Lisinopril kapena enalapril - ndibwino? Kodi kusiyana kwakukulu ndi kotani?

Captopril anali woyamba mankhwala ochotsa kuthamanga kwa magazi kupondera ACE. Kuchokera ku mankhwala ena omwe amachepetsa magazi, idatenga nthawi yayitali. M'zaka 80. Zaka zapitazo, analogue yake idawonekera - Enalapril.

Kuphatikiza pa kuponderezedwa kwa kuthamanga kwa matenda oopsa, mankhwalawa amathandizidwa kuti mtima usagwidwe ndi mawonekedwe osakhazikika, komanso matenda oopsa. Amapangidwanso kuti ateteze kupezeka kwa kulephera kwa mtima kwa odwala omwe ali ndi vuto lakumanzere kwamitsempha yamagazi komanso kupewa kulowetsedwa kwa myocardial, kuti azikhala odwala omwe ali ndi vuto losakhazikika la angina pectoris.

The yogwira thunthu la enalopril ndi chigawo chimodzi cha dzina lomweli. Thupi limakhala mankhwala: mutalowa mkati mwa thupi, limasinthidwa kukhala metabolite yogwira - enalaprilat. Amakhulupirira kuti kutha kwake kukhala ndi mphamvu ya antihypertensive kumayambitsa kuponderezana ndi ntchito ya ACE, yomwe, imachepetsa mapangidwe a angiotensin II, omwe amathandizira kuchepa kwamitsempha yamagazi ndipo nthawi yomweyo imalimbikitsa mapangidwe a aldosterone.

Chifukwa cha izi ndi njira zingapo zomwe zimayambitsidwa ndi enalaprilat, vasodilation imachitika, kuchepa kwa kutumphuka kwathunthu kwamatumbo, kugwira ntchito kwa minofu ya mtima kumatha bwino komanso kupirira kwake kuti katundu azikula.

Mankhwala amapangidwa m'mapiritsi okhala ndi enalapril osiyanasiyana - 5, 10, 15 ndi 20 mg. Chithandizo chimayamba ndi limodzi mlingo wa 2,5-5 mg wa mankhwala. Mlingo wapakati ndi 10-20 mg / s, wogawidwa pawiri.

Lisinopril

Mankhwalawa adayamba kupezeka zaka za m'ma 80. Zaka makumi awiri, koma adayamba kumasulidwa pambuyo pake. Zochita za mankhwalawa zimaperekedwa ndi lisinopril, chinthu chomwe chimatha kulepheretsanso ntchito ya eniotensin-yotembenuza, yomwe imakhudza njira zomwe zimayendetsa kuthamanga kwa magazi mthupi.

Monga enalapril, lisinopril imachepetsa mapangidwe a angiotensin II, omwe amatha kuphatikiza mitsempha yamagazi, amachepetsa OPSS ndi kukana m'mitsempha yamapapu, ndikuwongolera mtima kukana kupsinjika.

Mankhwalawa adapangidwira kuti athetse kukakamiza kwa odwala omwe ali ndi matenda oopsa (kuwonjezera apo, angagwiritsidwe ntchito ngati chida chachikulu kapena chowonjezera pamodzi ndi mankhwala ena), ndi vuto la mtima. Amathandizadi bwino ndi myocardial infarction, ngati anagwiritsidwa ntchito tsiku loyamba pambuyo vuto la mtima, komanso matenda a shuga.

Mankhwala amapangidwanso m'mapiritsi okhala ndi zosinopril zosiyanasiyana: 2,5, 5, 10 ndi 20 mg piritsi limodzi.

Mlingo wa tsiku ndi tsiku kumayambiriro kwa mankhwala ndi 2,5 mg, omwe amatengedwa nthawi, ndi maphunziro a kukonza kwa 5-20 mg (kutengera zisonyezo).

Vuto la kusankha: kufanana ndi kusiyanasiyana kwa mankhwala

Monga momwe tikuwonera kuchokera pamakhwala, onsewa omwe amaphatikizidwa mgulu lomweli la mankhwala ali ndi zofanana zofanana motero amachita chimodzimodzi. Chifukwa chake, funso la kusankha kwa mankhwalawa a Lisinopril kapena Elanopril, ndikuwona kuti ndi liti lomwe lingathandize pazochitika zonse, sizophweka, ngakhale kwa katswiri.

Kuwongolera ntchitoyi ndikupeza kusiyana pakati pa mankhwalawa zaka makumi angapo zapitazo, maphunziro apiritsi okhala ndi magulu angapo odzipereka adachitika. Zomwe zidapezedwa zidawonetsa kuti magwiridwe antchito a mankhwalawa ndi ofanana: Lisinopril ndi Enalapril adachepetsedwa kupsinjika, ndipo kusiyana pakati pawo kunali pang'ono. Chifukwa chake, mwachitsanzo, zidawonedwa kuti Lisinopril ali ndi ntchito yayitali, kotero imawongolera bwino kupsinjika masana, mosiyana ndi wopikisana naye.

Kusiyana kwa njira komanso kuchuluka kwa mapiritsi omwe abwera kuchokera mthupi kunawonetsa: Enalapril - kudzera impso ndi matumbo, mankhwala achiwiri - a impso.

Kuphatikiza apo, akatswiri ena amati lisinopril imatha kusintha mwachangu, mosiyana ndi enalapril. Itha kuledzera kuti ichotse mavuto obwera chifukwa chotsatira, ngati sikupitilira tsiku limodzi chitaukiridwa.

Enalapril amatha kuyambitsa vuto lodana ndi chifuwa chowuma. Izi zimachitika nthawi yayitali pakulandila, ndipo ngati zichitika, mulingo wa mankhwalawa uyenera kuunikidwanso m'malo mwake ndi mankhwala ena.

Mankhwala amatengera chinthu chimodzi. Thupi limakhala mankhwala: pambuyo pakukonzekera pakamwa, ramipril amasinthidwa kukhala metabolite ndi mphamvu yambiri. Imapondereza ACE, chifukwa chomwe zinthu za vasoconstriction ndi kuchuluka kwa magazi zimachotsedwa. Monga Enalapril ndi Lisinopril, zinthu zomwe zimagwira zimachepetsa OPSS, zimachepetsa kuthamanga m'mitsempha yamagazi yamapapu.

Imakhala ndi phindu pamkhalidwe wa CVS: odwala omwe ali ndi vuto losakhazikika pamtima amachepetsa mwayi woti afe mwadzidzidzi, amachepetsa kupita patsogolo kwa kulephera kwa mtima ndikuchepetsa kuchuluka kwa mikhalidwe yomwe kuchipatala chikufunika.

Ramipril amachepetsa mobwerezabwereza matenda a MI, sitiroko, ndi kufa kwa odwala pambuyo pa matenda am'mitsempha.

Mankhwalawa ali ngati mapiritsi. Mphamvu ya antihypertensive ya ramipril imadziwonekera mu maola 1-2, imakulitsa mpaka maola 6 ndipo imatha osachepera tsiku.

Mlingo watsimikiza pambuyo popima wodwalayo. Kuchuluka kotsimikizidwa ndi opanga ndi 1.25-2.5 mg kamodzi kapena kawiri pa tsiku. Ngati thupi limalekerera mothandizidwa ndi ramipril, ndiye kuti kuchuluka kwa mankhwalawa ndikotheka. Kuchuluka kwa mankhwalawo ndi njira yokonzanso kumatsimikizidwira payekhapayekha.

Kuyerekeza kwa Ramipril ndi mankhwala ena

Mosiyana ndi mankhwala ena a kuthamanga kwa magazi, a Ramipril akadali amodzi mwa mankhwala ochepa omwe samangogwira bwino ndi matenda oopsa, komanso nthawi yomweyo amalepheretsa matenda a mtima komanso kukula kwa kulowerera kwa myocardial. Malinga ndi akatswiri ena, titha kuwaona ngati muyezo wagolide pakati pa mankhwalawa. Mankhwalawa akuwonetsa kukhudzana kwakukulu pochiza odwala omwe ali ndi chiopsezo chachikulu cha MI, stroke ndi kufa, makamaka mu mtundu wa 2 odwala matenda ashuga. Mankhwala anachepetsa kuyambika kwawo kwa atherosulinosis.

Ramipril amadziwika kuti ndiwothandiza kwambiri kuposa mankhwala omwe ali pamwambapa kapena Captopril, chifukwa amateteza bwino ubongo, njira yozungulira ya fundus, impso ndi zotumphukira ziwopsezo kuchokera kuzovuta. Pakadali pano, ili ndiye njira yokhayo yomwe, limodzi ndi mphamvu ya antihypertensive, imaletsanso kuphwanya mu CVS.

Ramipril ndi Lisinopril: kusiyana kwake ndi kotani

Poyerekeza mankhwala awiri, mwayi wake ndiwopanda pake pamankhwala oyamba. Lisinopril samasungunuka m'mafuta, chifukwa chake samalowa kwambiri ndipo alibe mphamvu ngati Ramipril.

Perindopril

Mankhwala ntchito monotherapy kapena okhazikika zovuta regimens ntchito odwala ochepa ochepa matenda oopsa. Amadziwikanso chifukwa cha kulephera kwa mtima komwe kumachitika mwa mawonekedwe osakhazikika, kupewa kutenganso matenda a sitiroko kwa omwe zidachitika kale. Monga prophylactic, imagwiritsidwa ntchito pochepetsa chiopsezo cha mtima ndi mtima wamatenda mwa odwala omwe ali ndi matenda amitsempha yamagazi.

Katundu wogwira wa Perindopril ndiye chinthu chimodzi chomwe chimadziwika. Zinthu zimaphatikizidwa ndi gulu la mankhwala a ACE inhibitor. Njira yamachitidwe ake ndi ofanana ndi Enalapril, Lisinopril ndi Ramipril: imaletsa vasoconstriction, imachepetsa OPSS, imawonjezera kutulutsa kwa mtima ndi kukana kupsinjika.

Hypotensive mphamvu ya perindopril imayamba ola limodzi mutatha kumwa mankhwalawa, imafika pachimake patatha maola 6-8 ndipo imatha tsiku limodzi.

Mankhwalawa amapezeka m'mapiritsi okhala ndi perindopril 2, 4, 8 mg.

Mlingo woyenera wa mankhwalawa kumayambiriro kwa mankhwalawa kamodzi patsiku la 1-2 mg. Ndi maphunziro othandizira, 2-4 mg imayikidwa. Ndi ochepa matenda oopsa, kudya tsiku lililonse kwa 4 mg kumawonetsedwa (kuwonjezeka kwa 8 mg ndikotheka) panthawi.

Odwala aimpso pathologies, kusintha kwa perindopril kumachitika poganizira mkhalidwe wa chiwalo.

Monga mtundu wina uliwonse wa mankhwala, mankhwalawa ogwirizana ndi matenda oopsa ayenera kusankhidwa poganizira zovuta zonse zaumoyo wa wodwalayo ndi momwe ziwalo zake zimagwirira ntchito. Pankhaniyi, kusankha koyenera pakati pa enalapril, lisinopril ndi zina za ACE zoletsa ndizotheka.

Enalapril ndi Lisinopril: pali kusiyana kotani?

Pofufuza kusiyana pakati pa mankhwalawa, chidziwitso kuchokera kuzomwe angagwiritse ntchito chingathandize. Mwapadera cholemba ndi kapangidwe kake ndi zisonyezo, komanso ma contraindication ogwiritsa ntchito.

• Zomwe zimagwira ntchito ya enalapril ndi enalapril maleate, kugwiritsidwa ntchito komwe piritsi limodzi limasiyanirana 5 mg.
• Gawo lothandiza la lisinopril ndi lisinopril dihydrate, mlingo ndi 5, 10 kapena 20 mg.

