Glucose yankho: malangizo ogwiritsira ntchito

Glucose ndi m'modzi mwa adani akuluakulu a matenda ashuga. Mamolekyu ake, ngakhale ali ndi kukula kwakukulu poyerekeza ndi mamolekyu amchere, amatha kuchoka mwachangu kuzungulira kwamitsempha yamagazi.

Chifukwa chake, kuchokera malo ophatikizana, dextrose imadutsa maselo. Njirayi imakhala chifukwa chachikulu chopanga insulin.

Zotsatira zake zakumasulidwa, kagayidwe kamadzi ndi kaboni dioksidijeni kumachitika. Ngati pali kuchuluka kwa dextrose m'magazi, ndiye kuti kuphatikiza kwa mankhwalawo popanda zopinga kumachotsedwa impso.

Kuphatikizika ndi mawonekedwe a yankho

Mankhwala ali ndi pafupifupi 100 ml:

1. glucose 5 g kapena 10 g (yogwira mankhwala),
2. sodium chloride, madzi a jakisoni 100 ml, hydrochloric acid 0,1 M (zotulutsa).

Njira yothetsera glucose ndi madzi opanda khungu kapena pang'ono chikasu.

Glucose ndi monosaccharide yofunika yomwe imakhudza gawo lazomwe zimagwiritsa ntchito mphamvu. Ndiye gwero lalikulu la chakudya chamatumbo chomwe chimapezeka mosavuta. Zopatsa mphamvu za caloric ndi 4 kcal pa gramu.

The zikuchokera mankhwala amatha kukhala osiyanasiyana osiyanasiyana: kuwonjezera makutidwe ndi okosijeni ndi kuchepetsa, kusintha antitoxic ntchito chiwindi. Pambuyo pokonzekera intravenous, chinthucho chimachepetsa kuchepa kwa nayitrogeni ndi mapuloteni, komanso zimathandizira kuchulukana kwa glycogen.

Kukonzekera kwa isotonic kwa 5% kumatha kudzaza kuchepa kwa madzi. Ili ndi detoxifying ndi metabolic zotsatira, kukhala wopereka michere yamtengo wapatali komanso yofulumira.

Ndi kukhazikitsidwa kwa 10% hypertonic glucose solution:

• kuthamanga kwa magazi a osmotic
• madzi osefukira amathira m'magazi,
• kagayidwe kachakudya njira.
• ntchito yoyeretsa imayenda bwino,
• diuresis imachuluka.

Zizindikiro zogwiritsidwa ntchito

Dextrose (kapena glucose) ndi chinthu chomwe chimapereka mphamvu zambiri zamagetsi m'thupi.

Kukhazikitsidwa kwa njira yotsekemera m'mitsempha kumathandizira kuthamanga kwa magazi a magazi, kumakuthandizani kuti muwonjezere kuchuluka kwa madzi kuchokera ku minyewa kulowa m'magazi, kutsegula njira za metabolic, kusintha ntchito ya chiwindi, kuonjezera ntchito ya minyewa yamtima, kukulitsa mitsempha ya magazi ndikuwonjezera diuresis.

Malinga ndi malangizo a Dextrose, isotonic solution yokwanira peresenti ikubwezeretsanso bcc (kuchuluka kwa magazi ozungulira). Kuphatikiza apo, Dextrose amagwiritsidwa ntchito ngati kulowetsedwa kwapakatikati kapena zosungunulira posalozera pakumwa mankhwala ena.

Mtengo wama calorific wa 1 lita imodzi yankho la 5% ndi 840 kJ, 10% - 1680 kJ.

Popeza mankhwala a dextrose, mankhwalawa ndikofunika kugwiritsa ntchito ngati:

• Zakudya zomanga thupi
• Hypoglycemia,
• Matenda oopsa
• Hemorrhagic diathesis,
• Kuzula
• Matenda a chiwindi, omwe amatsatana ndi kuledzera kwa thupi,
• Kuthetsa madzi m'thupi
• Kugwa
• Manjenjemera.

Contraindication

Kugwiritsa ntchito kwa Dextrose kwaphatikizidwa mu:

• Hypersensitivity
• Mafuta poyizoni wa thupi (ndi kuchepa kwa magazi, kuphatikiza chamkati, komwe kumawonetsedwa ndi kutupa kwa ubongo, mapapu, mtima ndi / kapena kulephera kwa aimpso, hyperosmolar coma),
• Matenda a shuga
• Hyperglycemia,
• Hyperlactacidemia,
• Anapanga pambuyo opaleshoni, mkhutu kugwiritsidwa ntchito.

Kutsatira malangizowo mu malangizo a Dextrose, yankho liyenera kuperekedwa mosamala kwa odwala omwe ali ndi mtima wosakhazikika komanso aimpso kulephera, komanso mikhalidwe yoyendetsedwa ndi hyponatremia.

