Biguanides pa matenda a shuga

Gulu la mankhwala osokoneza bongo limaperekedwa kwa wodwala aliyense payekhapayekha. Biguanides ndi mankhwala opangidwa kuti achepetse shuga wamagazi a munthu wodwala matenda ashuga. Mankhwalawa amapangidwa m'mapiritsi. Nthawi zambiri, mankhwalawa amatchulidwa ngati njira yothandizira odwala omwe ali ndi matenda a shuga 2. Ndi monotherapy, mankhwalawa sawonjezeka (5-10% ya milandu). Biguanides amayang'ana kwambiri ntchito chifukwa cha zovuta zoyambitsa matenda. ...

Ndi monotherapy, mankhwalawa sawonjezeka (5-10% ya milandu). Biguanides amayang'ana kwambiri ntchito chifukwa cha zovuta zoyambitsa matenda. Gysric dyspepsia ndichinthu chovuta kwambiri chomwe mankhwalawa amapatsidwa.

Njira yochitira mankhwalawa

Ndi mtundu 2 wa shuga, anthu omwe amatenga biguanides amakhala ndi chidwi ndi insulin, koma palibe kuwonjezereka kwa kutulutsa kwake. Potengera zakusintha, pali kuwonjezeka kwa gawo la insulin m'magazi a anthu. Chinthu chinanso chabwino chothandizira mankhwalawa ndi metformin ndi kuchepa kwa thupi la wodwalayo. Mankhwalawa ndi sulfonylureas, limodzi ndi insulin, zotsatira zake ndi zosemphana ndi kuchepa thupi.

Mndandanda wazopondera

Anthu omwe amachita nawo masewera olimbitsa thupi oopsa (othamanga, omanga, ogwira ntchito m'mafakitale) amagwera pagululi. Anthu opsinjika maganizo amatha kupeza zovuta za kumwa mankhwalawa. Therapy ikuchitika molumikizana ndi maphunziro amtundu kuti azisintha momwe akumvera.

Kodi amagwira bwanji ntchito

Biguanides a shuga agwiritsidwa ntchito kuyambira m'ma 1970. Samayambitsa insulin chifukwa cha kapamba. Kuchita kwa mankhwalawa kumachitika chifukwa cha kuletsa kwa gluconeogeneis. Mankhwala ofala kwambiri amtunduwu ndi Metformin (Siofor).

Mosiyana ndi sulfonylurea ndi zotumphukira zake, Metformin satsitsa shuga ndipo sayambitsa hypoglycemia. Izi ndizofunikira ndikatha kusala usiku umodzi. Mankhwalawa amaletsa kuchuluka kwa shuga wamagazi mukatha kudya. Metformin imakulitsa chidwi cha maselo ndi minofu ya thupi kupita ku insulin. Kuphatikiza apo, amachepetsa kudya kwa glucose m'maselo ndi minofu, amachepetsa mayamwidwe m'matumbo.

Pogwiritsa ntchito nthawi yayitali, ma biguanides ali ndi phindu pa metabolism yamafuta. Amabweza m'mbuyo ntchito yotembenuzira glucose kukhala mafuta acids, ndipo nthawi zina amachepetsa zomwe zili triglycerides, cholesterol m'magazi. Zotsatira za biguanides pakalibe insulini sizikupezeka.

Metformin imatengedwa bwino kwambiri kuchokera m'matumbo am'mimba ndipo imalowa m'magazi a m'magazi, momwe mumalowera ndende zake patatha maola awiri mutatha kumwa. Kutha kwa theka-moyo kuli mpaka maola 4.5.

Zizindikiro ndi contraindication

Mwina kugwiritsa ntchito ma biguanides kuphatikiza ndi insulin. Muthanso kumwa nawo limodzi ndi mankhwala ena ochepetsa shuga.

Mankhwala ndi contraindised mu milandu:

• shuga wodalira insulin (pokhapokha akaphatikizidwa ndi kunenepa kwambiri),
• kusiya kwa insulin,
• ketoacidosis
• Kulephera kwaimpso, kuphwanya chiwindi,
• mtima ndi kupuma,
• kusowa kwamadzi, kugwedezeka,
• uchidakwa wambiri,
• lactic acidosis,
• mimba, yoyamwitsa,
• Zakudya zopatsa mphamvu zochepa (zosakwana ma kilocalori 1000 patsiku),
• zaka za ana.

