lwm zoo, ntxiv rau kev mob ntshav txhaws.

Calcium-dawb diuretic

Kev noj ntshav dawb tsis muaj cov tshuaj diuretics yog muab rau cov neeg mob uas muaj ntshav siab ua ke nrog txha. Qhov no yog qhov kev ntsuas tsim nyog los tiv thaiv kev nce qib ntawm pob txha qog ntshav hauv cov neeg mob, thiab vim li ntawd, qhov tshwm sim ntawm cov pob txha tawg tshiab. Voj thiab potassium-sparing diuretics yaug calcium, thaum thiazide diuretics, ntawm qhov tsis sib xws, txo qis kev nthuav tawm ntawm calcium ions nyob hauv cov zis. Yog vim li cas thiaj tsuas thiazide-zoo li thiab thiazide diuretics raug kho rau cov neeg mob txha txha. Txawm li cas los xij, calcium-txuag diuretics yog qhov tsim nyog tsis yog rau cov tib neeg uas muaj kab mob pob txha, tab sis kuj tseem rau lwm tus neeg muaj kev pheej hmoo loj ntawm kev txhim kho ORA kev raug mob, piv txwv li, cov laus neeg. Cov kev tshawb fawb pom tau tias cov neeg noj thiazide-zoo li diuretics rau kev kho tus mob ntshav qab zib tsis tshua muaj kev puas siab ntsws dua li cov uas tau kho lwm yam tshuaj diuretics.

Tab sis, txawm hais tias piav txog qhov zoo ntawm diuretic, calcium-khaws cia, lawv tuaj yeem ua nyob rau qee pab pawg ntawm cov neeg mob, vim tias lawv qhov kev sib koom ua ke tau muaj kev cuam tshuam ntau ntxiv ntawm cov magnesium thiab potassium los ntawm lub cev, uas txhais tau tias cov neeg mob hyperuricemia, gout, hypokalemia thiab lwm tus tsis tuaj yeem raug tshuaj.

Antihypertensive diuretics

Ib qho lus qhia zoo tshaj plaws hauv kev kho mob siab siab hauv cov neeg mob yog kev siv tshuaj tua kab mob hyotensive. Thiab qhov taw tes tsis yog tsuas yog tias yuav luag txhua tus tshuaj diuretics tuaj yeem txo qhov siab, qee qhov tsis ua qis dua rau kev ua tau zoo rau cov tshuaj tshwj xeeb tshaj tawm rau kev kho mob ntawm cov mob ntshav siab, tab sis kuj hais tias kev kho mob nrog antihypertensive diuretics piv, piv txwv li, nrog b blockers. , nws yuav raug nqi rau tus neeg mob 9-15 zaug pheej yig dua, uas yog qhov tseem ceeb, muab qhov tseeb hais tias ib pawg ntawm cov tib neeg muaj kev txom nyem los ntawm kev mob ntshav siab yog cov neeg laus nyiaj laus, uas nws muaj nyiaj txiag feem ntau tsis tso cai rau lawv them tus nqi kim. Flax kev kho mob.

Thaum noj cov tshuaj diuretics, cov kev ua haujlwm hypotensive tau ua tiav vim qhov tseeb tias thaum pib theem ntawm kev kho mob muaj qhov kev txo qis ntawm cov ntshav ncig thiab mob tawm tswv yim (cov khoom ntawm sodium chloride yog depleted), thiab txawm tias tom qab ob peb lub hlis cov ntshav khiav tau zoo, cov hlab ntshav los ntawm lub sijhawm no txo ​​qis kev cuam tshuam, thiaj li pab txhawb nqa. antihypertensive nyhuv ua tiav thaum kho.

Cov ntaub ntawv txaus siab ntawm cov ncauj lus no!

Diuretics yog tshuaj uas tsim cov tshuaj diuretic. Cov tshuaj uas nrov tshaj plaws thiab feem ntau siv yog ob pawg diuretic - thiazide thiab thiazide-li diuretics. Thaj teb ntawm kev thov cov tshuaj no feem ntau txwv rau cov kab mob ntawm lub raum thiab mob txeeb zig, tab sis lawv kuj tau siv los kho cov kua qaub-puag thiab cov dej-electrolyte sib npaug. Xyoo tsis ntev los no, lawv tau pom lawv daim ntawv thov hauv kev kho plawv nrog lub hom phiaj txo qis ntshav siab thiab txo cov thauj ntawm lub plawv.

