Wessel Douai F jakisoni: malangizo ogwiritsira ntchito

Othandizira antithrombotic. Sulodexide.

Khodi ya PBX B01A B11.

• Angiopathies okhala ndi chiopsezo chowonjezeka cha thrombosis, incl. thrombosis pambuyo pachimake myocardial infarction
• matenda osokoneza bongo: stroko (pachimake ischemic stroke komanso nthawi yoyambitsanso kukomoka itatha)
• discirculatory encephalopathy yoyambitsidwa ndi atherosulinosis, matenda ashuga, matenda oopsa, komanso kuchepa kwa mitsempha,
• Matenda a occlusive a zotumphukira mitsempha ya atherosulinotic ndi matenda ashuga
• phlebopathy ndi mitsempha yayikulu
• microangiopathies (nephropathy, retinopathy, neuropathy) ndi macroangiopathies (diabetesic phokoso syndrome, encephalopathy, mtima) chifukwa cha matenda ashuga,
• thrombophilia, antiphospholipid syndrome
• heparin thrombocytopenia.

Mlingo ndi makonzedwe

mayendedwe apakati

Njira zochizira zomwe amagwiritsidwa ntchito masiku onse zimaphatikizapo kuperekera mankhwala kwa makolo kutsatiridwa ndi makapisozi; nthawi zina, chithandizo ndi Sulodexide chitha kuyambitsidwa mwachindunji kuchokera kumabotolo. Malangizo a mankhwalawa komanso Mlingo wothandizirana amatha kusinthidwa molingana ndi lingaliro la dokotala pamaziko a mayeso azachipatala ndi zotsatira za kudziwa magawo a ma laboratori.

Pafupifupi, makapisozi amakulimbikitsidwa kuti atenge pakati pa zakudya, ngati tsiku lililonse makapisozi agawidwa ma Mlingo angapo, tikulimbikitsidwa kuti pakhale pakati pa maola 12 pakati pamankhwala.

Pazonse, njira yonse ya chithandizo imalimbikitsidwa kubwereza kamodzi pachaka.

Angiopathies okhala ndi chiopsezo chowonjezeka cha thrombosis, incl. thrombosis pambuyo pachimake myocardial infarction

M'mwezi woyamba, jakisoni wa intramuscular ya 600 LO ya sodeodexide (zomwe zili mu 1 ampoule) zimaperekedwa tsiku lililonse, pambuyo pake maphunzirowo amapitilizidwa, kumwa mapiritsi a 1-2 pamlomo kawiri patsiku (500-1000 LO / tsiku). Zotsatira zabwino kwambiri zitha kupezeka ngati chithandizo chikuyambitsidwa pakatha masiku 10 pambuyo poti chachitika cha kupunduka kwa myocardial.

Cerebrovascular matenda: stroko (pachimake ischemic sitiroko ndi kukonzanso koyambirira pambuyo sitiroko)

Chithandizo chimayamba ndi kuperekera kwa tsiku ndi tsiku kwa 600 LO ya sodeode kapena kukomoka kapena kulowetsedwa, komwe zomwe zakumwa 1 za mankhwala zimasungunuka mu 150-200 ml ya saline yanyama. Kutalika kwa kulowetsedwa ndikuyambira mphindi 60 (kuthamanga 25-50 akutsikira / mphindi) mpaka mphindi 120 (kuthamanga 35-65 madontho / mphindi). Kutalika kwa mankhwala ndi masiku 15-20. Kenako, mankhwalawa amayenera kupitilizidwa ndikugwiritsa ntchito makapisozi, omwe amatengedwa pakamwa ndi 1 kapisozi kawiri pa tsiku (500 LO / tsiku) kwa masiku 30 mpaka 40.

Atherosclerosis-inachititsa discirculatory encephalopathy, matenda ashuga, matenda oopsa, komanso mtima

Ndi bwino kumwa makapisozi awiri a mankhwalawa kawiri pa tsiku (500-1000 LO / tsiku) pakamwa kwa miyezi 3-6. Njira ya mankhwalawa imatha kuyamba ndikuyambitsa 600 LO sulodexide patsiku kwa masiku 10-30.

Matenda ophatikizika am'mitsempha yama cell ndi matenda a shuga

Chithandizo chimayamba ndi mu mnofu wa tsiku ndi tsiku wa 600 LO sulodexide ndipo umapitilira masiku 20-30. Kenako maphunzirowo amapitilidwa, kutenga makapisozi a pakamwa 1-2 kawiri pa tsiku (500-1000 LO / tsiku) kwa miyezi iwiri.

Phlebopathy ndi mitsempha yayikulu

Nthawi zambiri zotchulidwa kukonzekera makapisozi a sulodexide pa mlingo wa 500-1000 LO / tsiku (2 kapena 4 makapisozi) kwa miyezi 2-6. Njira ya mankhwalawa imatha kuyamba ndikulowetsa tsiku ndi tsiku kwa 600 LO sulodexide patsiku kwa masiku 10-30.

