Kukonzekera kwa Glucocorticoid: Zizindikiro ndi ma contraindication ogwiritsa ntchito, bongo ndi zotheka zomwe zingachitike

Kuchulukitsa kwamanjenje.

Kuchokera pamtima:

Mitsempha yakuya kwambiri.

Kuchokera m'mimba:

Zilonda zam'mimba za m'mimba ndi matumbo.

Kutulutsa magazi kuchokera mumimba.

Kuwonongeka kwamafuta kwa chiwindi.

Kuchokera pamalingaliro:

Posterior subcapsular cataract.

Kuchokera ku endocrine system:

Kuletsa kwa ntchito ndi kusintha kwa adrenal cortex.

Pa khungu:

Kuchokera ku minculoskeletal system:

Fractures ndi aseptic necrosis yamafupa.

Kukula mobwerezabwereza mwa ana.

Kuchokera pakubala:

Kusamba kwamwamuna.

Kuphwanya kugonana.

Zachedwetsedwa pakukula kwa kugonana.

Kumbali ya zowonetsa zasayansi:

Kusungidwa kwa sodium ndi madzi.

Kuchulukitsa kwa matenda opatsirana oyamba ndi otupa.

MALO OGWIRITSIRA NTCHITO.

Zolemba zamkati ndi pharynx.

Kuuma ndi kuwotcha kwa mphuno ndi pharynx.

Kukonzekera kwa septum yammphuno.

Kuponderezedwa kwa hypothalamic-pituitary-adrenal axis (HPA)

Kuponderezedwa kwa HPA ndi chimodzi mwazinthu zowopsa zomwe zimagwiritsidwa ntchito ndi steroid. Kutha kuyankha pazovuta zapadziko lonse lapansi (mwachitsanzo, pakuchita opaleshoni kapena kuvulala) zitha kufooka, kuyika wodwalayo pachiwopsezo cha hypotension ndi hypoglycemia. Zizindikiro zake zimaphatikizapo kusokonezeka kwamakhalidwe, nseru, postological hypotension, ndi hypoglycemia. Kuopsa kwa zomwe zimachitika kumadalira mlingo, nthawi komanso njira ya chithandizo, ngakhale zinthu zina ndizothekanso. Pali zosiyana zingapo pazomwe zimachitika chifukwa cha mankhwala a steroid. Odwala ena anali ndi kuponderezedwa kwa HPA akamagwiritsa ntchito ma milligram 15 a prednisone omwe amatengedwa tsiku lililonse kwa milungu ingapo, pomwe ena sanawonetse zizindikiro za kuponderezedwa kwa HPA ngakhale anali kugwiritsa ntchito Mlingo wapamwamba tsiku lililonse kwakanthawi. Chifukwa chake, ndizovuta kuneneratu kuopsa kwa kuponderezedwa kwa HPA mwa wodwala makamaka potengera mlingo komanso nthawi yayitali. Kukonzekera kwa dose kumakhudza kuchuluka kwa kuponderezedwa kwa HPA. Mlingo wokhudza thupi wa glucocorticosteroids (5-7,5 mamililita a prednisone) omwe amatengedwa m'mawa samayambitsa kuponderezedwa kwa HPA, koma ngati mankhwala omwewo amaperekedwa usiku, kubwezeretsa kwachilendo kwa cortisol tsiku lililonse. Mlingo pamwamba pa zokhudza thupi zimayamba kukhala ndi vuto linalake patatha mwezi umodzi. Mankhwala tsiku lililonse tsiku lililonse mumalandira mankhwala a 8 koloko m'mawa tsiku lililonse, palibe kuponderezana kwakukulu kwa HPA. Komanso ma cyclic a masiku a 5 a masiku othandizira kuyambira sabata ziwiri mpaka 4 samatengera kukakamiza. Komabe, kuzungulira kwamasabata awiri komanso kuchotsedwa kwa masabata awiri kumayambitsa kuponderezedwa kwa HPA. Mlingo wa tsiku ndi tsiku wa glucocorticosteroids omwe amamwa m'mawa amatulutsa kuperewera pang'ono kwa HPA kuposa mlingo womwewo womwe umagawidwa ndi kumwa tsiku.

Kuchira kwa HPA kumatha kuchitika pakatha miyezi 12. Ntchito ya hypothalamic-pituitary imabweranso koyamba miyezi 2-5 itachotsedwa pakukonzekera, ndipo ikuwoneka ndi mawonekedwe a plasma yachilendo magawo a adrenocorticotropic timadzi (ACTH). Zizindikiro zakuchira kwa adrenal ziyamba kuwonekera pambuyo pa miyezi 6-9, ndindandandandandawo ndikubwerera. Kuyankha kwakukulu kwa adrenal ku ACTH sikungawoneke kale kuposa miyezi 9-12 atasiya kulandira chithandizo. Palibe njira yotsimikiziridwa yolimbikitsira kuchira kwantchito ya HPA.

Kuwonjezeka kwa milingo ya ACTH sikuwoneka kuti ikuthandizira kuchira kwa adrenal. Ndikosavuta kudziwa kuti kusaperekera mayankho kwa adrenal kwatenga nthawi yayitali bwanji. Chifukwa cha kuchuluka kwa odwala, sizinatheke kukhazikitsa mgwirizano wodalirika pakati pa kuchuluka kwa kuponderezedwa kwa HPA ndi kuchuluka kwa cortisol m'magazi. Kuti athane ndi vuto losatsimikizika ili, kuyezetsa kwa axero kwa HPA kukukhala kofunikira popanga zisankho. Pa mayeso osiyanasiyana (insulin-ikiwayambitsa hypoglycemia, ndi zina), mayeso omwe amagwiritsidwa ntchito kwambiri ndi ACTH, chifukwa chake zotsatira zake zimagwirizanitsidwa bwino ndi misempha ya cortisol yomwe imayezedwa panthawi ya kupsinjika. Kuphatikizika kwa cortisol kumatsimikiziridwa, kenako phokoso limodzi (250 mug) ya ACTH (cosintropin) ya jekeseni. Cortisol ndende imayesedwa mu zitsanzo za magazi zomwe zimatengedwa pambuyo pa 30 ndi 60 Mphindi. Ngakhale kuti mayesowa amapereka zotsatira zoyipa zabodza, anthu ambiri amaganiza kuti ndizosavuta komanso zotetezeka poyerekeza ndi insulin-insulin hypoglycemia - mayeso omwe amadziwika kuti ndi '`golide woyenera' 'pa mayeso a HPA.

Amakhulupilira kuti kuyesa pogwiritsa ntchito corticotropin-releasing hormone (CRH) kumaphatikiza kuzindikira kwa insulin-induced hypoglycemia test mosavuta ndi mayeso a ACTH. Ngakhale ndikofunikira kuzindikira kuponderezana kwa HPA pakapita nthawi, sichinthu chokhacho chokhacho chimalongosola kuthekera kwa odwala omwe akupanga corticosteroid therapy kuti athe kuchitapo kanthu moyenerera pamavuto. Odwala ena amakhala ndi kuyankha kopitilira muyeso ngakhale kuti kulibe HPA axis kukakamiza, ndipo odwala omwe ali ndi HPA yopanikizika sangakhale ndi zizindikiro za chipatala za adrenal insufficiency.

Odwala omwe ali ndi hypothyroidism, cirrhosis, hypoalbuminemia, komanso odwala okalamba, zotsatira za glucocorticosteroids zimatha kupititsidwa patsogolo.

Popereka mankhwala a glucocorticosteroids pa nthawi yomwe mayi ali ndi pakati, chiwopsezo chotsatira cha mayiyo ndi chiopsezo cha zotsatirapo zoipa za mwana wosabadwayo ziyenera kukumbukiridwa, chifukwa kugwiritsa ntchito mankhwalawa kungayambitse kukula kwa fetal, zolakwika zina za chitukuko (cleft palate), kuvuta kwa adrenal cortex (wachitatu trimester) mimba).

Mu ana ndi akulu omwe amatenga glucocorticosteroids, matenda opatsirana monga chikuku ndi nthomba amatha kukhala akulu.

Odwala kutenga immunosuppress Mlingo wa glucocorticosteroids ali contraindicated mu makonzedwe a moyo katemera.

Osteoporosis imayamba 30-50% ya odwala omwe amatenga glucocorticosteroids a nthawi yayitali (mitundu ya pakamwa kapena jekeseni). Monga lamulo, msana, mafupa a m'chiuno, nthiti, manja, miyendo zimakhudzidwa.

Zilonda za Steroid munthawi ya mankhwala a glucocorticosteroids amatha kukhala asymptomatic kapena asymptomatic, kuwonetsera kutulutsa magazi ndi mafuta. Chifukwa chake, odwala omwe amalandila kwa nthawi yayitali glucocorticosteroids ayenera kuyang'aniridwa ndi fibroesophagogastroduodenoscopy ndi kusanthula kwamagazi kwamatsenga.

M'matenda osiyanasiyana otupa kapena autoimmune (nyamakazi, systemic lupus erythematosus, ndi matenda am'matumbo), milandu ya kukana kwa steroid ingachitike.

Ndi munthawi yomweyo kugwiritsa ntchito glucocorticosteroids ndi mankhwala ena, zotsatirazi zingaoneke:

Ndi maantacid - kuchepa kwa mayamwidwe a glucocorticosteroids.

Ndi barbiturates, hexamidine, diphenin, carbamazepine, diphenhydramine ndi rifampicin - imathandizira biotransformation la glucocorticosteroids m'chiwindi.

Ndi isoniazid ndi erythromycin, kutsika kwa biotransformation la glucocorticosteroids mu chiwindi.

Ndi salicylates, butadione, barbiturates, digitoxin, penicillin ndi chloramphenicol - kuchulukitsa kwa mankhwalawa.

Ndi isoniazid - matenda amisala.

Ndi reserpine, mayiko ovuta.

Ndi ma tridclic antidepressants - kuchuluka kwa intraocular.

Ndi adrenergic agonists - kuchuluka kwa mankhwalawa.

Ndi theophylline - kukula kwa zotsatira za mtima ndi kuchuluka kwa mphamvu ya anti-yotupa ya glucocorticosteroids.

Ndi diuretics, amphotericin, mineralocorticoids - chiwopsezo chowonjezereka cha hypokalemia.

Ndi anticoagulants osadziwika, fibrinolytics, butadione, ibuprofen ndi ethacrine acid - zovuta za hemorrhagic.

Ndi indomethacin ndi salicylates - zotupa zam'mimba za m'mimba.

Ndi paracetamol - kuchuluka kwa mankhwalawa.

Ndi azathioprine, chiopsezo chowonjezereka cha myopathies, amphaka.

Ndi mercaptopurine, kuwonjezeka kwa kuchuluka kwa uric acid m'mwazi ndikotheka.

Ndi hingamine - ndizotheka kuwonjezera zosafunikira za mankhwalawa (dermatitis, myopathy, corneal opacity).

Ndi methandrostenolone - kuchuluka kwa achire komanso osafunikira zotsatira za glucocorticosteroids.

Ndi androgens ndi kukonzekera kwachitsulo - erythropoiesis yowonjezereka chifukwa cha kuchuluka kwa kapangidwe ka erythropoietin.

Ndi mankhwala ochepetsa shuga - kuchepa kwa mphamvu ya mankhwalawa.

Kutalika kwa nthawi yayitali glucocorticosteroids ndi β 2 --adrenomimetics ali ndi njira yowonjezera komanso synergism. Theophylline imathandizira odana ndi yotupa ntchito ya inhaled glucocorticosteroids.

Mukamagwiritsa ntchito glucocorticosteroids, ndikofunikira kuti mupeze chithandizo choyenera chokwanira ndi zovuta zochepa. Nthawi zambiri, ma steroid samachiza matendawa, m'malo mwake, amachepetsa kapena kusintha kusintha komwe kumayambitsa matendawo komanso kuchepetsedwa kwa chitetezo cha mthupi ndikuchepetsa zizindikiro za matendawa. Chifukwa chake, maubwino achire omwe akuyembekezeredwa komanso zoopsa zomwe zingachitike zingafunike kuyesedwa mosamala. Chiwopsezo sichikhudzidwa ndimankhwala ochepa (7-14 masiku), ngakhale mutagwiritsa ntchito Mlingo wambiri, womwe umatha kukhala wothandiza kwambiri pazinthu zina (mwachitsanzo, mphumu yayikulu). Kulakalaka kwambiri komanso kusangalala ndi zotsatira zoyipa zomwe zimakhala ndi maphunziro apfupi. Palibe zotsatila za nthawi yayitali. Lingaliro loti muyambitse maphunziro a steroid yayitali limafunikira kuganizira zoopsa zomwe tafotokozazi.

Corticosteroids amasiyana makamaka pakakhala nthawi komanso kuchuluka kwa zochita. Othandizira ochita kudya mwachangu sangachepetse nkhwangwa ya HPA, makamaka ngati mlingo wam'mawa womwe umagwiritsidwa ntchito ngati gawo la regimen tsiku lililonse. Othandizira pang'onopang'ono amasankhidwa m'malo omwe muyenera kugwiritsa ntchito Mlingo waukulu. Mineralocorticoid ntchito ya mankhwala ndi zofunika kwa adrenal kuchepa, koma osati yotupa njira kapena immunoreactivity. Mosasamala za mankhwala omwe adasankhidwa, ndikofunikira kupitiliza osagwiritsa ntchito mankhwala a steroid, ngati izi zingatheke kugwiritsa ntchito mitundu yaying'ono ya corticosteroids.

Prednisone imagwiritsidwa ntchito kwambiri pakati pa glucocorticosteroids. Moyo wake wamfupi komanso wamtengo wotsika zimapangitsa mankhwalawa kukhala othandiza kwambiri mu immunosuppressive ndi anti-kutupa action. Prednisone ndi metabolite yogwira ya prednisone ndipo imagwiritsidwa ntchito pothana ndi mavuto a chiwindi. Dexamethasone ndi wamphamvu kwambiri kuwirikiza kasanu ndi kawiri kuposa prednisone ndipo amakhala ndi theka la moyo wa maola 24. Izi zimapangitsa kuti ikhale yothandiza poyesa axPA ya HPA. Hydrocortisone (cortisone), mankhwala osachepera kanayi kwamphamvu kuposa prednisone. Amagwiritsidwa ntchito makamaka mu mankhwala a teknoloji ya adjunctive odwala omwe ali ndi HPA yoletsa. Florinef (9-alpha-fluorohydroxycortisone) ndi wamphamvu mineralocorticoid (wopanda glucocorticoid kwenikweni), wogwiritsidwa ntchito makamaka m'malo mwa mankhwala a adrenal cortical insufficiency.

Mwachidziwitso, kugwiritsa ntchito ACTH kumawoneka kokongola chifukwa kungapewe kuponderezedwa ndi HPA, koma ACTH imathandizanso kuyankha kosafunikira kwa mineralocorticoid ndi androgen. Kuphatikiza apo, sizikudziwika kuti yankho la glucocorticoid lidzalandidwa kuchokera ku mlingo wotani. Zovuta izi zimachepetsa kugwiritsa ntchito ACTH.

Kusankha kwa chiwembu: tsiku lililonse kapena tsiku lililonse

Mankhwalawa matenda ambiri omwe amafuna corticosteroid mankhwala (mphumu, sarcoidosis ndi ena), chiwembu tsiku lililonse chimagwiritsidwa ntchito bwino, ngakhale nthawi zambiri kumayambiriro kwa chithandizo chamankhwala chizikhala tsiku ndi tsiku. Ubwino wofunikira wa regimen tsiku lililonse ndikuletsa kupanikizika kwakukulu kwa axis ya HPA ndi kuchepetsa chiopsezo cha Cushingoid popanda kutaya kwakukulu kwa ntchito yoletsa kutupa. Chiwopsezo cha zovuta zambiri zomwe zafotokozedwa pamwambapa zimachepetsedwa kapena kuthetseratu kugwiritsa ntchito njirayi tsiku lililonse.