Njira yamachitidwe

Mankhwala onsewa ndi a ACE inhibitors ndipo ali ndi kapangidwe kofananira kama mankhwala (kokhala ndi gulu la carboxyl). Chifukwa chake, malingaliro a zochita za Enalapril ndi Lisinopril siosiyana: amaletsa maonekedwe a angiotensin ambiri, omwe amachepetsa mitsempha ndipo mosagwirizana amathandizira kuti madzi asungidwe. Chifukwa cha kudya kwamankhwala pafupipafupi, kuthamanga kwa magazi kumachepa, kuthamanga kwa magazi ndi mtima zimagwira.

Mankhwala awiri:

• kulephera kwa mtima
• kuthamanga kwa magazi (matenda oopsa).

Malangizo a Lisinopril amapezekanso:

• kuvulala kwamtima kwambiri - necrosis (necrosis) yam'kati mwa mtima - kuphatikizira ndi kulephera kwamitsempha yamanja,
• aimpso kuwonongeka mu shuga.

Contraindication

Zoletsa kugwiritsa ntchito Lisinopril ndi Enalapril sizimasiyana:

• ACEI tsankho,
• Mimba ndi kuyamwa
• kupendekera (stenosis) kwamitsempha yama impso,
• angioedema (mkhalidwe womwe nkhope ndi khosi limatupa) - cholowa kapena cham'mbuyomu
• wazaka 18.

Lisinopril amadziwikanso ndi anthu osalolera ku shuga ya mkaka, popeza mankhwalawa amagwiritsidwa ntchito ngati chothandizira.

Zotsatira zoyipa

Mndandanda wa zoyipa ndizofanana pamankhwala onse awiri:

• matenda ammimba
• matenda a impso ndi chiwindi.
• chifuwa chowuma
• kupweteka kwa mtima
• mutu ndi kukomoka
• orthostatic hypotension (chizungulire chikukwera),
• hematopoiesis,
• chifuwa
• minofu kukokana
• zosokoneza tulo
• kufooka wamba.

Tulutsani mafomu ndi mtengo

Enalapril imapezeka ku Russia komanso kumayiko ena, motero pali kusiyana kwamitengo yamapiritsi:

• 5 mg, 20 ma PC. - 7-75 rub.,
• 5 mg, zidutswa 28 - ma ruble 79,
• 10 mg, 20 ma PC. - 19-100 rubles.,
• 10 mg, zidutswa 28 - ma ruble 52,
• 10 mg, zidutswa 50 - ma ruble 167,
• 20 mg, 20 ma PC. - 23-85 rub.,
• 20 mg, zidutswa 28 - ma ruble 7,
• 20 mg, zidutswa 50 - 200 ma ruble.

Lisinopril pamapiritsi amapangidwanso ndi mabizinesi osiyanasiyana opanga mankhwala, ndipo mtengo wake umasiyanasiyana mosiyanasiyana:

• 5 mg, zidutswa 30 - 35-160 rubles.,
• 10 mg - 59-121 ma ruble,
• Zidutswa 30 - 35-160 rubles,
• 60 zidutswa - 197 ma ruble,
• 20 mg, 20 ma PC. - 43- 178 ma ruble.,
• 30 ma PC - 181-229 rub.,
• Zidutswa 50 - 172 ma ruble.

Kodi angiotensin amatembenuza ma enzyme zoletsa?

Enzyme yodabwitsa ya ACE yatchulidwa pamwambapa, momwe mphamvu ya magazi imakhudzira kuthamanga kwa magazi. ACE, kapena angiotensin-akatembenuka enzyme, ndiyofunika kwambiri enzyme yomwe imakhudza RAAS (renin-angiotensin-aldosterone system), yomwe imapangitsa "kuthamanga" kwa kuthamanga kwa magazi mthupi.

Kuchulukitsa kwa dongosololi kumayambitsa kutsekeka kwa mitsempha yamagazi, yomwe imawonetsedwa ndi kuwonjezeka kwa magazi. Chifukwa chake, zinthu zomwe zitha kufooketsa pang'ono ntchito ya RAAS pokhudzana ndi eniotensin-kutembenuza enzyme amatchedwa ACE inhibitors. Kodi blockers ACE onse ndi ofanana, kodi pali kusiyana kulikonse ndipo ndibwino?

Zosiyanasiyana za ACE Inhibitors

Muzochita zamakono zochizira, ma inhibitors a 3th a ACE amagwiritsidwa ntchito, omwe amatha kusiyanasiyana:

• pharmacokinetic katundu (nthawi yochitapo kanthu, kuchuluka kwa chinyezi kuchokera mthupi, kukhalapo kwa metabolite yogwira),
• kapangidwe ka mankhwala.

Zomwe zimakhalapo pakupanga komwe kumalumikizana ndi malo ogwira ntchito a ACE amatilola kugawanitsa zoletsa zomwe zilipo mu mitundu:

• ndi kukhalapo kwa gulu la sulfhydryl - awa akuphatikizapo Zofenopril, Pivalopril, Captopril,
• ndi kukhalapo kwa gulu la phosphoryl (phosphinyl) - Fosinopril,
• ndi kukhalapo kwa gulu la carboxyl - Perindopril, Ramipril, Lisinopril, Enalapril.

Monga mukuwonera, mankhwala onse okondweretsa omwe tili nawo amtundu womwewo, mwanjira yomwe pali gulu la maboxbox. Kukhalapo kwake mu chinthu yogwira, mosiyana ndi gulu la sulfhydryl, sikumupangitsani kuwoneka kwa zotupa pakhungu, kusokonezeka kwa tulo ndi zovuta zina zambiri. Kuphatikiza apo, kupezeka kwa gulu la carboxyl kumakhudza nthawi ya mankhwalawa (maola 18 mpaka 24). Kodi pali kusiyana kotani pakati pa lisinopril ndi enalapril, omwe ali bwino kwa iwo?

Gulu la ACE zoletsa ndi physico-mankhwala

Kodi pali kusiyana kotani pakati pa lisinopril ndi enalapril?

Chifukwa chake, tinganene chiyani za oimira otchuka a ACE inhibitors - Lisinopril ndi Enalapril, zomwe zili bwinoko, pali kusiyana kotani pakati pa mankhwalawa?

1. Zomwe zimagwira ntchito ya enalapril ndi enalapril maleate.
2. Zomwe zimagwira ntchito yachiwiri ndi Lisinopril dihydrate.
3. Loyamba ndi mankhwala, ndiye kuti, chinthu chomwe chimasinthidwa kukhala chinthu chogwira ntchito (metabolite) panthawi ya kagayidwe.
4. Lisinopril samadziwika ndi zochita za metabolic m'thupi.

Zizindikiro zogwiritsidwa ntchito

Tiyeni tidziwe bwino zomwe zikuwonetsa kugwiritsa ntchito mankhwalawa.

Enalapril imagwiritsidwa ntchito pa:

• matenda oopsa oopsa (kuphatikizapo kukonzanso),
• kulephera kosalekeza.

Lisinopril adalembedwa kuti:

• Kukonzanso kwamphamvu komanso kofunikira (monotherapy komanso kuphatikiza),
• pachimake myocardial infarction (tsiku loyamba),
• kulephera kwa mtima
• matenda ashuga nephropathy.

Zabwino ndi ziti? Monga mukuwonera, mawonekedwe a Lisinopril amawoneka bwino kwambiri kuposa kukula kwa enalapril.

Kodi pali kusiyana pakulimbikitsa thupi?

Enalapril ndi Lisinopril, ngati kuyerekezera kumachitika molingana ndi magawo monga njira yothawira kuchokera mthupi ndi mawonekedwe a metabolic, amatha kutengera magulu osiyanasiyana. Pankhaniyi, ACE inhibitors agawidwa m'magulu atatu:

1. Mankhwala a Lipophilic omwe ma metabolites osagwira amathandizidwa kudzera mu chiwindi (chomwe ndi khalidwe la Captopril).
2. Lipophilic mankhwala osokoneza bongo, mawonekedwe a metabolites omwe amagwira ntchito m'gulu lino amapezeka makamaka kudzera pachiwindi ndi impso (Enalapril ndi wa gululi).
3. Mankhwala a Hydrophilic omwe samapangidwira mu thupi, koma amawachotsa osasinthika kudzera mu impso (Lisinopril ali mkalasi iyi).

Kuchokera pamenepa zikuwoneka bwino - kusiyana pakati pa Enalapril ndi Lisinopril ndikuti woyamba, mosiyana ndi wachiwiri, ndiwowuma. Ndiye kuti, pambuyo pakukumeza koyamba m'thupi, kuphatikizira kwa biotransformation mu metabolite yogwira kumachitika - mu nkhani iyi, enalaprilat.

Kodi pali kusiyana kotani pakati pa mankhwalawa komanso muyezo?

Malinga ndi malangizo ogwiritsira ntchito, mlingo ndi ma regimen a enalapril ndi lisinopril ali motere.

10-20 mg

10-20 mg

20-40 mg

Mlingo woyambira mg / tsiku	Mulingo woyenera	Mulingo woyenera	Nthawi yolandirira komanso pafupipafupi
Enalapril: ndi RG (kukonzanso kwamitsempha yamagazi) - 5 mg, ndi mtima kulephera - 2,5 mg, Odwala achikulire kuposa zaka 65 - 2,5 mg	Zabwino - 10 mg 10 mg	1-2 kawiri pa tsiku, mosasamala chakudya
Lisinopril: monotherapy kwa matenda oopsa - 5 mg, ndi kulephera kwa aimpso - kuyambira 2,5 mpaka 10 mg (kutengera chilolezo cha creatinine)	Kamodzi patsiku, osasamala chakudyacho

Kusiyana kwa dongosolo la mankhwalawa, monga tikuonera, ndikosakwaniritsidwa ndipo sikumayankha funso - ndani ali bwino.

Kodi ndibwino kuchitanji pofotokoza za odwala omwe adalandira?

Kafukufuku wowunika kwa odwala omwe adamwa mankhwalawa onse akuwonetsa kuti ambiri mwa iwo sawona kusiyana kwakukulu ndipo samawunikira zomwe zili bwino ndi mankhwalawo omwe akufunsidwa.

1. Iwo omwe amayenera kuthana ndi zovuta (makamaka akudandaula chifukwa cha chifuwa chowopsa cha paroxysmal) a Enalapril adazindikira kuti ndikusintha kwa Lisinopril, chithunzi cha zotsatira zoyipa sichinasinthe.
2. Iwo omwe akuwonetsa kusakhutira ndikuti kuti akwaniritse njira yokhazikika yochizira, zoletsa za ACE ziyenera kumwedwa kwa nthawi yayitali, zindikirani kuchepa uku mu onse Enalapril ndi Lisinopril.
3. Iwo omwe amakhutira ndi Enalapril chifukwa cha mtengo wotsika ndipo, chifukwa chake, amatha kumwa mapiritsi kwa nthawi yayitali, alembe kuti sanazindikire kusintha kulikonse atasinthira ku Lisinopril.

Kuchokera pazidziwitso izi zikuwonekeratu kuti funsoli - Enalapril kapena Lisinopril, zomwe zili bwino - kuwunika kwa odwala sikupereka yankho.

Kodi chothandiza kwambiri ndi chiyani madokotala?

Kuti mudziwe malingaliro a madotolo, olemba tsamba lathu adachita kafukufuku pakati pa akatswiri a zamankhwala, akatswiri a gastroenterologists, pulmonologists ndi akatswiri ena. Ndemanga za madotolo pankhani yomwe ili yothandiza kwambiri - Lisinopril kapena Enalapril, zimakupangitsani kuganiza.

