Mankhwala a diuretic amakhudza ntchito ya impso ndikuthandizira njira ya mkodzo.
Limagwirira ntchito zochita ambiri okodzetsa, makamaka ngati potaziyamu wothandiza kukodzetsa, zimatengera luso lotha kubwezeretsa mayiyo mu impso, makamaka mu aimpso tubules, ma elekitiroma.
Kuwonjezeka kwa kuchuluka kwa ma electrolyte otulutsidwa kumachitika nthawi yomweyo ndi kutulutsidwa kwa voliyumu ina yamadzi.
Diuretic yoyamba idawoneka m'zaka za zana la 19, pamene mankhwala a zebury amapezeka, omwe amagwiritsidwa ntchito kwambiri pochiza syphilis. Koma pokhudzana ndi matendawa, mankhwalawa sanali ogwira ntchito, koma mphamvu yake yokhudza kukodzetsa thupi anazindikira.
Pambuyo kanthawi, kukonzekera kwa mercury kunasinthidwa ndi mankhwala oopsa.
Posachedwa, kusinthidwa kwa kapangidwe ka diuretics kunapangitsa kuti pakhale mankhwala amphamvu kwambiri a diuretic, omwe ali ndi gulu lawo.
Kodi okodzetsa ndi chiyani?
Mankhwala a diuretic nthawi zambiri amagwiritsidwa ntchito ku:
- ndi kulephera kwa mtima;
- ndi edema;
- perekani mkodzo popewa vuto laimpso;
- kuchepetsa kuthamanga kwa magazi;
- ndi poizoni, chotsani poizoni.
Tiyenera kudziwa kuti okodzetsa matenda oopsa komanso kulephera kwa mtima ndi omwe amapanga bwino kwambiri.Kukwezeka kwambiri kungakhale chifukwa cha matenda osiyanasiyana amtima, matenda a kwamikodzo ndi mtima. Matendawa amaphatikizidwa ndi kuchepa kwa mchere wa thupi. Mankhwala a diuretic amachotsa kudziunjikira kwambiri kwa zinthu motero amachepetsa kutupa.
Ndi kuthamanga kwa magazi, sodium yochulukirapo imakhudza kamvekedwe ka minofu ya mitsempha yamagazi, yomwe imayamba kuchepa komanso mgwirizano. Mankhwala a diuretic omwe amagwiritsidwa ntchito ngati antihypertensives amatsuka sodium kunja kwa thupi ndikulimbikitsa vasodilation, omwe amachepetsa kuthamanga kwa magazi.
Pochita poizoni, zina mwa ziphezizi zimapukusidwa ndi impso. Kupititsa patsogolo njirayi, ma diuretics amagwiritsidwanso ntchito. Muzipatala, njira iyi imatchedwa "kukakamiza diuresis."
Choyamba, njira zambiri zothetsera zimaperekedwa kwa odwala mothandizidwa ndi odwala, pambuyo pake zimagwiritsidwa ntchito kwambiri, zomwe nthawi yomweyo zimachotsa madzimadzi m'thupi, komanso, ndi poizoni.
Ma diuretics ndi gulu lawo
Matenda osiyanasiyana othandizira okodzetsa amaperekedwa, okhala ndi makina osiyana ochitira.
Gulu:
- Mankhwala osokoneza bongo omwe amakhudza kugwira ntchito kwa renal tubule epithelium, mndandanda: Triamteren Amiloride, Ethacosterone acid, Torasemide, Bumetamide, Flurosemide, Indapamide, Clopamide, Metolazone, Chlortalidone, Methclothiazide, Bendroflumethiozide, Hydroclazolezid.
- Osmotic diuretics: Monitol.
- Potaziyamu yosawononga diuretics: Veroshpiron (Spironolactone) amatanthauza okangana ndi a mineralocorticoid receptors.
Gulu la okodzetsa mwa kugwiritsa ntchito bwino kwa sodium kuchokera mthupi:
- Zosagwira - chotsani 5% sodium.
- Kuchita kwapakatikati - sodium 10% imachotsedwa.
