Mavuto a shuga a mellitus: yang'anani pentoxifylline

Mavuto osaneneka a matenda a shuga amayambitsa kutsika kwa nthawi komanso moyo wa anthu omwe ali ndi matendawa. Kubwezera anthu omwe ali ndi matenda ashuga ndizovuta kukwanitsa ndipo sizotheka patali nthawi zonse kuti muchepetse kukula ndi kupitilira kwa zovuta. Popeza pathogenesis yodziwika ya zovuta zamatenda a shuga, ndikofunikira kugwiritsa ntchito mankhwala achilengedwe, omwe amaphatikizapo mankhwala osasankhidwa a phosphodiesterase blocker pentoxifylline, omwe amapereka kuphatikiza kwa kufooka kwa vasodilation, antiplatelet agent ndi angioprotector. Kuwunika kwa kugwiritsa ntchito pentoxifylline mu zovuta zingapo za matenda a shuga kumawonetsedwa.

Mavuto a shuga a mellitus: yang'anani pentoxifylline

Mavuto azovuta za shuga amayamba chifukwa chochepetsa kutalika ndi moyo wa anthu omwe ali ndi matendawa. Kubwezeredwa kwa matenda a shuga ndikovuta kukwaniritsa ndipo sikuloleza kuletsa kukula kwawo ndi kupitirira kwawo. Poganizira gulu la pathogenesis yamavuto amishuga, kugwiritsa ntchito makonzedwe a dongosolo lomwe osasankha blocker wa phosphodiesterase pentoxifylline kuphatikiza zovuta za zotumphukira za vasodilator, wothandizirana ndi antiplatelet wothandizila ndi angioprotectora. Kuwunikira kwa kugwiritsa ntchito bwino kwa pentoxifylline pamavuto osiyanasiyana a shuga omwe amaperekedwa.

Vesi la pepala la sayansi pamutu wakuti "Mavuto azovuta za matenda ashuga: kuyang'ana pa pentoxifylline"

MALANGIZO OTHANDIZA NDI ZOFUNIKIRA NDI

Mavuto azovuta za matenda ashuga: kuyang'ana pentoxifylline

dokotala wa sayansi ya zamankhwala, pulofesa wa 1 dipatimenti yamatenda amkati mwa Belarusian State Medical University

MokhortT. Belarusian State Medical University, Minsk Matenda azovuta za matenda a shuga:

yang'anani pa pentoxifylline

Chidule Mavuto osaneneka a matenda a shuga amayambitsa kutsika kwa nthawi komanso moyo wa anthu omwe ali ndi matendawa. Kubwezera anthu omwe ali ndi matenda ashuga ndizovuta kukwanitsa ndipo sizotheka patali nthawi zonse kuti muchepetse kukula ndi kupitilira kwa zovuta. Popeza pathogenesis yodziwika ya zovuta zamatenda a shuga, ndikofunikira kugwiritsa ntchito mankhwala achilengedwe, omwe amaphatikizapo osasankha phosphodiesterase blocker - pentoxifylline, yomwe imapereka kuphatikiza kwa kufooka kwa vasodilation, antiplatelet agent ndi angioprotector. Kuwunika kwa kugwiritsa ntchito pentoxifylline mu zovuta zingapo za matenda a shuga kumawonetsedwa.

Mawu osakira: matenda a shuga, kupsinjika, pentoxifylline, matenda ashuga, matenda ashuga nephropathy, ntchito yanzeru, matenda osagwira mtima a chiwindi, matenda a mtima.

Nkhani zamankhwala. - 2015. - Na. 4. - S. 4-9.

Chidule Mavuto azovuta za shuga amayamba chifukwa chochepetsa kutalika ndi moyo wa anthu omwe ali ndi matendawa. Kubwezeredwa kwa matenda a shuga ndikovuta kukwaniritsa ndipo sikuloleza kuletsa kukula kwawo ndi kupitirira kwawo. Poganizira gulu la pathogenesis la zovuta za matenda ashuga, kugwiritsa ntchito makonzedwe a dongosolo lomwe osasankha blocker wa phosphodiesterase - pentoxifylline kuphatikiza zovuta za zotumphukira za vasodilator, antiplatelet agent ndi angioprotectora. Kuwunikira kwa kugwiritsa ntchito bwino kwa pentoxifylline pamavuto osiyanasiyana a shuga omwe amaperekedwa.

Mawu osakira: matenda a shuga, kupsinjika, pentoxifylline, matenda ashuga a retinopathy, nephropathy, kuzindikira kwa matenda, matenda osapatsa mowa.

Meditsinskie novosti. - 2015. - N4. - P. 4-9.

Matenda osatha, kapena mochedwa, zovuta za matenda a shuga (DM) ndizomwe zimayambitsa kuchepa kwakutali ndi moyo wa anthu omwe ali ndi matenda awa. Pachikhalidwe, mawonekedwe a zovuta zovuta amaphatikiza ma microangiopathies (retinopathy, nephropathy), neuropathy ndi macroangiopathies (atherosulinosis ya mitsempha ya mitsempha ndi kukula kwa matenda amitsempha yamagazi, matenda amitsempha yamagazi ndi zina. M'zaka zaposachedwa, kaundula wamkulu wolembera odwala matenda osokoneza bongo omwe ali ndi vuto la kunenepa kwambiri komanso mtundu wa matenda ashuga 2 wafotokozedwa, zomwe zimatipangitsa kuti tizigwirizana ndi matenda amtunduwu. Kukula kwa chidziwitso cha kukhumudwa ndi kuchepa kwa thupi kumathandizanso chidwi, chomwe chimazindikira kufunika kokhala ndi njira zochiritsira.

Kafukufuku wambiri adazindikira zomwe zimayambitsa matenda osokoneza bongo (matenda oopsa a hyperglycemia, matenda oopsa, dyslipidemia) ndikuzindikira njira zothandizira kupewa matenda othandizira odwala matenda ashuga. Meta-amasanthula kafukufuku omwe amawunika zotsatira za kulipira kagayidwe kazakudya zam'mimba, mawonekedwe a kuthamanga kwa magazi ndi mbiri ya lipid awonetsedwa

muchepetse zoopsa zobwera mochedwa, koma, mwatsoka, osati kupewa kwathunthu ndi kuchira. Mwachiwonekere, momwe multifactorial chikhalidwe cha pathogenesis cha zovuta za shuga imawerengera kufunika kwa njira zowonjezera zothandizira kupititsa patsogolo zinthu za angio- ndi neuropathies. Kwa zaka zambiri, yagwiritsidwa ntchito ngati mankhwala ochizira komanso kupewa matenda a mtima.

osasankha phosphodiesterase blocker - pentoxifylline (PF), kuphatikiza zotsatira za vasodilator ofooka wopanda kanthu, wothandizira antiplatelet ndi angioprotector. PF yapangidwa mu 1965 ngati chinthu kuchokera kuma methylxanthines angapo okhala ndi katundu wa vasodilating. Pambuyo pa mayeso oyeserera komanso kuchipatala mu 1972, pa lingaliro la Grigoleit ndi Werner, mankhwalawa adayamba kugwiritsidwa ntchito kuchipatala

Mavuto obwera chifukwa cha matenda ashuga

Theory General of Diabetes Complication (Brownlee M.) Fonseca V.A. Matenda a matenda ashuga otanthauzira mu 2006

t Collagen t Fibronectin

Kuphwanya lamulo. Kumveketsa Kochulukitsa Kwambiri majini angapo

mtsempha wamagazi angiogeneis wa mtima capillaries

1Я1Н Zachilengedwe komanso ma cell a pentoxifylline

Main katundu Zochita zina zathupi

Kutulutsa Magazi Magazi Kuundana kwamachiritso

Maso amagetsi ndi magazi

Erythrocyte defformance + +

¿Zozungulira plasma fibrinogen + +

Kuchepetsa mphamvu ya leukocytes + +

Kuphatikiza ndi kuphatikiza kwa leukocytes + + +

Re Kupulumutsidwa kwa ma superoxide ndi ma neutrophils + +

¿Kusuntha kwa neutrophils FAT + +

Kupanga kwa TNF-monocytes +

Response Kuyankha kwa Leukocyte ku TNF-a +

Response Kuyankha kwa Leukocyte ku IL-2 +

Killer Ntchito zopha mwachilengedwe +

Kuphatikiza kwa magazi ndi fibrinolysis

Tissue plasminogen activator + +

Kuchiritsa konsekonse komanso minofu yolumikizana

Kuyankha ndi TNF-fibroblasts +

Dziwani: FAT ndi gulu loyambitsa maselo, + ndi zotsatira zabwino, | - kuchuluka, - kuchepa.

chizolowezi kukonza njira mu microvasculature.

Amayendedwe akuchitika kwa PF amadziwika kudzera mukuwonjezeka kwa zomwe zili mu c-AMP ndi ATP komanso kuchepa kwa calcium. Zotsatira za PF:

- kumawonjezera kuchuluka kwa cell membrane wa maselo ofiira am'magazi ndipo amachepetsa kufooka,

- Amachepetsa kuphatikizika kwamaselo ofiira,

- imakhala yofowoka pakhungu,

- Amachepetsa kukhuthala kwa magazi (kuchuluka kwa fibrinolysis ndikuchepetsa ndende ya fibrinogen),

- Amachepetsa kuphatikiza mapulateleti,

- amachotsa zowonongeka za neutrophils pa endothelium.