1. Ena amakhulupirira kuti enalapril ali ndi umboni wambiri pochiza matenda olephera a mtima.
2. Ena mwachidule - kuipa kwa mankhwalawa ndikufunika kwakanthawi kovomerezeka pakukonzekera kuti muthe kukwaniritsa zochizira.
3. M'modzi mwa akatswiri amtima wawo akuti 10% yokha mwa odwala awo amawona kuthekera kotengera zoletsa izi za ACE.
4. Ku funso loti chifukwa chiyani odwala okalamba ambiri amakonda kusunga kuthamanga kwa magazi, monga Enalapril kapena Lisinopril, yankho limodzi lokha - zonse ndizakuti mapiritsiwa ndi otchipa (monga momwe nthabwala zimanenera, "tiribe mafuta lero - timamwa maapulo otchipa ...").
5. Zokhudza mavuto, malingaliro a pulmonologists ndi osangalatsa. Amanenanso milandu yovuta kwambiri, yovuta kusiya kutsokomola ndikumwa ma ACE zoletsa. Monga momwe m'modzi wa opaleshoni yamtima adatsimikizira, mphindi iliyonse ya odwala ake amayamba kutsokomola chifukwa chogwiritsa ntchito Lisinopril kapena Enalapril.

Ndiye kuyankha funsoli, lomwe limakhala lamphamvu - Enalapril kapena Lisinopril, komanso lomwe lili bwinonso, madokotala nawonso zimawavuta.

Zotsatira zoyipa

Zotsatira zoyipa kwambiri zomwe zimadziwika ndi Lisinopril ndi Enalapril:

• kuoneka ngati kutsokomola kouma,
• dontho lakuthwa magazi.
• kutopa kopanda pake, kusowa kwa magazi, kupweteka kwa mutu,
• kupweteka pachifuwa
• kutaya kwa kukoma
• matenda amwazi.

Komabe, Enalapril, yomwe ndi mankhwala osokoneza bongo ndipo amaphatikizidwa m'chiwindi, amakhalanso ndi zotsatira zoyipa monga hepatotoxic zotsatira (ndiye kuti, zotsatira zoyipa ku chiwindi). Ndipo kutenga Lisinopril kumapangitsa mavuto pa impso. Chifukwa chake, kupatsa chidwi ndi ichi ndikuyankha funso la Lisinopril kapena Enalapril - zomwe zili bwino, zovuta. Posankha mankhwala, kupezeka kwa concomitant pathologies mu wodwala kuyenera kuganiziridwanso. Pamaso pakepa wolumikizika ntchito, musagwiritse ntchito enalapril, ndipo ngati vuto la impso, musagwiritse ntchito lisinopril.

Kufotokozera Kwambiri pa Enalapril

Mankhwala a antihypertensive Enalapril amachita chifukwa cha zomwe zili ndi dzina lomweli la enalapril. Ndi zoletsa za ACE zomwe, kudzera m'njira zina, zimayambitsa zoletsa za renin-angiotensin. Kugwiritsa ntchito mankhwalawa kumapereka kuchepa kwamphamvu kopanikizika popanda kuwonjezera kuchuluka kwa mtima.

Amapezeka m'mapiritsi a 2,5, 5, 10 ndi 20 mg. Wopanga - Agio Pharmaceuticals, India. Zopangidwanso ndi makampani aku Russia ndi aku Ukraine.

Zotsatira za mankhwalawa zimayamba maola ochepa pambuyo pokhazikitsa. Kutsika kwakukulu kwa kupsinjika kumawonedwa pambuyo maola 4. Chowonetsedwa pakugwiritsa ntchito kwakanthawi.

Kufufuza ndi Kugwira Ntchito Mwaluso

Enalapril ili pamndandanda wa WHO wamankhwala ofunikira. Kafukufuku wambiri akuwonetsa zotsatira zabwino za mankhwalawa pa prognosis ya matenda oopsa.

Zotsatira za ANBP2 zimveketsa kuti kumwa mankhwalawa kumachepetsa kufa ndipo chiwopsezo cha matenda a CVD ndichothandiza kwambiri kuposa okodzetsa. Enalapril amachepetsa kwambiri zovuta za matenda omwe alipo. Kafukufukuyu adawonetsanso kuthekera kwa mankhwalawa kuchepetsa chiopsezo cha kufa pokhudzana ndi vuto la mtima mwa amuna.

Enalapril adawonetsedwa kuti ndiwothandiza kwa odwala omwe ali ndi vuto la mtima omwe ali ndi njira yowerengera yakhungu. Ndi maphunziro a miyezi itatu akumamwa mankhwalawo, kusintha kwa ziwonetsero zamagazi ndikuchotsa kwazomwe zimayambitsa matenda oyambitsidwa.

Kafukufuku Wakafukufuku adatsimikiza kuti mankhwala osokoneza bongo a 60 mg / tsiku osakanikirana ndi okodzetsa amachepetsa chiopsezo cha imfa mu mtima.

"Enalapril pochizira kulephera kwa mtima." Wodwala wovuta.

Mndandanda wa WHO Model wa Mankhwala Ofunika, a 2009.

Zotsatira zoyipa

Mankhwala amalekeredwa bwino. Kuwonongeka kwa zovuta kumalumikizidwa ndi kuchiritsidwa kwa zinthu. Pali zinthu zingapo pamene mankhwalawa amaperekedwa mosamala.

Kumwa mankhwalawa nthawi zambiri kumayambitsa chifuwa. Ndiosabereka ndipo imatha atatha kulipira ndalama. Odwala ena amakhala ndi minyewa yam'mimba, chizungulire, mawonetseredwe a khungu, nseru, orthostatic matenda oopsa, kutsegula m'mimba.

Mankhwala amatengedwa pakamwa, ngakhale chakudyacho. Akuluakulu pa mankhwalawa matenda oopsa amatha 0.01-0.02 g patsiku. Ngati mulingo woyenera sagwira ntchito, umasintha poganizira zovuta zomwe zimayambitsa matendawa. Mlingo wokwanira patsiku soposa 0.04 g.

Pakulephera kwa mtima, mulingo woyambira ndi 0,0025 g.Utha kukwera mpaka 10-20 mg mpaka kawiri pa tsiku. Enalapril ikhoza kugwiritsidwa ntchito yokha kapena kuphatikiza ndi mankhwala ena a antihypertensive. Ndi kuchepa kwamankhwala kukakamiza, mlingo umasintha.

Ndani adzagwirizana

Chizindikiro chachikulu chomwera mapiritsiwa ndi matenda oopsa. Mankhwalawa amalembedwa ndi dokotala. Enalapril imagwiritsidwa ntchito kwambiri pakukonzanso matenda oopsa osagwirizana ndi mankhwala wamba. Komanso, mankhwalawa amapatsidwa mankhwala osokoneza mtima omwe amayamba chifukwa cha matenda amisempha. Nthawi zina, amapatsidwa bronchospasm.

Kufotokozera Kwambiri kwa Lisinopril

Mankhwala a antihypertensive Lisinopril ali ndi lisinopril dihydrate. Ndi choletsa nthawi yayitali. Amagwiritsidwa ntchito pochiza matenda oopsa komanso kupewa zotsatira. Zake ndizotheka kugwiritsa ntchito kwa odwala omwe ali ndi kunenepa kwambiri.

Amapezeka m'mapiritsi a 5, 10 ndi 20 mg. Wopanga - Wothandiza, Ukraine.

Mankhwala amachepetsa mapangidwe a angiotensin ndipo amaletsa aldosterone. Kuchulukitsa zolimbitsa thupi, kutsitsa magazi, kukulitsa mitsempha, ndikuchepetsa kutaya mtima.

Kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumabweretsa kuchepa kwa hypertrophy ya minofu ya mtima ndi mitsempha. Chithandizo chimayambitsa kusinthasintha kwa magazi mu matenda a ischemic. Imawonjezera moyo wa odwala omwe ali ndi vuto la mtima.

Zimayamba kugwira ntchito mkati mwa ola limodzi, kusunga zotsatira zake tsiku limodzi. Zotsatira zamankhwala oopsa zimawonedwa masiku 1-2 kuyambira kuchiyambika kwa makonzedwe. Zotsatira zokhazikika zimawonedwa pambuyo pa masabata 4-8.

Chikhalidwe cha Lisinopril

Lisinopril ndi cholengedwa chachiwiri cha ACE. Amachepetsa kupanikizika kwa maola 24 pambuyo pa gawo limodzi. Kuchulukana mu minofu ya adipose sikukuchitika, chifukwa chake ndi kothandiza kwambiri pochiza matenda oopsa mwa anthu onenepa kwambiri. Mankhwalawa amalekeredwa bwino ndipo amakhala ndi mlozera wabwino kwambiri.

Kuphatikizikako kumaphatikizira ntchito yogwira - lisinopril dihydrate. Amapezeka m'mapiritsi a 5, 10 ndi 20 mg.

Limagwirira a zochita za mankhwalawa amatengera kukakamiza kwa enzyme, yomwe imatembenuza mahomoni angiotensin I kukhala angiotensin II, omwe amachititsa vasospasm ndikuwonjezera kuthamanga kwa magazi. Ndi kuchepa kwa kuchuluka kwake m'magazi, kukulira kwa zotumphukira, makamaka mitsempha, kumachitika. Chifukwa cha izi, mankhwalawa ali ndi tanthauzo lotsogolera. Kuphatikiza apo, kugwiritsa ntchito nthawi yayitali, magazi am'matumbo amkati, magazi amitsempha am'manja amachepa.

Zisonyezero zosankhidwa:

• matenda oopsa - angagwiritsidwe ntchito pawokha kapena kuphatikiza mankhwala ena a antihypertgency,
• Kulephera kwamtima kosalekeza - kuphatikiza okodzetsa ndi mtima wama mtima,
• zovuta mankhwala a myocardial infarction kumayambiriro,
• matenda ashuga nephropathy.

• chidwi cha lisinopril kapena choletsa china cha ACE,
• kutupa kwa zilizonse zamtundu uliwonse,
• mimba (nthawi zonse) komanso nthawi yoyamwitsa,
• zaka za ana (mpaka zaka 18).

Pali ma contraindations omwe mankhwalawa amaperekedwa, koma mosamala kwambiri:

• stenosis ya msempha mavavu kapena mitral,
• kukanika kwa aimpso: a impso artery stenosis, kusakwanira kwa creatinine chilolezo chochepera 30 ml / min., kupatsidwa zina, dialysis,
• matenda amisala
• matenda a mtima
• matenda ophatikizika a minofu: scleroderma, systemic lupus erythematosus,
• matenda ashuga
• kusowa kwamadzi ndi magazi.

Zotsatira zoyipa mutatha kutenga Lisinopril, mutha kukumana:

• chizungulire, kupweteka mutu, kufooka kwathunthu, kusazindikira.
• chifuwa chowuma
• Kuchokera pamtima dongosolo - hypotension, kuchuluka kapena kuchepa kwa mtima, kupweteka pachifuwa.
• Kuchokera kwamankhwala amanjenje - kusakhazikika kwamanjenje, kugona,
• Kuchokera kwam'mimba thirakiti - kuchepa kwa chakudya, pakamwa pouma, nseru, kusanza, dyspepsia, kupweteka kwam'mimba,
• pakhungu - thupi siligwirizana, zotupa, kuyabwa, dazi, thukuta kwambiri,
• m'magazi - kuchepa kwa hemoglobin, leukopenia, thrombocytopenia.

Zotsatira zoyipa mutatha kutenga Lisinopril, mutha kukumana ndi: chizungulire, kupweteka mutu, kufooka, kugona.