Chenjezo liyenera kuthandizidwa poika anthu opitirira zaka 60 ngati agwira ntchito zolimba. Pankhaniyi, pali chiwopsezo chachikulu chotenga lactic acidosis chikomokere.

Zotsatira zoyipa ndi bongo

Pafupifupi 10 mpaka 25 peresenti ya milandu, odwala omwe amatenga biguanides amakumana ndi zovuta monga kulawa kwazitsulo mkamwa, kusowa chilimbikitso, ndi mseru. Kuti muchepetse mwayi wokhala ndi zizindikiro zotere, ndikofunika kumwa mankhwalawa mukamadya kapena mukatha kudya. Mlingo uyenera kuchuluka pang'onopang'ono.

Nthawi zina, kukulitsa kwa magazi m'thupi la megaloblastic, kuchepa kwa cyanocobalamin ndikotheka. Nthawi zambiri, zotupa za khungu lawo sizipezeka pakhungu.

Pankhani ya bongo, lactic acidosis zizindikiro zimachitika. Zizindikiro za izi ndi kufooka, kupuma, kugona, kugona mseru, ndi m'mimba. Kuzizira kwa malekezero, bradycardia, hypotension ndikofunikira. Chithandizo cha lactic acidosis ndi chizindikiro.

Mlingo wa mankhwalawa uyenera kukhazikitsidwa nthawi iliyonse payokha. Muyenera kukhala ndi glucometer pafupi. Ndikofunikanso kuganizira za kukhala bwino: nthawi zambiri mavuto amabwera chifukwa cha mlingo woyenera.

Kuchiza ndi biguanides kuyenera kuyamba ndi mlingo wochepa - osapitirira 500-1000 g patsiku (motero, mapiritsi 1 kapena 2 a 0,5 g). Ngati palibe zoyipa zimawonedwa, ndiye kuti muyezo utha kuchuluka. Mlingo wokwanira wa mankhwala patsiku ndi magalamu atatu.

Chifukwa chake, Metformin ndi chida chothandiza kwambiri pochiza komanso kupewa matenda ashuga. Ndikofunikira kutsatira mosamala malangizo ogwiritsira ntchito mankhwalawa.

Zizindikiro zogwiritsidwa ntchito

B. pa mankhwalawa matenda a shuga angagwiritsidwe ntchito: a) ngati njira yodziyimira yodziwira, b) mogwirizana ndi kukonzekera kwa sulfanylurea, c) kuphatikiza ndi insulin.

Kafukufuku wachipatala adakhazikitsa kuthekera kwa kugwiritsidwa ntchito kwa B. pochiza odwala omwe ali ndi matenda osiyanasiyana a shuga mellitus, kupatula odwala omwe ali ndi ketoacidosis. Komabe, monga njira yodziyimira yoyenera ya mankhwala B. ingagwiritsidwe ntchito mitundu yochepa ya shuga mwa odwala onenepa kwambiri.

Chithandizo cha matenda a shuga mellitus B., monga njira zina zonse zochizira matendawa, zimachokera pa mfundo yolipirira zovuta za metabolic. Zakudya zomwe zimagwiritsidwa ntchito ndi mankhwala a B. sizimasiyana ndi zakudya zomwe zimachitika tsiku lililonse kwa odwala matenda a shuga. Odwala omwe ali ndi kulemera koyenera, ayenera kukhala odzaza ndi zopatsa mphamvu, kupatula shuga ndi zinthu zina zomwe zimapanga chakudya cham'mimba mosavuta (mpunga, semolina, ndi zina), komanso kwa odwala omwe ali ndi kunenepa kwambiri ayenera kukhala ocheperako caloric oletsedwa ndi mafuta ndi chakudya komanso. kupatula shuga.

Kutsitsa kwa shuga kwa B. kumapangidwa mokwanira m'masiku ochepa kuchokera pomwe iwo anayamba kugwiritsa ntchito.

Kuti muwone kuyipa kwa chithandizo, ayenera kumwedwa kwa masiku osachepera asanu ndi awiri. Ngati chithandizo cha B. sichikupangitsani kubwezeredwa kwa zovuta za metabolic, ndiye kuti ziyenera kusiyidwa ngati njira yodziyimira payokha.

Kusavutikira kwachiwiri kwa B. kumachitika kawirikawiri: malinga ndi Clinic ya Joslin (E. P. Joslin, 1971), zimachitika osaposa 6% odwala. Kutalika kwa kupitiriza kwa kulandira kwa B. kwa odwala osiyana - zaka 10 ndi kupitilira.