Mlingo ndi makonzedwe

Isotonic dextrose solution (5%) imayendetsedwa:

• Subcutaneally 300-500 ml (kapena kuposa),
• Njira yodontha kudzera mkati (300 ml mpaka 1-2 malita patsiku).

Mulingo wapamwamba wotsogolera yankho la 5% ndi madontho 150 (omwe amafanana ndi 7 ml ya dextrose) miniti kapena 400 ml pa ola limodzi.

Hypertonic solution, malingana ndi malangizo, iyenera kupaka jetini. Mlingo umodzi umachokera ku 10 mpaka 50 ml. Nthawi zina, ngati pakufunika thandizo mwachangu, amaloledwa kupereka yankho kudzera mu njira yovunda, koma muyezo wosaposa 250-300 ml patsiku.

Mulingo wambiri woyendetsa 10% Dextrose ndi madontho 60 pamphindi (omwe amafanana ndi 3 ml of solution). Mlingo wapamwamba kwambiri wa tsiku lililonse kwa munthu wamkulu ndi lita imodzi.

Ngati yankho limagwiritsidwa ntchito pothandiza odwala achikulire omwe ali ndi metabolism yachilengedwe, mlingo wa tsiku ndi tsiku nthawi zambiri umatsimikiziridwa kulemera kwa wodwalayo - kuyambira 4-6 g pa kilogalamu imodzi ya kulemera kwa thupi (izi zikufanana ndi 250-450 g patsiku). Kwa odwala omwe kuchuluka kwa metabolic amachepetsa, kugwiritsa ntchito Dextrose kumawonetsedwa muyezo wotsikirapo (nthawi zambiri ndi 200-300 g). Kuchuluka kwa madzi olowetsedwa kuyenera kuyambira 30 mpaka 40 ml / kg pa tsiku.

Mlingo wa kukhazikitsidwa kwa yankho munthawi yachilengedwe ya metabolism umachokera ku 0,25 mpaka 0,5 g / h pa kilogalamu iliyonse yakulemera kwa thupi. Ngati njira za metabolic zimachepetsedwa, mlingo wa makonzedwe uyenera kuchepetsedwa ndi theka - mpaka 0.125-0.25 g / h pa kilogalamu iliyonse ya kulemera kwa thupi.

Pazakudya za makolo, dextrose imayendetsedwa motere:

• 6 g / kg patsiku - tsiku loyamba,
• 15 g / kg patsiku - masiku otsatirawa.

Njira yothetsera vutoli imayikidwa pamodzi ndi amino acid ndi mafuta.

Mukamawerengera kuchuluka kwa Dextrose, kuchuluka kolovomerezeka wamadzi wovomerezeka kuyenera kukumbukiridwa. Kwa ana omwe amalemera kuchokera pa 2 mpaka 10 kg, ndi 100-165 ml / kg patsiku, kwa ana omwe ali ndi kulemera kwa 10 mpaka 40 makilogalamu - kutengera boma la 45-100 ml / kg patsiku.

Mulingo wapamwamba wotsogola ndi 0,75 g / h pa kilogalamu imodzi yakulemera kwa thupi.

Zotsatira zoyipa

Kwenikweni, mankhwalawa amalekeredwa bwino. Nthawi zina infusions ndi dextrose imatha kuyambitsa kukula kwa malungo, kusokonezeka m'madzi amchere wamchere (kuphatikizapo hyperglycemia, hypervolemia, hypomagnesemia, ndi zina), kuperewera kwamphamvu kwamanzere kwamitsempha.

Zizindikiro za mankhwala osokoneza bongo a dextrose ndi glucosuria, hyperglycemia, kusowa bwino kwa madzi mu electrolyte. Ndi chitukuko chawo, kulowetsedwa kuyenera kuyimitsidwa ndipo insulin iyenera kuperekedwa kwa wodwala. Mankhwala ena ndiwowonekera.

Malangizo apadera

Pofuna kukonza mayamwidwe a dextrose omwe amagwiritsidwa ntchito muyezo waukulu, tikulimbikitsidwa kupatsa insulin kwa wodwala nthawi yomweyo. Mankhwalawa amawerengedwa motere - 1 UNIT ya insulin pa 4-5 magalamu a dextrose.

Kugwiritsa ntchito dextrose osakanikirana ndi mankhwala ena kumafunikira kayendedwe ka mankhwala.

Onse njira yothetsera kulowetsedwa kwa magawo asanu ndi khumi amagwiritsidwe ntchito molingana ndi zisonyezo nthawi ya pakati komanso yoyamwitsa.

Anthu odwala matenda ashuga a dextrose amayenera kuperekedwa motsogozedwa ndi zomwe zili mumkodzo ndi magazi.