Ndondomeko ya tsiku ndi tsiku yokha siyingaletse kuponderezana kwa axero ya HPA ngati, mwachitsanzo, dexamethasone imagwiritsidwa ntchito pochiza. Kuphatikiza apo, dongosolo la mankhwalawa liyenera kuonedwa mosamalitsa. Kulephera kutsatira dongosolo kapena kusintha kwa mankhwala a tsiku loyamba sikulepheretsa kuponderezedwa kwa HPA.

Daily corticosteroid mankhwala amagwiritsidwa ntchito kuchulukitsa kwa matendawa komanso kuthandizira matenda ena omwe angakhudzidwe ndi regimen ya tsiku ndi tsiku (mwachitsanzo, arteritis ya kanthawi, pemphigus vulgaris). Zikakhala kuti mankhwalawa amalephera tsiku lililonse, kuponderezedwa kwa HPA kumatha kuchepetsedwa ngati kumwa kwathunthu kwa tsiku ndi tsiku kumwedwa nthawi imodzi m'mawa, pa mlingo wotsika kwambiri. A single regimen ya mankhwala ndi othandiza ngati limodzi mlingo regimen. Komabe, mosiyana ndi chiwembucho tsiku lililonse, chiopsezo chotenga matenda a Cushing ndiokulirapo.

Kusintha kuyambira tsiku lililonse kupita tsiku lina lililonse

Odwala ambiri omwe ali ndi mphamvu pamankhwala olimbitsa thupi tsiku lililonse amakhala ofuna kuti asinthane ndi regimen tsiku lililonse (kusiyapo, onani pamwambapa). Izi zimakuthandizani kuti musinthane ndi chiwembu chochepa kwambiri popanda kusiya matenda. Mosiyana ndi kuchepetsa mankhwalawa, kuchuluka kwa mankhwalawa sikusintha. Kusinthaku kumachitika ndi kuwonjezeka pang'onopang'ono kwa mlingo wa tsiku loyamba komanso kuchepa kwa mankhwalawa tsiku lachiwiri, mpaka mlingo wambiri utatengedwa tsiku lina lililonse, popanda mankhwala ena patsiku lapakati.

Kuchuluka kwa kusintha kumadalira ntchito yamatenda oyambira, nthawi yayitali ya chithandizo, kuchuluka kwa kuponderezedwa kwa HPA, komanso momwe wodwala alili. Pulogalamu yofananira imakhala ndikuwonjezera mlingo wa tsiku loyamba ndikuchepetsa mlingo wa tsiku lachiwiri pakuwonjezera kwa mamiligalamu 10 a prednisone (kapena ofanana nawo) pamene mlingo wa tsiku ndi tsiku unali wopitilira mamiligalamu 40, komanso pakukweza kwa mamiligalamu 5 pamene mlingo watsiku ndi tsiku unali 20 mpaka 40 milligram. Pa mlingo womwe uli pansi pa mamilimita 20, gawo liyenera kukhala mamiligalamu 2,5. Nthawi yayitali pakati pa zosinthazi imayamba kuyambira tsiku limodzi mpaka masabata angapo ndipo imatsimikiziridwa molimba mtima chifukwa cha mayankho a wodwala. Ndikofunika kukumbukira kuti odwala ambiri omwe amatenga corticosteroid tsiku ndi tsiku kwa masabata opitilira 2-4 amakhala ataponderezedwa ndi HPA.

Mlingo wochepetsera komanso kusiya ntchito kwamankhwala

Kuchepetsa kwakanthawi kwa corticosteroid mankhwala okhala mwezi wopitilira mwezi umodzi ndi kuchuluka kwa mamililita 20-30 a prednisone patsiku kungachititse kuchuluka kwadzidzidzi kwa matenda oyambitsawo kapena kungayambitse kufooka. Palibe njira zotsimikiziridwa zothamangitsira kuchira kwa HPA. M'pofunika kuwongolera mawonetseredwe a matendawa ndikuchepetsa mulingo, kuwonetsetsa kuchuluka kwa matendawa kapena chizindikiro cha adrenal insufficiency (postural hypotension, kufooka ndi kusowa kwa m'mimba).

Njira yolimbikitsa yochepetsera mulingo wamankhwala ndikusintha kwa ma milligrams 10 a prednisone kapena ofanana pakapita masabata atatu aliwonse ngati gawo loyambirira limaposa mamiligalamu 40 patsiku. Ngati mulingo wochepera mamiligalamu 40, gawo ndi ma milligram asanu.Mankhwala a prednisone (5-7,5 mg) atachitika, wodwalayo amatha kusintha mapiritsi a 1 mg wa prednisone kapena mlingo wofanana wa hydrocortisone, kotero kuti kuchepetsa kwina kwa mankhwalawa kungapangidwenso pang'onopang'ono. Kupungitsanso kowonjezera kwa sabata kapena kwa sabata ziwiri kungapangitsidwe pakukula kwa milligram.

Panthawi yochepetsera Mlingo, odwala ena amakhala ndi matenda osokoneza bongo, omwe amakhala ndi nkhawa, myalgia, arthralgia, anorexia, mutu, komanso nseru. Kafukufuku walephera kudziwa mgwirizano pakati pa izi ndi kuchuluka kwa cortisol kapena 17-hydroxycorticosteroid. Nthawi zambiri, madandaulo amachitika pomwe magawo anali abwinobwino. Kuyankha kwa HPA kunalinso kwachilendo mwa ambiri mwa odwalawa. Njira zomwe zimayambitsa matendawa sizikudziwika, koma zikuwoneka kuti zikugwirizana ndi kuchuluka kwake komwe mulingo womwe umachepetsa.

Steroid mankhwala-anachititsa adrenal kuchepa chizindikiritso

Mukamadikirira kupsinjika (kuphatikizapo panthawi yopangira opaleshoni), ndikofunikira kudziwa mkhalidwe wazitsulo za HPA ndikuwonetsa ngati chithandizo chowonjezera cha steroid chidzafunika. Monga tanena kale, ndizovuta kwambiri kulosera zamtundu wa HPA ndikutalika, zomwe zimapangitsa kuyesa axis ya HPA kukhala yofunikira posankha ngati wodwala angafunikire mankhwala ena a steroid. Pankhaniyi, kuyesa kwa cosintropin (kupanga ACTH) ndi njira yosavuta, yotetezeka komanso yothandiza poyesa nkhwangwa ya HPA. Ngati kuchuluka kwa cortisol pambuyo pa mphindi 60 kupitirira 18 mug / dL kapena pali kuwonjezeka kuchokera kumayambiriro osachepera 10 mug / dL, ndiye kuti yankho la adrenal ndilokwanira kuti wodwalayo athe kupirira kupanikizika kofanana ndi kupweteka kwamankhwala. Kuyesaku kutha kuchitika pogwiritsa ntchito 100 mug CRH kudzera m'mitsempha. Ngati wodwala alibe yankho loyenera la adrenal, mankhwala ena owonjezera a corticosteroid ayenera kuchitidwa kuti athane ndi nkhawa. Hydrocortisone imagwiritsidwa ntchito kwambiri. Kutengera ndi kupsinjika kwa kupsinjika, ma milligrams a 100-400 a hydrocortisone patsiku amagwiritsidwa ntchito Mlingo zingapo. Mulingo wocheperako wa mulingo wa ma milligram (100 mamiligalamu) umafanana ndi kupsinjika pakabuka m'mimba, chimfine, kapena mano. Wopsinjika kwambiri (kuvulala kapena kuchitidwa opaleshoni), wodwalayo ayenera kupatsidwa mamiligalamu 100 a hydrocortisone kholo lililonse pamaola asanu ndi atatu. Syringe yokonzedweratu yokhala ndi ma milligram a 4 a dexamethasone iyenera kugwiritsidwa ntchito pakugwiritsa ntchito makolo pakagwa mwadzidzidzi, ngati chithandizo chachipatala sichipezeka, wodwalayo sakudziwa kapena sangathe kulandira ma steroid pakamwa.

Ma Steroid ayenera kugwiritsidwa ntchito mosamala kwa odwala omwe malingaliro awo kapena nzeru zawo zingakhudzidwe chifukwa choopsa cha kuponderezedwa kwa HPA. Odwala omwe atenga regorteid corticosteroid tsiku lililonse ayenera kulandira malangizo okhudzana ndi kutsatira mankhwalawo ndikumwa mankhwalawa asanakwane 8 a.m. kuti muchepetse chiopsezo choponderezedwa ndi HPA. Odwala ayenera kudziwitsidwa za kufunika kokulitsa kuchuluka kwa mankhwalawa ngati pali kupsinjika kapena matenda panthawi yonse ya corticosteroid mankhwala. Odwala ayenera kumvetsetsa kufunika kothanirana ndi dokotala ndikuwonjezera kuchuluka kwa mankhwalawa ngati akupsinjika mwakuthupi kapena m'maganizo.

Odwala ambiri amaopa kutha kwa mankhwala a steroid kapena amakana kuchepetsa kuchuluka kwa ma steroid chifukwa choopa kuti angayambenso kudwala. Kuwunikanso mwatsatanetsatane za zotsatira zoyipa zamanthawi yayitali ndikofunikira kufotokoza kufunika kwa kuchepetsa magazi ndi kufunikira kwa kuimitsa kwapadera kwa corticosteroids.Muzochitika zomwe chithandizo cha tsiku ndi tsiku chofunikira kwambiri, zotsatira zamavuto (kuphatikizapo Cushing's syndrome) zitha kuchepetsedwa podziwitsa wodwalayo mwayi wokhala pomwepo ndi kutembenuka kwawo.

Mankhwala osokoneza bongo omwe amayamba kugwiritsidwa ntchito pang'onopang'ono: methotrexate, sulfasalazine, chloroquine, auronofin

Methotrexate lingalirani za kukonza njira yothetsera jakisoni, lyophilisate pokonzekera yankho la jakisoni, yankho la jakisoni, mapiritsi, mapiritsi okhala ndi ntchito - antitumor agent - antimetabolite.

Njira yamachitidwe. Antitumor, cytostatic wothandizila gulu la antimetabolite linalake ndipo amalepheretsa kuchepa kwa magazi, amene akuphatikizidwa pakubwezeretsa dihydrofolate acid kuti tetrahydrofolate acid (wonyamula zofunikira za kaboni pakufunika kwa kaphatikizidwe ka purine nucleotides ndi zotumphukira zawo).

Imalepheretsa kaphatikizidwe, kukonza kwa DNA ndi cell mitosis. Makamaka chidwi ndi zochita mofulumira kuchuluka kwa zimakhala: maselo a zilonda zam'mimba, kupweteka kwa m'mafupa, maselo a embryonic, maselo a epithelial a m'mimba, chikhodzodzo, komanso khomo lamkamwa. Pamodzi ndi antitumor, imakhala ndi immunosuppression.

Pharmacokinetics Kuthira pakamwa kumatengera mlingo: mutamwa 30 mg / m2 bwino, odziwika bwino a bioavailability ndi 60%. Mafuta amachepetsa mukamamwa Mlingo wopitirira 80 mg / m2 (akukhulupirira kuti chifukwa cha kuchuluka).

Mwa ana omwe ali ndi leukemia, mayamwidwe amachokera ku 23 mpaka 95%. TCmax - 40 min-4 h yokhala ndi pakamwa komanso 30-60 min - ndi kayendetsedwe ka i / m. Chakudya chimachepetsa mayamwidwe ndikuchepetsa Cmax. Kuyankhulana ndi mapuloteni a plasma - pafupifupi 50%, makamaka ndi albumin. Kugawa voliyumu - 0,18 l / kg.

Mukalandira mankhwala othandizira, mosasamala kanthu za njira yoyendetsera, samalowa mu BBB (pambuyo poyang'anira intrathecal mu CSF, kutsimikizika kwakukulu kumachitika). Imalowa mkaka wa m'mawere.

Pambuyo pakamwa, imapangidwa pang'ono ndi matumbo, gawo lalikulu - m'chiwindi (mosasamala kanthu za kayendetsedwe kake) ndikupanga mawonekedwe a pharmacologically yogwira polyglutamine, yomwe imathandizanso kuphatikizira kwa dihydrofolate reductase ndi syntmidine synthesis.

T1 / 2 mwa odwala omwe amalandira ochepera 30 mg / m2 ya mankhwalawa mu gawo loyamba ndi maola 2-4, ndipo gawo lomaliza (lomwe ndi lalitali) - maola 3 mpaka 10 pogwiritsa ntchito maola ochepa ndi 8-15 mukamagwiritsa ntchito Mlingo waukulu wa mankhwala. Kulephera kwa aimpso, magawo onse a kuchotsedwa kwa mankhwalawa amatha kukulitsidwa.

Imafufutidwa makamaka ndi impso mu mawonekedwe osasinthika mwa kusefedwa kwa glomerular ndi katulutsidwe ka tubular (iv ikamayendetsa 80-90% yowachotsa mkati mwa maola 24), mpaka 10% imachotsedwa ndi bile (ndikubwezeretsanso pambuyo pake m'matumbo). Kuchoka kwa mankhwalawa odwala omwe ali ndi vuto laimpso, akuwonetsedwa ngati ascites kapena transudate kumachepetsedwa kwambiri. Ndi makonzedwe obwerezabwereza, amadziunjikira mumtundu wa polyglutamates.

Zizindikiro. Khansa ya m'mawere, khansa ya m'mimba ndi khosi, khansa yam'mapapo (cell yaying'ono komanso yaying'ono), trophoblastic chotupa (uterine chorionepithelioma, cystic Drift, kuphatikizapo kuwonongeka), khansa yamchiberekero, khansa yamchiberekero, khansa ya chikhodzodzo, khansa ya colorectal, khansa esophagus, khansa ya m'mimba, khansa ya pancreatic, khansa ya testicular, khansa yam'madzi yotupa, kuchepa kwamatenda a meninges (kupewa ndi chithandizo), pachimake myeloid leukemia, osakhala Hodgkin lymphoma (makamaka lymphosarcoma, makamaka kwa ana, ndi Burkitt's lim. phogranulomatosis, fungal mycosis, non-metastatic osteosarcoma, sarcoma wa zofewa, zimakhala ndi khansa yamgonje.

Mitundu ikuluikulu ya psoriasis, nyamakazi yamatsenga, nyamakazi, dermatomyositis, SLE, ankylosing spondylitis.

Contraindication Hypersensitivity, chitetezo chokwanira, pakati, kuyamwa.

Mankhwalawa psoriasis ndi matenda amitsempha (mwa kufuna): kuletsa kwambiri kwa mafupa a hematopoiesis, kwambiri hepatic / aimpso kulephera.

Mosamala. Ascites, kuchepa madzi m'thupi, kufinya kwam'mimba thirakiti matenda, kusefukira kwam'mimba kapena kupatsirana kwa m'mimba, kulephera kwa impso, matenda amtundu wa bakiteriya, fungus kapena bacteria - chiopsezo chokhala ndi matenda opatsirana ponseponse (omwe asinthidwa posachedwa, kuphatikizapo posachedwa ndi wodwala) - herpes simplex, herpes zoster herpes (viremic gawo), nkhuku, chikuku, amoebiasis, solidyloidosis (kuzindikiridwa kapena kukayikiridwa), gout (kuphatikizapo mbiri) kapena urate nephrourolithiasis (kuphatikizapo mbiri), matenda ndi kutupa ix m'kamwa mucosa, kusanza, kutsekula m'mimba (imfa madzimadzi chifukwa kusanza kwambiri ndi kutsekula m'mimba mwina patsogolo kawopsedwe wa methotrexate), chapamimba chilonda ndi 12 mmatumbo chilonda, anam'peza matenda a m'matumbo, mankhwala amphamvu asanayambe kapena radiotherapy, asthenia.