- Yothandiza kwambiri - chotsani sodium yoposa 15%.
Limagwirira a zochita za okodzetsa
Makina a zochita zama diuretics amatha kuphunziridwa ndi chitsanzo cha zotsatira zawo zamankhwala. Mwachitsanzo, kuchepa kwa kuthamanga kwa magazi chifukwa cha machitidwe awiri:
- Anachepetsa mphamvu ya sodium.
- Zokhudza mphamvu ya mtsempha wamagazi.
Chifukwa chake, matenda oopsa oopsa amatha kuimitsidwa ndi kuchepa kwa magazi ndi kukonzanso kwakutalika kwa kamvekedwe ka mtima.
Kutsika kwa kuchepa kwa okosijeni m'matumbo a mtima mukamagwiritsa ntchito okodzetsa kumalumikizidwa ndi:
- ndi nkhawa yopumira ma cell myocardial;
- ndi kusintha kwakachulukidwe ka impso;
- ndi kuchepa kwa zomatira zophatikizika;
- ndi kuchepa kwa katundu kumanzere kwamitseko yamanzere.
Ma diuretics ena, mwachitsanzo, Mannitol, samangowonjezera kuchuluka kwamadzi am'mimba nthawi ya edema, komanso amatha kuwonjezera kukakamiza kwa osmolar kuthamanga kwamadzimadzi.
Ma diuretics, chifukwa cha zomwe ali, amatha kupumula minofu yosalala ya mitsempha, bronchi, ndi ma ducts a bile, ali ndi mphamvu ya antispasmodic.
Zisonyezero zoika ma diuretics
Zizindikiro zoyambira kuperekera okodzetsa ndi matenda oopsa, makamaka zonsezi zimagwira ntchito kwa okalamba. Mankhwala a diuretic amaperekedwa kuti asungidwe sodium. Izi ndi monga ascites, aimpso aakulu ndi kulephera kwa mtima.
Ndi mafupa, wodwala amamuika thiazide diuretics. Mankhwala osokoneza bongo a Potaziyamu amawonetsedwa pobadwa nako Liddle syndrome (kuchotsedwa kwa potaziyamu yambiri komanso positi wa sodium).
Loop okodzetsa zimakhudzanso aimpso ntchito, zotchulidwa kuti intraocular anzawo, glaucoma, mtima edema, matenda enaake.
Zochizira komanso kupewa matenda oopsa oopsa, madokotala amatenga mankhwala a thiazide, omwe muyezo waukulu umathandiza odwala omwe ali ndi matenda oopsa. Zatsimikizika kuti thiazide diuretics mu prophylactic Mlingo imachepetsa chiopsezo cha stroke.
Kutenga mankhwalawa muyezo waukulu osavomerezeka, imakhala yofala ndi kukula kwa hypokalemia.
Pofuna kupewa izi, thiazide diuretics imatha kuphatikizidwa ndi potaziyamu yosasamala okodzetsa.
Mankhwalawa okodzetsa, mankhwala othandizira komanso othandizira amadziwika. Mu yogwira gawo, Mlingo wamphamvu wokhala ndi ma diuretics (Furosemide) akuwonetsedwa. Ndi mankhwala othandizira kukonza, kugwiritsa ntchito okodzetsa pafupipafupi.
Contraindication pa ntchito okodzetsa
Odwala ophatikizika matenda a chiwindi, hypokalemia, kugwiritsa ntchito okodzetsa ndi contraindicated. Liopture ya loop sinafotokozeredwe kwa odwala omwe amalolera kuchita zina mwa mankhwala a sulfanilamide (hypoglycemic and antibacterial mankhwala).
Kwa anthu omwe ali ndi kupuma komanso kupweteka kwambiri kwaimpso, okodzetsedwa amatsutsana. Ma diuretics a gulu la thiazide (Methiklothiazide, Bendroflumethiozide, Cyclganizazide, Hydrochlorothiazide) amatsutsana mu mtundu 2 wa shuga, chifukwa wodwalayo angakulitse kwambiri shuga m'magazi.