Palibe deta yomwe ingawonetse vuto la mankhwalawa kuthamanga kwa magalimoto ndi malingaliro. Ndiye kuti, yankho lake silimalepheretsa munthu kuyendetsa galimoto kapena kugwira ntchito zomwe zingakhale zovulaza thanzi komanso moyo.

Ma Symonyms a Dextrose - Glucose ndi Glucosteril.

Analogs ndi makina ochitira zinthu: Aminoven, Aminodez, Aminokrovin, Aminoplasmal, Aminotrof, Hydramin, Hepasol, dipeptiven, Intralipid, Infezol, Infuzamin, Infuzolipol, Nefrotect, Nutriflex, Oliklinomel, Omegaiblmim, Elimlin, Hemgaiblm, Elimlin, Hemgais, Elimlin, Elimlin. SMOF Kabiven, Moriamin S-2.

Zotsatira za pharmacological

Plasma m'malo, kupatsanso madzi, metabolic ndi detoxization wothandizira. Makina ochitapo kanthu ndi chifukwa cha kuphatikiza kwa glucose m'magulu a mphamvu (glycolysis) ndi pulasitiki (transamination, lipogenesis, nucleotide synthesis) kagayidwe.

Amatenga mbali zosiyanasiyana kagayidwe kachakudya mu thupi, timapitiriza redox njira mu thupi, bwino antitoxic ntchito chiwindi. Glucose, kulowa minofu, phosphorylates, kusintha glucose-6-phosphate, amene amachita nawo mbali zambiri za kagayidwe kachakudya thupi. Ndi kagayidwe ka glucose, mphamvu yochulukirapo imatulutsidwa mu zimakhala zofunika kuti mukhale ndi moyo.

100 mg / ml ya glucose solution ndi hypertonic poyerekeza ndi madzi am'magazi, okhala ndi zochulukirapo za osmotic. Mothandizidwa ndi mtsempha wa magazi, zimawonjezera kutulutsa kwa minyewa m'magazi amitsempha, kumawonjezera diuresis, kumawonjezera kutulutsa kwa poizoni mkodzo, ndikuthandizira ntchito ya chiwindi.

Ikaphatikizidwa ku mtundu wa isotonic (50 mg / ml solution), imabwezeretsanso kuchuluka kwa madzimadzi otayika, imasunga kuchuluka kwa plasma yozungulira.

Theoretical osmolality ya glucose solution ya 50 mg / ml ndi 287 mOsm / kg.

Theoretical osmolality ya glucose solution 100 mg / ml - 602 mOsm / kg

Pharmacokinetics

Mothandizidwa ndi mtsempha wamitsempha, yankho lake limatuluka mwachangu pabedi lamitsempha.

Kusamukira ku cell kumayendetsedwa ndi insulin. Mu thupi timadutsa biotransfform pamsewu wa hexose phosphate - njira yayikulu ya mphamvu kagayidwe kamapangidwe kazinthu zazikulu (ATP) ndi njira ya pentose phosphate - njira yayikulu

njira ya metabolism ya pulasitiki ndikupanga ma nucleotides, amino acid, glycerol.

Ma mamolekyulu a glucose amagwiritsidwa ntchito popanga mphamvu zamthupi. Glucose omwe amalowa ndi ma phosphorylates, amakhala glucose-6-phosphate, yemwe pambuyo pake amaphatikizidwa ndi metabolism (zotsatira zomaliza za metabolism ndi mpweya ndi madzi). Imalowa mosavuta mu zotchinga za histoeticological mu ziwalo zonse ndi matishu.

Imamizidwa kwathunthu ndi thupi, siyimapukutidwa ndi impso (mawonekedwe a mkodzo ndi chizindikiro cha pathological).

Mlingo ndi makonzedwe

Asanayambe, dokotala amakakamizidwa kuti ayang'ane botolo la mankhwala. Njira yothetsera vutoli iyenera kukhala yoonekera, osati yokhala ndi tinthu tating'onoting'ono kapena matope Mankhwalawa amadziwika kuti ndi oyenera kugwiritsidwa ntchito pamaso pa zilembo ndikusunga zolimba za phukusi.

The ndende ndi kuchuluka kwa kuperekedwa kwa shuga njira yovomerezeka kulowetsedwa zimayikidwa pazinthu zingapo, kuphatikiza zaka, kulemera kwa thupi ndi mkhalidwe wa wodwala. Ndikulimbikitsidwa nthawi ndi nthawi kudziwa kuchuluka kwa shuga m'magazi.

Isotonic njira 50 mg / ml kutumikiridwa m`nsinga ndi tikulimbikitsidwa mlingo wa 70 madontho / mphindi (3 ml / kg thupi pa ola).

Hypertonic solution 100 mg / ml kutumikiridwa m`nsinga ndi analimbikitsa 60 madontho / mphindi (2,5 ml / kg thupi pa ola).

Kukhazikitsidwa kwa mayankho a 50 mg / ml ndi 100 mg / ml ya glucose ndikotheka ndi jakisoni wamadzi - 10-50 ml.