Khalidwe la Enalapril

Ndi za m'badwo wachiwiri wa ACE zoletsa. Kuphatikiza pakuwonjezera matenda oopsa, imagwiritsidwa ntchito pochiza mavuto osaneneka oopsa. Mankhwalawa amalekeredwa bwino ndi thupi. Anakumanapo ndi maphunziro angapo azachipatala omwe odwala sanatenge nawo matenda oopsa okha, komanso chifukwa cha kulephera kwa mtima, matenda a shuga komanso matenda a mtima. Muzochitika zonse, mankhwalawa atsimikizira kugwira ntchito kwake komanso chitetezo.

Lili ndi yogwira mankhwala - enalapril. Njira yotulutsira: mapiritsi a 5, 10 ndi 20 mg.

Mfundo ya machitidwe ake imakhazikikanso ndikuletsa kwa angiotensin II. Ndi kudya pafupipafupi m'magazi, mulingo wa potaziyamu ndi renin, enzyme yomwe imapangidwa ndi impso ndikuwongolera kuthamanga kwa magazi, imakwera. Vasodilation kumachitika, kukana mwa iwo kumachepa, kukakamizidwa kumachepa. Mankhwalawa alinso ndi zotsatira za mtima - chiyembekezo cha odwala omwe ali ndi vuto la mtima omwe nthawi zonse amatenga kuwonjezeka kwa enalapril.

Zisonyezero zogwiritsidwa ntchito:

• ochepa matenda oopsa, kuphatikizapo chiyambi,
• kulephera kwa mtima.

• Hypersensitivity
• aimpso mtsempha wamagazi,
• mbiri ya edema ya angioneurotic,
• Mimba, kuyamwa,
• zaka za ana.

• chizungulire, kufooka wamba, chisokonezo, mutu,
• chifuwa chowuma
• mbali yamtima - kutsitsa kuthamanga kwa magazi, tachycardia, bradycardia, palpitations, kupweteka pachifuwa.
• Kuchokera kwamankhwala amanjenje - kusinthasintha kwa manjenje, kugona kwambiri,
• Kuchokera m'mimba thirakiti - kusowa kudya, pakamwa pouma, kusanza ndi mseru, kusanza, kumva kupweteka m'mimba,
• pa khungu - matupi awo sagwirizana, kuyabwa ndi urticaria.

Zizindikiro ntchito enalapril: ochepa matenda oopsa, kuphatikizapo chiyambi.

Kuyerekeza kwa Lisinopril ndi Enalapril

Zinthu zogwira zomwe ndi gawo la mankhwalawa ndi ACE inhibitors. Ndiye kuti, Lisinopril ndi Enalapril ndi fanizo, amasinthana.

Zida izi ndizofanana zingapo:

1. Ali ndi tanthauzo lotsogola ndipo amalekeredwa bwino.
2. Amachepetsa kukakamiza poletsa mapangidwe a mahasi angiotensin, omwe amachititsa vasoconstriction. Pambuyo makonzedwe, ziwiya ziwonjezeka, zotumphukira magazi zimachepa, systolic ndi diastolic magazi amawonjezera.
3. Thandizani kuchepetsa chiopsezo cha stroke.
4. Amakhala ndi zotsatira za mtima: amasintha kuperekera magazi kumtima, kuchepetsa katundu, ndikuchepetsa hypertrophy yamanzere.
5. Amaphatikizidwa ndi magulu ena onse a mankhwala omwe amagwiritsidwa ntchito pochiza matenda oopsa. Izi ndizofunikira kwa odwala omwe mankhwalawa othandizira.
6. Kuchulukitsa chiyembekezo cha moyo wa odwala omwe ali ndi vuto la mtima.
7. Zotsatira zoyipa ndizosowa kwambiri.
8. Mosiyana ndi antihypertensive mankhwala a magulu ena, sizikhudza potency.
9. Itha kuthandizidwa mosasamala chakudya - izi sizikhudza kuyambika ndi kutalika kwa mavutowo.
10. Mafuta (mayamwidwe ndi matupi athupi) onse osaposa 60%.
11. Mphamvu ya antihypertensive imayamba kuwonekera pambuyo pa ola limodzi.
12. Hafu ya moyo ndi maola 12.
13. Mphamvu yokhazikika imayamba pambuyo pa miyezi 1-2 ya kudya pafupipafupi.
14. Mlingo wa wodwala aliyense amasankhidwa payekha, koma kuchuluka kwake patsiku sikuyenera kupitirira 40 mg.

Kodi pali kusiyana kotani?

Kusiyanitsa kwakukulu pakati pa zida izi ndi motere:

1. Enalapril imakumana ndi kagayidwe - m'thupi limasandulika kukhala enalaprilat, yomwe imagwira ntchito. Lisinopril samapangidwira, samayikidwa mu minofu ya adipose.
2. Lisinopril adawonekera pambuyo pake (mankhwalawa ndi amakono kwambiri). Koma ku Enalapril, maphunziro azachipatala ambiri adachitika.
3. Enalapril ndi mankhwala osankhidwa pochiza odwala matenda oopsa komanso odwala matenda ashuga.
4. Ndikulimbikitsidwa kuti mutengedwe kamodzi patsiku, pomwe zotsatirazi zimapitilira maola 24. Koma odwala ambiri amawona kuti mlingo umodzi wa enalapril kuti akhazikitse kupanikizika sikokwanira, chifukwa chake madokotala amalimbikitsa kuti akhale ndi mlingo wambiri.
5. Enalapril amamangidwa kumapuloteni amwazi ndi 50-60%. Lisinopril samamanga konse.
6. Kuchuluka kwa enalapril kumawonedwa pambuyo maola 4-6, Lisinopril - maola 6-7.
7. Kutupa kwa enalapril kumachitika kudzera mu chiwindi ndi impso, ndipo lisinopril yekha ndi impso.
8. Lisinopril amapezeka kokha pamapiritsi. Enalapril ikhoza kugulidwa ngati maupulo a jakisoni. Mwanjira yovomerezeka, mankhwalawa amagwiritsidwa ntchito pothana ndi zovuta zosokoneza bongo.
9. Wopanga Enalapril amapangidwa ku Serbia ndi Russia, ndipo chachiwiri ndi mankhwala apabanja.

Cholimba ndi chiani?

Mphamvu ya mankhwala onsewa ndi yofanana. Zomwe zimapangitsa kuchepetsa kuthamanga kwa magazi nthawi zambiri zimachitika mukamamwa 10-20 mg ya mankhwala. Koma chifukwa chakuti enalapril iyenera kusinthika m'chiwindi kuti ikhale yogwira ya metabolite enalaprilat, mphamvu yake itha kukhala yofooka ndikuchepa kwa ntchito ya chiwalochi. Chifukwa chake, ndibwino kwa odwala omwe ali ndi matenda a chiwindi kuchokera pamavuto kuti atenge lisinopril, chifukwa silimapukusidwa.

Ndemanga za Odwala

Antonina, wazaka 58, Perm

Ndinatenga Enalapril chifukwa cha matenda oopsa muyezo wa 10 mg tsiku lililonse. Ndinkakonda mankhwalawa, adalekeredwa bwino, sizinayambitse zovuta. Koma nthawi zina kupanikizika kumakulirakulira ndikuyenera kuwonjezera mlingo. Ndipo dotolo adayamwa kuti amwe Lisinopril yemweyo mlingo: nawo, kupanikizika kumakhalabe kwabwinobwino tsiku lonse.

Peter, wazaka 62, Tver

Ndili ndi matenda ashuga, ndipo motsutsana ndi mbiri yake adakumana ndi zovuta ndi impso, kupsinjika kumalumphira. Dokotala adalemba mapiritsi a Enalapril, koma patatha masiku ochepa ndidayamba kutsokomola. Kenako adotolo adasinthanitsa ndi Lisinopril. Matendawa adabweranso kwawoko, kutsokomola kumapita, kukakamizidwa kunalibe, ndipo kunalibe zotsatirapo zake.

Alexey, wazaka 72, Samara

Pambuyo pa vuto la mtima, ndimamwa mankhwala ambiri osiyanasiyana, kuphatikiza Enalapril. Zimathandiza ndi kukakamiza ndipo zimachirikiza mtima. Nthawi ndi nthawi, adotolo adanena kuti zisinthe ndi lisinopril kuti pasakhale kusuta. Mankhwala onse awiriwa amalekeredwa komanso kuthandizidwa ndi kukakamizidwa.

Pharmacokinetics

Pambuyo pakukonzekera pakamwa, bioavailability wa lisinopril ndi 25-29%. Magwiridwe antchito a chiwindi samakhudza bioavailability. Kudya sikusintha mayamwidwe amtundu wa m'mimba. Mu thupi laumunthu, silimapukusidwa ndikuchotsedwa mkodzo osasinthika. Mu plasma, lisinopril samangirira kumapuloteni. Hafu ya moyo ndi maola 12.6. Mankhwala amayamba kusefedwa, amamutsekera ndikumubwezeretsanso tubules. Kuchuluka kwa ndende kumafikira maola 6 mutatha kumwa kamodzi, ndipo msambo wokhazikika womwe umakhala wambiri ndi pambuyo pa masiku awiri ndi atatu.

Mu matenda oopsa, mlingo woyambirira ndi 10 mg / tsiku limodzi, kenako ndikuwonjezereka kwapang'onopang'ono mpaka 40 mg / tsiku.

Chifukwa chake, mankhwalawa odwala omwe ali ndi matenda oopsa ndi matenda am'mimba, dokotala ali ndi mwayi wosankha mankhwala kuchokera m'magulu osiyanasiyana a ACE inhibitors, kutengera mawonekedwe awo a pharmacokinetic.

Pantchito yathu, tinayang'ana momwe ntchito ya ACE inhibitor (lisinopril) imathandizira odwala omwe ali ndi matenda oopsa osiyanasiyana.

Zipangizo ndi njira zakufufuzira

Phunziroli lidaphatikizapo odwala 60 oopsa ogwirizana ndi steatosis (gulu 1), cirrhosis (gulu 2), zilonda zam'mimba (gulu 3), anthu 20 pagulu lirilonse, motsatana.

Kugawa kwamiyeso ya lisinopril kumachitika sabata iliyonse motsogozedwa ndi kuyang'anira tsiku ndi tsiku kuthamanga kwa magazi (ABPM). Kutengera madandaulo, mbiri yakale yakuchipatala komanso deta yoyeserera (kuyezetsa magazi, esophagogastroduodenoscopy, kuyesa kwa zam'mimba), kupezeka kwa matenda ochokera ku chiwindi ndi kupukusa kwam'mimba kokhazikika. Odwala okhala ndi zilonda zam'mimba zokhala ndi chiwindi chokhazikika amapanga gulu loyerekeza (Gome 1).

Kuti muwone kuyendetsa bwino kwa lisinopril, kuwunika kwa ABPM-02 kunachitika pogwiritsa ntchito njira ya ABRM-02 pogwiritsa ntchito njira ya oscillometric yoyezera kuthamanga kwa magazi mumayendedwe aulere. Kulembetsa kunachitika ndi dzanja "losagwira ntchito" popanda asymmetry ya kuthamanga kwa magazi. Ndi asymmetry ya kuthamanga kwa magazi kuposa 5 mm RT. Art. kuwerenga kunachitika pamkono ndi mitengo yokwera. Kuyeza kwa kuthamanga kwa magazi kunachitika kwa maola 24 mphindi 15 zilizonse kuyambira maola 6.00 mpaka 22.00 ndipo mphindi 30 zilizonse kuyambira 22,00 mpaka maola 6.00.