Mankhwalawa ndi ofunika makamaka pa matenda ashuga, chifukwa kuwonjezeka kwa hemoglobin m'magazi a hyperglycemia kosasintha kumayang'ana maselo ofiira amwazi ndikuwonjezera kutsata kwawo ndikuchepa kwa kuchepa.

Chifukwa cha kapangidwe kake ka mankhwala, PF imatha kuwonjezera kapangidwe ka prostacyclin ndikuchepetsa mapangidwe a thromboxane A2 maselo a endothelial, kuletsa kaphatikizidwe ka chotupa necrotic factor-a (TNF-a) ndi ma cytokines ena, kusintha plasma fibrinogen ndende ndi zochita za plasminogen activator inhibitor, block phosphodiesterase, yomwe imabweretsa kuchuluka kwa ma cell a cAMP 17, 32, 35, 39. Zotsatira zonsezi zimalepheretsa kuphatikiza mapulateleti ndi maselo ofiira amwazi, omwe amakhudza kwambiri maselo a rheological Magazi katundu.

Zotsatira zazikulu zofunikira za PF zimaperekedwa pagome. Zoposa zaka makumi anayi ndikugwiritsa ntchito PF (m'maphunziro onse momwe PF yoyambirira - Trental idagwiritsidwira ntchito) ikuwonetsa kugwira ntchito kwake mwanjira zosiyanasiyana, koma, poganizira za matenda ashuga, timawunika mwayi wogwiritsa ntchito PF pazovuta zina zovuta.

Matenda obriterative matenda am'mitsempha yam'munsi (HOSANK) ndi omwe amachititsa kuti matenda ashuga komanso osakanikirana a matenda ashuga asokoneze. Palibe kukayikira kuti njira zoyambira zochiritsira zimakhazikitsidwa pakubwezeretsa kutuluka kwa magazi m'mitsempha, i.e. kulowerera kwa angiosuction pamaso pa stenosis wovuta. Njira zopewera komanso zochizira zimaphatikizapo, kuwonjezera pazovomerezeka zomwe zimavomerezedwa (kubwezera chakudya cha carbohydrate,

dyslipidemia, matenda a kuthamanga kwa magazi), owonjezera. Malangizo owonjezera:

- kusuta, kusuta, (pakakhala kudalirana pang'ono kwa mphindi 45-60 kuyenda mpaka kupweteka kumawonekeranso ndi kupumula katatu pamlungu),

- antiplatelet ndi antithrombotic agents - aspirin kapena thienopyridines (ticlopidine kapena clopidogrel) kapena mapulateleti a receptor glycoprotein IIb / IIIa zoletsa (abciximab, eptifibatide, tirofiban).

Kuti athetse zizindikiro za kuchepa kwapakati, quinolinone, Cilostazol, mwatsoka sanalembetsedwe ku Republic of Belarus ngati mankhwala oyamba. Cilostazol tikulephera mtundu 3 phosphodiesterase ndipo kumawonjezera intracellular zili cAMP, mobwerezabwereza linalake ndipo tikulephera kuphatikizanso kwa maselo, apamwamba kuposa aspirin, dipyridamole, ticlopidine ndi PF, tikulephera mapangidwe a cell arterial komanso kuchuluka kwa maselo a minofu yosalala, ndipo ali ndi vasodilator ndi hypo lipid. Cilosta-zol ndiye mankhwala okhawo amene achepetsa mapangidwe a restenoses pambuyo poyikidwa zitsulo zosapanga bwino (CREST).

Popeza sangathe kugwiritsa ntchito cholostazol, mankhwala omwe amasankhidwa ndi PF, kugwiritsa ntchito komwe, malinga ndi zotsatira za kuwunika kwa meta 23, kuphatikiza kuwunika kwa odwala 2816, kumawonjezera nthawi yopweteka yoyenda komanso nthawi yayitali yoyenda ndikulankhula kwapang'onopang'ono (gawo Fontaine 2). M'maphunziro omwe anaphatikizidwa, mtunda wopanda ululu unakwera kuchokera pa 33.8 mpaka 73.9%. Kuphatikiza apo, cilostazol imakhala yothekera kwambiri kuposa PF yomwe imayambitsa zovuta (kupweteka mutu, kusowa kwa tulo, kutsegula m'mimba ndi palpitations). Popeza chidziwitso chotsika kwambiri cha cocostazol poyerekeza ndi PF, kuchuluka kochepa kofananirako pakukwaniritsidwa ndi kulekerera kwa mankhwalawa komanso mtengo wokwera wa chithandizo ndi cilostazol, PF iyenera kusankhidwa poyambira chithandizo, ndipo cilostazol iyenera kukhazikitsidwa ngati vuto la PF likulephera.

Malingaliro ogwiritsira ntchito PF ku HOZANK akuphatikizira gawo lotsimikizika la kutupa "kuzizira", komwe kumadziwika osati ndi kuwonjezeka kwa zochita za olembera, komanso chifukwa cha kuyambitsa zinthu

endothelium wa procoagulant minofu factor, leukocyte adhesion, chopinga cha endothelial nitric oxide synthesis, activation ya plasminogen-1 activator inhibitor synthesis. Njira izi zimathandizira vasoconstriction ndikuwonjezera mamasukidwe amwazi ndi chiopsezo chowonjezereka cha thrombosis. Komanso, PF, monga tafotokozera pamwambapa, amatha kuchepetsa kusintha kwa maselo ofiira ndimomwe amawonjezerera maluso awo omatira pamikhalidwe ya hyperglycemia 30, 45.

M'malingaliro a madotolo, pamakhala malingaliro omwe achoka omwe amatsata "matenda achifwamba", omwe amayamba pomwe wodwalayo amakhala ndi neuropathy yokhudzana ndi mitsempha komanso chifukwa chodandaula. Njira zazikulu zoyeserera za Pf zimafotokozedwa ndi kukhudzidwa osati kuwunikira kwa chotengera, koma kuthamanga kwa magazi, komwe sikuloleza kukula kwa "kuba mlengalenga".

Kafukufuku wambiri walephera kuwonetsa phindu la PF pochiza matenda a shuga. Komabe, kusintha kwa kayendedwe ka magazi m'mbali mwa mitsempha ya matendawa kunawonedwa, ndikuphatikizidwa ndi kusintha kwa minyewa kwa odwala omwe ali ndi mtundu wa 1 ndi mtundu wa 2 wa matenda ashuga a m'mitsempha atatha kugwiritsa ntchito PF 10, 27. EReggap et al. akuwonetsa kuti kusowa kwa njira zochizira za PF mu neuropathy kumalumikizidwa ndi kuyang'ana kwakanthawi, chifukwa zingatenge zaka zitatu mpaka zinayi kuti pakhale kusintha.

Matenda a shuga am'magazi amitundu yosiyanasiyana nthawi zambiri amakhala limodzi ndi zilonda zam'mimba - awa ndi mawonekedwe achiwonetsero cha zotumphukira zamitsempha yamagazi (HoAznk ndi mitsempha ya varicose) ndi mitsempha. Kukula kwa zilonda za trophic kumakhazikitsidwa ndi kutsegula kwa apoptosis, kuchuluka kwa mapuloteni, kuchepa kwa zinthu zomwe zimakula komanso ma cytokines, mkhutu wa angiogene, ndi zina. antibacterial mankhwala (ngati akuwonetsa), mankhwala akumaloko pogwiritsa ntchito mphamvu zomwe zingabwezeretsenso mankhwala. Popeza kuphatikiza pafupipafupi kwa matenda amitsempha yamagazi ndi mitsempha ya varicose ndi kukula kwa venous kusakwanira, kugwiritsidwa ntchito kwa PF kumachepetsa kuwonongeka kwa minofu kumiyendo yophunziridwa, kumathandizanso kuchiritsa kwa odwala omwe ali ndi zilonda zam'mbuyo zosagonjetseka zam'mbuyo zam'mbuyo zam'mimba

ambiri odwala. Chifukwa chake, pofufuza kawiri kawiri, osasinthika, oyembekezeredwa, oyesedwa ndi odwala 80 okhala ndi chithunzi cha zilonda zam'mimbazi zam'mphepete, kuwonjezeredwa kwa pentoxifylline pamayendedwe ovala komanso kumangidwa mabandeji kumawonjezera pafupipafupi machiritso am zilonda zam'mimba.

Matenda a shuga a retinopathy amadziwika ndi kusintha kwa makulidwe apansi panthaka, kukula kwa kukomoka kwa endothelial ndi kuchuluka, kuchuluka kwa maselo ofiira am'mimba komanso kuthamanga kwa okosijeni (hypoxia), kuphatikizira kwa mapulosi, kuchepa kwa kuchuluka kwa ma pericyte ndi kukula kwa aneurysms, edema edema ndi zotupa. Complex retinopathy therapy, yomwe imayika kufunika kwa laser Photocoagulation ya retina, imaphatikizapo kulipira chindapusa cha shuga, kuthamanga kwa magazi (mankhwala osankha oyamba ndi angiotensin-kutembenuza enzyme inhibitors), lipid-kuchepetsa mankhwala ndi ma antiplatelet agents (aspirin, omwe samawonjezera chiopsezo cha zotupa, ticlopidine kapena PF). Ngati pali zosemphana zatsatanetsatane pakugwiritsa ntchito ma statins mu retinopathy (mu kafukufuku wa HPS mu gulu la simvastatin, kufunika kwa laser Photocoagulation kumawonjezera osaneneka (ndi 8%), ku ASCOT-LLA kuchuluka kwa retinal thrombosis kunali kosadalirika (+ 3%), ndipo atorvastatin idagwiritsidwa ntchito pa kafukufuku wa CARDS zinapangitsa kuti kuchepa kwa kupita patsogolo kwa DR ndi kufunikira kwa laser Photocoagulation 6, 7, 34. Kuthamanga ndi kuchiritsa kwa fenofibrate kwatsimikiziridwa mu maphunziro a FIELD ndi ACCord 14, 42.