Mankhwalawa akukonzekera sulfanylurea, kuwonjezera kwa B. kumatha kulipiritsa zovuta za metabolic komwe mankhwala omwe ali ndi mankhwala a sulfanylurea okha ndi osathandiza. Iliyonse ya mankhwalawa imakwaniritsa zomwe wina akuchita: kukonzekera kwa sulfonylurea kumalimbikitsa kutulutsa insulin, ndipo B. kusintha magwiridwe amtundu wa glucose.

Ngati mankhwalawa ophatikizidwa ndi sulfanylurea ndi B. Kukonzekera, komwe kungachitike mkati mwa masiku 7-10, sikupereka chindapusa cha zovuta za metabolic, ndiye kuti ziyenera kusiyidwa, ndipo insulin iyenera kuperekedwa kwa wodwala. Pankhani ya mphamvu ya kuphatikiza mankhwala ndi B. ndi sulfonamides, ndizotheka kuchepetsa kuchuluka kwa mankhwala onse ndi kuchoka pang'onopang'ono kwa B. Funso loti lingathandize kuchepetsa Mlingo wa mankhwala omwe amatengedwa pa os amasankhidwa pamaziko a zizindikiro za shuga ndi mkodzo.

Kwa odwala omwe amalandira insulin, kugwiritsidwa ntchito kwa B. nthawi zambiri kumachepetsa kufunika kwa insulin. Akamalembedwera munthawi yomwe kuchuluka kwa shuga m'magazi kumafikira, ndikofunikira kuchepetsa mlingo wa insulin pafupifupi 15%.

Kugwiritsa ntchito kwa B. kukuwonetsedwa mitundu ya matenda a shuga. Ndi njira yovuta matendawa mwa odwala ena, ndizotheka kugwiritsa ntchito B. kukwaniritsa kukhazikika kwina kwamisempha ya magazi, koma mwa odwala ambiri zovuta za matenda a shuga sizichepa. Matenda a hypoglycemic a sayambitsa.

Kukonzekera kwa Biguanide ndi kugwiritsa ntchito kwawo

Chifukwa cha kuyandikira kwa Mlingo wowonjezera wa B. poizoni, mfundo yayikulu ya chithandizo cha B. ndikugwiritsa ntchito milingo yaying'ono kumayambiriro kwa chithandizo, ndikuwonjezereka kwa masiku aliwonse a 2-4 ngati mungathe kulolera. Kukonzekera konse kwa K. kuyenera kumwedwa mutangomaliza kudya kuti mankhwalawa asatayike. thirakiti.

B. anatengedwa pakamwa. Amadzilowetsa m'matumbo ang'onoang'ono ndikugawidwa mwachangu. Kuphatikizika kwawo m'magazi atamwa mankhwala othandizira kumangofika 0,5-0.4 μg / ml. Kuchulukitsa mwachilengedwe kwa B. kumawonedwa mu impso, chiwindi, gren adrenal, kapamba, ndulu. thirakiti, mapapu. Ochepa ochepa aiwo amatsimikiza mu ubongo ndi minofu ya adipose.

Phenethylbiguanide imapangidwa kuti ibe-N'-p-hydroxy-beta-phenethylbiguanide, dimethylbiguanide ndi butylbiguanide sapangidwa mwa anthu. Gawo limodzi mwa magawo atatu a phenethylbiguanide limapukusidwa ngati metabolite, ndipo magawo awiri mwa atatu ali osasinthika.

B. wobowola mkodzo ndi ndowe. Malinga ndi Beckman (R. Beckman, 1968, 1969), phenethylbiguanide ndi metabolite ake amapezeka mkodzo mu gawo la 45-55%, ndipo butylbiguanide - mu 90% ya mlingo umodzi wa 50 mg wotengedwa, dimethylbiguanide amamuthira mkodzo wa 36 ola kuchuluka kwa 63% ya kumwa kamodzi, osagwiritsa ntchito gawo la B. amachotsa ndowe, komanso gawo laling'ono la iwo, lomwe limalowa m'matumbo ndi bile. Ntchito ya hafu-ya biol, ntchito ya B. imapanga apprx. Maola 2.8.

Mphamvu yotsitsa shuga ya B., yopangidwa m'mapiritsi, imayamba kudziwonetsa mkati mwa maola 0.5-1 atatha kudya, mphamvu kwambiri imatheka pambuyo pa maola 4-6, kenako mphamvuyo imatsika ndikuyima ndi maola 10.