Pofuna kumveketsa mawonekedwe amitsempha yamagazi obisika komanso kuwunika mphamvu ya lisinopril, malingaliro okhudzana ndi magazi anali otsimikiza kuchokera ku ABPM. Nthawi zambiri, masana, kuthamanga kwa magazi sikuyenera kupitilira 140 ndi 90 mm Hg. Art., Usiku - 120 ndi 80 mm RT. Art. Monga chizindikiro cha kupsinjika, tinawerengera nthawi (VI) - kuchuluka kwa nthawi yomwe kuthamanga kwa magazi kumadutsa nthawi yovuta kwambiri (malinga ndi malingaliro a American Society of Hypertension, kuchuluka kwa kuthamanga kwa magazi kopitilira 30% kumawonetsa kukhalapo kwa kuthamanga kwa magazi) .

Pakuwongola deta, pulogalamu ya Statistica 5.0 idagwiritsidwa ntchito. Pazisonyezo zilizonse, kuchuluka kwa tanthauzo ndi kupatuka kochokera pamtengo wamtunduwu amawerengedwa. Kufunikira kwa kusintha kwa zizidziwitso kunatsimikiziridwa pakuyesa kwa Fisher. Kusiyanako kunawonedwa kukhala kofunika malinga ndi mavoti a p 265: 3.67 mwa 5)

Kusintha kwa nkhani 01/30/2019

Matenda oopsa (AH) mu Russian Federation (RF) imakhalabe vuto lalikulu kwambiri pazachipatala ndi chikhalidwe cha anthu. Izi zikuchitika chifukwa cha kuchuluka kwa matendawa (pafupifupi 40% ya anthu achikulire ku Russian Federation ali ndi kuthamanga kwa magazi), komanso chifukwa choti matenda oopsa ndiwofunikira kwambiri pamatenda akulu a mtima - kulowerera m'mitsempha.

Kuchulukirabe kosalekeza kwa kuthamanga kwa magazi (BP) mpaka 140/90 mm. Hg. Art. ndi kumtunda - Chizindikiro cha matenda oopsa (matenda oopsa).

Zowopsa zomwe zimapangitsa chiwonetsero cha matenda oopsa zimaphatikizapo:

• Zaka (abambo opitirira zaka 55, azimayi oposa zaka 65)
• Kusuta
• kumangokhala
• Kunenepa kwambiri (m'chiuno kupitirira 94 masentimita kwa amuna ndi oposa 80 cm kwa akazi)
• Milandu yam'banja yamatenda oyamba a mtima (mwa amuna ochepera zaka 55, mwa akazi ochepera zaka 65)
• Kufunika kwa kuthamanga kwa magazi mu okalamba (kusiyana pakati pa systolic (kumtunda) ndi kuthamanga kwa magazi (diastoli (kutsika)). Nthawi zambiri, ndi 30-50 mm Hg.
• Kusala plasma glucose 5.6-6.9 mmol / L
• Dyslipidemia: cholesterol yathunthu kuposa 5.0 mmol / L, otsika osalimba lipoprotein cholesterol 3.0 mmol / L kapena kuposa, amuna osalimba kwambiri lipoprotein cholesterol 1.0 mmol / L kapena kuchepera kwa amuna, ndi 1.2 mmol / L kapena ochepera kwa akazi, triglycerides wamkulu kuposa 1.7 mmol / l
• Zinthu zovuta
• uchidakwa
• Zakudya zamchere zochuluka (zoposa magalamu 5 patsiku).

Komanso matenda ndi zinthu monga:

• Matenda a shuga a shuga (kuthamanga kwa madzi a m'magazi a 7.0 mmol / L kapena kupitiliza ndi miyeso yobwereza, komanso shuga wa plasma atatha kudya 11.0 mmol / L ndi zina)
• Matenda ena a endocrinological (pheochromocytoma, aldosteronism)
• Impso ndi aimpso
• Kumwa mankhwala ndi zinthu zina (glucocorticosteroids, mankhwala osapweteka a antiidal, mankhwala oletsa kubereka a mahomoni, erythropoietin, cocaine, cyclosporine).

Kudziwa zomwe zimayambitsa matendawa, kukula kwa zovuta kumatha kupewa. Pangozi ndi anthu okalamba.

Malinga ndi gulu lamakono lomwe bungwe la World Health Organisation (WHO) latulutsa, matenda oopsa agawidwa m'magulu:

• 1 digiri: Kuchulukitsa kwa magazi 140-159 / 90-99 mm RTST
• 2 digiri: Kuchuluka kwa kuthamanga kwa magazi 160-179 / 100-109 mm RTST
• Kalasi 3: Kuchulukitsa kwa kuthamanga kwa magazi kufika pa 180/110 mmHg komanso pamwambapa.

Zisonyezo zamagazi zomwe zimapezeka kunyumba zitha kukhala zowonjezerapo pakuwunika momwe mankhwalawo alili ndipo ndikofunikira pakuwonetsetsa matenda oopsa. Ntchito ya wodwala ndikuwonetsetsa kuti adziwe momwe magazi amayendera, pomwe kuthamanga kwa magazi ndi kugunda kwa mtima kumayikidwa poyeza osachepera m'mawa, masana, madzulo. Ndikothekanso kuyankhapo pamakhalidwe (kukweza, kudya, kuchita masewera olimbitsa thupi, zochitika zovuta).

Njira ya kuyeza kuthamanga kwa magazi:

• Finyani mwachangu mpweya mu cuff mpaka kukakamizidwa kwa 20 mmHg, kuthamanga kwa magazi a systolic (SBP), mwa kutha kwa zamkati
• Kuthamanga kwa magazi kumayeza ndi kulondola kwa 2 mmHg
• Chepetsani kupanikizika kwa cuff pamlingo pafupifupi 2 mmHg m'mphindi imodzi
• Mlingo wopsinjika momwe kamvekedwe koyamba kamafanana ndi GARDEN
• Mlingo wapanthawi yomwe kufalikira kwa matani kumachitika kumafanana ndi diastolic magazi (DBP)
• Ngati matalala ndi ofooka, muyenera kukweza dzanja lanu ndikuyenda motsutsana ndi burashi, ndiye kubwereza muyeso, pomwe simuyenera kufinya mtsempha mwamphamvu ndi membrane wa phonendoscope
• Muyeso yoyamba, kuthamanga kwa magazi kumakhazikika pa manja onse awiri. Kupitilira apo, muyeso umachitika mkono womwe magazi ake amakhala okwera kwambiri
• Odwala omwe ali ndi matenda a shuga komanso anthu omwe amalandila mankhwala a antihypertensive, magazi amayeneranso kuyesedwa pakatha mphindi ziwiri atayimirira.

Odwala omwe ali ndi matenda oopsa amamva kupweteka m'mutu (nthawi zambiri kumadera amtundu, mizimu), zochitika za chizungulire, kutopa msanga, kugona tulo, kupweteka kwapamtima, komanso kuwonongeka kwa mawonekedwe.
Matendawa amaphatikizidwa ndimatenda oopsa kwambiri (magazi akayamba kukwera kwambiri, kukodza pafupipafupi, kupweteka mutu, chizungulire, palpitations, malungo), kuperewera kwaimpso - nephrossteosis, stroko, intracerebral hemorrhage, myocardial infarction.

Pofuna kupewa zovuta, odwala matenda oopsa ayenera kuyang'anitsitsa kuthamanga kwa magazi awo ndikumwa mankhwala apadera a antihypertensive.
Ngati munthu akuda nkhawa ndi zomwe zidatchulidwazi pamwambapa, komanso kupanikizidwa nthawi 1-2 pamwezi - uwu ndi mwayi wolumikizana ndi akatswiri odziwa zamankhwala kapena zamankhwala omwe adzapereke mayeso ofunikira, ndipo mtsogolomo adzazindikira njira zina zamankhwala. Pambuyo pakuchita kafukufuku wofunikira ndikofunikira kufotokoza momwe mungagwiritsire ntchito mankhwala.

Kudzisankhira nokha mankhwala kungathe kuwopseza kukulitsa zovuta zosafunikira, zovuta komanso zitha kupha! Sizoletsedwa kugwiritsa ntchito mankhwala osokoneza bongo potsatira mfundo za "abwenzi othandizira" kapena kugwiritsa ntchito malingaliro a akatswiri pamakampani a mankhwala. Kugwiritsa ntchito mankhwala a antihypertensive ndikotheka kokha malinga ndi zomwe dokotala wakupatsani!

Cholinga chachikulu chothandizira odwala ndi matenda oopsa ndikuchepetsa chiopsezo chokhala ndi zovuta zamtima ndi kufa kwa iwo!

1. Zochita kusintha moyo:

• Kusuta kufafaniza
• Kulemera kwa thupi
• Mowa osamwa osakwana 30 g / tsiku kwa amuna ndi 20 g / tsiku kwa akazi
• Kuchuluka kwa zolimbitsa thupi - kuchita masewera olimbitsa thupi pafupipafupi kwa mphindi 30 mpaka 4 kawiri pa sabata
• Kuchepetsa kumwa kwa mchere mpaka 3-5 g / tsiku
• Sinthani muzakudya ndi kuchuluka kwa kudya kwa zakudya zamasamba, kuchuluka kwa zakudya za potaziyamu, calcium (wopezeka mumasamba, zipatso, mbewu) ndi magnesium (wopezeka muzomera zamkaka), komanso kuchepa kwa mafuta a nyama.

Njira izi zimaperekedwa kwa odwala onse omwe ali ndi matenda oopsa, kuphatikizapo omwe amalandila antihypertensive mankhwala. Amakulolani kuti: muchepetse kuthamanga kwa magazi, muchepetse kufunika kwa antihypertensive mankhwala, zimakhudza zomwe zingachitike pachiwopsezo.

2. Mankhwala osokoneza bongo

Lero tikambirana za mankhwalawa - mankhwala amakono ochizira matenda oopsa.
Matenda oopsa a arterial ndi matenda osachiritsika omwe amangofunika kuwunika kwa magazi pafupipafupi, komanso kudya mankhwala mosalekeza. Palibe njira yothandizira antihypertensive, mankhwala onse amatengedwa kwamuyaya. Ngati monotherapy siyothandiza, mankhwala ochokera m'magulu osiyanasiyana amasankhidwa, nthawi zambiri kuphatikiza mankhwalawa angapo.
Monga lamulo, chikhumbo cha wodwala wokhala ndi matenda oopsa ndikupeza mankhwala amphamvu kwambiri, koma osati okwera mtengo. Komabe, ziyenera kumvetsedwa kuti izi sizipezeka.
Ndi mankhwala amtundu wanji awa omwe amapereka kwa odwala omwe ali ndi kuthamanga kwa magazi?