Kwa zaka zambiri, PF yakhala ikugwiritsidwa ntchito pochiza matenda ashuga retinopathy. Kusasinthika kwa izi kumakhazikika pakubwezeretsa magazi ndi kuchepa kwa retinal hypoxia mwa odzipereka athanzi, odwala omwe ali ndi retin vein thrombosis komanso kuwonongeka mwadzidzidzi, komanso matenda ashuga retinopathy 8, 13, 33.

E. Ferrari adatsimikizira kusintha kwamphamvu yamagazi m'magazi komanso kuwonjezeka kwakukulu kwa magazi m'magawo a retina mwa odwala omwe amalandila PF poyerekeza ndi odwala omwe ali mu gulu la placebo, komanso kuthekera kwa PF popewa kutsekeka kwa mitsempha yotupa ya m'mimba, kuphatikizapo odwala matenda ashuga retinopathy. Zosindikizidwa za kuchepetsa kupitirira kwa retinopathy mwa ana omwe ali ndi matenda ashuga 1. Kusanthula kwa meta

Zotsatira za meta-kuwunika kwa pentoxifylline mu diabetesic nephropathy: zotsatira za proteinuria

Zotsatira za pentoxifylline pa proteinuria mu matenda a impso: a meta-analysis /

McCormick B. B., Sodor A., Akbari A., Fergusson D., Doucette S., Knoll G. // Am. J. Impso Dis. - 2008 .-- Vol. 52 (3). - P. 454 - 463.

Dongosolo la Cochrane la maphunziro 97 likuwonetsa kufunikira kochita kafukufuku mwachisawawa ndi kapangidwe kokwanira kutsimikizira kugwira ntchito kwa retinopathy mu shuga.

Matenda a shuga. Ndondomeko yogwiritsira ntchito PF mu matenda ashuga nephropathy:

- momwe ma chemokines ndi mamolekyulu omatira,

- zotsatira za maselo ozungulira, zolembera zam'mimba - neutrophils, monocytes, lymphocyte,

- momwe mawonekedwe a kutupa "kuzizira" - chopinga cha ma cytokines,

- chopinga wa kuwunika kwa masanjidwe akunja.

Phindu la PF pa hemorheological mali amwazi pakukhazikitsa matenda a shuga a nephropathy adawonetsedwa ndi kuchepa kwa proteinuria mu mitundu 1 ndi 2 matenda a shuga, mosasamala kanthu ka metabolic control ndi boma la aimpso 10, 12, 37, 38. Izi zimawonekanso kwa odwala omwe ali ndi matenda ashuga komanso ochepa matenda oopsa. omwe adalandira PF ngati monotherapy kapena kuphatikiza ndi angiotensin-converting enzyme 23, 37. Ndikofunikira kudziwa kuti panthawi yopanga meta kuwunika kwa PF pa proteinuria, zotsatira zake za hypoproteinuric olimba.

Zinawonetsedwa kuti PF imangopereka kuchepa kwa mapuloteni a mkodzo, komanso kuchepa kwa TNF-a m'magazi amwazi, momwe omwe mu gulu la nephropathy adachulukirachulukira. PF imatha kulepheretsa kuwonongeka kwa ... acetyl-p-glucosaminidase (chizindikiro cha zotupa za impso) mkodzo, ndikuwonetsa zabwino

Zowonekera bwino osati kuwonetsedwa kwa zotupa za glomerular, komanso kuwonongeka kwa impso-interstitial impso mwa odwala omwe ali ndi matenda a shuga 2.

Zinakhazikitsidwa kuti TNF-a ndi ma cytokine ena ovomereza amatenga gawo lofunikira pakukweza kwa matenda ashuga nephropathy 19, 20, 26. TNF-a is a multifunctional pro-yotupa cytokine yotetezedwa makamaka ndi macrophages, makamaka adipose minofu, komanso kukhala ndi auto- ndi paracrine zotsatira, kukhala mkhalapakati wa kukana insulini komanso chizindikiritso cha matenda osagwira ntchito mthupi, omwe udindo wawo wa pathogenesis wa matenda ashuga nephropathy ndiwosagwirizana, PF imalephereka, yomwe imawonetsetsa kuti ikuyenda bwino.

Mu malo amodzi okha, omwe akuyembekezeredwa, osasankhidwa, kuyesedwa kwa PREDIAN pa cohort ya odwala 169 omwe ali ndi matenda a shuga 2 ndi matenda ashuga nephropathy (CKD st. 3-4), zinatsimikiziridwa kuti kuwonjezeredwa kwa PF kwa angiotensin kutembenuza ma enzyme inhibitors kumawonjezera zotsatira zabwino zomwe zidakwaniritsidwa (kuchepetsa proteinuria, serum creatinine, kusungidwa GFR, yachepetsa milingo ya pro-yotupa ya cytokines TNF-a, interleukin-6 ndi 10).

Chifukwa chake, ngakhale PF sichikuphatikizidwa pazomwe zilimbikitso zamankhwala othandizira odwala matenda a shuga, kafukufuku waposachedwa amatilola kuwona kuti ndi mankhwala olimbikitsa kuphatikizidwa mu zovuta zamankhwala a matenda awa.

Zovuta zazidziwitso. Ngakhale kuti kuchepa kwazidziwitso kwa odwala omwe ali ndi matenda a shuga kwadziwika kuyambira 1922, pamene W.R. Miles ndi H.F Root adanenapo za kuyanjana kwa matenda am'matendawa ndi matenda ashuga, ndipo izi zatsimikizika mwa ambiri

maphunziro, mndandanda wa "muyezo" wa zovuta za matenda ashuga, izi siziphatikizidwa. Komabe, kuwonongeka kwazidziwitso mu shuga kumakhala ndi mawonekedwe a multifactorial (gawo lamitsempha, kuphatikiza chiwopsezo cha stroketi komanso kuwonongeka kwa sitiroko, kukhudzika kwa amyloid, kusinthasintha kwa glycemic ndi activation ya protein glycation ndi neuroglucopenia, etc.) ndipo amalembedwa mwa anthu odwala matenda a shuga mpaka 25%. Chiwopsezo cha matenda a dementia m'matenda a shuga ndi apamwamba kuwirikiza ka 1.6 kuposa anthu onse, chiopsezo cha kuchepa kwa mitsempha ndi 2.0-2.6 nthawi zambiri, chiopsezo cha matenda a Alzheimer ndichokwera maulendo 1.5, mosasamala za zaka zomwe matenda ashuga adayamba.

Kugwiritsa ntchito kwa PF kumayambitsa kuwonjezeka kwakukulu kwa magazi amitsempha yathunthu, kuyenda kwa magazi am'madera m'dera la ischemia la chithokomiro ndipo sikupangitsa kuti kubera kwazitsulo. Kafukufuku yemwe adachitika m'zaka makumi angapo zapitazi adawonetsa zatsopano za mankhwalawa omwe amawonjezera mwayi wogwiritsidwa ntchito kwachipatala m'njira zosiyanasiyana za matenda aubongo ischemia, omwe machitidwe azachipatala nthawi zambiri amaphatikizidwa ndi mawu akuti "discirculatory encephalopathy" (DE) posakhala umboni wa kuchepa kwazindikiritso. Zikuwonetsedwa kuti kuikidwa kwa PF kumawonjezeka pafupifupi 20% kuzungulira kwazigawo komanso kwazizindikiro kwa odwala omwe ali ndi matenda osakhazikika.

Chifukwa chake, powunikira mayesero 10 azachipatala omwe amayesedwa mosiyanasiyana kuti awone kuyendetsa bwino kwa PF, kuchepa kwa kuchuluka kwa kuchepa kwa chizindikiritso kunapezekanso, komanso kuchepa kwakukulu kwa chiwopsezo chakuwonongeka kobwereza kwa ischemic.

Kuwunikira mwadongosolo potengera zotsatira za kusanthula kwa mapangidwe makumi awiri, oyerekeza, osasinthika, owunika malo, owonera kawiri anadzipereka kuti athe kuwunika momwe mankhwalawo amathandizira odwala omwe ali ndi vuto la mtima. Zotsatira zabwino za PF (1200 mg / tsiku) zidakhazikitsidwa mwa odwala omwe ali ndi dementia ya mtima, yodziwika ndi kusintha kwa ntchito yazidziwitso. Kuphatikiza apo, kuopsa komanso kusiyana kwa kusiyana kumakulirakusewera pogwiritsa ntchito njira yolimbira yodziwira matenda am'mitsempha.

Kafukufuku wambiri atsimikizira kuthekera kwa kugwiritsa ntchito PF pakafunika kukopa chinyengo: kuchepa kwa kupitilira kwa kuzindikira

zovuta, kukumbukira bwino, chidwi, makamaka achikulire 25, 29.