Mankhwalawa zilonda zam'mimba neoplasms (osasankha): aciduria (mkodzo pH wochepera 7), chopinga wa marow hematopoiesis.

Mlingo Mkati, intramuscularly, intravenly, intraathelyly kapena intrathecally (ndizoletsedwa kugwiritsa ntchito mankhwala omwe ali ndi mankhwala osungirako okhala ndi benzyl mowa chifukwa cholowerera makonzedwe a intrathecal.

Mapiritsi amatengedwa pakamwa musanadye, osafuna kutafuna. Mlingo ndi nthawi ya mankhwalawa imayikidwa payekha kutengera mtundu wa chemotherapy, zikuonetsa, chithandizo

Mlingo pamwambapa 100 mg / m2 umathandizidwa pokhapokha kudzera m'mitsempha kapena njira yokhazikika imasungunuka ndi 5% dextrose solution (10 mg - 0,5-1 l ya dextrose solution) komanso pansi pa calcium calcium.

Mu nyamakazi yokhala ndi nyamakazi: mlingo woyambirira nthawi zambiri umakhala 7.5 mg kamodzi pa sabata pa nthawi kapena 2,5 mg maola 12 aliwonse (katatu kokha pa sabata). Kuti mukwaniritse bwino kwambiri, mlingo wa sabata iliyonse ungathe kuwonjezereka (osapitirira 20 mg), ndiye kuti mlingowo uyenera kuchepetsedwa kwambiri.

Mu psoriasis, milingo yoyambirira imakhala pakamwa, i.v. kapena iv, 7.5-25 mg / sabata, kamodzi, kapena 2,5 mg pamtunda wa maola 12 katatu pa sabata mpaka kukwaniritsidwa kokwanira, koma osapitirira 30 mg / sabata. Mlingo umachulukitsidwa pang'onopang'ono, m'mene mulingo woyenera umakwaniritsidwa, mlingo umayamba kuchepa mpaka kutsika kwambiri.

Zotsatira zoyipa.Kuchokera ku ziwalo za hemopoietic: leukopenia ndi thrombocytopenia, pancytopenia, magazi (kuphatikizanso aplastic), neutropenia, agranulocytosis, eosinophilia, lymphadenopathy, lymphoproliferative matenda, hypogammaglobulinemia.

Kuchokera m'mimba. ntchito ya "chiwindi" transaminases), kapamba.

Kuchokera ku dongosolo lamanjenje: mutu, kugona, dysarthria, aphasia, hemiparesis, paresis, kupweteka, mukamagwiritsa ntchito Mlingo wambiri - kuyimitsidwa kwapang'onopang'ono kwa ntchito za kuzindikira, kuchepa kwa chidwi, chidwi chapadera cha cranial, encephalopathy (kuphatikizapo leukoencephalopathy).

Pa khungu: erythematous zidzolo, khungu loyenda, urticaria, photosensitivity, mkhutu khungu khungu, alopecia, ecchymosis, telangiectasia, ziphuphu zakumaso, furunculosis, erythema multiforme (kuphatikiza Stevens-Johnson syndrome), poyizoni epermermal necrolysis, zilonda zam'mimba komanso khungu.

Kuchokera kumbali ya gawo la masomphenyawo: conjunctivitis, kuwonongeka kwa mawonekedwe (kuphatikizira khungu la kanthawi kochepa).

Kuchokera pakapumidwe: osowa - pulmonary fibrosis, kupuma kulephera, alveolitis, pneumonitis ya pakati (kuphatikizapo kupha), COPD.

Kuchokera ku CCC: pericarditis, pericardial activation, kuchepa kwa magazi, thromboembolism (kuphatikizapo ochepa thrombosis, ubongo wamitsempha yamagazi, kupindika kwamitsempha, kupindika kwamitsempha, thrombophlebitis, pulmonary embolism.

Kuchokera ku genitourinary system: nephropathy kapena kulephera kwa aimpso, azotemia, cystitis, hematuria, proteinuria, mkhutu wamatumbo ndi ovogenesis, osigospermia, kuchepa kwa libido, kusabala, kusowa kwa magazi, kutaya kwamkati, kufooka kwa fetal, zolakwika pakukula kwa fetal.

Kuchokera ku minculoskeletal system: arthralgia, myalgia, mafupa am'madzi, osteonecrosis, Fractures.

Matenda: matenda owopsa amoyo (monga chibayo cha chibayo), CMV (kuphatikizapo chibayo cha CMV), sepsis (kuphatikizapo kupha), nocardiosis, histoplasmosis, cryptococcosis, matenda oyambitsidwa ndi Herpes zoster ndi Herpes simplex (kuphatikizidwa).

Zina: vasculitis, matenda osokoneza bongo, lymphoma (kuphatikizapo kusintha), chotupa lysis syndrome, zofewa minofu necrosis, anaphylactoid zimachitika, mwadzidzidzi kufa.

Mankhwalawa nyamakazi: oposa 10% - kuchuluka kwa "chiwindi" transaminases, nseru, kusanza, 3-10% - stomatitis, thrombocytopenia (osakwana 100 zikwi / μl), 1-3% - zotupa pakhungu, kuyabwa, matenda am'mimba, kutsegula m'mimba, leopopenia ( osakwana 3000 / μl), chibayo, chizungulire, chibayo, ena - adachepetsa hematocrit, mutu, matenda (kuphatikizapo kupumira thirakiti), anorexia, arthralgia, kupweteka pachifuwa, kutsokomola, kukomoka, kusokonezeka kwa maso, nosebleeds, fever, thukuta kwambiri, tinnitus, kumaliseche.

Mankhwalawa psoriasis: Alopecia, photosensitivity, kutentha kwa khungu, osakhala - ziphuphu zowawa pakhungu.

Mankhwalawa achinyamata nyamakazi: kuchuluka kwa "chiwindi" transaminases (14%), matenda am'mimba thirakiti (11%), kuphatikiza nseru, kusanza, kutsekula m'mimba, stomatitis (2%), leukopenia (2%), kupweteka kwa mutu (1.2%), alopecia (0.5%), chizungulire (0.2%), zotupa pakhungu (0.2%).

Bongo. Chithandizo: kukhazikitsidwa kwa antidote - calcium folamin, ngati kuli kotheka, makamaka muora loyamba, muyezo wofanana kapena wapamwamba kuposa mlingo wa methotrexate, Mlingo wotsatira umaperekedwa ngati pakufunika, kutengera kuchuluka kwa methotrexate mu seramu. Pofuna kupewa kupangika kwa methotrexate ndi / kapena ma metabolites mu mafupa aimpso, thupi limapukusidwa ndi alkalinized, lomwe limathandizira kuchoka kwa methotrexate.

Kuchita. Zimawonjezera ntchito ya anticoagulant ya coumarin kapena zotumphukira zamagetsi kapena / kapena zimawonjezera chiopsezo chotaya magazi mwakuchepetsa kaphatikizidwe kazinthu zomwe zimayambitsa chiwindi ndi mapangidwe opindika.

Ikuwonjezera kuchuluka kwa uric acid m'magazi, motero, pochiza odwala omwe ali ndi hyperuricemia ndi gout, kusintha kwa anti-gout mankhwala (allopurinol, colchicine, sulfinpyrazone) kungafunike, kugwiritsa ntchito uricosuric anti-gout mankhwala kungakulitse chiopsezo cha nephropathy yokhudzana ndi kuchuluka kwa uric acid. (ndikofunikira kugwiritsa ntchito allopurinol).

The munthawi yomweyo makonzedwe a salicylates, phenylbutazone, phenytoin, sulfanilamides, sulfonylurea zotumphukira, aminobenzoic acid, pyrimethamine kapena trimethoprim, angapo maantibayotiki (penicillin, tetracycline, chloramphenicol), indico anticoagulants ndi hypolipidemic kapena kuchepa kwa katulutsidwe ka tubular, komwe nthawi zina kumatha kubweretsa kukula kwambiri kwa zotsatira zoyipa, nthawi zina ngakhale kupha.

NSAIDs omwe ali ndi Mlingo wambiri wa methotrexate amathandizira kuti achepetse nthawi ndikuchepetsa kuchotsedwa kwa ziwonetserozi, zomwe zimatha kupha munthu chifukwa cha kuledzera kwambiri kwa hematological ndi m'mimba.Ndikulimbikitsidwa kusiya kumwa phenylbutazone kwa masiku 7-12, piroxicam kwa masiku 10, diflunisal ndi indomethacin kwa maola 24-48, ketoprofen ndi NSAIDs ndi T1 / 2 12-24 maola ochepa asanachitike kulowetsedwa kwa methotrexate osachepera maola 12 (kutengera ndi kuchuluka kwa methotrexate m'mwazi) itatha. Chenjezo liyenera kuphatikizidwa pophatikiza ma NSAIDs ndi otsika Mlingo wa methotrexate (amachepetsa kuchulukitsidwa kwa methotrexate ndi aimpso tubules).

Mankhwala omwe amalepheretsa katulutsidwe ka tubular (mwachitsanzo, phenenecid) amawonjezera kawopsedwe a methotrexate pochepetsa kuchotsa kwake ndi impso.

Maantibayotiki omwe samalidwa bwino m'matumbo am'mimba (tetracyclines, chloramphenicol) amachepetsa kuyamwa kwa methotrexate komanso kusokoneza kagayidwe kake chifukwa cha kuponderezedwa kwa microflora yamatumbo.

Retinoids, azathioprine, sulfasalazine, ethanol, ndi mankhwala ena a hepatotoxic amalimbikitsa chiopsezo cha hepatotoxicity.

Mankhwala okhala ndi folate (kuphatikiza multivitamini) amachepetsa poizoni wa methotrexate pamongo.

L-asparaginase amachepetsa kuopsa kwa antitumor mphamvu ya methotrexate poletsa kubwereza kwa cell.

Anesthesia yogwiritsa ntchito dinitrogen oxide imatha kubweretsa kukula kwa myelosuppression yosakanikirika ndi stomatitis.

Acyclovir wa makina oyang'anira ndi intrathecal makonzedwe a methotrexate amawonjezera mwayi wokhala ndi vuto la minyewa.

Kugwiritsira ntchito cytarabine maola 48 isanachitike kapena mkati mwa mphindi 10 atangoyamba mankhwala a methotrexate kungayambitse kukula kwa synergistic cytotoxic zotsatira (tikulimbikitsidwa kusintha njira yochokera pakayendetsedwe ka kayendedwe ka hematological).

Mankhwala a Hematotoxic amalimbikitsa chiopsezo cha hematotoxicity ya methotrexate.

Imachepetsa chilolezo cha theophylline.

Neomycin yothandizira pakamwa imachepetsa kuyamwa kwa methotrexate pakamwa.

Odwala angapo omwe ali ndi psoriasis kapena mycosis fungoides omwe amathandizidwa ndi methotrexate osakanikirana ndi mankhwala a PUVA (methocheren ndi UFO) adapezeka kuti ali ndi khansa yapakhungu.

Kuphatikiza ndi mankhwala a radiation kungakulitse chiopsezo cha kupsinjika kwa mafupa.

Methotrexate imatha kuchepetsa mayankho popewa katemera, choncho, nthawi yayitali yogwiritsira ntchito katemera wa amoyo ndi wa inactivated imasiyana kuyambira miyezi itatu mpaka 12.

Dzina Chemical. (1 - thio - beta - D - glucopyrazinato) (triethylphosphine) golide 2, 3, 4, 6 - tetraacetate

Zotsatira za pharmacological. Kukonzekera kwa golide pakumwa pakamwa (kumakhala ndi 29% Au), kumakhala ndi zotsutsana ndi kutupa. Makina ochitapo kanthu samamvetsetsa kwathunthu: amakhulupirira kuti kuponderezedwa kwa chitetezo cham'magazi chifukwa cha kupezeka kwa Au 3+ ndi ma monocytes ndi polymorphic nyukiliya ya leukocytes, zomwe zimatsogolera kulepheretsa phagocytosis ndi blockade ya enzymes lysosomal. Amachepetsa ntchito ya sulfhydryl machitidwe ndi ma enzyme ma protein a leukocytes ndi lymphocyte, omwe amachititsa kuchepa kwa ndende ya Ig ndi rheumatoid factor, linalake kuphatikizika kwa collagen ndi Pg.

The achire zotsatira amakula pang'onopang'ono ndipo zimawonedwa pambuyo miyezi 3-4 (nthawi zina miyezi 6) kuyambira nthawi yomwe amamwa mankhwalawa.

Pharmacokinetics Mafuta pambuyo pakamwa makonzedwe - 25%. Kuyankhulana ndi mapuloteni a plasma - 60%. Css imadziwika miyezi itatu mutangoyamba kumene chithandizo, pa 6 mg / tsiku ndi 68 μg / ml.

Imaphatikizidwa mwachangu m'chiwindi (auranofin osasinthika sichimapezeka m'magazi). T1 / 2 m'magazi - masiku 21-31, m'matumbo - masiku 42-128. Amachotseredwa ndi impso (60%) komanso ndi bile.

Zizindikiro. Rheumatoid nyamakazi (chithandizo ndi kupewa kuti mupeze kusintha koyambirira kwa ma radiology m'magawo), nyamakazi yamatsenga, Felty's syndrome.

Contraindication Hypersensitivity, CHF, aimpso kulephera, hepatitis (yogwira gawo), chopinga wa marow hematopoiesis, exfoliative dermatitis, enterocolitis, pakati, kuyamwa, cachexia, urticaria, chikanga, zotupa pakhungu.

Mlingo.Mkati: achikulire - 6 mg / tsiku, ana - 0,1 mg / kg / tsiku mu Mlingo 2 wogawanika.

Ngati phwando silikugwira ntchito kwa miyezi inayi komanso kulekereredwa bwino, ndizotheka kuwonjezera mlingo kwa akuluakulu mpaka 9 mg / tsiku mu Mlingo 3 wogawanika, komanso kwa ana mpaka 0,2 mg / kg / tsiku. Ngati mankhwala alephera pakatha miyezi itatu yotsatira, mankhwalawa amachotsedwa.

Zotsatira zoyipa. Kuchokera wamanjenje ndi ziwalo zamatsenga: ulesi, kuyerekezera zinthu m'magazi, khunyu, conjunctivitis.

Kuchokera kupuma dongosolo: pharyngitis, tracheitis, pneumonia, pneumofibrosis.

Kuchokera m'mimba: gingivitis, glossitis, stomatitis, kusanza, kutsekula m'mimba kapena kudzimbidwa, gastralgia, gastritis, necrotic enteritis, ulcerative enterocolitis, colitis, m'mimba kutaya, cholestasis, cholelithiasis, hepatitis, chiwindi kulephera.

Kuchokera ku genitourinary system: nephrotic syndrome yokhala ndi proteinuria yayikulu, kulephera kwa impso, vaginitis.

Kuchokera pa hematopoietic dongosolo: agranulocytosis, pancytopenia, kuchepa magazi, leukopenia, thrombocytopenia.

Thupi lawo siligwirizana: zotupa pakhungu, kuyabwa kwa khungu, eosinophilia, dermatitis, hyperthermia.

Kuchita. Zosagwirizana ndi penicillins, levamisole, chloroquine, yogwirizana ndi NSAIDs.

Zotsatira zoyipa zimapangidwa ndi cytostatics, hepato- ndi nephrotoxic mankhwala, penicillamine.

Mankhwala a Myelotoxic amalimbikitsa mphamvu ya hematotoxic ya mankhwalawa.