Akuluakulu ndi metabolism yofananira, mlingo wa tsiku ndi tsiku wa jekeseni wa m'magazi sayenera kupitirira 1.5-6 g / kg ya kulemera kwa thupi patsiku (ndi kuchepa kwa metabolic, mlingo wa tsiku ndi tsiku umachepetsedwa), pomwe voliyumu ya tsiku ndi tsiku yamadzimadzi ndi 30-40 ml / kg.

Kwa ana pakudya kwa makolo, kuphatikiza mafuta ndi ma amino acid, 6 g / kg / tsiku limayendetsedwa tsiku loyamba, kenako mpaka 15 g / kg / tsiku. Mukamawerengera kuchuluka kwa shuga ndi kukhazikitsidwa kwa mayankho a 50 mg / ml ndi 100 mg / ml dextrose, ndikofunikira kuganizira kuchuluka kovomerezeka kwa madzi akumwa: kwa ana omwe ali ndi thupi 2,5 kg - 100-165 ml / kg / tsiku, kwa ana omwe ali ndi thupi lolemera 10-40 kg - 45-100 ml / kg / tsiku.

Mukamagwiritsa ntchito njira ya glucose monga zosungunulira, mlingo womwe umalimbikitsidwa ndi 50-250 ml pa mlingo uliwonse wa mankhwalawa kuti uthetsedwe, zomwe zimapangitsa kudziwa kuchuluka kwa makonzedwe.

Zotsatira zoyipa

Zotsatira zoyipa zomwe zimapezeka jekeseni: kupweteka kwa jekeseni malo, mtsempha kukwiya, phlebitis, venous thrombosis.

Kuphwanya dongosolo la endocrine ndi metkbolizma: hyperglycemia, hypokalemia, hypophosphatemia, hypomagnesemia, acidosis.

Matumbo am'mimba: polydipsia, nseru.

Zokhudza thupi: Hypervolemia, thupi lawo siligwirizana (malungo, zotupa pakhungu, hypervolemia).

Pazochitika zoyipa, makonzedwe a yankho ayenera kuthetsedwera, mkhalidwe wa wodwalayo woyesedwa ndi kuthandizidwa uyenera kuperekedwa. Njira yothetsera vutoli iyenera kusungidwa pakuwunika pambuyo pake.

Kutulutsa Fomu

Mankhwalawa ali ngati njira yothetsera kulowetsedwa kwa 5%.

Imayimiriridwa ndi madzi opanda mandala owonekera a 1000, 500, 250 ndi 100 ml mumbale zamapulasitiki, 60 kapena 50 ma PC. (100 ml), ma 36 ndi ma 30 ma PC. (250 ml), 24 ndi 20 ma PC. (500 ml), 12 ndi 10 ma PC. (1000 ml) m'matumba otetezedwa osiyana, omwe amaikidwa m'mabokosi amakatoni ndi nambala yoyenera ya malangizo ogwiritsa ntchito.

10% yankho la glucose ndi khungu lopanda utoto, lamadzimadzi 20 kapena 24 ma PC. m'matumba oteteza, 500 ml iliyonse m'mbale zamapulasitiki, zonyamula makatoni.

Gawo lothandizira la mankhwalawa ndi dextrose monohydrate, chinthu china ndi madzi omwe angathe kubayidwa.

Zisonyezero zakudikirira

Kodi malonda ake amapangira chiyani? Njira ya glucose ya kulowetsedwa imagwiritsidwa ntchito:

• monga gwero lama chakudya,
• monga gawo lamagazi olowetsa magazi komanso anti-shock (ndi kugwa, manjenje),
• ngati njira yothetsera kuchepetsera ndi kusungunula kwamankhwala,
• milandu ya hypoglycemia yolimbitsa thupi (pofuna kupewa komanso mankhwalawa),
• ndi kukula kwa madzi am'madzi (chifukwa cha kusanza kwambiri, kutsegula m'mimba, komanso nthawi yothandizira).

Mlingo ndi njira yoyendetsera

Njira ya glucose ya kulowetsedwa imayendetsedwa kudzera m'mitsempha. Kuzindikira ndi kumwa kwa mankhwalawa kumatsimikizika kutengera mkhalidwe, zaka ndi kulemera kwa wodwalayo. Ndikofunikira kuwunika mosamala kuchuluka kwa dextrose m'magazi. Monga lamulo, mankhwalawa amaphatikizidwa ndi zotumphukira kapena mkati mwa mtsempha poganizira osmolarity wa yankho. Kupanga kwa 5% hyperosmolar glucose solution kungayambitse kupweteka kwa mitsempha ndi mitsempha. Ngati ndi kotheka, panthawi yogwiritsa ntchito mayankho onse a makolo, tikulimbikitsidwa kugwiritsa ntchito zosefera pamzere wapa njira za kulowetsedwa.