Zambiri pa kuthekera kwa PF kuchepetsa kuchepa kwa matenda amisala ndi chidwi kuchokera pakuwona komwe kungagwiritsidwe ntchito kwa mankhwalawa kupewetsa ziwonetsero za pachimake pachimake. Kafukufuku wachitika popewa kuteteza kubwerezabwereza kwa ischemic.

Kuthekera kotsimikizika kwa ma PFs kupewera zotumphukira maselo a mononuclear cell, neutrophils ndi T-lymphocyte, kuletsa kuphatikizika kwa ma cytokines a pro-yotupa kumatha kupereka zotsatira zowonjezera pakukula kwa matenda a ischemia ndi kuchepa kwanzeru. Tsoka ilo, sizotheka kupeza kafukufuku pa vutoli lomwe limachitika chifukwa cha odwala omwe ali ndi matenda ashuga, koma njira zachilengedwe zopangira chidziwitso chazovuta zikuwonetsa kuti kugwiritsa ntchito PF kudzakhala ndi zotsatira zabwino pakuwonetsetsa kwa odwala.

Matenda a chiwindi osagwirizana ndi mowa (NAFLD). Zimatsimikiziridwa kuti mwa odwala omwe ali ndi BMI yowonjezera ya 10-40% ndi kukana insulini, chiopsezo cha NAFLD chikuwonjezeka. Kunenepa kwambiri mu matenda a 95-100% kumaphatikizidwa ndikupanga hepatosis komanso 20-47% ya steatohepatitis. Matenda a shuga a Type 2 amaphatikizidwa ndi NAFLD mu 75% ya milandu. Kuyanjana kwa anthu odwala matenda ashuga ndi NAFLD kumakhala ndi zotsutsana ndi matendawa. Ndi NAFLD ndi matenda ashuga, ma frequency a coronary, cerebrovascular and peripheral vascular pathology amakula, zomwe zimapangitsa kuti chiwopsezo cha mtima komanso chikukulolani kuti muwonetsere kupezeka kwa NAFLD monga chiopsezo cha matenda amtima wamtundu 2 shuga, mosasamala kanthu za kayendedwe ka glycemic, mbiri ya mankhwala 40, 43. Ubalewu umatsimikizidwanso NAFLD ndi chiwopsezo chowonjezeka cha zovuta za shuga. Kumbali ina, kukhalapo kwa matenda ashuga kumayendetsedwa ndi kutseguka kwa kutupa, poyambitsa kupititsa patsogolo kwa NAFLD mu steatohepatitis (NaSg).

Zimatsimikiziridwa kuti kuchuluka kwa mafuta mu hepatocytes ndi maselo a stellate chifukwa cha kuchuluka kwa mafuta a mafuta a chiwindi m'chiwindi, chiwindi cha steatosis chimapangidwa, magawo a oxidation amapangidwa ndipo kuphatikizika kwakukulu kwa zochita zopanga oxidative kumayambitsidwa, zomwe zimapangitsa kuwonongeka kwa maselo a chiwindi ndi kupangika kwa steatohepatitis osakhala mowa. 43. Ubwenzi wa NAFLD ndi kunenepa kwambiri kwa visc, ndikupangitsa kukula kwa IR ndi zina

kusokonezeka kwa metabolic komwe kumachitika chifukwa chopanga kuchuluka kwambiri kwa magawo okhala ndi maselo a visceral adipose (pro-yotupa ya cytokines - chotupa necrosis factor-a (TNF-a), interleukin-6, etc., adipocytokines - adipe-nectin, ghrelin, etc. ), yomwe imafotokozera kukula kwa metabolic syndrome ndi zigawo zake, imatsimikizira njira zodzitetezera komanso zochizira.

Pamodzi ndi malingaliro othandizira kuchepetsa thupi, kuchita masewera olimbitsa thupi, kukwaniritsa ndi kusunga Normoglycemia, kugwiritsa ntchito lipid-kuchepetsa mankhwala, ndi mavitamini, mphamvu ya PF yatsimikiziridwa. Izi zikuchitika chifukwa chotsimikizira gawo la ma cytokines ovomerezeka-kuphatikiza, kuphatikizapo TNF-a, mu pathogenesis ya NAFLD. Odwala omwe ali ndi NASH, overexpression ya TNF-a mRNA adapezeka osati mu adipose minofu, komanso hepatocytes, yomwe imawonetsedwa ndi kutsutsana kwa plasma kwa TNF-a, zomwe zimatsogolera pakukhazikitsidwa kwa zovuta zingapo zomwe zimakhudzana ndi NAFLD 41, 46. Zomwe zili pamwambapa zimatsimikizira kufunikira kwa kuphatikiza mu kagwiritsidwe ka mankhwala a NASH kukonzekera kwa TNF-zoletsa. PF ndi angiotensin receptor blockers (losartan) zitha kugwiritsidwa ntchito pazolinga izi.

Kafukufuku wofufuza ndi zamankhwala awonetsa kuthekera kwa PF poletsa kupanga kwa TNF -kulemba ka gene. Posachedwa, kusanthula kwa meta kwa maphunziro asanu (odwala 147) kwasindikizidwa komwe kumayesa kuyendetsa bwino kwa pentoxifylline kwa NAFLD, kuwonetsa kuchepa kwa ntchito ya michere, interleukin-6, kusintha kwa chithunzi cha mbiri - kuchepa kwa chiwopsezo cha ntchito ya steatohepatitis, kusintha kwa kuwonetsa kwa kutupa kwaposachedwa, kusintha kwazovuta za steatosis kapangidwe ka khungu ndi kuuma kwa fibrosis. Mlingo woyenera wa PF omwe adagwiritsidwa ntchito mu maphunziro omwe ali pamwambawa anali 1200-1600 mg tsiku lililonse kwa miyezi 6-12.

Masinthidwe owoneka bwino amalola kuvomereza kuphatikizidwa kwa PF mu chithandizo cha NAFLD. Zotsatira zake zidapanga maziko akuti mchaka cha 2012 World Gastroenterological Organisation idaphatikizira pentoxifylline m'mankhwala omwe analimbikitsidwa pochizira NAFLD.

Kulephera kwa mtima. Mwa zina mwazomwe zimayambitsa kukhazikika kwa mtima kulephera, matenda a shuga amatenga kutsogoleredwa limodzi ndi matenda osatha

matenda a m'mapapo, matenda oopsa, komanso matenda a mtima. Chiwopsezo cha kufa chifukwa cha matenda amtima ndi 2.8 - 13.3 kuchulukirapo kuposa anthu opanda matenda ashuga - iyi ndi axiom. Zomwe zimapangitsa ndikuthamanga kwa atherosulinosis, kutseguka kwa kutupa, komanso kuwonongeka kwenikweni kwa matenda ashuga, omwe nthawi zambiri amatchedwa "matenda ashuga a mtima," omwe mu magawo oyamba a matenda a kagayidwe kazakudya amatha kuphatikizidwa ndi kuwonjezeka kwa systolic ndipo, nthawi zambiri, ntchito ya diastolic ya ventricle yamanzere.

Zotsatira zazikulu za PF zimatha kukhala zothandiza pang'onopang'ono kulephera kwa mtima, pakukhazikitsa omwe ophatikizana amatupa amayembekezeka kuchita nawo gawo, atha kukhala ambiri chifukwa cha zotsatira za mankhwalawa popanga TNF-a ndi ma cytokines ena. Mitengo yochepetsera ya cytokines ndikuwonetsa kulephera kwa mtima zalembedwa m'maphunziro osiyanasiyana oyesa ndi zamankhwala. Kuwunikira kwa meta kwa maphunziro asanu ndi limodzi pa kuwunika koyerekeza kwa zotsatira za PF (1200 mg patsiku kwa miyezi 6) pazowonetsa kulephera kwa mtima kunaphatikizapo deta ya odwala 221 omwe ali ndi gawo la ejection sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

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Onse-Russian Maphunziro pa intaneti

Zambiri ndi zida zomwe zawonetsedwa patsamba lino ndizasayansi, zolemba, zowunikira komanso zowunikira mwachilengedwe, zimapangidwira okhawo azachipatala, sizolinga zawo kupititsa patsogolo malonda pamsika ndipo sizingagwiritsidwe ntchito ngati upangiri kapena malingaliro kwa wodwala pakugwiritsa ntchito mankhwala ndi njira zochizira popanda kukambirana ndi dokotala.

Mankhwala, zomwe zimapezeka patsamba lino, zatsutsana, musanagwiritse ntchito, muyenera kuwerengera malangizo ndi kufunsa katswiri.

Malingaliro a Executive sangayanjane ndi malingaliro a olemba ndi ophunzitsa. Kuwongolera sikumapereka chitsimikiziro chilichonse pamalowo ndi zomwe zili mkati mwake, kuphatikiza, popanda malire, pankhani ya phindu la sayansi, kufunika kwake, kulondola, kutsimikiza, kudalirika kwa sayansi yasayansi yoperekedwa ndi ophunzitsa kapena kutsatira zomwe zili ndi miyezo yapadziko lonse lapansi yamankhwala abwino ndi / kapena mankhwala pa umboni. Tsambali silikhala ndi mlandu pazolimbikitsa kapena malingaliro aliwonse omwe angakhalepo, kapenanso kugwiritsa ntchito zinthu zomwe zili pamalowo pazochitika zina zamankhwala. Zambiri zasayansi zimaperekedwa momwe zidapangidwira kale, popanda chitsimikizo cha kukwanira kapena nthawi. Oyang'anira amayesetsa kupatsa ogwiritsa ntchito chidziwitso cholondola komanso chodalirika, koma nthawi yomweyo sichimapatula kuthekera kwa zolakwitsa.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwala amapangidwa mu mawonekedwe a mapiritsi, dragees ndi yankho la intravenous infusions (ma dontho), jakisoni ndi mu mnofu makonzedwe.