Microangiopathies (nephropathy, retinopathy, neuropathy) ndi macroangiopathies (diabetesic phazi syndrome, encephalopathy, mtima) chifukwa cha matenda ashuga

Chithandizo cha odwala omwe ali ndi micro- ndi macroangiopathies tikulimbikitsidwa pamagawo awiri. Choyamba, masamba a 600 a sodeodeide amaperekedwa tsiku lililonse kwa masiku 15, kenako chithandizo chimapitilizidwa, kutenga makapisozi awiri kawiri patsiku (500-1000 LO / tsiku). Popeza ndi chithandizo chanthawi yochepa zotsatira zake zimatha kutayika pamlingo wina, ndikulimbikitsidwa kuti pakhale nthawi yachiwiri ya mankhwalawa mpaka miyezi inayi.

Thrombophilia, antiphospholipid syndrome

Njira yodziwika yoyambira imaphatikizira kukonzekera kwa 500-1000 LO sulodexide patsiku (2 kapena 4 makapisozi) kwa miyezi 6-12. Sulodexide makapisozi nthawi zambiri amawerengeka atalandira chithandizo chamankhwala ochepa heparin osakanikirana ndi acetylsalicylic acid, ndipo mulingo wotsatira suyenera kusinthidwa.

heparin thrombocytopenia

Pankhani ya heparin, thrombocytopenia, kukhazikitsidwa kwa heparin kapena ochepa maselo kulemera heparin m'malo mwa kulowetsedwa kwa sulodexide. Kuti muchite izi, zomwe zili mu 1 ampoule a mankhwalawa (600 LO sodeodexide) zimapukusidwa mu 20 ml ya 0,9% sodium kolorayidi ndi kupatsidwa kulowetsedwa pang'onopang'ono kwa mphindi 5 (kuthamanga 80 madontho / mphindi). Pambuyo pake, maLO a 600 a sodeodeide amadzipaka mu 100 ml ya 0,9% ya sodium kolorayidi ndipo amayendetsedwa mu mawonekedwe a kulowererapo kwa mphindi 60 (kuthamanga 35 madontho / mphindi) lirilonse 12:00 mpaka pakufunika chithandizo cha anticoagulant.

Zotsatira zoyipa

Otsatirawa ndi chidziwitso chotsatira cha zoyipa zomwe zimawonedwa pakuyesa odwala 3258 omwe amagwiritsa ntchito Mlingo wambiri ndi mitundu ya mankhwala.

Zotsatira zoyipa zomwe zimagwiritsidwa ntchito ndi sulodexide, zomwe zimagawidwa malinga ndi magulu a ziwalo zamthupi ndi pafupipafupi. Mawu ofunsira otsatirawa amagwiritsidwa ntchito kutsimikizira kuchuluka kwa zoyipa: nthawi zambiri (≥ 1/10), nthawi zambiri (kuyambira ≥ 1/100 mpaka

Bongo

Mankhwala osokoneza bongo amatha kuthandizira kukula kwa zizindikiro za hemorrhagic, monga hemorrhagic diathesis kapena magazi. Ngati magazi akutuluka, 1% yankho la protamine sulfate iyenera kuperekedwa. Mwambiri, ndi mankhwala osokoneza bongo, kugwiritsa ntchito mankhwalawa kuyenera kusiyidwa ndipo kuyenera koyambitsa matenda kuyenera kuyamba.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Popeza palibe chochitika chokhudzana ndi kugwiritsa ntchito mankhwalawa munthawi yoyamba kubereka, azimayi sayenera kulandira mankhwalawa panthawiyi, pokhapokha, malinga ndi dokotala, phindu lomwe lingachitike chifukwa cha chithandizo cha mayiyo limaposa chiwopsezo cha mwana wosabadwayo.

Pali zochepa zomwe zimachitika ndi kugwiritsa ntchito mankhwala a sulodexide wachiwiri komanso wachitatu wokonza mankhwalawa pochizira zovuta zam'mimba zomwe zimayambitsa mtundu wa I ndi mtundu wa matenda a shuga a II komanso mochedwa toxicosis. Zikatero, sulodexide anali kutumikiridwa tsiku lililonse intramuscularly pa mankhwala a 600 LO patsiku kwa masiku 10, pambuyo pake, pakamwa pamankhwala amapangira 1 kapisozi kawiri patsiku (500 LOs / tsiku) kwa masiku 15-30. Pankhani ya toxosis, mankhwalawa akhoza kuphatikizidwa ndi njira zamankhwala zochiritsira.

Munthawi ya II ndi III trimesters a mimba, mankhwalawa ayenera kugwiritsidwa ntchito mosamala, moyang'aniridwa ndi dokotala.

Sizikudziwika ngati sulodexide kapena ma metabolites ake amachotsedwa mkaka wa m'mawere. Chifukwa chake, pazifukwa zotetezeka, sizikulimbikitsidwa kusankha amayi nthawi yotsika.