Malangizo apadera. Pamaso pathu ndi chithandizo, ndikofunikira kuwongolera chithunzi cha magazi otumphukira (Hb okhutira, kuchuluka kwa mapulateleti), ntchito ya impso (urea ndende, creatinine, mapuloteni a mkodzo), ntchito ya chiwindi (ntchito ya "chiwindi" transaminases) chaka choyamba cha chithandizo - pamwezi, chachiwiri - miyezi iwiri iliyonse. Ndi proteinuria yoposa 1 g / tsiku, mankhwala ayenera kusiyidwa.

Sulfasalazine, mapiritsi okhala ndi kanthu

Gulu la pharmacological ndi antimicrobial komanso anti-kutupa matumbo.

Zotsatira za pharmacological. Wothandizila matumbo oyamwa, sulfonamide, amakhalanso ndi anti-yotupa. Kuthekera kogwiritsa ntchito colitis yosatsata mankhwalawa pakukhudzidwa kumalumikizidwa ndi kuthekera kwa sulfasalazine kusankha kosakanikirana kwa minofu yolumikizana yamatumbo ndikumasulidwa kwa 5-aminosalicylic acid (5-ASA), yomwe imakhala ndi ntchito yotsutsana ndi kutupa, ndi sulfapyridine, yomwe imakhala ndi antimicrobial bacteriostatic athari, wotsutsana ndi Paba.

Imagwira motsutsana ndi diplococci, streptococci, gonococci, E. coli.

Pharmacokinetics Mafuta - 10%, imayang'aniridwa ndi microflora yamatumbo ndikupanga sulfapyridine - 60-80 ndi 25% 5-ASA. Kuyankhulana ndi mapuloteni a plasma a sulfasalazine - 99%, sulfapyridine - 50%, 5-ASA - 43%.

Sulfapyridine imapangidwa m'chiwindi ndi hydroxylation kuti ipange metabolites ya metabolites, 5-ASA ndi acetylation. T1 / 2 ya sulfasalazine - maola 5 mpaka 10, sulfapyridine - maola 6 mpaka 14, maola a 5-ASA - 0,6-1.4.Amatulutsidwa m'matumbo - 5% sulfapyridine ndi 67% 5-ASA, impso - 75-91% ya sulfasalazine (mu m'masiku atatu).

Zizindikiro. Nonspecific ulcerative colitis.

Contraindication Hypersensitivity, chiwindi ndi / kapena kulephera kwa aimpso, kuchepa kwa magazi, porphyria, kuperewera kwa glucose-6-phosphate dehydrogenase, mkaka wa m`mawere, zaka za ana (mpaka zaka 5).

Gawo la zochita pa mwana wosabadwa. B

Mlingo Mkati, 1 g 4-6 kawiri pa tsiku, kwa masabata 2-3, kutsatiridwa ndi kuchepa kwapang'onopang'ono kwa 0,5-1 g tsiku lililonse la masiku 5-7, njira ya mankhwalawa imatha mpaka miyezi 4-6. Ana wazaka 5-7 - 0,25-0,5 g 3-6 kawiri pa tsiku, wamkulu kuposa zaka 7 - 0,5 g 3-6 kawiri pa tsiku.

Zotsatira zoyipa. Mutu, chizungulire, dyspepsia: nseru, kusanza, kutsegula m'mimba, kupweteka kwam'mimba, kusowa kwa chakudya, kuphatikizika kwa magazi mu ndowe, zapakati pneumonitis, hepatitis ya mankhwala osokoneza bongo, photosensitivity, mtundu wa lalanje wamkati, agranulocytosis, leukopenia, thrombocytopenia thupi lawo siligwirizana: poyizoni epermermal necrolysis (matenda a Lyell), chotupa cha erythema (Stevens-Johnson syndrome), kuwopsa kwa anaphylactic.

Kuchita.Imawonjezera zotsatira za anticoagulants, antiepileptic and oral hypoglycemic, komanso zotsatira zoyipa za cytostatics, immunosuppressants, hepato- ndi nephrotoxic.

Mankhwala omwe amalepheretsa mafupa a hematopoiesis kuonjezera chiopsezo cha myelosuppression.

Chloroquine (Delagil) mapiritsi. Gulu la ma pharmacological ndiwothandizira antimalarial.

Zotsatira za pharmacological. Antiprotozoal ilinso ndi immunosuppress and anti-yotupa. Amayambitsa kuphedwa kwa mitundu ya exthrocyte yamitundu yonse yamitundu yonse ya plasmodia. Ili ndi gametocidal, kupatula Plasmodium falciparum (yowonetsa anti-gametocidal athari). Chifukwa cha kuletsa kwa syntic acid synthesis, imatchulidwa modunosuppression komanso osatchula anti-kutupa kwenikweni.

Pharmacokinetics Pambuyo pakumwa pakamwa, imathamanga ndipo imatsala pang'ono kulowa m'mimba. Cmax imafikiridwa pambuyo pa maola 2-6. 55% imamangidwa ku plasma albin. Imafalikira mofulumira ku ziwalo ndi ziwalo za thupi (chiwindi, impso, ndulu, mapapu). Imalowa mosavuta mu BBB ndi placenta.

Amapangidwira pang'ono (25%). Imafufutidwa ndi impso (70% - yosasinthika) pang'onopang'ono. T1 / 2 - miyezi iwiri.

Ndi kulephera kwa aimpso, kumatha kudziunjikira. Ndi acidic anachita mkodzo, mankhwalawa amayamba, ndipo zamchere zimachulukanso.

Zizindikiro. Malungo (kupewa komanso kuchiza mitundu yonse)

Contraindication Hypersensitivity, chiwindi ndi / kapena kulephera kwa aimpso, kuletsa kwa mafupa a hematopoiesis, kusokonezeka kwakukulu kwa phokoso, psoriatic nyamakazi, neutropenia, porphyrinuria, pakati.

Mlingo Mkati, kupewa matenda a malungo - 0,5 ga sabata yoyamba 2, ndiye 1 nthawi yomweyo tsiku lomwelo la sabata. Chithandizo cha malungo chikuchitika malinga ndi chiwembu chotsatira: tsiku 1 kamodzi 1 g, pambuyo pa maola 6-8 - 0,5 g, pamasiku 2 ndi 3 a mankhwalawa - 0,75 g tsiku lililonse 1 mg. Ngati ndi kotheka - iv.

Kwa amoebiasis, 0,5 ga katatu pa tsiku kwa masiku 7, ndiye kuti 0,25 g katatu pa tsiku kwa masiku ena 7, ndiye kuti 0,75 ga 2 pa sabata kwa miyezi 2-6.

Ndi nyamakazi - 0,25 ga 2 pa tsiku kwa masiku 7, ndiye - 0,25 g tsiku lililonse kwa miyezi 12.

Ndi SLE - tsiku ndi tsiku 0,25-0,5 g.

Mu Photodermatosis, 0,25 g tsiku lililonse kwa sabata 1, ndiye 0,5-0.75 g mlungu uliwonse.

Zotsatira zoyipa. Kuchokera pamiyambo ya kugaya chakudya: nseru, kusanza, gastralgia.

Kuchokera kwamanjenje: chizungulire, kupweteka mutu, kusokonezeka kwa kugona, psychoses, khunyu.

Kuchokera ku CCC: kuwonongeka kwa myocardial ndikusintha ku ECG, kuchepa kwa kuthamanga kwa magazi.

Kuchokera ku ziwalo zam'maganizo: ndikugwiritsa ntchito nthawi yayitali - kugwetsa chifuwa, kuwonongeka kwa retina, kuwona mkhutu, ndikulira m'makutu.

Thupi lawo siligwirizana: dermatitis, photosensitivity.

Zina: myalgia, leukopenia, kusintha kwa khungu ndi tsitsi.

Zisonyezo za glucocorticoids

Zizindikiro zamagulu a glucocorticoids ndi awa:

1. mankhwalawa adrenal matenda (glucocorticoids amagwiritsidwa ntchito pachimake kukanika, mawonekedwe osakwanira, obadwa nako cortical hyperplasia), momwe sangathe kutulutsa kwathunthu (kapena) kupanga mahomoni ochuluka,
2. Chithandizo cha matenda a autoimmune (rheumatism, sarcoidosis) - kutengera kuthekera kwa mahomoni awa kuchititsa chitetezo cha mthupi, kuponderezana kapena kuwayambitsa. Glucocorticoids amagwiritsidwanso ntchito pa nyamakazi,
3. Chithandizo cha matenda a kwamikodzo, kuphatikizapo kutupa. Ma mahomoniwa amatha kuthana ndi zotupa zachiwawa,
4. glucocorticoids for allerg amagwiritsidwa ntchito ngati othandizira omwe amakhudza kupanga kwachilengedwenso mankhwala omwe amapangitsa kuti pakhale tsankho la munthu payekha,
5. mankhwalawa matenda a kupuma dongosolo (glucocorticoids ndi mankhwala a mphumu, chibayo, chifuwa chachikulu). Tiyenera kudziwa kuti mankhwala osiyanasiyana ali ndi ma pharmacodynamics osiyanasiyana. Mankhwala ena amachita mwachangu mokwanira, ena pang'onopang'ono.Njira yofulumira, yotalika, siyingagwiritsidwe ntchito ngati pakufunika kuthandizira kuwonekera kwakuthupi (mwachitsanzo, kuwukira kwa asthmatic),
6. glucocorticoids mu mano imagwiritsidwa ntchito pochiza pulpitis, periodontitis, zina zotupa, komanso popanga mawonekedwe osakaniza komanso monga anti-shock othandizira anaphylactic kugwedezeka chifukwa cha mankhwala.
7. Chithandizo cha mavuto a pakhungu, zotupa m'matumbo,
8. Chithandizo cha matenda am'mimba thirakiti. Chizindikiro cha glucocorticoids ndi matenda a Crohn,
9. Chithandizo cha odwala pambuyo povulala (kuphatikiza kumbuyo) ndi chifukwa cha anti-shock, anti-kutupa zotsatira za mankhwalawo.
10. monga gawo la zovuta mankhwala - ndi matenda edema.

Pamaziko a zinthu zomwe zili m'gulu la glucocorticosteroids, mankhwala okonzekera adapangidwa monga mafuta, mapiritsi, mayankho mu ampoules, zakumwa zochiritsira:

• Cortisone
• Prednisone
• Dexamethasone
• Hydrocortisone
• Beclomethasone
• Triamcinolone.

Dokotala yekha, pamaziko a zisonyezo, amatha kupereka mankhwala a glucocorticoids a m'deralo ndikusankha kutalika kwa mankhwalawa.

Zotsatira zoyipa

Kuchuluka kwa zabwino zomwe ma glucocorticoids ali nazo kwapangitsa kugwiritsidwa ntchito kwawo kwa mankhwala.

Mankhwala a mahomoni sanali otetezeka konse, amadziwika ndi kukhalapo kwa ambiri:

1. kuwonongeka pamawonekedwe a tsitsi ndi khungu, mawonekedwe a matupi otambalala, tsitsi lakuda,
2. kukula kwambiri kwa tsitsi m'malo opezeka m'thupi mwa akazi,
3. kuchepa kwa mphamvu ya mtima,
4. maonekedwe akusintha kwa mahomoni,
5. kuyambitsa nkhawa, psychosis,
6. kuphwanya zamchere mchere.

Kugwiritsa ntchito glucocorticoids kungayambitse kuwoneka kwamatenda ambiri:

1. zilonda zam'mimba
2. kunenepa
3. chitetezo chokwanira
4. dysmenorrhea.

Pali nthawi zina pamene glucocorticosteroids amachititsa kuti matendawa akhazikike msanga, ma causative othandizira omwe anali m'thupi kale, koma analibe mphamvu yochulukana kwambiri chifukwa cha ntchito ya chitetezo cha m'thupi.

Zotsatira zoyipa sizichitika kokha chifukwa chogwiritsidwa ntchito kwa nthawi yayitali a glucocorticosteroids kapena mankhwala osokoneza bongo. Amadziwikanso ndikuthothomoka kwakuthwa kwa mankhwalawa, chifukwa atalandira ma encyclopedia a mahomoni, ma gren adrenal imayimitsa yokha.

Pambuyo pakutha kwa mankhwala a mahomoni, mawonetseredwe ndi otheka:

1. kufooka
2. mawonekedwe a kupweteka kwamisempha
3. kusowa kwa chakudya
4. kutentha kuwonjezeka
5. kuchuluka kwa ma pathologies ena omwe alipo.

Choopsa choopsa chomwe chimayambitsidwa ndi kufooka kwadzidzidzi kwa mahomoni otere ndi kuperewera kwenikweni kwa adrenal.

Chizindikiro chake chachikulu ndi kuchepa kwa kuthamanga kwa magazi, zizindikiro zowonjezera - kuvulala kwam'mimba, limodzi ndi ululu, kufooka, khunyu.

Ndizowopsa kusiya mwakufuna kwanu kugwiritsa ntchito ma glucocorticosteroids ngati kuti mumadzipangira nokha pogwiritsa ntchito.

Contraindication

Kuchuluka kwa zoyambitsidwa chifukwa cha kugwiritsa ntchito glucocorticosteroids, kumayambitsa ma contraindication ambiri pakugwiritsa ntchito:

1. matenda oopsa
2. kulephera kwazungulira
3. mimba
4. chindapusa
5. chifuwa chachikulu
6. matenda ashuga
7. endocarditis
8. yade.

Kugwiritsa ntchito mankhwala okhala ndi glucocorticoids pochizira matenda sikumaloledwa pokhapokha chitetezo chowonjezera cha thupi pakukula kwa matenda ena opatsirana chimaperekedwa. Mwachitsanzo, kumeza khungu ndi mafuta okhala ndi glucocorticoids, munthu amachepetsa chitetezo cha m'deralo ndipo amatha kutenga matenda oyamba ndi fungus.

Popereka mankhwala a glucocorticoids, azimayi azaka zoyenera kubereka amafunika kuonetsetsa kuti palibe kutenga pakati - mahomoni oterewa amatha kubweretsa kusakwanira kwa adrenal mu fetus.

Makanema okhudzana nawo

Zotsatira zoyipa za glucocorticosteroids mu kanema:

Glucocorticoids imayeneradi kuyang'aniridwa ndi kuzindikira kwa madokotala, chifukwa amatha kuthandizira pamavuto osiyanasiyana otere. Koma mankhwala a mahomoni amafunikira chisamaliro chapadera pakukonzekera nthawi yayitali ya chithandizo ndi kumwa. Dotolo ayenera kudziwitsa wodwalayo za zovuta zonse zomwe zingagwiritsidwe ntchito pogwiritsa ntchito glucocorticoids, komanso zoopsa zomwe zimayembekezera kukana kwakukulu kwa mankhwalawo.

Magulu osiyanasiyana a mankhwalawa amagwiritsidwa ntchito pochiza matenda a impso. Chimodzi mwa izo ndi glucocorticosteroids. Mankhwala amatha kusuntha m'thupi. Nthawi zambiri amagwiritsidwa ntchito ngati njira yodzithandizira panjirayi komanso kuchulukitsa matenda.

Glucocorticosteroids (GCS) - dzina lodziwika bwino lamahomoni omwe amapangidwa ndi cortical wosanjikiza tamadontho totulutsa adrenal. Gululi limaphatikizapo glucocorticoids (cortisone, hydrocortisone) ndi mineralocorticoids (aldosterone). Masiku ano, mapangidwe a corticosteroids amagwiritsidwa ntchito mochizira. Koma pakadali pano, chitetezo chawo ndi kugwira ntchito bwino kwa thupi kumaphunziridwabe, mbali zambiri zogwiritsira ntchito ndizotsutsana.