Mosasamala mtundu wa kumasulidwa, mankhwalawa amakhala ndi kaphikidwe kogwira kwambiri - chinthu pentoxifylline (mu Latin - Pentoxyphyllinum).

Pankhaniyi, Mlingo wa gawo yogwira ntchito ukhoza kukhala wosiyana.

Mapiritsi okhala ndi interic okhala ndi 100 mg ya pentoxifylline.

Mankhwalawa ndi a gulu la vasodilators (vasodilators).

Njira yothetsera jakisoni ili ndi 20 mg yogwira pophika 1 ml. Mankhwalawa amagulitsidwa mu ampoules a 1, 2, 5 ml.

Ma Dragees (retard) ndi makapisozi omwe ali ndi nembira yama pinki. Piritsi limodzi muli 400 mg yogwira ntchito.

Njira yamachitidwe

Mankhwalawa ndi a gulu la vasodilators (vasodilators).

Pharmacological zotsatira za mankhwala umalimbana kusintha magazi ndi kusintha magazi.

Mankhwalawa ali ndi zotsatirazi mthupi la wodwalayo:

amachepetsa magazi m'magazi, amachepetsa mwayi wamagazi,
amachepetsa mitsempha yamagazi (pang'ono), amachotsa mavuto ndi kuchepa kwa magazi,
amalimbikitsa kukhathamiritsa kwa okosijeni, kuletsa kukula kwa hypoxia (chifukwa cha kuchuluka kwa ziwiya zam'mapapo mwanga ndi mtima),
kumawonjezera mamvekedwe a diaphragm, minofu yopuma,
zopindulitsa pa ntchito yamanjenje,
Zimathandizira kuthetsa kukokana komanso kupweteka m'misempha ya ng'ombe yokhudzana ndi kuzungulira kwa miyendo.

Mankhwala amachepetsa kukhuthala kwa magazi, amachepetsa mwayi wamagazi.

Zomwe zimathandiza

Mankhwala ntchito mankhwalawa zotsatirazi pathologies:

kuphwanya magazi owonjezera kumanja ndi kumapazi (matenda a Raynaud),
kuwonongeka kwa minofu chifukwa cha kuwonongeka kwam'magazi m'mitsempha ndi mitsempha (zilonda zamkati zam'mimba, matenda a posthlebotic, gangrene),
kuwonongeka kwamawonekedwe ndi kumva komwe kumayenderana ndi kulephera kwa magazi,
ischemia
Matenda a Buerger (thromboangiitis obliterans),
kusabala kochititsidwa ndi magazi osakwanira ku ziwalo zoberekera,
matenda atherosulinosis,
ochepa matenda oopsa
angiopathy odwala matenda a shuga,
matenda a mtima
vegetovascular dystonia,
encephalopathy yamitundu yosiyanasiyana.

Mankhwalawa amagwiritsidwa ntchito pochiza matenda a Raynaud.
Mankhwalawa ndi othandizira matenda a ischemia.
Pentoxifylline imagwiritsidwa ntchito pobereka chifukwa cha kusakwanira kwa magazi ku ziwalo zoberekera.
Chida chimagwiritsidwa ntchito pochiza matenda oopsa.
Pentoxifylline amagwiritsidwa ntchito pochiza angiopathy mwa odwala matenda a shuga.
Pentoxifylline amalembera vegetovascular dystonia.

Chidachi chimagwiritsidwanso ntchito pochiza matenda a osteochondrosis ngati vasodilator wothandiza.

Contraindication

Mndandanda wa contraindication kugwiritsa ntchito mankhwalawa umaphatikizapo:

matenda a porphyrin
pachimake myocardial infaration,
matenda am'mimba
magazi akulu.

Njira yothetsera vutoli siigwiritsidwa ntchito ku atherosulinosis ya mitsempha ya muubongo ndi mtima komanso mwamphamvu kwambiri.

Kugwiritsa ntchito Pentoxifylline sikumaperekedwa kwa odwala omwe ali ndi hypersensitivity kwa yogwira mankhwala, othandizira omwe amaphatikizidwa, kapenanso mankhwala ena a gulu la xanthine.

Ndi atherosulinosis yam'mitsempha yamaubongo ndi mtima, sagwiritsa ntchito mankhwalawa monga njira yothetsera.

Momwe angatenge

Mankhwala, omwe amapezeka mwa ma dragees ndi mapiritsi, amakonzedwa pakamwa. Gwiritsani ntchito mankhwalawa mukatha kudya. Simungathe kutafuna makapisozi. Ayenera kutsukidwa ndi madzi ochepa.

Dokotalayo ndi amene amawona muyezo wa mankhwalawo payekhapayekha kwa wodwala aliyense, poganizira za momwe thupi lake limakhalira ndikuzindikira za chithunzi cha matenda. Mlingo wofanana muyezo ndi 600 mg patsiku (200 mg katatu patsiku). Pambuyo pa masabata 1-2, pamene zizindikiro za matendazo zimacheperachepera, mlingo wa tsiku ndi tsiku umatsitsidwa mpaka 300 mg (100 mg katatu patsiku). Osamwa zochuluka kuposa kuchuluka kwa mankhwalawa tsiku lililonse (1200 mg).

Kutalika kwa mankhwalawa ndi pentoxifylline pamapiritsi ndi 4-12 milungu.

Njira yothetsera vutoli imatha kuperekedwa kudzera mu intramuscularly, kudzera m'mitsempha yamagazi. Mlingo umakhazikitsidwa payekhapayekha, poganizira kuopsa kwa matenda a mtima. Malangizo ogwiritsira ntchito mankhwalawa akuti muyenera kugwiritsa ntchito yankho motere:

Mwanjira ya ma dropper - 0,5 g ya mankhwala osakanikirana ndi 250-500 ml ya saline kapena 5% shuga. Ndikofunikira kukhazikitsa mankhwala pang'onopang'ono, mkati mwa maola 1.5-3.
Jekeseni (mtsempha wa magazi) - pa gawo loyambirira la mankhwalawa, 0,5 ga mankhwalawa amalembedwa (kuchepetsedwa mu 20-50 ml ya sodium kolorayidi), ndiye kuti mlingo umakulitsidwa kukhala 0,2-0.3 g (wothira 30-50 ml ya zosungunulira). Ndikofunikira kulowa mankhwala pang'onopang'ono (0,1 g mkati mwa mphindi 10).
Intramuscularly, mankhwalawa amaperekedwa pa mlingo wa 200-300 mg katatu patsiku.

Mlingo wofanana muyezo ndi 600 mg patsiku (200 mg katatu patsiku).

Kugwiritsa ntchito yankho kungaphatikizidwe ndi kukonzekera kwa pakamwa pa mawonekedwe a piritsi.

Ndi matenda ashuga

Kukonzekera kwa Pentoxifylline kumavomerezedwa kuti agwiritsidwe ntchito pochiza zilonda zam'mimba, zilonda zam'mimba, angiopathy komanso kupatuka kwawonekedwe muzochitika za odwala omwe ali ndi matenda a shuga. Komabe, mutha kumwa mankhwalawa pokhapokha ngati adokotala adakuwuzani, amene amamwetsa payekha payekha ndipo akuwonetsetsa kuti wodwalayo atamwa mankhwala a hypoglycemic. Kudzipatsa nokha mankhwala a pentoxifylline pamenepa sikuvomerezeka, chifukwa mankhwalawa osankhidwa molakwika angayambitse zotsatira zoyipa (kuphatikizapo hypoglycemic coma).

Pentoxifylline pomanga thupi

Kugwiritsa ntchito kwa Pentoxifylline kungakhale kothandiza osati kokha pochizira matenda a circulatory pathologies, komanso pamasewera, chifukwa mankhwalawa amatha kuwonjezera mphamvu ya maphunziro, kuwonjezera kupirira, kufulumizitsa kukwaniritsa zotsatira zomwe mukufuna chifukwa cha zotsatira zopindulitsa thupi.

Pentoxifylline imatha kuwonjezera luso la kuphunzitsa, kuwonjezera kupirira, imathandizira kukwaniritsa zotsatira zomwe mukufuna.

Ochita masewera komanso omanga olimbitsa thupi amalangizidwa kuti amwe mankhwalawa motere:

Ndikofunikira kuyamba ndi mlingo wochepa - 200 mg 2 kawiri pa tsiku. Imwani mapiritsi mutatha kudya.
Pokhapokha ngati pali zovuta komanso kulekerera bwino kwa mankhwalawa, mutha kuwonjezera kuchuluka kwa tsiku lililonse mpaka 1200 mg (400 mg katatu pa tsiku).
Kuti mukwaniritse bwino, ndikulimbikitsidwa kuti mumwe mankhwalawo m'mphindi 30 musanayambe ntchito ndipo maola ochepa atamaliza.
Kutalika kwa kugwiritsa ntchito mankhwalawa ndi milungu 3-4. Pambuyo pa maphunzirowa, muyenera kupuma kwa miyezi iwiri.