Mlingo wolimbikitsidwa wa shuga wa kulowetsedwa kwa achikulire:

• mu mawonekedwe a gwero lama carbohydrate ndi madzi akunja a isotopic kuchepa kwa thupi: ndi kulemera kwa thupi makilogalamu 70 - kuchokera 500 mpaka 3000 ml patsiku,
• wowonjezera kukonzekera kwa makolo (mu mawonekedwe a yankho) - kuchokera 100 mpaka 250 ml pa mlingo umodzi wa mankhwalawo.

Mlingo woyenera wa ana (kuphatikiza akhanda):

• ndi extracellular isotopic kuchepa kwa madzi komanso monga gwero lamoto: ndi kulemera kwa 10 makilogalamu - 110 ml / kg, 10-20 kg - 1000 ml + 50 ml pa kg, woposa 20 kg - 1600 ml + 20 ml pa kilogalamu,
• kwa dilution ya mankhwala (stock solution): 50-100 ml pa mlingo wa mankhwalawo.

Kuphatikiza apo, yankho la 10% la mankhwalawa limagwiritsidwa ntchito pochiza komanso pofuna kupewa hypoglycemia komanso munthawi ya kukonzanso madzi m'thupi. Mlingo wambiri watsiku ndi tsiku umatsimikiziridwa payekhapayekha, poganizira zaka ndi kulemera kwa thupi. Mlingo wa makonzedwe a mankhwalawa amasankhidwa malinga ndi zomwe akuwonetsa kuchipatala komanso momwe wodwalayo aliri. Popewa hyperglycemia, sikulimbikitsidwa kupitilira muyeso wa dextrose, chifukwa chake, mankhwalawa a mankhwalawa sayenera kukhala apamwamba kuposa 5 mg / kg / miniti.

Zotsatira zoyipa

Zotsatira zoyipa zomwe zimachitika pobwera ndi izi:

• Hypersensitivity.
• Hypervolemia, hypomagnesemia, hemodilution, hypokalemia, kuchepa kwa madzi, hypophosphatemia, hyperglycemia, electrolyte kusalinganika.
• Machitidwe a anaphylactic.
• Zotupa pakhungu, thukuta kwambiri.
• Venous thrombosis, phlebitis.
• Polyuria
• Zowawa zakwanuko pa malo a jakisoni.
• Kuzizira, kutentha thupi, kunjenjemera, kutentha thupi, kugwidwa ndi mavuto.
• Glucosuria.

Zofanana zoyipa zimatheka mwa odwala omwe ali ndi ziwengo kwa chimanga. Amathanso kuoneka ngati ali ndi zizindikiro zamtundu wina, monga hypotension, cyanosis, bronchospasm, pruritus, angioedema.

Malangizo apadera ogwiritsira ntchito malonda

Ndi chitukuko cha zizindikiro kapena chizindikiro cha hypersensitivity reaction, makonzedwe amayenera kuyimitsidwa nthawi yomweyo. Mankhwalawa sangathe kugwiritsidwa ntchito ngati wodwala ali ndi vuto losagwirizana ndi chimanga ndi zopangidwa zake. Poganizira zamankhwala zomwe wodwalayo ali nazo, mawonekedwe a kagayidwe kazomwe amagwiritsa ntchito), liwiro ndi kuchuluka kwa kulowetsedwa, kulowetsedwa kwa intravenous kungayambitse kukula kwa kusalinganika kwa elekitiroma (hypophosphatemia, hypomagnesemia, hyponatremia, hypokalemia, hyperhydrate ndi kuperewera kwa thupi, kuphatikiza zizindikiro za hyperemia pulmonary edema), hyperosmolarity, hypoosmolarity, osmotic diuresis ndi kusowa kwamadzi. Hypoosmotic hyponatremia imatha kupweteka mutu, nseru, kufooka, kukokana, matenda ammimba, chikomokere ndi imfa. Ndi zizindikiro zazikulu za hyponatremic encephalopathy, chithandizo chamankhwala chofunikira ndikofunikira.

Chiwopsezo chowonjezeka cha hypoosmotic hyponatremia chimawonedwa mwa ana, okalamba, azimayi, odwala a postoperative ndi anthu omwe ali ndi psychogenic polydipsia. Chiwopsezo chokhala ndi encephalopathy ndichipatala pang'onopang'ono mwa ana osaposa zaka 16, azimayi am'mbuyomu, odwala omwe ali ndi matenda amkati mwamitsempha komanso odwala ndi hypoxemia. Ndikofunikira nthawi zonse kuyesa mayeso a labotale kuti muwunikire kusintha kwamadzimadzi, ma electrolyte ndi acid moyenera panthawi yayitali yokhala ndi chidziwitso cha mankhwala ndi kuwunika kwa Mlingo womwe umagwiritsidwa ntchito.