Gulu ndi mawonekedwe a kumasulidwa

Glucocorticosteroids amapangidwa ndi adrenal cortex mothandizidwa ndi chapakati mantha dongosolo ndi pituitary gland. Amayang'anira kapangidwe ka mahomoni - hypothalamus. Ndikusowa kwa GCS m'magazi a hydrocortisone komanso zinthu zovuta (zoopsa, matenda), imapanga corticoliberin, yomwe imalimbikitsa kutulutsidwa kwa ACG kuchokera ku pituitary gland. Mothandizidwa ndi hormone iyi, glucocorticosteroids amapangidwa mu adrenal cortex.

GCS imakhala ndi anti-yotupa, imayendetsa chakudya, lipid, mapuloteni, amawongolera ntchito ya impso, momwe thupi limayankhira pamavuto. Muzochita zamankhwala, mahomoni achilengedwe ndi mawonekedwe awo opangira amagwiritsidwa ntchito.

Monga mankhwala GCS idayamba kugwiritsidwa ntchito mkati mwa zaka zapitazi. Mahomoni opanga ali ndi katundu wofanana ndi wachilengedwe. Amapondereza njira yotupa, koma samakhudza oyambitsa matenda. Corticosteroids italeka kugwira ntchito, matenda amatha kuyambanso.

Glucocorticosteroids kumbali imodzi imatulutsa mphamvu yamankhwala othandizira, amakulolani kukwaniritsa zotsatira zabwino munthawi yochepa. Kumbali inayi, kugwiritsa ntchito kwawo kuli ndi mitundu yambiri yosiyanasiyana yamagetsi ndi ziwalo zosiyanasiyana.

Mahomoni amachititsa kupsinjika, komwe kumayambitsa kufooka kwa chitetezo cha mthupi, chifukwa nthawi zambiri chimaperekedwa m'malo opanda phokoso. Kuphatikiza apo, kupanga corticosteroids kumachepetsa ntchito yachilengedwe, yomwe ingapangitse kuti matumbo a adrenal asokonezeke. Chifukwa chake corticosteroids ayenera kuyang'aniridwa ndi dokotala ndipo ziyenera kulembedwa pokhapokha ngati mankhwala ena sangathe.

Glucocorticosteroids amamasulidwa mu mawonekedwe a:

• mapiritsi
• jakisoni njira
• aerosol
• mafuta odzola, mafuta.

Zizindikiro ndi contraindication

Machitidwe a GCS ndi osiyanasiyana:

• odana ndi yotupa
• antiellgic,
• immunomodulatory.

Mankhwalawa amagwiritsidwa ntchito kuletsa kutupa m'matenda ambiri:

• rheumatism
• matenda a magazi
• systemic lupus erythematosus,
• Mphumu ya bronchial,
• chibayo
• dermatitis
• matenda amitsempha
• ziwengo ndi ena ambiri.

Corticosteroids angagwiritsidwe ntchito pa matenda a impso:

• kutupa kwa impso
• kukomoka kobadwa nako kwa adrenal kotekisi,
• lupus erythematosus
• nephrotic syndrome.

• tsankho
• chikuku
• katemera chamoyo
• matenda oopsa.

Mahomoni amayikidwa mosamala kwambiri pamaso pa matenda otsatirawa:

• matenda ashuga
• matenda oopsa
• zilonda zam'mimba
• kulephera kwa mtima
• thrombosis
• glaucoma ndi matenda oyipa
• chifuwa chachikulu
• mavuto amisala.

Ma mineralocorcoids sangatengedwe ndi hepatic ndipo, matenda oopsa, matenda ashuga komanso potaziyamu m'magazi a m'magazi.

Zindikirani! GCS imatha kuyambitsa mavuto ambiri m'malo osiyanasiyana a thupi. Ma horoni ofooka komanso ocheperako omwe amagwiritsidwa ntchito kwakanthawi kochepa, monga lamulo, samayambitsa zovuta kwambiri. Kuti muchepetse chiopsezo chokhala ndi zotsatira zosafunikira, muyenera kuyankha pakapita nthawi kusintha kulikonse mthupi ndikusintha Mlingo wa mankhwalawa.

Matendawa

Palibe malingaliro aliwonse okhudzana ndi kugwiritsa ntchito GCS. Sikuti njira yeniyeni yochiritsira. Chosiyana ndi kusakwanira kwa adrenal, momwe glucocorticoids amagwira ntchito yothana ndi mankhwala. Asanapange mankhwala ena aliwonse a mahomoni a matenda a kwamikodzo, dokotala amayenera kuganizira zabwino ndi zovuta zake.

Kwa wodwala aliyense, mulingo wake umasankhidwa molimbikitsa kukwaniritsa zomwe mukufuna. Nthawi ndi nthawi, imakonzedwanso, kutengera kusintha kwa zizindikiro ndi kukula kwa zoyipa. Mlingo umodzi wa corticosteroids ndiotetezeka thanzi. Ndipo maphunziro okwanira sabata 1 osavomerezeka popanda kuvulaza kwenikweni sikuvulaza thupi. Mosiyana, ngati kukayikira kwakukulu kwa adrenal kumayikiridwa, kayendetsedwe kamodzi ka GCS kamatha kupulumutsa moyo wa wodwalayo.

Tiyenera kukumbukira kuti kufafaniza kwakanema kwa mankhwala a mahomoni kungapangitse iatrogenic adrenal kuchepa. Ngati nthawi yayitali makonzedwe a corticosteroids mu matenda a impso akuyembekezeredwa, mlingo wocheperako wokwanira kukwaniritsa mphamvu zabwino umasankhidwa. Koma maphunziro ataliatali amalembedwa, monga lamulo, ngati matendawa akuwopseza moyo wa wodwalayo.

Chithandizo cha matenda a impso ndi corticosteroids chitha kukhala:

• Zambiri - ogwiritsidwa ntchito pachiwopsezo cha moyo, kutumikiridwa kudzera m'mitsempha.
• Kuchepetsa - Kwa matenda okhalitsa, amakonda kupatsidwa mapiritsi omwe ayenera kumwedwa kwa nthawi yayitali. Njira yolandirira pang'onopang'ono imagwiritsidwa ntchito.
• Kusinthana - ntchito corticosteroids osakhalitsa komanso nthawi yayitali, kamodzi m'mawa, kamodzi pa masiku awiri.
• Kupitilira - kutenga masiku 3-4, kenako kupuma kwa masiku 4.
• Mankhwala othandizira - jakisoni imodzi ya corticosteroids mu mtsempha wa 1 g mwadzidzidzi.

Chithandizo cha matenda a impso omwe ali ndi mahomoni osokoneza bongo ayenera kuthandizidwa ndi vitamini D ndi calcium kuti muchepetse mafupa. Kuchepetsa mphamvu ya corticosteroids pamimba, tikulimbikitsidwa kugwiritsa ntchito Almagel, Fosfalugel.

Pali kusagwirizana pakati pa akatswiri pazokhudza kugwiritsa ntchito glucocorticosteroids mu matenda a impso. Wofatsa nthawi zambiri amathandizika pochiza ndi corticosteroids; mankhwala ndi mzere woyamba mankhwala a matenda. Sabata yoyamba, odwala amapatsidwa prednisone muyezo wa 1-2 mg / kg. Pakupita milungu isanu ndi umodzi, kuchuluka kwa mankhwalawa omwe amwedwa kumachepetsedwa. Madokotala ena amalimbikitsa kumwa mankhwalawa tsiku lililonse.

Nthawi zambiri pambuyo kuthetsedwa kwa glucocorticosteroids, kubwereranso kumachitika. Odwala oterewa amawatengedwa kuti sagwirizana ndi GCS ndipo amathandizidwa ndi ma immunosuppressants ena (Azathioprine). Lupus nephritis amathanso kuthandizidwa ndimankhwala a mahomoni. Pamene nembanemba, mahomoni (prednisone 120 mg) amalamulidwa kwa miyezi 2-2,5 tsiku lililonse, ndikuchepetsa pang'ono pang'onopang'ono kwa miyezi iwiri yotsatira.

Onani mndandanda ndi mawonekedwe a mtengo wotsika mtengo waimpso.

Malangizo ogwiritsira ntchito Ncyin ya cystitis akufotokozedwa patsamba.

Pa adilesi, werengani zomwe zikuwonetsa chikhodzodzo mwa amuna ndi momwe mungakonzekerere phunzirolo.

Malamulo oletsa kumwa mankhwala osokoneza bongo

Ngati kutenga mahomoni ndikutalika, ndiye kuti muyenera kuthetseratu pang'onopang'ono. Mankhwala amaletsa ntchito ya adrenal cortex, ngati mumasokoneza mwadzidzidzi, ndiye kuti izi zimawopseza wodwalayo chifukwa cha kusakwanira kwa adrenal.

Palibe chiwembu chokhazikitsidwa chokwanira chofuna kuchepetsa kuchuluka kwa GCS. Zonse zimatengera kutalika kwa njira ya mankhwala ndi ntchito ya mankhwala.Ngati mankhwalawa ndi osakhalitsa, kumwa GCS kumatha kuchepetsedwa ndi 2.5 ml tsiku lililonse la 3-4 (kugwiritsa ntchito Prednisolon monga chitsanzo). Ngati mankhwalawa ali a nthawi yayitali, ndiye kuti kuchepetsa kufatsa kwa mankhwalawa kuyenera kuchepetsedwa - 2,5 mg pakadutsa masiku 7-20.

Mosamala muyenera kuchepetsa mlingo wochepera 10 mg - 1.25 mg tsiku lililonse kwa masiku 3-7. Ngati GCS yoyambirira idalembedwa muyezo waukulu, ndiye kuti kuchepetsa kwake kungachitike kwambiri (m'masiku atatu, 5-10 mg). Ngati kuchuluka kwa 30% ya mlingo woyambirira wafika, pambuyo pake masabata onse a 1.2 amachepetsa ndi 1.25 mg. Chifukwa chake, ndikotheka kukwaniritsa kuchuluka kwa mankhwalawa kwa nthawi yayitali.

Mndandanda wa glucocorticosteroids

GCS imagawika m'magulu angapo kutengera nthawi yomwe achitapo kanthu.

• Cortisone
• Hydrocortisone
• Mazipredon
• Solu Cortef,
• Fluticasone
• Cyclesonide.

• Dexamethasone (Dexamed, Megadexan),
• Betamethasone (Celeston),
• Triamcinolone (Kenalog, Berlicort, Triacort).

Mtengo wa glucocorticosteroids ukhoza kukhala wosiyana malingana ndi wopanga, mawonekedwe omasulidwa komanso mtengo wamtengo wamakanolo apamwamba.

Mtengo wapakati wa mankhwala wamba:

• Prednisolone - 100% mapiritsi 5 mg 103 ma ruble, 3 ma ampoules a 1 ml (30 mg) 48 ma ruble,
• Dexamethasone - 1 ml yankho la 25 ampoules 130-180 ma ruble, 0,5 mg mapiritsi 10 zidutswa 45 ma ruble,
• Hydrocortisone - ampoules 2 ml 2.5% 10 zidutswa 148 rubles,
• Amasewera - mapiritsi 4 mg 30 zidutswa 175-190 rubles,
• Diprospan - 1 ampoule wa 1 ml ya ma ruble 217.

Glucocorticosteroids ndi mahomoni opangidwa ndi ma adrenal gland. Zimagawidwa m'thupi lathu lonse, ndipo zimagwira ntchito zingapo. M'matenda ena, kuphatikiza impso, amagwiritsa ntchito kupanga ndi zachilengedwe corticosteroids kuti athane ndi kutupa ndi mavuto ena. Koma chithandizo cha glucocorticosteroid chili ndi mbali ziwiri. Kugwiritsa ntchito kwawo kumatha kubweretsa zovuta zambiri. Chifukwa chake, ziyenera kukhazikitsidwa ndi dokotala.

Kanema - kuwunikanso mawunikidwe a magwiritsidwe ntchito a glucocorticosteroids ndi momwe mungapewere zoyipa pogwiritsa ntchito mankhwala:

Limagwirira zake zochita ndi pharmacological zotsatira

Limagwirira a odana ndi yotupa zotsatira za corticosteroids ndi kupondereza magawo onse a kutupa. Mwa kukhazikika kwa zimimba za ma cell ndi ma subcellular,, incl. lysis, mankhwala a antiidal a kutupa amateteza kutulutsidwa kwa ma enzymes a proteinolytic mu cell, kuletsa mapangidwe a okosijeni a okosijeni aulere ndi lipid peroxides mu nembanemba. Pakuwala, corticosteroids amachititsa ziwiya zazing'ono ndikuchepetsa ntchito ya hyaluronidase, potero kuletsa gawo la kukwiya, kuletsa kudziphatika kwa neutrophils ndi monocytes ku mtima endothelium, kuchepetsa kulowa kwawo mu minofu, ndikuchepetsa ntchito ya macrophages ndi ma fibroblasts.

Pakukonzekera ntchito yotsutsa-kutupa, gawo lofunikira limachitika ndi kuthekera kwa GCS poletsa kaphatikizidwe ndi kumasulidwa kwa oyimira pakati otupa (PG, histamine, serotonin, bradykinin, ndi zina). Amayambitsa kapangidwe ka lipocortins, phospholipase A2 biosynthesis inhibitors, ndikuchepetsa mapangidwe a COX-2 poyang'ana kutupa. Izi zimabweretsa kutulutsidwa kochepa kwa arachidonic acid kuchokera ku phospholipids ya membrane wam'm cell ndikuchepa kwamapangidwe ake a metabolites (PG, leukotrienes ndi platelet activating factor).

GCS ikhoza kuletsa kuchuluka, chifukwa amaletsa kulowa kwa ma monocytes mu minofu yovulazidwa, kuletsa kutenga nawo gawo kwakutupa, kuletsa kaphatikizidwe ka mucopolysaccharides, mapuloteni ndikuletsa njira za lymphopoiesis. Ndi kutupa kwa genesis yopatsirana ya corticosteroids, chifukwa cha kupezeka kwa immunosuppressive, ndikofunika kuphatikiza ndi antimicrobial mankhwala.

Mphamvu ya immunosuppressive ya corticosteroids imatheka chifukwa cha kuchepa kwa kuchuluka ndi zochitika za T-lymphocyte zikuzungulira m'magazi, kuchepa kwa kupanga ma immunoglobulins komanso mphamvu ya maselo othandizira a T-cell pa B-lymphocyte, kuchepa kwa zomwe zimakwanira m'magazi, mapangidwe a immune immune complexes ndi zina zambiri zomwe zimapangitsa kuti ma cell azitha kusintha ma processor. .

Zotsatira zakale za GCS zimachitika chifukwa cha kuchepa kwa kuchuluka kwa ma basophil ozungulira, kuphwanya kwa mgwirizano wa Fc receptors omwe ali pamwamba pa maselo am'mimba, ndi Fc dera la IgE ndi gawo la C3 lolumikizira, lomwe limalepheretsa chizindikirochi kulowa mu khungu ndipo limayendera limodzi ndi kuchepa kwa kumasulidwa kwa histamine, heparin, ndi serotonin ndi ena oletsa matupi a ziwonetsero za mtundu wina ndipo amalepheretsa kusintha kwawo pama cell.

Zotsatira za antishock zimachitika chifukwa chotenga gawo la corticosteroids mu kayendetsedwe ka mtima wa vascular, motsutsana ndi kumbuyo kwawo, kumverera kwa mitsempha yamagazi kupita ku catecholamines kumawonjezera, komwe kumapangitsa kuwonjezeka kwa kuthamanga kwa magazi, kusintha kwa mchere wamchere, sodium ndi madzi zimasungidwa, kuchuluka kwa plasma ndikuwonjezeka kwa hypovolemia.

Glucocorticosteroids (GCS) - mankhwala ndi chiyani

Glucocorticoids ndi glucocorticosteroids ndi chinthu chimodzi chofanana, zophatikizira zomwe zimawonetsa mahomoni opangidwa ndi adrenal cortex, onse mwachilengedwe komanso kapangidwe, nthawi zina amagwiritsa ntchito GKS yofotokozera mwachidule.