Matumbo

Mankhwala angayambitse kutupa kwa chiwindi, limodzi ndi zovuta mu kutuluka kwa mapapo amkati, kuchulukitsa kwa matenda otupa a ndulu, kukulira kwamatumbo, kuchepa kwamtima, komanso kumva kutiuma pakamwa. Nthawi zina, magazi amatuluka m'matumbo amawonedwa.

Chidacho chimatha kuyambitsa chiwindi, limodzi ndi zovuta mu kutuluka kwa mapapo a bile.

Pakati mantha dongosolo

Kusokonezeka, kupweteka mutu, chizungulire, komanso kugona pang'ono kumachitika.

Wodwala yemwe amamwa mankhwalawo nthawi zambiri amakhala wosakwiya ndipo amakhala ndi nkhawa kwambiri.

Mukamagwiritsa ntchito mankhwalawa, zimachitika khungu (kuyabwa, urticaria) ndi anaphylactic mantha.

Zina

Pakhoza kukhala kuwonongeka pamalingaliro a tsitsi, misomali, kutupa, kufiyira pakhungu ("kunyezimira" kwa magazi pankhope ndi chifuwa).

Mukamagwiritsa ntchito mankhwalawa, khungu limayamba kusokonekera komanso kuwonongeka kwa anaphylactic.

Kuphwanya kwamawonedwe owonekera ndi kukula kwa ma scotomas amaso sikumachotsedwa.

Malangizo apadera

Mankhwala a Pentoxifylline amachitika mosamala kwambiri anthu omwe ali ndi vuto la zilonda zam'mimba komanso duodenum, pathologies a impso ndi chiwindi, kulephera kwa mtima, amakonda kuthamanga magazi. Kwa magulu awa a odwala, kusintha kwakakamizidwe kake komanso kuwongolera mosamalitsa kuchipatala pakufunika.

Kuyenderana ndi mowa

Madokotala amalimbikitsa mwamphamvu kuti odwala omwe amamwa mankhwala a Pentoxifylline asamamwe kumwa mowa asanathe.

Ndikulimbikitsidwa kuti musamamwe mowa musanathe chithandizo ndi Pentoxifylline.

Mowa wa Ethyl umatha kumangika ku mamolekyulu a mankhwala osokoneza bongo, kuwasokoneza kapena kuwongolera zomwe zimagwira, zomwe zingayambitse kuchepa kwa mphamvu ya mankhwalawa kapena kuyambitsa zovuta.

Zokhudza mphamvu pakuwongolera njira

Mankhwalawa sakukhudza mwachindunji mphamvu yakuwongolera machitidwe ophatikizika, kuphatikiza magalimoto, komabe, ngati zotsatira zoyipa (chizungulire, kusokonezeka kwa kugona, ndi zina) zimachitika, chidwi cha wodwalayo chitha kuwonongeka. Izi zitha kuchepetsa kuyendetsa bwino komanso magalimoto ena.

Zomwe zimaperekedwa kwa ana

Kuchita bwino ndi chitetezo cha mankhwalawa muubwana sichinaphunzire, chifukwa chake opanga Pentoxifylline samalimbikitsa kupereka mankhwala kwa odwala omwe sanakwanitse zaka 18.

Pentoxifylline simalimbikitsidwa kuti apereke mankhwalawa kwa odwala ochepera zaka 18.

Komabe, pochita, ngati kuli kofunikira, madokotala amatha kupereka mankhwala kwa mwana wazaka zopitilira 12. Nthawi zambiri izi zimachitika chifukwa cha zovuta kuzungulira kwa magazi komanso kusagwira bwino ntchito kwa njira zina.

Bongo

Ndi kugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali, zotsatirazi za bongo zingachitike:

nseru, kusanza kwa "malo a khofi" (akuwonetsa kukula kwa magazi m'mimba),
chizungulire
kufooka
kukokana.

Woopsa milandu bongo, kukomoka, kupuma, anaphylaxis.

Milandu yayikulu kwambiri, kukomoka, kupuma, ma anaphylaxis amawonedwa.

Kuchita ndi mankhwala ena

Mankhwala atha kuwonjezera zotsatira za mankhwala otsatirawa:

anticoagulants
manga
kuthamanga kwa magazi kumachepetsa mankhwala
maantibayotiki
mankhwala a insulin okhala ndi hypoglycemic,
kukonzekera kwa valproic acid.

Kugwiritsa ntchito pamodzi kwa Pentoxifylline ndi mankhwala okhala ndi cimetidine kumawonjezera chiopsezo cha mavuto. Kukonzekera kochokera ku ketorolac ndi mexicam sikugwirizana ndi Pentoxifylline, chifukwa akamagwiritsa ntchito mankhwala, amawonjezera mwayi wokhala ndi magazi mkati.

Mutha kugula zokhazo ngati muli ndi malangizo oyenerera omwe dokotala wakupatsani.

Sitikulimbikitsidwa kuphatikiza kugwiritsa ntchito mankhwalawa ndi kugwiritsidwa ntchito kwa ma xanthines ena, chifukwa izi zimatha kuyambitsa mantha ambiri.

Mankhwalawa a pathologies omwe amayamba chifukwa cha kusokonezeka kwa magazi, ma analogu a Pentoxifylline otsatirawa amagwiritsidwa ntchito:

Cavinton
Trental
Pentoxifylline-NAS,
Piracetam
Pentilin
Mexicoidol
Fluxital
Latren
nicotinic acid.

Kuti mudziwe ndi iti mwa mankhwalawa omwe amagwiritsidwa ntchito bwino ndikulowerera kwina kwa magazi, muyenera kufunsa dokotala.

ZOPHUNZITSIRA ZOSAVUTA. Kodi ndiyenera kuchepetsa mitsempha yamagazi ndimankhwala. Pentoxifylline

Ndemanga za Pentoxifylline

Madokotala ndi odwala ambiri amayesetsa kugwiritsa ntchito Pentoxifylline.

E. G. Polyakov, neurosurgeon, Krasnoyarsk

Mankhwala ali ndi tanthauzo labwino mu matenda osiyanasiyana a chapakati ndi kufalikira kwa magazi. Chidachi ndichabwino kwambiri komanso mtengo wotsika, chifukwa chake chimapezeka m'magulu onse a odwala. Zoyipa za mankhwalawa zimaphatikizanso kufooka kwa angiopathies.

Lily, wazaka 31, Astrakhan

Nthawi zambiri ndimadwala matenda ovulala a vegetovascular dystonia, omwe adandichitira bwino. Tsopano ndikuthandizidwa ndi Pentoxifylline. Ndili ndi vuto lotsatira, ndiyamba kumwa mankhwalawa (mu masiku 10). Kuthandizirana kumachitika m'masiku oyamba a chithandizo, ndipo pakatha masiku 10 zizindikilo zonse zimatha. Chisamaliro chapadera chikuyenera kulipidwa ku mtengo wa mankhwalawa: ndizotsika kwambiri kuti poyamba zimawopsa. Koma mtundu wa Russian Pentoxifylline siwolakwika kuposa wa analogues akunja, womwe umawononga 2, kapena ngakhale katatu mtengo wokwera.

Igor, wazaka 29, Volgograd

Kupititsa patsogolo kukwera kwa magazi mu impso, ma vasodilators amayenera kutengedwa. Curantil adasankhidwa kale, koma mutu wake udakhala wowawa kwambiri, chifukwa chake ndidasinthira ku Trental. Awa ndi mapiritsi abwino, koma okwera mtengo kwambiri, kotero ndidasankha kuwachotsa ndi Pentoxifylline wopangidwa ndi Russia. Sindinazindikire kusiyana kulikonse (kupatula mtengo wake). Amachitanso, samayambitsa mavuto, amagwira ntchito yawo mwangwiro.

Kupanga ndi mawonekedwe a kumasulidwa

Mapiritsi a 100 ndi 400 mg, atakulungidwa ndi zokutira zapinki. Phukusili lili ndi 20 ndi 60 zidutswa.

Mapiritsi a 100 ndi 400 mg. Phukusili lili ndi 20 ndi 60 zidutswa.

Enteric wokutidwa mapiritsi a 400 ndi 600 mg osasunthika omwe ali ndi mzere wogawa - phukusi lili ndi zidutswa 50.

Ampoule ndi yankho la jakisoni. Mu 1 ml yankho lili:

pentoxifylline - 20 mg,
sodium mankhwala enaake - 90 mg,
madzi - mpaka 1 ml.

Amapezeka mu ampoules a 5 ml. Phukusili lili ndi ma ampoules asanu.

Kodi ndizowopsa kumwa pentoxifylline pa nthawi yapakati?

Amadziwika kuti mankhwala aliwonse amaloledwa kumwa nthawi

pokhapokha atapereka chiwopsezo chapadera cha mayi ndi mwana wosabadwayo. Pentoxifylline sanadutse izi, chifukwa chake, malangizo onse amawonetsa kuti ali ndi pakati pa pakati.

Kodi pali zomwe zikuwonetsa kutumiza pentoxifylline pa nthawi yoyembekezera?

Monga mukudziwa, m'masabata oyamba omwe ali ndi pakati, mankhwala onse amatsutsana. Mankhwala omwe sanaphunzire maphunziro otetezeka ayenera kugwiritsidwa ntchito pokhapokha milungu makumi awiri atatenga pakati, moyang'aniridwa ndi dokotala woyembekezera.

Koma pamakhala zochitika zina za fetal momwe zimafunikira kumwa mankhwalawa. Amagwiritsidwa ntchito kukonza kupezeka kwa placenta ndi magazi ndi mpweya.