Pali zochepa zomwe zimagwiritsidwa ntchito pokonzekera sulodexide mankhwalawa odwala matenda ashuga nephropathy ndi glomerulonephritis achinyamata wazaka 13-17. Zikatero, 600 LO ya sulodexide imayendetsedwa tsiku ndi tsiku kwa masiku 15, kenako makapisozi awiri a mankhwalawa amaperekedwa pakamwa kawiri pa tsiku (500-1000 LO / tsiku) kwa masabata awiri.

Zomwe zimagwira ndikuwonetsetsa kuti mankhwalawo ali ndi ana osakwana zaka 12 sizipezeka.

Zolemba ntchito

Pakati pa chithandizo, hemocoagulation parameter (kutsimikiza kwa coagulogram) iyenera kuyang'aniridwa nthawi ndi nthawi. Kumayambiriro komanso kutha kwa chithandizo, magawo a labotale otsatirawa ayenera kutsimikizika: nthawi yodziyimira ya thromboplastin, nthawi ya magazi / nthawi yowundana, ndi mulingo wa antithrombin. Mukamagwiritsa ntchito mankhwalawa, nthawi yodziyimira ya thromboplastin imachulukitsa pafupifupi nthawi 1.5.

Kutha kusinthitsa kuchuluka kwa zochita mukamayendetsa kapena kugwiritsa ntchito njira zina.

Ngati chizungulire chikuwonekera pakumwa, munthu ayenera kupewa kuyendetsa magalimoto ndikugwiritsa ntchito njira zina.

Mankhwala

Mankhwala. Wessel Douai F ndi makonzedwe a sulodexide, osakanikirana achilengedwe a glycosaminoglycans otalikirana ndi matumbo a mucosa a nkhumba, amapanga gawo laling'ono la heparin lomwe limalemera pafupifupi 8000 Da (80%) ndi dermatan sulfate (20%).

Sulodexide ndi chibadwa antithrombotic, anticoagulants, profibrinolytic ndi angioprotective kwenikweni.

Mphamvu ya anticoagulants ya sulodexide ndi chifukwa cha ubale wake ndi cofactor heparin II, amalepheretsa thrombin.

Mphamvu ya antithrombotic ya sodeodeide imakhala yolumikizidwa ndi zoletsa za Xa, kulimbikitsa kaphatikizidwe ndi katulutsidwe ka prostacyclin (PGI2) ndi kuchepa kwa plasma fibrinogen level.

Mphamvu ya profibrinolytic imayamba chifukwa cha kuchuluka kwa ntchito ya minofu ya plasminogen activator ndi kuchepa kwa ntchito ya inhibitor yake.

Mphamvu ya angioprotective imalumikizidwa ndi kubwezeretsa kwa kakhazikidwe kazinthu komanso makulidwe a maselo amtundu wa endothelial ndi kusintha kwa kuphatikizika kwa milandu yovuta ya zotumphukira zam'mimba.

Kuphatikiza apo, sulodexide imasinthasintha magwiridwe ena a magazi mwa kuchepetsa msana wa triglycerides (womwe umalumikizidwa ndi kutsegula kwa lipoprotein lipase, enzyme yomwe imayang'anira hydrolysis ya triglycerides).

Mphamvu ya mankhwalawa mu diabetesic nephropathy imatsimikiziridwa ndi kuthekera kwa sulodexides kuti achepetse makulidwe apansi ndi kupanga matrix a interellular pochepetsa kuchuluka kwa maselo a mesangium.

Pharmacokinetics Sulodexide imalowetsedwa m'matumbo ang'onoang'ono. 90% ya mankhwala omwe amaperekedwa ndi sulodexide amadzaza mu mtima endothelium, pomwe ndende yake imakhala yokwanira 20-30 nthawi kuposa kuchuluka kwa ziwalo zina. Sulodexide imapangidwa ndi chiwindi, ndipo imachotsedwa makamaka ndi impso. Mosiyana ndi heparin wosakhazikika komanso wotsika kwambiri wa heparin, kusamba kwamphamvu, komwe kungapangitse kuchepa kwa antithrombotic kanthu komanso kuthamanga kwakukulu kwa zotuluka za sodeodexide, sizichitika. Mu maphunziro akugawa sulodexide, adawonetsedwa kuti amatsitsidwa ndi impso ndi theka la moyo womwe umafika 4:00.

Kusagwirizana

Popeza sulodexide ndi polysaccharide yokhala ndi acidic acid pang'ono, ikagulitsidwa ngati yophatikiza kunja, imatha kupanga ma protein ndi zinthu zina zomwe zimakhala ndi zinthu zofunika. Zinthu zotsatirazi zomwe zimagwiritsidwa ntchito popangira jakisoni wophatikizira sizigwirizana ndi sodeodeide: vitamini K, zovuta za mavitamini a B, hyaluronidase, hydrocortisone, calcium gluconate, mchere wa quaternary ammonium, chloramphenicol, tetracycline ndi streptomycin.