Tus txheej txheem ntawm kev nqis tes ua, kev taw qhia rau kev siv ntawm thiazide diuretics.

Feem ntau, cov tshuaj ntawm cov pab pawg no yog siv los kho cov kab mob pathology ntawm lub chaw tso zis thiab zis. Cov tshuaj no ua nrog quab yuam nruab nrab, cov nyhuv tshwm sim nws tus kheej tom qab ib mus rau peb teev, thiab lub sijhawm ncua ntev li ib nrab ntawm ib hnub.Lub tshuab ntawm kev ua yog kev txwv tsis pub rov qab thim rov qab ntawm sodium thiab dej hauv qhov ze ntawm lub raum plab, vim tias lawv tau tawm hauv cov zis ntawm qhov nrawm nrawm. Tsis tas li ntawd, thiazide diuretics txo qhov kev pom zoo ntawm calcium, ntxiv rau tus nqi thiab kev siv ntau ntawm kev tsim cov uric acid hauv lub raum.

Hom diuretics zoo qhia rau cov kab hauv qab no:

• edematous mob siab
• arterial hypertension, uas tsis yog tso tseg los ntawm txoj kev pom zoo, txo cov nuj nqis siab,
• mob plawv thiab mob plawv tsis ua hauj lwm.

Cov tshuaj tseem ceeb ntawm cov pab pawg no suav tias yog chlortiazide thiab hydrochlorothiazide, qhov pib ntawm qhov kev ua tau zoo uas tshwm sim hauv thawj teev, thiab lawv cov nyhuv kav txog 12-13 teev.

Sab nraud thiab contraindications.

Cov kev mob tshwm sim muaj xws li qee qhov kev cuam tshuam ntawm cov metabolism hauv lub cev, nrog rau cov kev hloov pauv hauv cov metabolism hauv cov hauv paus ntsiab lus thiab cov vitamins. Tsis tas li, hypokalemia (ib qho kev txo qis hauv kev suav ntawm cov poov tshuaj hauv cov ntshav) qee zaum pom los ntawm kev mob tshwm sim, thaum cov tshuaj tsis cuam tshuam mus ib ntus thiab cov tshuaj muaj cov ntsiab lus tseem ceeb ntawm cov kab kawm no (panangin, asparkum) tau raug xaj. Koj tseem tuaj yeem sau cia ib qho kev txo qis ntawm cov sodium hauv plasma ntau ntxiv, nrog rau kev nce ntxiv ntawm cov concentration ntawm uric acid. Qhov kawg, nyeg, ua rau mob caj dab ntawm cov pob qij txha, thiab tseem cuam tshuam rau lub raum parenchyma. Tom qab nres kev siv cov tshuaj no, tag nrho lub cev ua haujlwm li qub.

Yog tias cov neeg mob nrog rau cov tshuaj diuretics noj beta-blockers, tom qab ntawd lwm cov txiaj ntsig tuaj yeem yuav yog cov metabolism hauv cov piam thaj.

Ntawm lub contraindications, hauv qab no yuav tsum tau sau tseg:

• inflammatory sib koom tes kab mob
• glomerular pom kev sib txawv hauv ob lub raum,
• qhov txo qis hauv cov qib ntawm cov potassium thiab sodium hauv cov ntshav ntshav,
• cev xeeb tub thiab lub sijhawm pub mis niam,
• kev tsis haum tshuaj lossis qhov tsis haum rau ib qho twg ntawm cov tshuaj.

Niaj hnub no, ib lub tsev muag tshuaj twg muaj cov tshuaj tiav ntawm cov tshuaj no, uas koj tuaj yeem yuav nqi tsawg me ntsis yam tsis muaj kws kho mob sau ntawv. Txawm li cas los xij, nws yog ib qho tseem ceeb heev uas kev teem sijhawm ntawm cov tshuaj mob hnyav no yog kws kho mob tsim nyog sau tseg, qhia tias muaj pes tsawg, tsawg zaus thiab lub sijhawm siv. Tom ntej no, peb yuav qhia koj luv luv txog cov tshuaj tseem ceeb los ntawm pab pawg no.