Kodi mankhwalawa amakhudza bwanji panthawi yoyembekezera?

Pentoxifylline imakhudza kuchepa kwa magazi m'matipi, kukulitsa mitsempha yaying'ono ya magazi, kuchepetsa mawonekedwe am magazi ndi kukonza kutsika kwake m'mitsempha yamagazi. Magazi amayamba kuzungulira kwambiri, potero amasintha mpweya wa okosijeni ku placenta. Izi ndizofunikira kwambiri pakukula kwa mwana wosabadwayo.

Mosakayikira, madokotala amayesa zabwino ndi zovuta zonse zomwe zimapatsa mankhwala pakudwala. Katundu wake wopindulitsa nthawi zambiri amakhala wapamwamba kuposa chiwopsezo cha zotsatira zoyipa.

Ndemanga za amayi apakati omwe amamwa Pentoxifylline nthawi zambiri zimakhala zabwino.

Malinga ndi malangizo, Pentoxifylline sinafotokozedwe pa nthawi ya mimba / mkaka wa m`mawere.

Popeza palibe chochitika chogwiritsa ntchito mankhwalawa pakati pa amayi apakati, komanso chitetezo cha zotsatira za mankhwalawa pakukula kwa mwana wosabadwayo sichinatsimikizidwe, mapiritsi a Pentoxifylline sanalembedwe kwa azimayi omwe akuyembekezera mwana.

Zambiri zokhudzana ndi kuphatikiza mankhwala omwe ali ndi mkaka wa m'mawere sanaperekedwe, chifukwa chake ngati pakufunika kuthandizidwa, mayi ayenera kusankha kumaliza mkaka kuti asayike mwana pangozi.

Kuyanjana kwa mankhwala osokoneza bongo

Imawonjezera mphamvu ya antihypertensive ndi antidiabetesic mankhwala (mlingo uyenera kuchepetsedwa). Akaphatikizidwa ndi sympatholytics, ganglioblockers, vasodilators, kutsitsa magazi ndizotheka, ndi ketolorac, meloxicam - kuwonjezeka kwa prothrombin nthawi ndi chiopsezo chotaya magazi, ndi heparin, mankhwala a fibrinolytic ndi anticoagulants osadziwika - kuchuluka kwa anticoagulant.

Cimetidine amachulukitsa ndende

Pentoxifylline

m'magazi ndi kuchuluka kwa mavuto.

Pentoxifylline, monga lamulo, imakulitsa mphamvu yamankhwala omwe amachepetsa kuthamanga kwa magazi, komanso mankhwala opangidwa ndi mankhwala

Kugwiritsidwa ntchito kophatikizidwa kwa Pentoxifylline ndi mankhwala enaake / zinthu kungapangitse kukulitsa zotsatirazi:

Cimetidine: imawonjezera kuchuluka kwa pentoxifylline m'madzi am'magazi, ndipo chifukwa chake
Valproic acid, heparin, theophylline, mankhwala a fibrinolytic, antihypertensive ndi hypoglycemic othandizira (insulin, oral hypoglycemic agents), mankhwala omwe amakhudza dongosolo la magazi okhudzana ndi magazi (anticoagulants, thrombolytics), mankhwala opatsirana pogwiritsira ntchito cephalosporins, kuchuluka):
Maganizo ena: kukalamba kwambiri kumayamba.

Maunikidwe a Ntchito

Cerebrovascular pathology, makamaka matenda amitsempha yamagazi, kufalikira kwamkati, matenda ashuga nephroangiopathy ndi matenda ena a shuga, kuphwanya kwapakati kwapazungulira (matenda a Raynaud, endarteritis, ndi zina zotere).

Ntchito makutu kuwonongeka kwa mtima.

Gawani mkati mwamkati komanso mwaubwenzi. Mkati, tengani, kuyambira ndi 0,2 ga (mapiritsi 2) katatu patsiku mukatha kudya, osafuna kutafuna. Pambuyo kumayambiriro kwa achire zotsatira (nthawi zambiri pambuyo pa masabata 1-2), mlingo umachepetsedwa kukhala 0,5 g (piritsi 1) katatu patsiku. Njira ya mankhwala ndi milungu 2-3. ndi zina zambiri.

Ngati ndi kotheka (kusokonezeka kwakukulu kwa zotumphukira kapena kufalikira kwa mtima / ischemic stroke) zimayendetsedwa kudzera m'mitsetse yamkati kapena kudzera m'mitsempha. 0,5 g (1 ampoule) amathandizira kudzera mu 250-500 ml ya isotonic sodium chloride solution kapena mu 5% shuga kwa mphindi 90-180.

Mlingo wa tsiku ndi tsiku utha kupititsidwanso ku 0,2-0.3 g. Mothandizidwa, woyamba ga ga ga 0 ga amaperekedwa mu 20-50 ml ya isotonic sodium chloride solution, ndipo m'masiku otsatirawa, 0-0-0.3 g iliyonse (mu 30-50 ml ya zosungunulira). Lowani pamlingo wa 0.1 g (5 ml ya yankho la 2% ya mankhwala) kwa mphindi 10

Mlingo komanso njira ya makonzedwe: mapiritsi, jakisoni, dontho

Mankhwala amatengedwa pakamwa ndi kholo, kutengera kuuma kwa matendawa.

Mukamamwa pakamwa, mapiritsi okhala ndi mulingo wa 100 mg amagwiritsidwa ntchito. Amayamba kumwa, makamaka, ndi 200 mg - mapiritsi 2 katatu patsiku mukatha kudya. Kenako, chithandizo chamankhwala chikakwaniritsidwa, mlingo umachepetsedwa, ndipo piritsi limapitilizidwa kumwa katatu patsiku. Njira ya mankhwala piritsi kukonzekera kumatenga mwezi.

Mu matenda owopsa komanso oopsa a ziwalo zamkati, pentoxifylline ndi mankhwala ampoules. Pali njira ziwiri zoperekera mankhwala: intraarterial and intravenous.

Wothandizirayo amayendetsedwa kudzera m'mitsempha ngati woponya. Mbale umodzi umagwiritsidwa ntchito pa 250 ml ya sodium chloride solution, kapena shuga. Mlingowu umaperekedwa kwa ola limodzi ndi theka mpaka maola awiri, pang'onopang'ono.

Mlingo wa tsiku ndi tsiku utha kuwonjezeredwa ndi kulekerera kwabwino kwa 0-0-0.3 g (monga momwe zikuwonekera).

Intraarterally, amayamba kupereka kwa mlingo wa 0,1 g wa mankhwalawa 50 ml ya sodium mankhwala enaake, ndiye 0-0-0.3 g iliyonse.

Njira yothetsera vutoli imalowetsedwa pang'onopang'ono kuposa mphindi 10. Maphunzirowa amagwiritsa 10 infusions.

Ndi matenda a mtima

Pentoxifylline (Trental) imagwiritsidwa ntchito bwino pa matenda a dyscirculatory

Matenda a Cerebrovascular ndi omwe akutsogolera imfa mwa anthu, makamaka okalamba. Nthawi zambiri pamakhala mavuto okhudzana ndi kufalikira kwa matenda a chithokomiro, komanso a matenda osachiritsika.

Ku Russia, ngozi zaposachedwa m'magazi zimatchulidwa kuti DE - discirculatory encephalopathies. Matendawa akuwonetsedwa ndikuphwanya pang'onopang'ono ntchito zaubongo, zomwe zimayambitsidwa ndi kulephera kwa magazi.

Zizindikiro zazikulu za matendawa ndi mawonekedwe amanjenje, ammaganizo komanso ozindikira, pakakhala kuchepa kwa kukumbukira, kuchepa kwa ntchito zamaganizidwe, kusokonezeka kwa kugona ndi zovuta zina.

Pofuna kuchiza matendawa, madokotala amamulembera Pentoxifylline, kapena analogues. Mankhwalawa amathandizira kusintha kwakachulukidwe ka magazi, kuchepetsa kuphatikizira kwa maselo ambiri, komanso kuwonjezera magazi.

Malinga ndi asayansi, kugwiritsa ntchito Pentoxifylline kwa milungu itatu kapena inayi kumathandizira kutsika kwamatumbo ndi 17%. Komabe, kugwiritsa ntchito mankhwalawa sikuyambitsa matenda achifwamba.

Pentoxifylline imagwiritsidwa ntchito kwambiri pochiza matenda a mtima. Izi zimaphatikizira kulumikizana kwapang'onopang'ono kwa odwala omwe awonongeka ndi ziwiya zam'munsi. Yothandiza mankhwala mankhwalawa trophic zilonda zam'munsi malekezero.

Mankhwalawa trophic zilonda

Matendawa amayambitsa mavuto akulu kwa odwala -

kuchira pang'onopang'ono, khalani ndi chizolowezi ch kubwerera.

Kugwiritsa ntchito Pentoxifylline kumakhala koyenera pochiza zilonda zam'mimba. Mankhwalawa, kukonza magazi m'magazi okhudzidwa, amalimbikitsa kuchira kwamphamvu kwa vuto la khungu motsutsana ndi njira zina.

Ndi matenda a chiwindi

Pentoxifylline amachepetsa zovuta

M'zaka zaposachedwa, madera atsopano apezedwa ndikugwiritsa ntchito Pentoxifylline. Pakadali pano, zabwino za mankhwalawa ndi mankhwalawa pamatenda monga matenda oopsa a hepatitis zatsimikiziridwa.