Mankhwala aliwonse a antihypertgency ali ndi njira yake yochitira zinthu, i.e. kukhudza awo kapena ena"Njira" zowonjezera kuthamanga kwa magazi:

a) Dongosolo la Renin-angiotensin - mankhwala a prorenin amapangidwa mu impso (ndi kuchepa kwa kuthinitsidwa), omwe umadutsa mu renin m'magazi. Renin (puloteni ya puloteni yotchedwa proteinolytic) imalumikizana ndi puloteni ya plasma - angiotensinogen, zomwe zimapangitsa kuti pakhale chinthu chosagwira, angiotensin I. Angiotensin, akamacheza ndi angiotensin kutembenuza enzyme (ACE), amadutsa mu yogwira mankhwala, angiotensin II. Katunduyu amathandizira kuwonjezeka kwa kuthamanga kwa magazi, vasoconstriction, kuchuluka kwa pafupipafupi ndi kulimba kwa mgwirizano wamtima, kukondoweza kwa mtima wamanjenje (zomwe zimapangitsanso kuwonjezeka kwa kuthamanga kwa magazi), komanso kuwonjezeka kwa kupanga kwa aldosterone. Aldosterone imathandizira kuti asungunuke sodium ndi madzi, zomwe zimapangitsanso kuthamanga kwa magazi. Angiotensin II ndi imodzi mwamphamvu kwambiri pamimba.

b) Mayendedwe a calcium a maselo a thupi lathu - kashiamu m'thupi ili m'ndende. Mukalandira calcium kudzera munjira zapadera mu cell, mapangidwe a proteinacos - cellomyosin. Pansi pa kuchitapo kwake, ziwiya zopapatiza, mtima umayamba kulimba kwambiri, kukakamizidwa kumawonjezeka ndipo kugunda kwa mtima kumakulitsidwa.

c) Adrenoreceptors - m'thupi lathu m'ziwalo zina muli ma receptor, mkwiyo wake womwe umakhudza kuthamanga kwa magazi. Izi zolandilira zimaphatikizapo alpha-adrenergic receptors (α1 ndi α2) ndi beta-adrenergic receptors (β1 ndi β2) Kukondoweza kwa α1-adrenergic receptors kumapangitsa kuti magazi azithamanga, α2-adrenergic receptors kutsika kwa kuthamanga kwa magazi komwe kuli Α-adrenergic receptors. β1-adrenergic receptors amapezeka pamtima, impso, kukondoweza kwawo kumawonjezera kuwonjezeka kwa kugunda kwa mtima, kuwonjezeka kwa myocardial oxygen akufuna komanso kuwonjezeka kwa kuthamanga kwa magazi. Kukondoweza kwa β2-adrenergic receptors yomwe ili mu bronchioles kumapangitsa kukula kwa bronchioles ndi kuchotsedwa kwa bronchospasm.

d) Dongosolo la chimbudzi - chifukwa chambiri madzi mthupi, kuthamanga kwa magazi kumakwera.

e) Mkulu wamanjenje wamkati - kukhumudwa kwa chapakati mantha dongosolo kumawonjezera kuthamanga kwa magazi. Mu ubongo muli malo a vasomotor omwe amawongolera kuthamanga kwa magazi.

Chifukwa chake, tidasanthula njira zazikulu zowonjezera kuthamanga kwa magazi mthupi la munthu. Yakwana nthawi yoti mupite ku mankhwala ochepetsa kuwononga magazi omwe amakhudza njira izi.

2. Zopanda calcium calcium blockers

Ma calcium blockers (calcium antagonists) ndi gulu la mankhwala omwe ali ndi machitidwe ofanana, koma amasiyana m'malo angapo, kuphatikiza ma pharmacokinetics, kusankha kwa minofu, komanso kuchuluka kwa mtima.
Dzina lina la gululi ndi olimbana ndi calcium ion.
Pali magawo atatu akulu a AK: dihydropyridine (woimira wamkulu ndi nifedipine), phenylalkylamines (woimira wamkulu ndi verapamil) ndi benzothiazepines (woimira wamkulu ndi diltiazem).
Posachedwa, adayamba kugawidwa m'magulu awiri akulu, kutengera mphamvu ya mtima. Diltiazem ndi verapamil amadziwika kuti amatsutsana ndi "calcium" - non-dihydropyridine. Gulu linalo (dihydropyridine) limaphatikizapo amlodipine, nifedipine ndi zina zonse zotuluka za dihydropyridine, kuwonjezeka kapena kusasintha kugunda kwa mtima.
Calcium calcium blockers amagwiritsidwa ntchito ochepa matenda oopsa, matenda a mtima (otsutsana mu mitundu yovuta!) Ndi arrhythmias. Ndi arrhythmias, si onse calcium blockers omwe amagwiritsidwa ntchito, koma kukoka kokha.

• Verapamil 40mg, 80mg (yayitali: Isoptin SR, Verogalid EP) - Mlingo 240mg,
• Diltiazem 90mg (Altiazem PP) - mlingo wa 180mg,

Oyimira otsatirawa (dihydropyridine derivatives) sagwiritsidwa ntchito pa arrhythmias: Contraindified mu pachimake myocardial infarction ndi osakhazikika angina.

• Nifedipine (Adalat, Cordaflex, Kordafen, Cordipin, Corinfar, Nifecard, Phenigidin) - mulingo wa 10 mg, 20 mg, NifecardXL 30 mg, 60 mg.
• Amlodipine (Norvask, Normodipine, Tenox, Cordy Kor, Es Cordy Kor, Cardilopin, Kulchek,
• Amlotop, Omelarkardio, Amlovas - Mlingo wa 5 mg, 10 mg,
• Felodipine (Plendil, Felodip) - 2.5mg, 5mg, 10mg,
• Nimodipine (Nimotop) - 30 mg,
• Lacidipine (Lacipil, Sakur) - 2mg, 4mg,
• Lercanidipine (Lerkamen) - 20mg.

Zotsatira zoyipa za dihydropyridine zotumphukira, kutupa, m'munsi miyendo, kupweteka mutu, kufupika kwa nkhope, kuwonjezeka kwa mtima, kuwonjezereka pokodza kungasonyezedwe. Ngati kutupira kumapitirira, mankhwalawo ayenera kusinthidwa.
Lerkamen, yemwe ndi woimira m'badwo wachitatu wa okonda calcium, chifukwa cha kusankha kwapamwamba pang'onopang'ono, amachititsa edema kukhala yocheperako poyerekeza ndi ena oimira gululi.

3. Beta-blockers

Pali mankhwala omwe samatseketsa ma receptors - osasankha, amakhala ophatikizidwa ndi mphumu ya bronchial, a obstative pulmonary matenda (COPD). Mankhwala ena amasankha okha beta-receptors a mtima - kusankha. Onse opanga beta amalepheretsa kuphatikiza kwa prorenin mu impso, potero akuletsa dongosolo la renin-angiotensin. Motere, mitsempha yamagazi imakulitsidwa, kuthamanga kwa magazi kumachepa.

• Metoprolol (Betalok ZOK 25mg, 50mg, 100mg, Egilok retard 25mg, 50mg, 100mg, 200mg, Egilok S, Vazokardinretard 200 mg, Metokardretard 100 mg) ,,
• Bisoprolol (Concor, Coronal, Biol, Bisogamma, Cordinorm, Niperten, Biprol, Bidop, Aritel) - nthawi zambiri mlingo ndi 5 mg, 10 mg,
• Nebivolol (Nebilet, Binelol) - 5 mg, 10 mg,
• Betaxolol (Lokren) - 20 mg,
• Carvedilol (Carvetrend, Coriol, Talliton, Dilatrend, Akridiol) - makamaka mlingo wa 6.25 mg, 12,5 mg, 25 mg.

Mankhwala osokoneza bongo a gululi amagwiritsidwa ntchito pochita matenda oopsa, kuphatikizapo matenda a mtima ndi corharymias.
Mankhwala osokoneza bongo achidule, kugwiritsa ntchito komwe sikungakhale koyenera kwa matenda oopsa: anaprilin (obzidan), atenolol, propranolol.

Milandu yayikulu kwa beta blockers:

• Mphumu ya bronchial,
• kuchepetsedwa kupanikizika
• wodwala sinus syndrome,
• matenda a zotumphukira mitsempha,
• bradycardia
• Cardiogenic mantha
• atrioventricular block ya degree yachiwiri kapena yachitatu.

Angiotensin Kutembenuza Enzyme Inhibitors (ACE)

Mankhwalawa amalepheretsa kusintha kwa angiotensin I kupita kwa angiotensin II. Zotsatira zake, kuchuluka kwa angiotensin II m'mwazi kumachepa, ziwiya zimachepa, ndipo kupsinjika kumachepa.
Oyimira (m'mabuku ndi matchulidwe - zinthu zomwe zimapangidwa ndi mankhwala omwewo):

• Captopril (Kapoten) - Mlingo wa 25 mg, 50 mg,
• Enalapril (Renitek, Burlipril, Renipril, Ednit, Enap, Enarenal, Enam) - mlingo umakonda kwambiri 5 mg, 10 mg, 20 mg,
• Lisinopril (Diroton, Dapril, Lysigamm, Lisinoton) - Mlingo wambiri nthawi zambiri ndi 5 mg, 10 mg, 20 mg,
• Perindopril (Prestarium A, Perineva) - Perindopril - Mlingo wa 2.5mg, 5mg, 10mg. Perineva - Mlingo wa 4 mg, 8 mg.,
• Ramipril (Tritace, Amprilan, Hartil, Pyramil) - Mlingo wa 2.5 mg, 5 mg, 10 mg,
• Hinapril (Akkupro) - 5mg, 10mg, 20mg, 40mg,
• Fosinopril (Fosicard, Monopril) - mu gawo la 10 mg, 20 mg,
• Trandolapril (Gopten) - 2mg,
• Zofenopril (Zokardis) - Mlingo wa 7.5 mg, 30 mg.

Mankhwalawa amapezeka mosiyanasiyana.

Chachilendo cha mankhwalawa Captopril (Kapoten) ndikuti chifukwa chakufupika nthawi, amachitika chifukwa cha zovuta zapakati zokha.

Omwe akuimira gulu la Enalapril ndi masinthidwe ake amagwiritsidwa ntchito nthawi zambiri. Mankhwalawa samasiyana pakapita nthawi, chifukwa chake 2 patsiku. Mwambiri, zotsatira zonse za ACE zoletsa zitha kuwonedwa pambuyo pa masabata a 1-2 atsogoza mankhwala. M'masamba ogulitsa mankhwala, mutha kupeza mitundu yambiri ya majenito (analogues) ya enalapril, i.e. mankhwala okhala ndi enalapril otsika mtengo omwe amapangidwa ndi mafakitale ang'onoang'ono opanga. Takambirana za mtundu wa zamagetsi munkhani ina; apa ndikofunikira kudziwa kuti ma enalapril ojambula ndi oyenera wina, sagwirira ntchito munthu.

ACE zoletsa amachititsa zotsatira zoyipa - chifuwa chowuma. Pankhani ya chitukuko cha chifuwa, ma inhibitors a ACE amasinthidwa ndi mankhwala a gulu lina.
Gulu la mankhwalawa limapangidwa pakati pa nthawi yoyembekezera, imakhudzanso mwana wosabadwayo!

Angiotensin receptor blockers (otsutsa) (sartans)

Othandizira awa amaletsa ma angiotensin receptors. Zotsatira zake, angiotensin II samayanjana nawo, mitsempha imakulitsa, kuthamanga kwa magazi kumachepa

• Lozartan (Kozaar 50mg, 100mg, Lozap 12.5mg, 50mg, 100mg, Lorista 12.5mg, 25mg, 50mg, 100mg, Vazotens 50mg, 100mg),
• Eprosartan (Teveten) - 400mg, 600mg,
• Valsartan (Diovan 40mg, 80mg, 160mg, 320mg, Valsacor 80mg, 160mg, 320mg, Valz 40mg, 80mg, 160mg, Nortian 40mg, 80mg, 160mg, Valsafors 80mg, 160mg),
• Irbesartan (Aprovel) - 150mg, 300mg,
  Candesartan (Atakand) - 8mg, 16mg, 32mg,
  Telmisartan (Mikardis) - 40 mg, 80 mg,
  Olmesartan (Cardosal) - 10mg, 20mg, 40mg.

Monga otsogola awo, amakupatsani mwayi wowunika zonse masabata 1-2 atayamba kuyang'anira. Osayambitsa chifuwa chowuma. Sayenera kugwiritsidwa ntchito panthawi yoyembekezera! Ngati amayi apezeka kuti ali ndi pakati pamankhwala, mankhwala othandizira omwe ali ndi gululo ayenera kusiyidwa!

5. Othandizira a Neurotropic apakatikati

Mankhwala a Neurotropic apakati amagwira mbali ya vasomotor mu ubongo, akumachepetsa kamvekedwe kake.