Samalani kwambiri mukamagwiritsa ntchito mankhwalawa

Mosamala kwambiri, mankhwalawa amaperekedwa kwa odwala omwe ali ndi chiopsezo chachikulu cha electrolyte ndi kusowa kwa madzi, komwe kumakulitsidwa ndi kuwonjezeka kwa kuchuluka kwa madzi aulere, kufunika kogwiritsa ntchito insulin kapena hyperglycemia. Mavoliyumu akuluakulu amathandizidwa pansi paulamuliro mwa odwala omwe ali ndi vuto la mtima, mapapo kapena zina, komanso kuchepa kwa magazi. Ndi kukhazikitsidwa kwa mlingo waukulu kapena kugwiritsa ntchito mankhwalawa kwa nthawi yayitali, ndikofunikira kuwongolera kuchuluka kwa potaziyamu m'magazi ndipo ngati kuli koyenera, tengani kukonzekera kwa potaziyamu.

Mosamala, kuyendetsa njira ya glucose kumachitika mwa odwala omwe ali ndi kutopa kwambiri, kuvulala pamutu, kuchepa kwa thiamine, kulolera pang'ono kwa dextrose, electrolyte ndi kusowa kwa madzi, kupweteka kwa pachimake kwa ischemic komanso kwa akhanda. Odwala omwe ali ndi kufooka kwambiri, kuyambitsidwa kwa zakudya kumatha kubweretsa kukula kwa syndromes yatsopano, yodziwika ndi kuwonjezeka kwa kutsutsana kwa magnesium, phosphorous ndi potaziyamu chifukwa cha kuchuluka kwa anabolism. Kuphatikiza apo, kuchepa kwa thiamine komanso kusungidwa kwamadzi kumatha. Popewa kukula kwa zovuta zotere, ndikofunikira kuwonetsetsa kuyang'anira ndikuwonjezera zakudya, kupewa kudya kwambiri.

Kodi mankhwalawo akuwonetsedwa kwa ndani?

5% yankho lomwe limayendetsedwa kudzera m'mitsempha imathandizira:

• kubwezeretsa mwachangu kwamadzi otaika (ndi kuthamanga, kutulutsa kwam'madzi ndi ma cell),
• kuchotsedwa kwa zinthu zadzidzidzi ndikusokonekera (monga imodzi mwazinthu zothandizira anti-shock ndi madzi am'magazi).

10% yankho limakhala ndi mawonedwe omwe amagwiritsidwa ntchito:

1. ndi kusowa kwamadzi (kusanza, kukhumudwa, pakatha ntchito),
2. vuto la poizoni ndi mitundu yonse ya ziphe kapena mankhwala osokoneza bongo (arsenic, mankhwala osokoneza bongo, carbon monoxide, phosgene, cyanides, aniline),
3. ndi hypoglycemia, hepatitis, dystrophy, chiwindi atrophy, ubongo ndi pulmonary edema, hemorrhagic diathesis, zovuta za mtima wa septic, matenda opatsirana, matenda a toxico
4. pa ntchito yokonza mankhwalawa intravenous makonzedwe (ndende ya 5% ndi 10%).

Kodi ndingagwiritse ntchito bwanji mankhwalawa?

Njira yothetsera isotonic ya 5% iyenera kuwonongedwa pamlingo waukulu kwambiri wa 7 ml pa mphindi (ma 150 akutsikira mphindi kapena 400 ml pa ola).

Akuluakulu, mankhwalawa amatha kuperekedwa kudzera mu mtsempha wa 2 malita patsiku. N`zotheka kumwa mankhwalawa subcutaneously ndi enemas.

Hypertonic solution (10%) imawonetsedwa kuti ingagwiritsidwe ntchito kokha mwa intravenous makonzedwe a 20/40/50 ml pa kulowetsedwa. Ngati pali umboni, ndiye kuti muwugwiritse msanga kuposa 60 dontho pamphindi. Mlingo waukulu wa akuluakulu ndi 1000 ml.

Mlingo wofanana wa mankhwala opatsirana kudzera pamitsempha zimatengera zomwe munthu aliyense amafuna. Akuluakulu popanda kunenepa kwambiri patsiku sangatenge oposa 4-6 g / kg patsiku (pafupifupi 250-450 g patsiku). Potere, kuchuluka kwa madzimadzi obaya ayenera kukhala 30 ml / kg pa tsiku.

Ndi kuchepa kwamphamvu kwa kagayidwe kachakudya njira, pali zisonyezo zochepetsera tsiku lililonse kuti 200-300 g.

Ngati chithandizo chakanthawi yayitali chikufunika, ndiye kuti izi zikuyenera kuchitika pang'onopang'ono poona kuchuluka kwa shuga m'magazi.

Kuti mayamwidwe mwachangu komanso athunthu a shuga nthawi zina, kuyamwa kwa insulin kumafunika.