Pamodzi ndi mineralocorticoids, corticosteroids amapanga gulu lochulukirapo la corticosteroids, koma corticosteroids amafunikira kwambiri ngati mankhwala. Mutha kuwerenga za mtundu wanji wa mankhwala - corticosteroids.

Amapatsa dotolo mwayi waukulu wowerengetsera matenda akulu, "kuzimitsa" zomwe zimayambitsa kutupa, zimatha kupititsa patsogolo mankhwala ena, kuthetsa kutupa, komanso kulepheretsa kumva kupweteka.

Mwa kuwonjezera mwakulitsa kuchuluka kwa ma corticosteroids m'thupi la wodwalayo, madokotala amathetsa mavuto omwe kale amawoneka kuti sangathe.

Sayansi yazachipatala yakwaniritsanso kuti masiku ano GCS ikhoza kuyikidwa "kunenedwa" - kuchita pazokha pamavuto, popanda kusokoneza ena omwe ali ndi thanzi labwino.

Chifukwa cha izi, ntchito yamavuto amachepetsa.

Kukula kwa mankhwala a glucocorticoid ndikokwanira. Ndalama izi zimagwiritsidwa ntchito:

Kuphatikiza apo, GCS imagwiritsidwa ntchito pochiza kuvulala (ali ndi mphamvu yothandizira anti-shock), komanso kubwezeretsa ntchito za thupi pambuyo pakugwira ntchito zovuta, radiation ndi chemotherapy.

Ndondomeko yotsatirira corticosteroids imaganizira kuchoka kwa glucocorticoids, ndiye kuti, kuopsa kwa kuwonongeka m'moyo wabwino wodwala atasiya kugwiritsa ntchito mankhwalawa.

Wodwalayo amatha kukulitsa zomwe zimatchedwa glucocorticoid insufficiency.

Kuti mupewe izi, ndichizolowezi kumaliza mankhwala ndi glucocorticoids modekha, kuchepetsa mosamala mankhwalawa kumapeto kwa maphunzirowo.

Chofunika kwambiri, machitidwe amachitidwe amachitika motsogozedwa ndi corticosteroids ma cellular, kuphatikizapo ma genetic, level.

Izi zikutanthauza kuti akatswiri okha omwe angathe kugwira ntchito ndi zakukonzekera zamankhwala zamtunduwu , mankhwala omwe amadzipatsa okha ndi oletsedwa, chifukwa amatha kuyambitsa mavuto onse.

Kupanga kwa glucocorticoids pa thupi sikumamvetsetsa bwino. Monga asayansi atatha kudziwa, corticosteroids imapangidwa molingana ndi "lamulo" la pituitary gland: imatulutsa chinthu chomwe chimatchedwa "corticotropin" m'mitsempha yamagazi, yomwe imatumiza yake - yomwe ingati ma corticosteroids omwe ma grenicosteroids atulutsa.

Chimodzi mwazinthu zawo zazikulu ndi glucocorticoid yogwira yotchedwa "cortisol", imatchedwanso "hormone yamavuto".

Ma mahomoni otere amapangidwa pazifukwa zosiyanasiyana, kuwunikira kwawo kumathandiza madokotala kuzindikira zodwala mu endocrine system, pathologies zazikulu ndikusankha mankhwalawa (kuphatikizapo GCS) ndi njira zamankhwala zomwe zingakhale zothandiza kwambiri nthawi iliyonse.

Glucocorticoids imakhudza thupi m'njira zingapo nthawi imodzi. Chimodzi mwazofunikira kwambiri ndi kuthana ndi kutupa.

GCS imatha kuchepetsa ntchito za ma enzyme omwe amawononga minofu yathupi, kupatula madera omwe akukhudzidwa ndi athanzi.

GCS imagwira pama membrane am' cell, kuwapanga iwo coarser, zomwe zikutanthauza kuphatikiza kagayidwe, chifukwa cha matendawa sapereka mpata wofalikira thupi lonse, ndikuyika "chimango cholimba".

Mwa njira zina za kukopa kwa corticosteroids pa thupi la munthu:

• Katemera wa immunoregulatory - munthawi zosiyanasiyana, chitetezo chokwanira chimachepa pang'ono kapena, m'malo mwake, chitetezo chimachepetsa (madokotala amagwiritsa ntchito corticosteroids pa nthawi yopatsirana minofu kuchokera kwa opereka),
• antiellgic,
• antishock - othandiza, mwachitsanzo, pakukhumudwitsidwa kwa anaphylactic, pamene mankhwalawa amayenera kupereka chowunikira mwachangu kupulumutsa wodwalayo.

GCS imatha kukhudza kupanga insulini (izi zimathandiza odwala omwe ali ndi hypoglycemia), imathandizira kupanga zinthu monga erythropoietin (kutenga nawo gawo m'magazi kumawonjezera hemoglobin), kumatha kukweza magazi, kuthana ndi metabolism.

Popereka mankhwala, madokotala amayenera kuganizira zovuta zambiri, kuphatikizapo zomwe zimatulutsa, pamene mankhwalawo amalowa m'magazi atayamwa kale, ndipo kuchokera pamenepo amalowa m'matumbo. Mitundu yambiri ya corticosteroids imalola kugwiritsa ntchito mankhwala ochulukirapo kwanuko.

Tsoka ilo, sikuti "zochitika" zonse za glucocorticoids ndizothandiza kwa anthu.

Kuchulukitsa kwa corticosteroids chifukwa chogwiritsa ntchito mankhwalawa kwa nthawi yayitali, mwachitsanzo, poti kusintha kwamkati wamkati - kashiamu imatsukidwa, mafupa amakhala osalimba, mafupa amayamba.

Glucocorticoids amadziwika ndi kutalika komwe amagwira mkati mwa thupi.

Mankhwala opatsirana mwachidule amakhalabe m'magazi a wodwalayo kuyambira maola awiri mpaka theka la tsiku (zitsanzo ndi Hydrocortisone, Cyclesonide, Mometasone). Malangizo ogwiritsira ntchito hydrocortisone atha kupezeka.

GCS ya sing'anga kanthu - mpaka tsiku limodzi ndi theka (Prednisolone, Methylprednisolone), kuchitidwa kwakutali - maola 36-52 (Dexamethasone, Beclomethasone).

Pali gulu monga njira ya mankhwalawo:

Ma glucocorticoids opatsirana amatha kukhala ndi mphamvu kwambiri mthupi la wodwalayo. Ndalamazi zilinso ndi gulu lawo.

Kutengera kuchuluka kwa fluorine omwe amapezeka, amakhala ophatikizidwa, opangidwa modabwitsa.

Mankhwala osiyanasiyana ogwiritsira ntchito GCS amapatsa madokotala mwayi wosankha mawonekedwe oyenera (mapiritsi, kirimu, mafuta, mafuta, inhaler, patch, madontho amphuno) ndi "zomwe zili" zofananira kuti zimve bwino zotsatira zamankhwala zomwe ndizofunikira, ndipo ayi Osachulukitsa mkhalidwe wa wodwalayo, zomwe zimapangitsa zotsatirapo zoyipa mthupi.

Pharmacology ndiye tsogolo la akatswiri, ndi dokotala yekha yemwe amadziwa zonse zobisika zomwe zimapangitsa kuti mankhwalawa akhale ndi thupi kapena munthawi yomwe amagwiritsidwa ntchito.

Mwachitsanzo, timapereka mayina a glucocorticoids:

Njira zochizira

Mitundu yosiyanasiyana ya njira zochizira pogwiritsa ntchito corticosteroids yapangidwa:

• ntchito - imagwiritsidwa ntchito ngati ma gren adrenal sangathe kudzipangira payokha kuchuluka kwamahomoni m'thupi,
• kuponderezana - kwa ana omwe ali ndi vuto lobadwa nalo panjira ya adrenal cortex,
• pharmacodynamic (imaphatikizapo chithandizo chambiri, chocheperako komanso cha nthawi yayitali) - mu anti-allergic and anti-yotupa mankhwala.

Munthawi zonsezi, mulingo woyenera wa mankhwala omwe amamwa komanso pafupipafupi amagwiritsidwa ntchito.

Chifukwa chake, kugwiritsa ntchito mankhwalawa kumaphatikizapo kumwa glucocorticoids kamodzi pakapita masiku awiri, chithandizo chamkati chimatanthawuza kuperekedwa kwa mankhwala osachepera 1 g kwa mankhwala osamalitsa odwala.

Kodi chifukwa chiyani ma glucocorticoids ali oopsa kwa thupi? Amasintha kuchuluka kwake kwa mahomoni ndipo nthawi zina amayambitsa zovuta zosayembekezereka. , makamaka ngati pazifukwa zina.

Matenda oyambitsidwa ndi corticosteroids amaphatikizapo, mwachitsanzo, kusokonekera kwa adrenal cortex.

Chowonadi ndi chakuti kugwiritsa ntchito mankhwala omwe amathandiza gren adrenal kugwira ntchito zawo, imawapatsa mwayi "wopuma." Ngati mankhwalawo atatha mwadzidzidzi, gland ya adrenal sangathenso kugwira ntchito yokhazikika.

Ndi mavuto enanso ati omwe angadikire mutatenga GCS? Izi ndi:

Ngati zoopsa zikuwoneka munthawi yake, pafupifupi mavuto onse omwe abwera atha kuthana ndi mavuto awo. Chachikulu sikuti muwonjezere kuchuluka kwa mankhwala omwe mumadzipangira nokha, koma kuchita zinthu motsatira malangizo a dokotala.

Zambiri

Adrenal cortex imapanga mitundu itatu ya mahomoni:

• kuwongolera potaziyamu-sodium metabolism (mineralocorticoids),
• oyang'anira ntchito yobereka (ma sexids),
• glucocorticosteroids, omwe ali ndi udindo woperekera kagayidwe kakang'ono.

Kupanga kwa corticosteroids kumayendetsedwa ndi pituitary ndi hypothalamus, koma kumachitika mu ziwalo za endocrine zopakidwa, zomwe zimakhala pamwamba pa impso, pomwe adadzipatsa dzina.

Kwa nthawi yoyamba mahomoniwa adagwiritsidwa ntchito ngati mankhwala mu 40s ya zaka zapitazi, adadziwika ndi dzina lawo chifukwa chakuwongolera kagayidwe ka glucose. Kafukufuku wowonjezeranso adawonetsa kuti mahomoni samangokhudza lipid, chakudya, mapuloteni, komanso amawongolera zochitika zam'magazi, impso, chitetezo cha mthupi, amatenga nawo gawo pachitukuko cha kagayidwe kazinthu zazikulu zam'mafupa.

Kugwiritsa ntchito mahomoni mwanjira zawo zachilengedwe, ngakhale kuli kwothandiza kwambiri, kumakhala kochepa chifukwa cha kuchuluka kwa zotsatira zoyipa.

Zofanana ndi zojambula

Glucocorticoids ndi mawonekedwe komanso magwiridwe antchito amthupi amenewo omwe amapangidwa mu adrenal cortex, m'gawo lake la mtolo. Mankhwala omwe aperekedwa mgululi agawidwa:

• glucocorticoids achilengedwe (cortisone, ngati mankhwala osokoneza bongo omwe amapanga metabolite),
• Mapangidwe opangira omwe amapezeka pamaziko a hydrocortisone () pakuphatikiza mankhwala osiyanasiyana ake molekyu.

Ndi iwo omwe amawerengera kusiyana kwamagwiritsidwe, magwiritsidwe asinthidwe amitundu omwe mankhwala omwe amaphatikizidwa amapereka.

Fludrocortisone, yopangidwa ndi kuwonjezeredwa kwa atomu ya fluorine kupita ku cortisone, imakhala yapamwamba kwambiri mu zochita za glucocorticoid, ndi nthawi 125 mwa mineralocorticoid cortisone.

Dexamethasone, ndi gulu la 16-methyl lonjezedwa ndi molekyulu ya flucrocortisone, imasungabe ntchito ya glucocorticoid, koma ili ndi mineralocorticoid pang'ono.

Methylprednisolone, pomwe 1 kwambiri adaonjezerapo, imaposa mphamvu ya mankhwala nthawi 5 mokulira kwa ntchito ya glucocorticoid.

Zopangira mankhwala ophatikizira a mahomoni a adrenal cortex amagwiritsidwa ntchito ngati mankhwala ovuta kwambiri pamene phindu lawo lamankhwala limaposa zovuta zawo. Nthawi zina, poganizira momwe zilili, kapena kuopsa kwa chotupa, palibenso njira ina kuposa kugwiritsa ntchito mankhwala a mahomoni. Mankhwala a Corticosteroid amagwiritsidwa ntchito popereka:

• odana ndi yotupa
• kukana
• antitoxic
• anti-mantha,
• immunosuppress action.

Izi sizotsatira zonse zamankhwala zomwe zingapezeke ndi mlingo wowerengeka, komanso njira yomwe munthu angakumanirane nayo poika ena. Matenda a msana, mankhwala a glucocorticoid amagwiritsidwanso ntchito chifukwa chokhoza kuchulukitsa mphamvu ya mankhwala omwe amagwiritsidwa ntchito panjira yovuta.

Mfundo yayikulu yolembera HA mankhwala ndi kukwaniritsa kwambiri, pamlingo wotsika kwambiri.Chifukwa chaichi, ndi olemera analogs kupanga okhala zotsatira kwambiri ndi kutchulidwa, kuchepetsa mlingo mlingo ndi nthawi anapatsidwa.

Gulu ndi magawo a mankhwala

Kugawidwa kofala kwamankhwala kogwiritsa ntchito mahomoni a adrenal sikunapangidwe. Kutsatilidwa anagawa HA mu malo ndi njira ya ntchito. Malinga ndi izi, gawo logawika kwambiri pamagawo ang'onoang'ono, mitundu yotsatirayi yamankhwala imasiyanitsidwa:

• jekeseni,
• zokhazikitsidwa
• zikutanthauza ntchito apakhungu monga mafuta, creams, angakhale angelo ndi suspensions.

Mfundo yachiwiri yogawa magulu azigawo ndikusakanikirana kwa chinthu chachikulu pakapangidwe kamankhwala. Mankhwala ndi kusiyanitsidwa ndi mbali lalikulu:

• prednisolone,
• methylprednisolone,
• betamethasone,
• dexamethasone, etc.

Pali kusiyana kwachipatala m'mankhwala a mahomoni malinga ndi nthawi yowonekera, yomwe imakhazikitsidwa pogwiritsa ntchito kafukufuku wasayansi. Glucocorticoids agawidwa m'njira:

• kuwonetsedwa kwakanthawi
• nthawi yayitali
• kuchitapo kwanthawi (yayitali).

Pogwiritsa ntchito mawonekedwe ofupikira, omwe ndi analogue yopanga mahomoni. Chifukwa wosasinthika wachibale wa kapangidwe kake, lili pafupifupi ziribe mphamvu pa muyezo madzi amchere kuwombola, ndipo popanda kuphwanya kagayidwe ma.

Betamethasone ndi dexamethasone, okhala ndi mawonekedwe osinthika, amatha kukhala ndi zotsatira zazitali, pomwe prednisolone ndi methylprednisolone ndi mankhwala osokoneza nthawi yayitali.

Mu mankhwala, pali magawano ina glucocorticoids, amene amasiyanitsa pa ntchito chuma m'munsi, ndipo kumaphatikizapo kusankha:

• amkati (achilengedwe) mankhwala
• analoguque (mafuta),
• ma analogi opanga (okhala ndi fluorine).