Txog hnub tim, thiazide diuretics suav nrog hydrochlorothiazide, indapamide, chlortalidone, thiab clopamide. Peb yuav qhia koj txog thawj ob qho hauv ntau qhov hauv qab.

Cov kws kho mob sau ntawv rau cov tshuaj no rau cov neeg mob edema thiab kub siab, yog tias lawv tsis yog cov pab pawg ntawm cov poj niam cev xeeb tub, cov niam laus, thiab cov laus. Nws nquag siv rau hauv cov neeg mob plawv thiab lub siab tsis ua haujlwm, nrog rau cov kab mob ua ntej rau urolithiasis. Nrog rau kev kub siab, qhov kev noj tshuaj txhua hnub feem ntau yog 1 ntsiav tshuaj, nrog rau qhov mob hnyav dhau los, txoj kev noj tshuaj no tuaj yeem ncav cuag plaub ntsiav tshuaj ib hnub. Ntawm cov kev mob tshwm sim, xeev siab, ntuav, arrhythmia, kev ua si convulsive, kev ua xua tuaj yeem ua qhov txawv txav, tab sis nws yuav tsum tau hais tias lawv muaj tsawg, tsis tshua muaj. Thaum lub sijhawm noj cov tshuaj no, nws raug nquahu kom tsawg dua nyob rau hauv tshav ntuj ncaj qha, vim tias cov tshuaj ua rau muaj kev cuam tshuam ntau dua ntawm tib neeg daim tawv nqaij mus rau ultraviolet hluav taws xob.

Cov tshuaj no yog siv rau kub siab. Nws yog qaug cawv thaum sawv ntxov ib hnub. Cov kev mob tshwm sim suav nrog kev ua kom tsis muaj zog, nkees, mob taub hau, muaj kev nyuaj siab, mob plab. Tsis txhob coj mus ua niam. Nyob rau hauv cov ntaub ntawv ntawm kev haus ntau dhau ntawm cov tshuaj, xeev siab, ntuav, kiv taub hau, thiab txawm tias tsis hnov ​​qab lub cev yuav tshwm sim. Hauv qhov no, koj yuav tsum hu rau lub tsheb thauj neeg mob thiab tib lub sijhawm haus dej kom hluav ncaig thiab sim yaug koj lub plab.

Diuretics, los yog diuretics, yog ib pawg loj heev ntawm cov tshuaj uas txo cov kua dej hauv cov kab noj hniav hauv lub cev thiab cov ntaub so ntswg los ntawm kev nthuav tawm cov zis ntawm lub cev tawm ntawm lub cev. Kev npaj ntawm pawg no tau siv dav hauv kev kho mob ntawm ntau yam kabmob, thiab tus naj npawb ntawm lawv cov ntau yam nce txhua xyoo.

Kev faib tawm tshuaj

Muaj ntau ntau hom kev faib tawm ntawm cov tshuaj diuretic. Tej zaum qhov tseeb ntawm lawv yog kev tso tawm thoob ntiaj teb ntawm diuretics los ntawm kev txiav txim ntawm kev ua haujlwm :

• thiazide diuretics,
• non-thiazide diuretics uas cuam tshuam rau ntu cortical ntawm Heine voj,
• poov tshuaj-sparing diuretics,
• voj diuretics
• kev sib xyaw ntawm diuretic thiab potassium-sparing cov neeg sawv cev.

Tseem muaj kev faib tawm ntawm diuretics nyob ntawm seb tus nqi ntawm qhov tshwm sim ntawm cov nyhuv, nyob ntawm lub sijhawm ntawm kev txiav txim thiab ntawm nws lub zog, ntawm tshuaj lom neeg sib xyaw, thiab lwm yam.

Tsis-thiazide diuretics

Pab pawg me no tseem hu ua thiazide-zoo li diuretics. Nws cov sawv cev nto moo tshaj plaws yog indapamide. Nws muaj tib yam li thiazide diuretics, thiab siv los kho kev mob ntshav siab. Hauv cov khw muag tshuaj, indapamide tuaj yeem pom hauv qab cov npe Indap, Indopres, Acripamide, Retapres, Arifon, Pamid, Arindap.

Ntxiv rau indapamide, chlortalidone (Oxodoline) kuj tseem siv rau ntawm no.