• Moxonidine (Physiotens, Moxonitex, Moxogamm) - 0,2 mg, 0,4 mg,
• Rilmenidine (Albarel (1 mg) - 1 mg,
• Methyldopa (Dopegit) - 250 mg.

Woimira woyamba wa gululi ndi clonidine, yemwe kale anali wogwiritsidwa ntchito pa matenda oopsa. Tsopano mankhwalawa amawagawa mosamalitsa malinga ndi zomwe wapatsidwa.
Pakadali pano, moxonidine amagwiritsidwa ntchito pochiza matenda othamanga, komanso pochiza. Mlingo wa 0.2mg, 0,4mg. Mlingo wapamwamba wa tsiku ndi tsiku ndi 0,6 mg / tsiku.

7. Opangira ma Alfa

Othandizira awa amalumikizana ndi alpha-adrenergic receptors ndikuwatchinjiriza chifukwa chokwiyitsa kwa norepinephrine. Zotsatira zake, kuthamanga kwa magazi kumachepa.
Omwe amagwiritsa ntchito - Doxazosin (Kardura, Tonocardin) - amapangidwa nthawi zambiri mumagawo a 1 mg, 2 mg. Amagwiritsidwa ntchito poyimitsa kuukira ndikuchiritsa kwa nthawi yayitali. Mankhwala ambiri a alpha-blocker asiidwa.

Chifukwa chiyani mankhwalala angapo amatengedwa ndi matenda oopsa?

Mu gawo loyambirira la matendawa, adotolo amafotokozera mankhwala amodzi, kutengera maphunziro ena ndikuganizira za matenda omwe alipo. Ngati mankhwala amodzi sangathandize, mankhwala ena nthawi zambiri amawonjezeredwa, ndikupanga kuphatikiza kwa mankhwalawa kuti muchepetse kuthamanga kwa magazi, zomwe zimakhudza njira zosiyanasiyana zochepetsera kuthamanga kwa magazi. Kuphatikiza mankhwala a Refractory (khola) ochepa matenda oopsa amatha kuphatikiza mankhwala osachepera 5-6!

Mankhwala osokoneza bongo amasankhidwa m'magulu osiyanasiyana. Mwachitsanzo:

• ACE inhibitor / diuretic
• angiotensin receptor blocker / okodzetsa,
• ACE inhibitor / calcium njira blocker,
• ACE inhibitor / calcium blocker / beta-blocker,
• angiotensin receptor blocker / calcium blocker / beta-blocker,
• ACE inhibitor / calcium chimbale blocker / diuretic ndi mitundu ina.

Pali mitundu yosiyanasiyana ya mankhwala osokoneza bongo monga: beta-blockers / calcium blockers blockers, beta-blockers / apakati akuchita mankhwala osokoneza bongo ndi mitundu ina. Ndiowopsa kuzisinkhasinkha.

Muli mankhwala osakanikirana omwe amaphatikiza piritsi limodzi la zinthu zomwe zimapezeka m'magulu osiyanasiyana a antihypertensive mankhwala.

• ACE inhibitor / diuretic
  • Enalapril / Hydrochlorothiazide (Co-Renitec, Enap NL, Enap N,
  • Enap NL 20, Renipril GT)
  • Enalapril / Indapamide (Enzix duo, Enzix duo forte)
  • Lisinopril / Hydrochlorothiazide (Iruzide, Lisinoton, Liten N)
  • Perindopril / Indapamide (NoliprelAi ndi NoliprelAforte)
  • Hinapril / Hydrochlorothiazide (Accid)
  • Fosinopril / Hydrochlorothiazide (Fosicard H)
• angiotensin receptor blocker / okodzetsa
  • Losartan / Hydrochlorothiazide (Gizaar, Lozap Plus, Lorista N,
  • Lorista ND)
  • Eprosartan / Hydrochlorothiazide (Teveten Plus)
  • Valsartan / Hydrochlorothiazide (Co-diovan)
  • Irbesartan / Hydrochlorothiazide (Co-Aprovel)
  • Candesartan / Hydrochlorothiazide (Atacand Plus)
  • Telmisartan / GHT (Mikardis Plus)
• ACE inhibitor / calcium channel blocker
  • Supandolapril / Verapamil (Tarka)
  • Lisinopril / Amlodipine (Equator)
• angiotensin receptor blocker / calcium blocker blocker
  • Valsartan / Amlodipine (Kutulutsa)
• dihydropyridine calcium channel blocker / beta blocker
  • Felodipine / Metoprolol (Logimax)
• beta-blocker / diuretic (osati chifukwa cha matenda ashuga komanso kunenepa kwambiri)
  • Bisoprolol / Hydrochlorothiazide (Lodose, Aritel Plus)

Mankhwala onse amapezeka pamtundu wosiyanasiyana wa chinthu chimodzi ndi chimodzi, adokotala ayenera kusankha mlingo wa wodwalayo.

Kukwaniritsa ndikusungabe kuchuluka kwa kuthamanga kwa magazi kumafuna kutsatira kwakanthawi kachipatala ndikuwunikira pafupipafupi kutsatira kwa kusintha kwa moyo ndi kutsatira malangizo a antihypertensive, komanso kuwongolera chithandizo malinga ndi kugwiriridwa, chitetezo ndi kulolerana kwa mankhwalawa. Pakuwunika mwamphamvu, kukhazikitsa kuyanjana pakati pa dokotala ndi wodwalayo, kuphunzitsa odwala m'masukulu a odwala omwe ali ndi matenda oopsa, ndikuwonjezera kutsatira kwa wodwala chithandizo ndikofunikira.

Kusintha kwa nkhani 01/30/2019

CardiologistZvezdochetovaNatalya Anatolyevna

Lisinopril ndi enalapril ndiwotsika mtengo, wogwira ntchito komanso wogwiritsidwa ntchito kwambiri pochiza mitundu yonse ya matenda oopsa komanso kulephera kwa mtima.

Kodi pali kusiyana kwanji pakati pa Lisinopril ndi Enalapril?

Njira zochiritsira zomwe Lisinopril ndi Enalapril ali nazo zimagwira ntchito zosiyanasiyana, koma ndi kusiyana kokhako pakati pa mankhwalawo. Mwa njira zina zonse, malinga ndi kufananiza kwa malangizo ogwiritsira ntchito, kukonzekera kuli kofanana komanso kofanana.

Zambiri: chilengedwe, mawonekedwe omasulira, magawo a formula

Woyamba mgululi adapangidwa "Captopril" ndipo anali ndi kusiyana kwakukulu munthawi yochitapo kanthu poyerekeza ndi mankhwala ena a nthawi imeneyo. Enalapril adapangidwa m'ma 80s m'zaka za zana la makumi awiri ndi Merck, monga cholowa m'malo mwa Captopril, ndipo ndi wa m'badwo wachiwiri wa mankhwala osokoneza bongo. Lisinopril adapangidwa mu 1975, ndipo pambuyo pake adayamba kupangidwa ku Hungary. Sanakhale ndi kusiyana kwakukulu kuchokera ku Enalapril. Tebulo likuwonetsa zonse komanso mawonekedwe a mankhwalawo komanso kusiyana kwake, komwe kumakupatsani mwayi wofanizira mankhwala.

Sonyezani kukakamiza kwanu

Kuyerekezera Mankhwala

Chikhazikitso	Lisinopril
Zogwira ntchito	Enalapril maleate	Lisinopril dihydrate
Zothandizira zothandizira	Nthawi zina zosiyana ndi opanga osiyanasiyana	Chokhazikika, kuchuluka kokha kumasintha malinga ndi kuchuluka kwa zinthu zoyambira
Kusintha	5, 10 ndi 20 mg
Kutalika kwa nthawi	mpaka maola 24
Kutulutsa Fomu	Mapiritsi
Njira yolerera	Amasiyanitsidwa ndi impso ndi chiwindi	Pakachotsedwa m'thupi, kapangidwe kake sikusintha
Kulowerera kudzera mu chotchinga chachikulu mu mkaka wa m'mawere	Pamwamba	Otsika
Kugwiritsa ntchito chinthu chachikulu pokonzekera kwina	Enap, Enamu	Lipril, Diroton, Scopril
Zowonjezera	Enalapril maleate imaphatikizidwa ndi jakisoni wa mavuto oopsa	―

Kukhazikitsidwa kwa zoletsa za ACE, Mlingo komanso pafupipafupi paulamuliri zitha kuchitidwa ndi dokotala.

Zizindikiro ndi contraindication

Mankhwala amagwiritsidwa ntchito ngati:

• matenda oopsa
• Monga mbali ya multicomponent mankhwala ochizira pachimake myocardial infarction,
• mtima kulephera gawo II-IV,
• microalbuminuria mu shuga,
• matenda a mtima.

Mankhwala sayenera kugwiritsidwa ntchito ngati:

• zaka mpaka 18
• yoyamwitsa kapena pakati
• matenda a impso
• tsankho limodzi ndi zigawo za mankhwala zimawonedwa,
• akukonzanso pambuyo pakuchotsa impso,
• dalaivala stenosis,
• kulephera kwa chiwindi kwapezeka
• kuzindikira hypertrophic cardiomyopathy,
• Edema ya Quincke imawonedwa,
• pali hyperkalemia.

Njira zogwiritsira ntchito

Mapiritsi amagwiritsidwa ntchito mosasamala chakudya nthawi yomweyo. "Lisinopril" amatengedwa kamodzi kwa maola 24, ngati mungayerekeze, ndiye kuti "Enalapril" nthawi zina amatengedwa kawiri. Mlingo woyambirira nthawi zambiri umakhala ndi 2,5 kapena 5 mg, umayikidwa potengera momwe wodwalayo alili ndi matenda oyanjana nawo. Dokotala angasinthe mlingo. 20 mg - mlingo waukulu patsiku, kangapo - 40 mg (wa Enalapril). Mankhwala osokoneza bongo amadziwika ndi kutsika kwakuthwa m'magazi a magazi kapena mawonekedwe a kugwidwa. Ngati zizindikiro zotere zikuwoneka, ndikofunikira kutsuka m'mimba, ndipo muzovuta kwambiri, kuwonjezera kukakamiza pobweretsa njira zamchere, zotsekera m'malo mwa plasma.

Mukamamwa, mavuto omwewa amawonekera:

• chifuwa chowuma
• chizungulire
• kutsegula m'mimba
• mutu
• zovuta za impso,
• thupi lawo siligwirizana
• kuchepa kwambiri kwa mavuto muyezo woyamba wa mankhwala ndi kotheka,
• Hyperkalemia, ngati kumwa mankhwala okhala ndi potaziyamu.

Chili bwino ndi kusiyana kwanji pakati pa Lisinopril ndi Enalapril?

Ndizosatheka kunena zomwe ndizothandiza kwambiri - "Lisinopril" kapena "Enalapril." Koma pali zosiyana pakati pawo. Mu 1992, kuyerekezera kwa mankhwalawa kunaperekedwa. Maphunzirowo adagawika m'magulu atatu - 2 adalandira 10 mg imodzi ya mankhwalawo, ndipo yachitatu - dummy. Kusanthula kwa tsokalo kunawonetsa kuti mwa odwala omwe amatenga ma inhibitors, kupanikizika kunachepa ndi chizindikiro chabwino, koma kusiyana sikunali kwakukulu. Pomwe gulu la placebo linalibe zizindikiro zotere. Nthawi yomweyo, "Lisinopril" anali wogwira ntchito masana, mosiyana ndi "Enalapril," chifukwa cha nthawi yayitali. Pankhaniyi, kutulutsidwa kwa Enalapril m'thupi sikunachitike ndi impso zokha, komanso ndi chiwindi, komwe sikoyenera nthawi zonse. Zinapezeka kuti Enalapril amatha kukhala ndi chifuwa chowuma kuposa ndi Lisinopril. Khunyu yopangidwa makamaka ndikugwiritsa ntchito nthawi yayitali, ndikuyimitsa, kuchepetsa mlingo kapena kusintha kwa mankhwala kumafunika.