Palibe chilichonse mwazomwe zidachitika, chifukwa chogwiritsidwa ntchito mosiyanasiyana kwa mitundu yosiyanasiyana ya HA, imaphatikizapo mawonekedwe athunthu a mankhwala a mahomoni, ndipo amagwiritsidwa ntchito mu terminology yaukadaulo ya mabungwe ena asayansi oyenerera.

Hormonal mankhwala a mkati

Mankhwala othandizira mkati amagawidwanso kuti:

• intranasal (imagwiritsidwa ntchito kudzera pamphuno),
• zamaubwana
• wamlomo
• kupweteka.

kulekana limapereka bwino matenda formulations panopa mmene anawasiyanitsira, likamanena utsogoleli wa mankhwala. Intranasal nthawi zambiri amagwiritsidwa ntchito pochiza:

• matupi awo sagwirizana rhinitis,
• kuchepa kwamitsempha mucosa,
• pa tizilombo ting'onoting'ono mu mphuno.

Parenteral imagwira ntchito pamatenda a adrenal cortex, matenda ena a chithokomiro, ndi zina zovuta za pathologies.

Mankhwala othandizira kupuma ndi enieni kuti awonekere, ndipo amawapangira zovuta kupuma. Mphumu ya bronchial, COPD, matupi awo sagwirizana ndi mankhwalawa amathandizidwa ndi mankhwalawa, monga chithandizo choyenera. Mwa mankhwala omwe amapezeka kwambiri pakhungu, amatha kudziwika:

• triamcinolone acetonide,
• beclomethasone dipropionate,
• mometasone furoate,
• budesonide
• fluticasone propionate.

Milandu yofunika kwambiri ya kupuma dongosolo kukakamizidwa kuchita matenda mayesero atsopano kupuma mankhwala zochizira mphumu bronchial pa mimba. Adawonetsa kuti chithandizo chokhala ndi mankhwala osokoneza bongo ku malo a pathological sichinangokulitsa kuchuluka kwa ana omwe ali ndi matenda a endocrine, komanso adathandizanso kudziwa mawonekedwe awo mwa ana omwe adabadwa ndi amayi omwe ali ndi mphumu komanso omwe sanagwiritse ntchito inhalers kuti athetse vuto lawo.

Kutuluka kwa njira ya intranasal komanso inhaled yotulutsira mankhwala kunapulumutsa odwala ku ngozi zina zomwe zimagwiritsidwa ntchito pogwiritsa ntchito mankhwala a Pare.

Ndikapangidwe kamitundu yama pharmacotherapeutic, ndi mitundu yatsopano yopanga, kugwiritsa ntchito ma glucocorticoid mahomoni, omwe amagwiritsidwa ntchito osakhudza ziwalo zamkati ndi metabolic system, amakhala oopsa.

Pharmacodynamics ndi limagwirira ntchito

Kulumikizana kwachilengedwe kwa mahomoni opangidwa ndi ma grenal adrenal kumalumikizidwa ndi pituitary gland ndi hypothalamus, ndipo kumachitika pogwiritsa ntchito kulumikizana kwina kwa cholembera china cha ma cell ku cell receptor. Kusaka kulemberana makalata pakati pa zinthu zomwe zimamangika kumatha kuchitika mkati mwa membrane wam'manja ndi kunja ngati timadzi tambiri timalowa. Ma HA amamangirira ku ma glucocorticoid receptors apadera mkati mwa cell membrane, omwe amachititsa mawonekedwe a RNA komanso kaphatikizidwe kamapuloteni oyendetsera.

Pali njira ya cytostatic yomwe imatha kuyimitsa mavuto a mahomoni, ndi michere ya enzymatic ndi zinthu zomwe zimathandizira kuchitapo kanthu.

Zotsatira zazikulu zomwe zimapezeka pogwiritsa ntchito corticosteroids m'thupi la munthu zitha kutchedwa kuti:

• kuphwanya kaphatikizidwe ka oyimira pakati otupa (ndi leukotrienes), mwa kutsekereza ndi kulepheretsa enzyme ya phospholipase,
• Mlingo wosiyanasiyana, kupatsirana kwa immunosuppressive ndi immunostimulating zotsatira, zoletsa za antibody kupanga, kupanga lymphokines ndi cytokines,
• choletsa kusiya, kukhazikika kwa nembanemba cell membrane,
• zimapangitsa kagayidwe kazakudya zamapuloteni, chakudya, calcium, mafuta, kagayidwe ka madzi,
• kuchuluka kwa chidwi cha makoma amitsempha yamagazi, ndi minofu yamtima ku ndi,
• kukondoweza kwa mapangidwe a maselo ofiira a m'magazi ndi mapulateleti,
• kuletsa kwa kupanga leukocytes, basophils ndi eosinophils,
• Zotsatira zamahomoni ena, kuphatikizira kumaliseche, luteinizing, mahomoni a chithokomiro.

Akamamwa pakamwa, amamwetsedwa mwachangu, m'matumbo ang'onoang'ono, mpaka kufika pazende zosakwanira ola limodzi. Kuyambitsa ndikusintha kwa makolo, ndipo zimaperekedwa ndi mawonekedwe a mankhwalawo. Amayatsidwa kudzera mu impso, kumangiriza mapuloteni m'magazi, ndipo amawonongeka pang'ono ndi chiwindi. Njira yotsogolera imadalira mtundu wa mankhwalawo, komanso mawonekedwe a matendawa. Mankhwalawa musculoskeletal system, jakisoni wa intraarticular amagwiritsidwanso ntchito.

Mndandanda wa mankhwala a mahomoni

Mndandanda wa mankhwala a gulu la glucocorticoid ndi ochulukirapo, koma muzochita zamankhwala zotsatirazi ndizomwe zimadziwika kwambiri:

• Prednisone
• Triamcinolone
• Dexamethasone
• Muthanga.

Mndandanda wa mankhwala omwe ali pansi pa mayina amalonda, kapena mitundu ina yokhala ndi mawonekedwe osinthika, samawoneka wamba, ndipo amafunika kuphunzira malangizo kuti agwiritse ntchito, ndikulongosola bwino kwa zotsutsana ndi zisonyezo, kapangidwe ka kapangidwe ka mankhwala, ndi mawonekedwe a cholinga.

Pa mindandanda B, mufunikira malo osungirako. Musanagwiritse ntchito mwaulere mankhwala amenewa, muyenera kufunsa dokotala, kuti mumvetsetse za mankhwalawo momwe mungagwiritsire ntchito ana akhanda, ana, amayi oyembekezera.

Mankhwala onse a gulu la glucocorticoid hormone amafotokozedwa mu gulu la Anatomical-therapeutic-kemikali gulu (ATX), lomwe limakhala ndi kapangidwe kake ndipo limathandizira kufunafuna mankhwala oyenera. Mankhwala aliwonse a gululi amayesedwa mosafunikira, ndipo amafotokozedwa ndi akatswiri.

Zizindikiro zogwiritsidwa ntchito

Mpaka pano, osati mbali zokha ndi zochizira zomwe zaphunziridwa bwino, komanso kuyanjana kwa HA ndi mankhwala ambiri, mlingo wofunikira, komanso mitundu yovuta ya mankhwala yapangidwa. Izi zidapangitsa kugwiritsidwa ntchito kwa mankhwalawa munthambi zambiri zamankhwala, ngati mankhwala oyambira komanso othandiza.

Mkhalidwe wazovuta momwe phindu lopanda kukayikitsa la GK lipanga mndandanda wazitali wautali, wambiri komanso wowopsa. Mu rheumatology amagwiritsidwa ntchito pochiza:

• systemic lupus erythematosus,
• ankylosing spondylitis,
• systemic scleroderma,
• rheumatic polymyalgia.

Glucocorticoids amagwiritsidwa ntchito pochiza vasculitis ndi pyelonephritis, mu endocrinology yomwe amathandizira:

• adrenal kusowa
• thyrotoxicosis ndi kuchepa.

• zilonda zam'mimba,
• matenda oopsa a chiwindi
• Matenda a Crohn ali pachimake.

Koma kuchuluka kwa mankhwala omwe ali ndi mahomoni sikumangokhala pa izi. Cardiology imagwiritsa ntchito:

• mitundu ina ya pericarditis,
• pambuyo-kachilombo komanso sanali enieni leukocyte myocarditis.

• ndi mphumu ya bronchial,
• chibayo,
• alveolitis ndi bronchiolitis,
• sarcoidosis wamapapu.

Mu hematology, mahomoni amtundu amachitira thrombocytopenia ndi magazi m'thupi.

HA - mankhwala ofunika kwambiri posankha pachimake, komanso pakufalikira. Ngakhale contraindication ndi zotsatira zoyipa, glucocorticoids ndi ena mwa omwe amagwiritsidwa ntchito kwambiri, ndipo nthawi zina sangachiritsidwe, mankhwala ochizira zilonda zam'mimba kwambiri. Mankhwalawa matenda a msana ntchito mankhwala:

• osteochondrosis,
• kuthetsa ululu
• nyamakazi yopanda matenda,
• Ankylosing spondylitis,
• kuwonongeka kwa msana ndi nembanemba.

Kulenga kwa mankhwala opangira kwachulukitsa ndikuwonjezera chiwopsezo cha gulu la mankhwalawa, ndikupititsa patsogolo zochulukitsa za zochita zawo.

Zomwe zimagwiritsidwa ntchito pochiritsa mahomoni ndi kusamala

Glucocorticosteroids, chifukwa chogwiritsa ntchito, amagwiritsidwa ntchito munthambi zosiyanasiyana zamankhwala pochiza matenda osiyanasiyana. Pafupifupi zinthu zonse zodziwika, njira zochizira ndi protocol zapangidwa m'zigawo zosiyanasiyana.

Kutalika kwa mankhwala, kuchuluka kwake

Ichi ndichifukwa chake zambiri zimanenedwa za kusadziwikanso kwakudziyendetsa pawokha kwa mankhwala a mahomoni opanga, za kusamala kwakukulu kogwiritsa ntchito kwawo, kusamala mosamala ndikugwiritsa ntchito mankhwala a gululi. Mankhwala aliwonse, ochiritsira kwambiri, osasankhidwa, komanso kulandiridwa kosayenera, amatha kuvulaza thupi. Chifukwa chake, chithandizo chikuyenera kuchitika kokha ndi dokotala yemwe amadziwa bwino zovuta zonse za mankhwala.

Malangizo ogwiritsira ntchito:

Glucocorticosteroid - chinthu chachilengedwe kapena chopangidwa kuchokera ku mahomoni a adrenal cortex.

Zotsatira za glucocorticosteroids m'thupi

Mwachilengedwe chawo, izi ndi ma steroid. Mwa anthu ndi nyama, malo akuluakulu omwe amapangidwako ndi adrenal cortex. Glucocorticosteroids nthawi zambiri imawonjezera kukana kwa thupi pamavuto azinthu, ndipo izi ndizomwe zimapangitsa kuti chilengedwe chikhale chofunikira.

Glucocorticosteroids amakhudza kagayidwe kachakudya mthupi, makamaka pa chakudya, mchere, mapuloteni ndi madzi.

Mankhwala opangidwa ndi glucocorticosteroid ngati mankhwala othana ndi kutupa, okhumudwitsa, mankhwala osokoneza bongo, antitoxic, ndi anti-shock.

Zotsatira zazikulu za glucocorticosteroids

Glucocorticosteroids amazindikira mphamvu zawo mwa kuphatikiza mwa ziwalo za cell mu cytoplasm. Pamenepo amadzimanga ndi ma intracellular receptors omwe amathandizira kuphatikizika kwa mapuloteni.Mphamvu yoletsa ma mahomoni awa pa phospholipase A2 ndi hyaluronidase, omwe ndi michere yotupa, imadziwikanso.

Zinthu za gululi zimakhazikitsa ma membala am'mimba, omwe amalepheretsa kutulutsa kwa zinthu zofunikira (histamine, leukotrienes, thromboxane) kuchokera ku maselo am'mimba. Amachedwetsa mapangidwe a cytokines ovomereza-kuchokera ku arachidonic acid.

Mphamvu ya immunosuppressive ya mahomoni a glucocorticosteroid amagwiritsidwa ntchito ngati mankhwala pothana ndi kupsinjika kwakukulu kwa chitetezo chathupi chomwe chimayendetsedwa ndi thupi lanu. Izi zimafunika kuti ziwalo zonyamula (mwachitsanzo, impso, mafupa), zotupa zoyipa, matenda a autoimmune. Zotsatira zabwino zamankhwala othandizira ndi glucocorticosteroids zimatheka pobwezeretsa kusuntha kwa maselo a tsinde ndi ma lymphocyte, komanso kulumikizana kwa magulu osiyanasiyana a ma lymphocyte wina ndi mnzake.

Kutha kwa glucocorticosteroids kuchulukitsa kuthamanga kwa magazi kumadziwika pakuwonjezera kutulutsa kwa adrenaline ndikubwezeretsanso chidwi cha adrenaline receptors kwa iwo, kufupikitsa lumen ya ziwiya ndikuchepetsa kukula kwawo. Katunduyu amalola kuti azithana ndi zadzidzidzi pamavuto.

Glucocorticosteroids amalimbikitsa mapangidwe a shuga m'chiwindi komanso kuwonongeka kwa mapuloteni, zomwe zimapangitsa kuti pakhale ma amino acid ndi glucose yaulere m'magazi. Mwanjira imeneyi, thupi limalandira zinthu zokwanira zamagetsi.

Mankhwala a Glucocorticosteroid

Mankhwala, kukonzekera kwa glucocorticosteroid malinga ndi nthawi yayitali ya zochita zimagawika m'magulu atatu: nthawi yayifupi, yayitali komanso nthawi yayitali.

Ma glucocorticosteroids omwe amakhalapo mwachidule amaphatikizapo hydrocortisone. Ichi ndi chidziwitso cha hydrocortisone ya thupi, poyerekeza ndi mankhwala ena, imakhala yovuta kwambiri pakumata kwamchere wamchere.

Mankhwala a nthawi yayitali glucocorticosteroids - methylprednisolone ndi prednisolone.

Ma glucocorticosteroids omwe amakhala ndi nthawi yayitali amaphatikizapo betamethasone ndi dexamethasone.

Mankhwalawa glucocorticosteroids, pakamwa mitundu ya inhalation, intranasal ndi parenteral amagwiritsidwa ntchito.

Mankhwala osokoneza pakamwa amatengedwa bwino bwino m'mimba, m'magazi amamangilira mapuloteni a plasma. Amagwiritsidwa ntchito pochiza kusokonekera kwa adrenal cortex, matenda a pulayimale, yachiwiri komanso yachiwiri, kusakwanira kwa chithokomiro, matenda a Crohn, matenda am'mapapo apakati komanso COPD.

Mwa glucocorticosteroids omwe amaphatikizidwa, budesonide, triamcinolone acetonide, beclomethasone dipropionate, mometasone furoate, fluticasone propionate amagwiritsidwa ntchito nthawi zambiri. Amayenerera bwino mankhwalawa oyambira ku matenda a mphumu ndi COPD, matupi awo sagwirizana.

Intranasal glucocorticosteroids amadziwika kuti mucyposis, matupi awo sagwirizana ndi idiopathic rhinitis. Kuzindikirika kwa kayendetsedwe kake kamaonetsa kuti gawo lina la mankhwalawa lidzalowa mucosa wamkamwa ndi kupuma, ndipo gawo lina lidzamezedwa ndikulowetsedwa m'mimba.

Kodi glucocorticoids ndi chiyani

Glucocorticoids ndi mtundu wa mahomoni amunthu omwe amapangidwa ndi ma adrenal gland, kapena m'malo mwake makungwa. Amatenga gawo limodzi pazochitika zomwe zimachitika mthupi. Mahomoni oterewa amayamba kugwira ntchito, makamaka panthawi yadzidzidzi: kugwedezeka, kupsinjika, kuvulala. Izi zimapangitsa kugwiritsa ntchito kwawo mankhwalawa kuti athe kupereka anti-yotupa, anti-allergen.