Kuchepetsa kachitidwe kosagwirizana ndi chinthu

Malangizo ogwiritsa ntchito anena kuti kapangidwe kake kapena chinthu chachikulu pazinthu zina kungapangitse kusokonezeka kwa thupi ku glucose ya 10% mwachitsanzo:

• malungo
• Hypervolemia
• hyperglycemia
• Kulephera pachimake kumanzere kwamitsempha.

Kugwiritsa ntchito nthawi yayitali (kapena kuchokera pakukhazikika kwa mankhwalawa) kungayambitse kutupa, kuledzera kwam'madzi, matenda a chiwindi kapena kufooka kwa zida zapakhungu.

M'malo omwe njira yogwiritsira ntchito mtsempha wamitsempha yolumikizidwa, kukula kwa matenda, thrombophlebitis ndi necrosis ya minofu ndikotheka, kutengera kukha magazi. Zomwe zimachitika pakukonzekera kwa glucose mu ampoules zitha kuchitika chifukwa cha kuwola kwa zinthu kapena mwa njira zolakwika zoyendetsera.

Ndi mtsempha wamkati, kuphwanya kwa electrolyte metabolism kumatha kudziwika:

Pofuna kupewa zoyipa zomwe zimapangidwa ndi odwala odwala, ndikofunikira kuyang'anitsitsa mosamala mlingo ndi njira yoyenera ya makonzedwe.

Kodi shuga amawombetsa ndani?

Malangizo ogwiritsira ntchito apereke chidziwitso pazomwe zimapangitsa contraindication:

• matenda ashuga
• matenda ammimba ndi mapapu,
• hyperglycemia
• hyperosmolar chikomokere,
• hyperlactacidemia,
• kulephera kwazungulira, ndikuwopseza kukula kwa edema ndi ubongo.

Kuchita ndi mankhwala ena

Yankho la glucose la 5% ndi 10% ndi kapangidwe kake kumathandizira kuyamwa kwa sodium kuchokera m'mimba. Mankhwala atha kuphatikizidwa limodzi ndi ascorbic acid.

Mothandizidwa nawo munthawi yomweyo amayenera kukhala pa 1 unit pa 4-5 g, yomwe imathandizira kuti mayendedwe azigwira bwino ntchito.

Poona izi, glucose 10% ndi othandizira wamphamvu wophatikiza omwe sangathe kutumizidwa nthawi yomweyo ndi hexamethylenetetramine.

Matendawa amatetezedwa bwino ndi:

• alkaloids mayankho
• opaleshoni wamba
• mapiritsi ogona.

Njira yothetsera vutoli imatha kufooketsa mphamvu ya analgesics, mankhwala a adrenomimetic ndikuchepetsa mphamvu ya nystatin.

Malingaliro ena oyambira

Mukamagwiritsa ntchito mankhwalawa intraven, kuchuluka kwa shuga m'magazi kuyenera kuyang'aniridwa nthawi zonse. Kukhazikitsidwa kwa shuga ochulukirapo kungakhale kovuta kwa odwala matenda ashuga omwe ali ndi vuto lalikulu lamagetsi. Yankho la 10% silingagwiritsidwe ntchito pambuyo povulaza pachimake mu ischemia mu mawonekedwe owopsa chifukwa cha zotsatira zoyipa za hyperglycemia pamankhwala.

Ngati pali zisonyezo, ndiye kuti mankhwalawa angagwiritsidwe ntchito mwa ana, pa nthawi ya pakati komanso pakubala.

Kufotokozera kwazinthuzi kukuwonetsa kuti glucose sangathe kusokoneza kuthekera koyendetsa kayendedwe ndi kayendedwe.

Milandu yambiri

Ngati kumwa kwambiri, mankhwalawo atha kunena zizindikiro za zoyipa. Kukula kwa hyperglycemia ndi chikomokoma ndikotheka kwambiri.

Pokhapokha pakuwonjezereka kwa kuchuluka kwa shuga, mantha angachitike. Mu pathogenesis mwa mikhalidwe iyi, kuyenda kwa osmotic kwamadzimadzi ndi ma electrolyte kumachita gawo lofunikira.

Njira yothetsera kulowetsedwa imatha kupangidwa mu ndende ya 5% kapena 10% mumadzi a 100, 250, 400 ndi 500 ml.

Kuchita ndi mankhwala ena

Akaphatikizidwa ndi mankhwala ena, ndikofunikira kuwunika momwe angagwirizanirane (kusaonekanso kwa mankhwala kapena kusakanikirana kwa pharmacodynamic ndikotheka).

Njira yothetsera shuga sayenera kusakanikirana ndi ma alkaloids (iwo amayamba kuwola), ndi mankhwala ochita kupanga pang'onopang'ono (ntchito yotsika), mapiritsi ogona (ntchito zawo zimachepa).