Ventricular arrhythmias amathanso kutsutsana pakusankhidwa kwa okodzetsa.
Kwa odwala omwe amatenga mchere wa lithiamu ndi mtima glycosides, okodzetsa ziwalo amatumizidwa mosamala kwambiri.
Osmotic diuretics sinafotokozeredwe kulephera kwa mtima.
Zotsatira zoyipa
Ma diuretics pamndandanda wa thiazide amatha kukulitsa kuchuluka kwa uric acid. Pachifukwachi, odwala omwe apezeka kuti ali ndi gout amatha kuwona kuipiraipira.
Ma diuretics a gulu la thiazide (hydrochlorothiazide, hypothiazide) atha kubweretsa zotsatira zosasangalatsa. Ngati mulingo woyenera wosankhidwa kapena wodwala akulekerera, zotsatirapo zake zitha kuwoneka:
- mutu
- kutsegula m'mimba ndikotheka;
- nseru
- kufooka
- kamwa yowuma
- kugona
Kusayimira kwa ayoni kumaphatikizapo:
- utachepa libido mwa amuna;
- chifuwa
- kuchuluka kwa shuga m'magazi;
- mafupa amkono minofu;
- kufooka kwa minofu;
- arrhythmia.
Zotsatira zoyipa za furosemide:
- kuchepa kwa potaziyamu, magnesium, calcium;
- Chizungulire
- nseru
- kamwa yowuma
- kukodza pafupipafupi.
Kusintha kwa kusinthana kwa ion, kuchuluka kwa uric acid, shuga, calcium ukuwonjezeka, zomwe zimaphatikizapo:
- paresthesia;
- zotupa pakhungu;
- kusamva.
Zotsatira zoyipa za olimbana ndi aldosterone zimaphatikizapo:
- zotupa pakhungu;
- gynecomastia;
- kukokana
- mutu
- kusanza, kusanza.
Amayi omwe ali ndi cholinga cholakwika ndi mlingo woyenera amawonedwa:
- hirsutism;
- kusamba kwa msambo.
Othandizira okodzetsa ena ndi kapangidwe kawo pochita thupi
Ma diuretics omwe amakhudza ntchito ya aimpso tubules amalepheretsa sodium kulowa mthupi kachiwiri ndikufinya chinthucho limodzi ndi mkodzo. Ma diuretics a sing'anga ogwira ntchito a Methiclothiazide Bendroflumethiosos, Cyclaniseazide amachititsa kuti azitha kuyamwa chlorine, komanso osati sodium. Chifukwa cha izi, amatchedwanso saluretics, kutanthauza "mchere".
Thiazide-ngati diuretics (Hypothiazide) amalembera makamaka edema, matenda a impso, kapena kulephera mtima. Hypothiazide imakonda kwambiri ngati othandizira ena.
Mankhwala amachotsa sodium yambiri ndikuchepetsa kupanikizika m'mitsempha. Kuphatikiza apo, mankhwala a thiazide amawonjezera mphamvu ya mankhwala, momwe amagwirira ntchito omwe cholinga chake ndi kutsitsa magazi.
Ndi kukhazikitsidwa kwa kuchuluka kwa mankhwalawa, mankhwalawa amadzimadzi amatha kuchulukitsa popanda kutsitsa magazi. Hypothiazide imapangidwanso kwa matenda a shuga insipidus ndi urolithiasis.
Zinthu zomwe zimapangidwa pokonzekera zimachepetsa kuchuluka kwa calcium ion ndikuletsa mapangidwe amchere mu impso.
Ma diuretics othandiza kwambiri amaphatikizapo Furosemide (Lasix). Mothandizidwa ndi mtsempha wa magazi mankhwalawa, zimachitika pambuyo pa mphindi 10. Mankhwala ndi oyenera;
- pachimake kukomoka kwamanzere kwamtima, limodzi ndi mapapo;
- zotumphukira edema;
- matenda oopsa;
- kuchotsa kwa poizoni.