Ndemanga pa kugwiritsa ntchito Pentoxifylline ndizabwino. Mankhwala ndi othandizira zotupa zam'mimba zamagulu ambiri ndi machitidwe. Nthawi zambiri munthu amene ali ndi vuto la minyewa amakakamizika kumwa mankhwala kawiri pachaka - pokhapokha mutha kuwongolera mkhalidwe wanu komanso matendawa.

Ndemanga zambiri zimafotokozedwa za kugwiritsa ntchito Pentoxifylline mwa amuna omwe akuvutika ndi endarteritis yomwe imachitika pakapita nthawi. Pentoxifylline ndi mankhwala awo 1, chifukwa matendawa amayamba kupita patsogolo.

Kodi mapiritsi ndi yankho ndi chiyani? Mankhwalawa amalembera kukhudzana ndi zotumphukira zamagazi, kupatsirana kwa minyewa, matenda a Raynaud, kusokoneza endarteritis, post-thrombotic syndrome, frostbite, gangrene, trophic zilonda zam'munsi zam'mitsempha, varicose mitsempha, mitsempha yotupa ya mitsempha, mitsempha yotupa.

Zomwe zikuwonetsa kugwiritsidwa ntchito kwa Pentoxifylline ndi: myocardial infarction, matenda a mtima, mphumu ya bronchial, kusokonezeka kwakukulu kwa magazi m'magazi a retina, choroid, otossteosis, kusabala kwa mtima wamankhwala.

Pentoxifylline yankho, malangizo ogwiritsira ntchito

Mankhwala mu ampoules chikuyendetsedwera intramuscularly ndipo kudzera mu mawonekedwe a wodwala supine.

Ndi matenda a aimpso, mlingo amachepetsa mpaka 50-70 peresenti ya muyezo.

Mothandizidwa mozungulira pang'onopang'ono, kuwerengetsa monga mwa chiwembu: 50 mg kwa 10 ml ya sodium kolorayidi 0,9%, jekeseni kwa mphindi 10, kenako ndikusintha ndikudontheza pansi: 100 mg kuchepetsedwa mu 250-500 ml ya sodium chloride 0,9% kapena dextrose solution 5 %

Intraarter: 100 mg imadzipaka mu 20-50 ml ya sodium kolorayidi.

Intramuscularly kutumikiridwa katatu patsiku, 100-200 mg.

Mapiritsi a Pentoxifylline, malangizo ogwiritsira ntchito

Kuphatikiza pa makulidwe aubwino, ndizovomerezeka kumwa mankhwala mkati mukatha kudya kawiri patsiku, pa 800-1200 mg. Mlingo woyamba wa tsiku lililonse piritsi ndi 600 mg, pang'onopang'ono kuchuluka kwa mankhwalawa kumachepetsedwa mpaka 300 mg patsiku. Mitundu yayitali ya mankhwalawa amatengedwa kawiri patsiku.

Pentoxifylline angioprotector akuwonetsedwa kuti azigwiritsidwa ntchito pakuwongolera matenda a mtima.

Mankhwala ndi mankhwala zochizira matenda ziwiya, venous kuchepa.

Pentoxifylline, woloŵedwa m'magazi, wakomweko umakhudza ziwiya zomwe zakhudzidwa, amachotsa ma atherosulinotic amana, amalimbitsa khoma la venous.

Zotsatira za mankhwala:

kuyanʻanila zotumphukira kufalikira (endarteritis, angiopathy),
atherossteotic kapena discirculatory angiopathies,
ngozi yamatenda,
pambuyo-ischemic, mkhalidwe wowopsa pambuyo.

Njira yothetsera kulowetsedwa, yankho la intravenous and intraarterial management

Intraarterial makonzedwe: mulingo - 10 mg pa mphindi, koyamba mlingo - 100 mg wa mankhwala (mu 0,9% sodium kolorayidi yankho ndi kuchuluka kwa 20-50 ml), mtsogolo, mlingo ukuwonjezeka mpaka 200-300 mg (mu 0,9% sodium chloride solution voliyumu 30-50 ml).

Pentoxifylline imayang'aniridwa pang'onopang'ono kwa mphindi 90-180:

Njira yothetsera kulowetsedwa: mlingo - 50-100 mg, ngati kuli kotheka - 200 mg (pazipita patsiku - 300 mg). Pakukhazikitsa, wodwalayo ayenera kukhala pamalo apamwamba,
Njira yothetsera mtsempha wa magazi ndi ma intra-arterial: mlingo - 100 mg ya mankhwala mu 0.9% sodium chloride solution kapena 5% glucose (dextrose) yokhala ndi voliyumu ya 250-500 ml. Ndi atherosclerosis yayikulu yamitsempha yamitsempha, kuyikiridwa kwa mankhwala m'mitsempha ya carotid ndi koletsedwa.

Odwala omwe ali ndi vuto la aimpso kulephera (chilolezo cha creatinine osakwana 30 ml pa mphindi) amafunika kuchepetsa kwa 30-50%.

Zochizira zam'mimba kapena matenda am'mimba otupa, kulowetsedwa kwamkati kumaperekedwa tsiku lililonse kapena tsiku lililonse.

Mapiritsi a Pentoxifylline amatengedwa pakamwa popanda kutafuna kapena kusweka (kwathunthu), kutsukidwa ndi madzi, makamaka mukatha kudya.

Monga lamulo, mapiritsi okhala ndi piritsi ya Pentoxifylline amaikidwa mu 2 ma PC. Katatu patsiku. Pakati, tsiku lililonse ndi 600 mg, pazipita ndi 1200 mg. Nthawi zambiri, pakatha milungu iwiri, munthu amatenga muyezo umodzi, pomwe kuchuluka kwa Pentoxifylline kusasinthike.

Dokotala amawona kutalika kwa njira ya achire payekhapayekha, monga lamulo, ndi miyezi 1-3.

Akulakwitsa aimpso kulephera (kwa kupanga kwa chilolezo chosakwana 10 ml pa mphindi), kuchepetsa kwa 2 kawiri ndikofunikira.

Pentoxifylline munthawi yayitali mitundu ya mankhwala imapangidwa pafupipafupi 2 pa tsiku, kutalika kwa njira yochizira kuyambira milungu iwiri kapena kupitilira.

Angioneuropathy (paresthesia, matenda a Raynaud),
Matenda oyamba ozungulira, omwe amayamba chifukwa cha kutupa, matenda a shuga, atherosulinosis,
Ngozi za Ischemic cerebrovascular (pachimake komanso chovuta),
Kuletsa endarteritis,
Kulephera kwina, pachimake komanso kwamkati kwa retina kapena choroid,
Matenda amtundu wa Trophic omwe amayamba chifukwa cha kuwonongeka kwa venous kapena ochepa miccirculation (frostbite, zilonda zam'mimba, gangrene, post-thrombophlebitis syndrome),
Kumva kuwonongeka ndi mtima etiology
Encephalopathy ya atherosulinotic ndi discirculatory etiology.

Kutalika kwa maphunziro a mankhwalawa komanso kumwa kwa tsiku ndi tsiku kumatsimikiziridwa ndi dokotala aliyense payekhapayekha, zomwe zimatengera kuzindikira kwake, kuuma kwa zizindikiro zamankhwala komanso mawonekedwe a thupi.

Piritsi imatengedwa mukangodya chakudya, kumeza nthawi yomweyo, osapwanya ndi kutafuna, kumwa madzi ambiri kapena madzi ena.

Malinga ndi malangizo, anthu azaka zopitilira 18 amapatsidwa mankhwala 200 mg pa katatu patsiku. Mapiritsi 400 mg ndi mankhwala 1 kapena 2 kawiri pa tsiku. Kutalika kwa mankhwalawa mogwirizana ndi malangizo ndi milungu itatu, ngati kuli kotheka, dokotalayo amawonjezera kapena kufupikitsa nthawi yayitali.

Mtengo wa Pentoxifylline

Mtengo wa mankhwalawa ndi mawonekedwe ake zimadalira wopanga, pa mlingo ndi mtundu wa kumasulidwa. Pafupifupi, mtengo wa mankhwala osokoneza bongo Pentoxifylline umachokera ku 33 mpaka 72 rubles.

Mtengo wa Trental umachokera ku ruble 157 mpaka 319, Agapurin amatenga ndalama kuchokera ku 90 mpaka 137 rubles.

Mtengo wa Pentoxifylline m'mapiritsi a 0,1 g umachokera ku 85 mpaka 130 ma ruble pachilichonse cha zidutswa 60.

Mtengo wa Pentoxifylline 2% ampoules wa 5 ml ndi 40 ma ruble pazinthu 10.

Mtengo woyenerana ndi Pentoxifylline ndi: mapiritsi a retard (400 mg aliyense, 20 ma PC.) - kuchokera ma ruble 273, mapiritsi okhala ndi kanthu (100 mg, 60 ma PC) - kuchokera ku ma ruble 62, jakisoni wothandizirana (20 mg / ml Ma ampoules 10 a 5 ml aliyense) - kuchokera ma ruble 35., Yang'anani pakukonzekera njira yothetsera kulowetsedwa kwamkati ndi kwamkati mwa 20 mg / ml, 10 ampoules ya 5 ml) - kuchokera ma ruble 36.

Mtengo wapakati wamapiritsi a Pentoxifylline ku pharmacies aku Moscow ndi ma ruble 450-600, kutengera mlingo ndi kuchuluka kwa mapiritsi omwe ali phukusi.