Phenformin ndi buformin, zomwe zimapezeka m'mabotolo ndi ma dragees, zimapatsa kuyamwa pang'onopang'ono komanso nthawi yayitali. Kukonzekera kwa zochita zazitali sikumayambitsa zovuta.

Phenethylbiguanide: Phenformin, DBI, 25 mg mapiritsi, tsiku lililonse 50-150 mg wa 3-4, DBI-TD, Dibein retard, Dibotin makapisozi, Instery-TD, DBI retard, Diabis retard, DB retard (makapisozi kapena dragees a 50 mg, mlingo wa tsiku lililonse wa 50-150 mg, motero, 1-2 pa tsiku limodzi ndi maola 12.).

Butyl BiguanideBuformin, Adebit, mapiritsi a 50 mg, tsiku lililonse mlingo wa 100-300 mg wa 3-4, Silubin retard, dragee wa 100 mg, tsiku lililonse mlingo wa 100-300 mg, motero, 1-2 pa tsiku limodzi ndi maola 12 .

Dimethylbiguanide: Metformin, Glucofag, mapiritsi a 500 mg, tsiku ndi tsiku - 1000-3000 mg mu Mlingo wa 3-4.

Zotsatira zoyipa za biguanides ikhoza kuwonetsedwa ndi kuphwanya kosiyanasiyana kuchokera kumbali ya chikasu-quiche. thirakiti - kukoma kwazitsulo mkamwa, kuchepa kwa chilala, kusanza, kusanza, kufooka, kutsekula m'mimba. Zophwanya zonsezi zimazimiririka atangochotsa mankhwala. Pakapita kanthawi, kuyang'anira kwa B. kuyambiranso, koma pamlingo wotsika.

Zowonongeka za chiwindi ndi impso pochizira B. sizinafotokozedwe.

Mabukuwo adatsutsa funso loti lingathe kukhala lactic acidosis kwa odwala omwe ali ndi matenda a shuga m'mankhwala a B. Komiti Yophunzirira ya Non-ketonemic Metabolic Acidosis mu Diabetes Mellitus (1963) adanenanso kuti pochizira B. kuchuluka kwa lactic acid m'magazi a odwala kumatha kuwonjezeka pang'ono.

Lactic acidosis yokhala ndi lactic acid wambiri m'magazi komanso kuchepa kwa magazi pH m'magazi a shuga omwe amalandila B. ndi osowa - osati pafupipafupi kuposa kwa odwala omwe salandila mankhwalawa.

Kwambiri, lactic acidosis imadziwika ndi vuto lalikulu la wodwala: mkhalidwe wogona, kupuma kwa Kussmaul, chikomokere, m'mphepete amatha kutha muimfa. Chiwopsezo chokhala ndi lactic acidosis kwa odwala omwe ali ndi matenda osokoneza bongo panthawi ya mankhwala a B. Amakhala ndi vuto la ketoacidosis, mtima kapena kulephera kwaimpso, komanso zinthu zina zingapo zomwe zimachitika ndi vuto la microcirculatory ndi minofu hypoxia.

Contraindication

B. ophatikizidwa chifukwa cha ketoacidosis, kulephera kwamtima, kulephera kwa impso, matenda opweteka, munthawi ya preoperative ndi nthawi ya postoperative, panthawi yapakati.

Zosangalatsa: Vasyukova E.A. ndiephyr o v a G.S. Biguanides pakuchiza matenda ashuga. Klin, wokondedwa., T. 49, No. 5, p. 25, 1971, bibliogr., Matenda a shuga, ed. V.R. Klyachko, p. 142, M., 1974, bibliogr., Ndi z pa z pa k A. ndi. za. Zotsatira za biguaniaes pakuyamwa kwamatumbo a shuga, shuga, v. 17, p. 492, 1968, K r ​​a 1 1 L. P. Kugwiritsira ntchito kwachipatala kwa othandizira a hypoglycemic, mu: Diabetes mellitus, ed. Wolemba M. Elienberg a. H. Rifkin, p. 648, N. Y. a. o., 1970, Williams R. H., Tanner D. C. a. About d e 1 1 W. D. Hypoglycemic zochita za phenethylamyl, -and isoamyl-diguanide, Matenda a shuga, v. 7, p. 87, 1958, Williams R. H. a. o. Kafukufuku wokhudzana ndi hypoglycemic acid of phenethyldiguanide, Metabolism, v. 6, p. 311, 1957.