Pakadali pano mitundu pafupifupi yokwana 20 ya enalapril ilipo pamsika wogulitsa mankhwala ku Russia, chifukwa chake, kufunikira kwa mtundu uliwonse wa mankhwalawa kumafunika.

Cholinga cha phunziroli chinali kuwunika momwe angiotensin akatembenuzira enzyme (ACE) inhibitor enalapril (enam, Dr. Reddy's Laboratories LTD) poyerekeza ndi kapangidwe kazithunzithunzi za mbiri ya kuthamanga kwa magazi kwa odwala omwe ali ndi vuto locheperachepera owopsa.

Phunziroli linaphatikizapo amuna azaka zapakati pa makumi asanu ndi limodzi mpaka makumi asanu ndi limodzi ndi zisanu ndi zitatu zokhala ndi matenda oopsa (malinga ndi njira za WHO), omwe magazi ake amakwera kwambiri kuyambira 95 mpaka 114 mm Hg. Art., Yemwe amafunikira kudya mankhwala a antihypertensive nthawi zonse. Odwala omwe ali ndi matenda osachiritsika ndipo amafunikira chithandizo chokhazikika, komanso contraindication kuti athandizidwe kwakanthawi ndi ACE inhibitors, sanaphatikizidwe mu phunziroli. Odwala onse, chithandizo cham'mbuyomu cha antihypertensive chinathetsedwa isanayambike phunzirolo, kenako placebo idakhazikitsidwa kwa masabata awiri. Pamapeto pa nthawi ya placebo, kusinthanitsa kunachitika. Wodwala aliyense amatenga enalapril (enam) kwa masabata asanu ndi atatu muyezo wa 10 mpaka 60 mg mu magawo awiri a magawo awiri (pafupifupi tsiku lililonse 25.3 + 3.6 mg) ndi Captopril (capoten, Akrikhin JSC, Russia) ) 50 mg kawiri pa tsiku (pafupifupi tsiku lililonse 90.1 + 6.0 mg). Pakati pa maphunziro okhudzana ndi mankhwala, placebo idasankhidwa kwa masabata awiri. Motsatira kuperekera kwa mankhwala kunatsimikiziridwa ndi chiwembu chokhazikitsidwa. Kamodzi masabata awiri aliwonse, wodwalayo amayesedwa ndi dokotala yemwe amayeza kuthamanga kwa magazi ndi zebulopazmomometer ndikuwerengera kugunda kwa mtima (HR). Kuwunika kwa maola atatu kunja kwa magazi kunachitika koyambirira, pambuyo pa masabata awiri atalandira placebo komanso pambuyo pa milungu 8 ya chithandizo chilichonse. Tinagwiritsa ntchito SpaceLabs Medical system, mtundu 90207 (USA). Njira imafotokozedwa mwatsatanetsatane ndi ife kale.

Phunziroli lidaphatikizapo odwala 21. Atatu "adasiya" phunzirolo: wodwala m'modzi - chifukwa cha kudzipereka kwa magazi pafupipafupi mu nthawi ya placebo, wina anakana kutenga nawo mbali phunzirolo, ndipo wachitatu - chifukwa cha bronchospasm munthawi ya placebo. Gawo lomaliza la phunziroli lidakhudza odwala 18 azaka za pakati pa 43 mpaka 67 (52.4) 1.5) nthawi yayitali kwambiri ya zaka 1-27 (11.7 ± zaka 1.9). Zizindikiro zotsatirazi zidawunikidwa: kuchuluka kwa magazi masiku onse a systolic (SBP, mmHg), kuchuluka kwa magazi tsiku lililonse kwa diastoli (DBP, mmHg), kugunda kwa mtima, kugunda kwa mtima, kugunda pamphindi), komanso padera masiku ndi usiku, Index ya nthawi ya SBP (IVSAD,%) ndi index ya nthawi ya DBP (IVDAD,%) - kuchuluka kwa miyeso yopitilira 140/90 mm Hg. Art.masana ndi 120/80 mm RT. Art. usiku, VarsAD ndi VARDAD (mmHg) - kusiyanasiyana kwa kuthamanga kwa magazi (monga kupatuka kwofunikira kwa njira) padera kwa usana ndi usiku.

Kusanthula kwa Statistics kunachitika pogwiritsa ntchito masamba a Spell 7.0. Njira zofunikira za kuchuluka kwamasinthidwe zidagwiritsidwa ntchito: kuwerengetsa kwapakati, zolakwika zofananira. Kufunikira kwa kusiyana kunatsimikiziridwa pogwiritsa ntchito zotsatsa za Student.

Gome 1. Zotsatira za enalapril, captopril ndi placebo patsiku lililonse la kuthamanga kwa magazi

Chizindikiro Poyambirira Malo Captopril Enalapril M ± m M ± m M ± m M ± m Tsiku GARDEN153,0±2,6152,0±2,6150,0±3,4145,0±2,6* DBP98,8±1,599,6±2,197,0±2,293,2±1,7* Kufika pamtima73,9±1,174,7±2,575,0±2,273,9±2,4 Tsiku GARDEN157,0±2,6156,0±2,3152,0±3,3148,0±2,4* DBP103,0±1,7104,0±1,8100,0±2,396,1±1,4** WARSAD11,4±0,611,3±0,612,0±0,912,9±0,8 WARDAD9,2±0,48,8±0,49,3±0,610,0±0,6 IVSAD87,7±3,888,3±2,874,0±5,5*68,0±5,7** IVADAD86,0±3,890,0±3,276,0±5,468,2±4,8* Kufika pamtima77,4±1,278,2±2,878,0±2,277,0±2,7 Usiku GARDEN146,0±2,9146,0±3,1146,0±3,7138,0±3,7 DBP92,6±1,493,2±2,392,0±2,386,4±2,8 WARSAD12,8±0,913,2±0,714,0±0,912,5±0,9 WARDAD10,7±0,611,3±0,612,0±0,711,0±0,7 IVSAD94,2±2,092,7±2,692,0±2,477,9±6,6* IVADAD83,3±3,279,2±5,179,0±4,963,2±7,4 Kufika pamtima68,5±1,369,6±2,571,0±2,468,4±1,8 Chidziwitso: * tsa

Pamapeto pa nthawi ya placebo, mphamvu ya magazi ya systolic ndi diastolic yoyezedwa ndi mercury sphygmomanometer (156.3 ± 3.5 / 103.6 ± 1.5 mm Hg) sizinasiyane kwambiri ndi mfundo zoyambira (161.8 ± 4.2 / 106 , 6 ± 1.7 mm Hg). Kuchiza ndi enalapril ndi Captopril kunayambitsa kuchepa kwakukulu kwa kuthamanga kwa magazi kwa diastolic (mpaka 91.5 ± 2.0 (p. Zotsatira zoyipa Nthawi yatsoka Ntchito Zowongolera Mlingo mg Zotsatira zoyipa Nthawi yatsoka Ntchito Zowongolera 1100Youma chifuwaMilungu 8Zosafunika10Youma chifuwa4 milunguMlingo kuchepetsa mpaka 5 mg 250Zowawa6 milunguMlingo kuchepetsa mpaka 37,5 mg10Zowawa4 milunguMlingo kuchepetsa mpaka 5 mg 350MutuMasabata awiriMlingo kuchepetsa 25 mg20Youma chifuwaMilungu 8Zosafunika 4100Sputum chifuwaMilungu 8Zosafunika40Youma chifuwaMilungu 8Zosafunika 5————20ZowawaMasabata awiriZosafunika 6100ZofookaMasabata 5Zosafunika20Mphamvu yotsekemeraMasabata 5Zosafunika 7100Youma chifuwa4 milunguZosafunika40Youma chifuwaMasabata 7Zosafunika 8————20Youma chifuwa4 milunguPatulani 9————15Youma chifuwa4 milunguZosafunika

Nitrosorbide ndi isodinite ndizodziwika kuti ndizothandiza kwambiri. Chomwe chimapangitsa kufooka kwa mapiritsi osasinthika ndi magawo osungunuka a mapiritsi (atawayika m'madzi adasungunuka pokhapokha masiku 5, kenako ndikuyambitsa kosasinthika).

Enalapril ngati mankhwala akhala akudziwika kwa nthawi yayitali. Ku Russia, mitundu pafupifupi iwiri ya enalapril yamakampani osiyanasiyana akunja ndi mtundu umodzi wa mitundu yopanga mankhwala ogulitsa kunyumba (Kursk Combine of Medicines) adalembetsedwa kale. Monga tikuwonera kuchokera pamwambapa, mtundu uliwonse wa mankhwalawa umayenera kuphunziridwa mosamala. Kuphatikiza apo, enalapril (enam) imagwiritsidwa ntchito kwambiri pazachipatala zothandiza chifukwa cha mtengo wotsika mtengo.

Kafukufuku wapano adawonetsa kukhudzika kwakukulu kwa ACE inhibitor enalapril (enam) mwa odwala omwe ali ofatsa komanso ochepa kwambiri oopsa. Mankhwalawa anali ndi mphamvu ya antihypertensive poyerekeza ndi placebo kawiri pa tsiku komanso masana. Enalapril ndi mankhwala okhala nthawi yayitali choncho amalimbikitsidwa kuti azitsatira kamodzi patsiku. Komabe, monga momwe machitidwe awonekera, kuti pakhale njira yodalirika yoyendetsera kuthamanga kwa magazi mwa odwala omwe ali ochepa kwambiri ochepa matenda oopsa, enalapril iyenera kugwiritsidwa ntchito kawiri pa tsiku.

Mphamvu ya antihypertensive ya captopril poyerekeza ndi placebo sinali yofunikira, panali kungopeka kutsika kwa kuthamanga kwa magazi. Mwachidziwikire Captopril idachepetsa index ya nthawi ya SBP yokha.

Chifukwa chake, kuyendetsa enalapril (enam) muyezo wa 10 mpaka 60 mg wa tsiku kwa 2 Mlingo wowonjezera wa odwala omwe ali ndi vuto lochepa kwambiri kwa matenda oopsa amathandizira kuwunika kwa magazi masana kwambiri kuposa kuposanso kwa captopril muyezo wa 50 mg 2 kawiri pa tsiku tsiku. Chifukwa chake, enalapril (enam, kampani ya Dr. Reddy's Laboratories LTD) pamlingo wa 10 mpaka 60 mg patsiku pa 2 Mlingo wothandizika kwa nthawi yayitali wa odwala omwe ali ndi vuto lochepa kwambiri la matenda oopsa amakhala ndi tanthauzo lambiri la antihypertensive kuposa captopril yomwe yatengedwa pa 50 mg 2 pa tsiku.

1. Kukushkin S.K., Lebedev A.V., Manoshkina E.M., Shamarin V.M.epi Kuyerekeza kuyesa kwa antihypertensive mphamvu ya ramipril (tritace) ndi Captopril (capoten) mwa kuwunika kwa ma ambulated kwa maola a maola 24 // Clinical Pharmacology ndi mankhwala 1997. Na. 6 (3). S. 27-28.
2. Martsevich S. Yu., Metelitsa V.I., Kozyreva M.P. et al. Mitundu yatsopano ya isosorbide dinitrate: kuwunika kwa odwala omwe ali ndi matenda a mtima a mtima // Farmakol. ndi poizoni. 1991. Ayi. 3. S. 53-56.