Ethacrinic acid (Ureghit) ili pafupi ndi Lasix, koma imakhala nthawi yayitali.
Monitol wodziwika bwino kwambiri amathandizira kudzera m'mitsempha. Mankhwala amathandizira kuthamanga kwa osmotic ya plasma ndi kutsika kwa intracranial ndi intraocular anzawo. Chifukwa chake, mankhwalawa amagwira ntchito kwambiri mu oliguria, yomwe imayambitsa kupsa, zoopsa kapena kuchepa kwa magazi.
Aldosterone antagonists (Aldactone, Veroshpiron) amaletsa kuyamwa kwa sodium ions ndikulepheretsa chinsinsi cha magnesium ndi potaziyamu. Mankhwala a gululi amawonetsedwa ndi edema, matenda oopsa komanso kusokonekera mtima. Potaziyamu yosasamala okodzetsa kwenikweni simalowa nembanemba.
Ma diuretics ndi matenda ashuga a 2
Tcherani khutu! Tiyenera kukumbukira kuti ndi mtundu wachiwiri wa matenda ashuga, wothandizila wina wokhawo amene angagwiritsidwe ntchito, ndiko kuti, kuperekera mankhwala osokoneza bongo osaganizira za matendawa kapena mankhwala omwe amadzidziwitsa yekha angayambitse zotsatira zoyipa mthupi.
Thiazide diuretics ya mtundu 2 matenda a shuga amachepetsa makamaka kuti achepetse kuthamanga kwa magazi, kwa edema komanso mankhwalawa chifukwa cha kuchepa kwa mtima.
Komanso thiazide diuretics amagwiritsidwa ntchito pofuna kuchiza odwala ambiri omwe ali ndi matenda oopsa omwe amakhala nthawi yayitali.
Mankhwalawa amachepetsa chidwi cha maselo kupita ku insulin ya mahomoni, zomwe zimapangitsa kuti magazi azikhala ndi glucose, triglycerides ndi cholesterol. Izi zimayika ziletso zazikulu pakugwiritsira ntchito izi diuretics mu mtundu 2 wa shuga.
Komabe, kafukufuku waposachedwa wazachipatala wakugwiritsira ntchito okodzetsa a matenda a shuga a 2 akuwonetsa kuti zotsatirapo zoyipa izi zimawonedwa nthawi zambiri ndi kuchuluka kwa mankhwalawa. Pa Mlingo wotsika, zotsatira zoyipa sizimachitika.
Zofunika! Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, popereka mankhwala a thiazide okodzetsa, odwala ayenera kudya masamba ndi zipatso zambiri momwe angathere. Izi zikuthandizira kuthetsa kutayika kwakukulu kwa potaziyamu, sodium, ndi magnesium. Kuphatikiza apo, chiopsezo chochepetsera chidwi cha thupi ku insulin iyenera kuganiziridwa.
Mtundu wachiwiri wa matenda a shuga a mellitus, mankhwala omwe amagwiritsidwa ntchito kwambiri ndi Indapamide, kapena, Arifon. Onse awiri a Indapamide ndi Arifon alibe phindu lililonse pakubadwa kwa thupi ndi lipid metabolism, komwe ndikofunikira kwambiri kwa matenda ashuga a 2.
Zododometsa zina za matenda a shuga a 2 zimalembedwa kochepa kwambiri pokhapokha ngati pali zina:
- malupu otupa a mtundu 2 a shuga amagwiritsidwa ntchito kamodzi pokhapokha ngati pakufunika kukwaniritsa kuthamanga kwa magazi;
- kuphatikiza thiazide komanso kuphatikiza potaziyamu - posafunikira kuchepetsa kutayika kwa potaziyamu.
Odwala omwe ali ndi vuto la shuga m'magazi ayenera kumvetsetsa kuti kumwa mankhwala aliwonse okodzetsa kumatha kuyambitsa vuto lalikulu - kuchepa kwa chidwi cha insulin. Komanso, mankhwalawa owonjezera matenda oopsa sangatenge nthawi yayitali.