Glucose imafooketsa ntchito ya analgesic, adrenomimetic mankhwala, inactivates streptomycin, amachepetsa mphamvu ya nystatin.

Chifukwa chakuti glucose ndi othandizira wokwanira oxidizing, sayenera kupatsidwa syringe yomweyo ndi hexamethylenetetramine.

Mothandizidwa ndi thiazide diuretics ndi furosemide, kulolerana kwa shuga kumachepa.

Njira yothetsera shuga imachepetsa poizoni wa pyrazinamide pachiwindi. Kukhazikitsidwa kwa njira yayikulu yothetsera shuga kumapangitsa kukula kwa hypokalemia, komwe kumawonjezera kuwopsa kwa kukonzekera kwa nthawi yomweyo.

Glucose sagwirizana pamayankho ndi aminophylline, solible barbiturates, erythromycin, hydrocortisone, warfarin, kanamycin, solfanle sulfanilamides, cyanocobalamin.

Njira yothetsera shuga sayenera kutumikiridwa munjira yomweyo ya kulowetsedwa kwa magazi chifukwa choopsa cha kuphatikizana kwa msana.

Popeza njira ya glucose ya kulowetsedwa kwamitsempha imakhala ndi acidic reaction (pH

Njira zopewera kupewa ngozi

Kuti mumve kwambiri shuga yemwe amapezeka pa Mlingo waukulu, insulin imayikidwa pamodzi ndi muyeso wa 1 unit ya insulin pa 4-5 g shuga. Kwa odwala matenda a shuga, shuga amaperekedwa motsogozedwa ndi zomwe zili m'magazi ndi mkodzo. Pa chithandizo, ndikofunikira kuyang'anira ionil.

Kugwiritsa ntchito shuga kwa odwala omwe ali ndi vuto lalikulu la ischemic stroke kungachedwetse kuchira.

Popewa hyperglycemia, kuchuluka kwa oxidation wa glucose sikungathe kupitirira.

Njira yothetsera shuga sayenera kutumizidwa mwachangu kapena kwa nthawi yayitali. Ngati kuzizira kumachitika pakakhala oyang'anira, mabungwe amayimitsidwa nthawi yomweyo. Popewa thrombophlebitis, iyenera kutumikiridwa pang'onopang'ono kudzera m'mitsempha yayikulu.

Ndi kulephera kwa aimpso, mtima wosakhazikika, hyponatremia, chisamaliro chapadera chimafunikira pokhazikitsa shuga, kuwunika kwa hemodynamics yapakati.

Kukopa pa kuyendetsa magalimoto ndi njira zina zowopsa. Zosakhudzidwa.

Mankhwala

Pharmacokinetics

Pambuyo pakukonzekera, imagawidwa mwachangu m'thupi lathu. Wosangalatsa ndi impso.

Mankhwala

Mafuta a 5% a glucose ndi isotonic pokhudzana ndi madzi am'magazi ndipo, akapatsidwa mankhwala, amabwezeranso kuchuluka kwa magazi, pomwe amataika, amathandizanso kupeza michere yambiri, komanso amathandizanso

poyizoni kuchokera m'thupi. Glucose imapereka gawo logwiritsanso ntchito mphamvu. Ndi jakisoni wovomerezeka, imayendetsa njira za metabolic, imayendetsa ntchito ya chiwindi, imakweza mphamvu ya contractile ya myocardium, imachepetsa mitsempha ya magazi, ndikuwonjezera diuresis.

Zizindikirokugwiritsa ntchito

- Hyper ndi isotonic kuchepa madzi

- kupewa kuphwanya kwamiyeso yamagetsi yamagetsi yamagetsi panthawi ya opaleshoni mwa ana

- monga zosungunulira zina zogwirizana ndi mankhwala.

Zochita zamankhwala osokoneza bongo

Pogwiritsa ntchito munthawi yomweyo ndi thiazide diuretics ndi furosemide, kuthekera kwawo kwakukopa shuga wa seramu kuyenera kuganiziridwanso. Insulin imathandizira kuti shuga atulutsidwe m'ziphuphu zake. Njira yothetsera shuga imachepetsa poizoni wa pyrazinamide pachiwindi. Kukhazikitsidwa kwa njira yayikulu yothetsera shuga kumapangitsa kukula kwa hypokalemia, komwe kumawonjezera kuwopsa kwa munthawi yomweyo kukonzekera kwa digitis.

Glucose sagwirizana pamayankho ndi aminophylline, solible barbiturates, erythromycin, hydrocortisone, warfarin, kanamycin, solfanle sulfanilamides, cyanocobalamin.

Chifukwa cha kuthekera kwa pseudoagglutination, ndizosatheka kugwiritsa ntchito njira ya shuga ya 5% m'thupi limodzi nthawi imodzi, musanayambe kapena kuikidwa magazi.