Limagwirira ntchito yawo pafupifupi motere:

1. mahomoni, kulowa mu cell, amakhudza ma receptor,
2. majini omwe amayang'anira momwe chitetezo cha mthupi chimapangidwira adachitidwa,
3. ntchito yogwira ma geni imachepetsa kutupa ndipo imalepheretsa chitetezo chamthupi cha wodwalayo.

Komanso mahomoni a glucocorticoid amalimbikitsa mitsempha ya magazi kukhala yokhazikika, pomwe imayamba kuchepa, pomwe ntchito yama cell a chiwindi imayendetsedwa. Chifukwa chake, thupi limatetezedwa ku poizoni ndi mkhalidwe wakunjenjemera.

Zotsatira za glucocorticoid mankhwala:

• matenda amisempha ya adrenal,
• matenda a musculoskeletal system,
• chifuwa
• mphumu
• matenda a pakhungu
• sarcoidosis
• Matenda a Crohn.

Ngati wodwalayo ali ndi vuto la mphumu kapena chifuwa, ndiye kuti mahomoni amayikidwa mu mawonekedwe a inhalations.

Zotsatira zoyipa

Glucocorticoids imathandizira kwambiri pakupanga mahomoni ena mthupi. Chithokomiro chimagwiritsidwa ntchito kwambiri ndi izi. Mothandizidwa ndi mahomoni a adrenal, ntchito zake zimachepa.

Zotsatira zoyipa za glucocorticoid mankhwala zitha kugawidwa m'magulu awiri: am'deralo komanso azinthu zonse.

Zotsatira zoyipa zapafupi

Nthawi zambiri, zotsatira zosafunikira zamtunduwu zimadza pambuyo pokonzekera ma inhalation pokonzekera.

Kuzindikira kwa shuga - ingomwani tsiku lililonse.

Wodwalayo amatha kusokonezedwa ndi:

• mphuno
• kusewera pafupipafupi
• thukuta m'mphuno,
• candidiasis mkamwa
• kutsokomola.

Monga lamulo, amakhala osakhalitsa komanso osowa kwathunthu pambuyo poti chithandizo cha mahomoni chimatha.

Zotsatira zoyipa

Mndandanda wazotsatira zamadongosolo achilengedwe ndizochulukirapo. Zimatengera dongosolo lomwe ndi lovuta kwambiri.

Mankhwala a Steroid amachepetsa mphamvu ya mapangidwe amtundu wa adrenal. Ndipo ngakhale atatha kugwiritsa ntchito ma steroid, kwa nthawi yayitali sathanso kugwira ntchito "mwamphamvu." Kuchotsa matenda m'thupi kumakhala koopsa chifukwa thupi limakhala ndi kuchepa kwakukulu kwa glucocorticoids. Ngakhale kuvulala kochepa kapena kupsinjika kumatha kuvulaza thupi. Munthu wopanda vuto lakelo amamva kupweteka, amakhala wopanda chidwi. Pali kusowa kwa chakudya komanso kuwonda kwakukulu.

Chodetsa nkhawa kwambiri ndi kuthekera kwa ma steroid. Kutsika kwa kukakamizidwa pansi pa kukopa kwawo ndizovuta kwambiri kuthana ndi mankhwala achikhalidwe.

Mankhwala a Steroid amachepetsa chitetezo chokwanira cha anthu, makamaka pochepetsa kukana kwa thupi kumatenda a bakiteriya. Kuopsa kwa matenda kumatengera mwachindunji mlingo wa glucocorticoids: mlingo waukulu - chiwopsezo chachikulu. Izi ndi zomwe zimayambitsa zovuta, nthawi zambiri zimakhala zakupha.

Ndi mankhwala obwezeretsanso mahomoni, matenda mthupi amakhala obisika, kumangowonjezera kutentha kwa thupi. Kupewa izi, katemera wa chimfine ndi pneumococcus amalimbikitsidwa kwa odwala asanalandire chithandizo. Komanso, sizingakhale zolakwika kupanga mayeso a tuberculin.

Nthawi zambiri glucocorticoids amayambitsa zovuta m'maganizo mwa odwala. Izi zitha kuwonetsedwa mu kusakwiya pang'ono, komanso mu kukhumudwa kwambiri komanso psychosis.

Nthawi zambiri zomwe zimachitika chifukwa cha chithandizo cha mahomoni zimatha kusintha maonekedwe a wodwalayo: kuwonda, kuzungulira nkhope, ziphuphu, matupi a lilac, kuvulala. Monga lamulo, zotsatira zosafunikira zotere zimachepetsedwa kapena kutha kwathunthu pambuyo pakuchepetsa kwa mlingo.

Timapereka kuchotsera kwa owerenga tsamba lathu!

Bongo

Kupitilira muyeso wofunikira, wamankhwala amtundu uliwonse, kumawononga thanzi ndi thanzi la wodwalayo. Mankhwala osokoneza bongo a glucocorticoids samachitika kangapo.

• kutupa
• kuphwanya mawonekedwe a electrolyte mthupi,
• kukokana.

Nthawi zina, ululu wam'mimba, kutentha kwa mtima, nseru, ndi kusanza ndizotheka.

Pazizindikiro zoyambirira za mankhwala osokoneza bongo a mahomoni, makonzedwe ake amayenera kuyimitsidwa. Mankhwalawa ndi chizindikiro. Chithandizo chapadera sichichita.

Kuchita ndi mankhwala ena

Ngati wodwala amatenga mankhwala pafupipafupi, ndikofunikira kudziwitsa dokotala za izi musanapange mankhwala a glucocorticoids. Kuyanjana kwa mankhwala ena ndimtundu wina uliwonse kumatha kuyambitsa zotsatira zosafunika.

Kugwiritsa ntchito nthawi yomweyo kuti muchepetse acidity yam'mimba ndi ma steroids kumafooketsa mphamvu yotsirizira. Kugwiritsa ntchito kwa mahomoni ndi ma aspirin kungapangitse zilonda zam'mimba, komanso paracetamol - kuwonjezereka kwake kawopsedwe.

Mankhwala opangidwa kuti achepetse kuchuluka kwa glucose amawonongeka ngati agwiritsidwa ntchito limodzi ndi glucocorticoids. Mahomoni a Steroid osakanikirana ndi okodzetsa amatha kubowola kwa potaziyamu m'thupi.

Mochenjera, ndikofunikira kumwa mankhwalawa kwa anthu okalamba, odwala matenda a chiwindi, chifukwa mu nkhani iyi mphamvu za mahomoni zimatha kupitilizidwa.

Odwala omwe akupezeka mu immunosuppressive timadzi timadzi timagulu totsutsana ndi jakisoni ya katemera.

Momwe mungachepetse mavuto

Pali magulu ena a odwala omwe aphatikizidwa mu glucocorticoid mankhwala.

Izi zikuphatikiza:

• odwala matenda ashuga
• odwala omwe ali ndi mbiri yodwala misala,
• m'matumbo odwala
• odwala omwe ali ndi matenda oopsa komanso / kapena kulephera kwa mtima.

Zina zitha kugwiritsidwa ntchito ngati mankhwala a mahomoni. Kuti muchepetse chiwopsezo cha mavuto, muyenera kuyang'anitsitsa thanzi lanu. Ngati pathologies aliwonse apezeka, adokotala ayenera kudziwitsidwa za izi.

Odwala onse omwe akumalandira chithandizo cha steroid, mosasamala mtundu ndi mtundu wake, akulimbikitsidwa kuti amwe ma vitamini-mineral complex, chidwi chapadera chiyenera kulipidwa ku calcium ndi vitamini D. Nthawi zina, mungafunike kumwa insulini.

Pofuna kumveketsa komanso kumva bwino, zonse zoyipa ndi njira zopumira zimafotokozedwera.

Gome: "Zosafunika chifukwa cha mankhwala a steroid ndi njira zowachepetsera"

Zotsatira zoyipa	Zizindikiro zazikulu	Ma Horoni omwe ali ndi vuto (pafupipafupi)	Zotheka Kuchepetsa Zochita
Kusungunuka kwa madzi m'thupi	Kutupa, monga lamulo, kumachitika kumaso, miyendo.	Cortisone, hydrocortisone.	Kugwiritsa ntchito okodzetsa, kutsatira zakudya zochepa.
Matendawa	Kupweteka kwambiri m'malo olumikizirana mafupa, msana, mafupa a mafupa ndi ma vertebrae (makamaka okalamba)	Dexamethasone	Kugwiritsa ntchito vitamini D, mchere wamchere
Zowononga minofu	Kumva kufooka miyendo, kufooka.	Dexamethasone, Prednisone, Prednisone.	Kugwiritsa ntchito kwa anabolics, kuthetsedwa kwa dexamethasone.
Zilonda zam'mimba	Mwambiri, ndi asymptomatic. Mwa 1 mwa 10 milandu, magazi am'mimba amatha.	Prednisone, prednisolone.	Methylprednisolone tikulimbikitsidwa. Njira yoyenera yoyendetsera ndi yoyambira.
Matenda a shuga	Monga lamulo, zovuta za matenda ashuga sizimawonedwa.	Muthanga	Kugwiritsa ntchito njira zina zochiritsira.
Mavuto amisala	Kuda nkhawa, kukwiya kwambiri, kusowa tulo, kukhumudwa, psychosis.	Imachitika kawirikawiri kwambiri pogwiritsa ntchito methylprednisolone.	Ngati ndi kotheka, pezani chithandizo cha mahomoni kwa anthu omwe ali ndi vuto losakhazikika la psyche. Palibe mwayi woterowo wogwiritsa ntchito ma psychotropics omwe ali ndi mankhwala osokoneza bongo.
Kulemera	Kumva njala yokhazikika, kuchuluka kwa chidwi.	Dexamethasone	Zakudya zopatsa thanzi, kupatula kwa mahomoni omwe amakulitsa kulemera.
Kuchepetsa thupi	Palibe zodziwikiratu.	Triamcinolone	Kugwiritsa ntchito kwa anabolic steroids, amino acid.

Tsoka ilo, chithandizo ndi glucocorticoids pafupifupi chimagwirizana nthawi zonse ndi kuwoneka kwa zotsatira zoyipa zina. Udindo wa izi wagona ndi adokotala komanso wodwala.Dokotala amafunikira kuti awerenge bwino za mbiri ya wodwalayo kuti apewe kuthekera kosagwirizana ndi zomwe mankhwala omwe adamwa amatenga. Wodwalayo, ayenera kuyang'anitsitsa kuchuluka kwa nthawi ndi kumwa mankhwalawa.

Glucocorticoids ndi mankhwala oopsa. Kugwiritsa ntchito kwawo kuyenera kutsutsidwa kokha chifukwa chofunikira kwambiri. Mankhwala ayenera kukhala achidule momwe angathere.

Kulandila kwa mahomoni mulimonsemo kungasokoneze bwino m'thupi. Chachikulu ndikuti zotsatira zake kwa wodwala ndizochepa.

Ngati pali mwayi wochita popanda kugwiritsa ntchito mahomoni, muyenera kugwiritsa ntchito.

Matenda a shuga nthawi zonse amayambitsa zovuta zakupha. Mwazi wamagazi ochulukirapo ndi woopsa kwambiri.

Aronova S.M. adafotokoza za chithandizo cha matenda ashuga. Werengani kwathunthu

Njira yamachitidwe ndi zotsatira zake

Corticosteroids ndi mahomoni a steroid komwe adachokera, momwe amagwirira ntchito ndi osiyana ndi mahomoni a mtundu wa protein. GCS imalowetsa maselo olimbana ndi kulowa mkati mwa cell yawo, komwe amamangirira ma receptor ndikupereka mphamvu yeniyeniyo.

Mankhwalawa amakhudza kugwira ntchito kwa maselo ambiri mthupi ndipo ndi ofunikira kwambiri. Zotsatira zawo zazikulu ndi izi:

1. 1. Chitani nawo gawo pa kagayidwe kachizolowezi:
   1. Zimakhudza kagayidwe kazakudya (kumaonjezera kuchuluka kwa shuga m'magazi m'njira zosiyanasiyana).
   2. 2. Gwiritsani ntchito kagayidwe kazakudya zomanga thupi (zolimbikitsa kupangika kwa RNA ndi mapuloteni m'chiwindi, zimathandizira kuwonongeka kwa mapuloteni m'misempha ndi minofu ina).
   3. 3. Gwiritsani ntchito kagayidwe kazakudya zamafuta (m'malo osiyanasiyana njira ziwiri zotsutsana zimachitika - kukula ndi kuwonongeka kwa minofu ya adipose).
2. Zochitika mineralocorticoid ntchito. Amatha kulimbikitsa ma receptors a mineralocorticoids (ngakhale pang'ono pang'ono kuposa mineralocorticoid mahomoni), zomwe chifukwa cha izi zimatsogolera kutulutsidwe kwa sodium mthupi. Izi zimakwiyitsa kusungunuka kwa madzimadzi, kuchuluka kwa magazi ndi kuchuluka kwa zotulutsa za potaziyamu mu mkodzo.
3. Kukaniza kwa thupi pamavuto kumawonjezeka. Kuwonjezeka kwa shuga m'magazi mothandizidwa ndi glucocorticoids kumapereka mphamvu yofunikira kuteteza motsutsana ndi kupsinjika, matenda, matenda, ndi zina zambiri.
4. Amakhala ndi immunosuppressive zotsatira (amachepetsa kuchuluka kwamagulu angapo a ma cell oyera).
5. Ali ndi mphamvu yotsutsa-yotupa, yomwe imafotokozedwa ndi kuchepa kwa gawo ndi kugawa kwa ntchito ya T ndi B lymphocyte ndi kuphwanya mapangidwe a oyimira pakati otupa. Amakhazikitsa lysosome nembanemba, amachepetsa kutulutsa kwa histamine ndi basophils. Zotsatira zake, magawo onse atatu a kutupa amakhala oletsedwa.
6. Chitani nawo gawo la endocrine system: chepetsani chinsinsi cha ACTH ndi thyrotropin, onjezani kupanga mahomoni okula.
7. Kukhudza dongosolo kupuma. Mwana wosabadwayo m'mwezi watha wa pakati, corticosteroids amathandizira kuti pakhale kupangika, komwe kumakhudza mapapo alveoli kuchokera mkati ndipo ndikofunikira kuti onse atsegulidwe panthawi yopumira koyamba, komanso kuteteza minofu yawo kuti isagwere m'tsogolo.
8. Kukhudza mtima. GCS imachulukitsa kuthamanga kwa magazi ndikuyikhazikika pamlingo wokwezeka uwu. Zotsatira zake zimakhudzana, mbali imodzi, ndi kuchuluka kwa magazi chifukwa chosungidwa ndi madzi chifukwa cha mineralocorticoid zochita, ndi zina, ndi kuwonjezeka kwamphamvu kwa minofu ya mtima ndi mitsempha yamagazi ku endate native catecholamines (adrenaline ndi norepinephrine).
9. Gwiritsani ntchito njira ya hematopoiesis. GCS imalepheretsa mapangidwe a hematopoietic zinthu zofunika pakugawikana kwa masentimita a tsinde la mafupa ofiira. Potengera maziko awa, milingo ya basophils, ma eosinophils ndi ma monocytes m'magazi amatsika. Mapangidwe a neutrophils akuwonjezeka.

Hydrocortisone - mitundu ya malangizo ndi malangizo ogwiritsira ntchito

Glucocorticoids: malo azamankhwala

Mankhwala a pharmacodynamic (osagwirizana ndi choloweza m'malo), ndikofunikira kugwiritsa ntchito mankhwala omwe ali ndi mineralocorticoid otsika ntchito. Glucocorticoids omwe amagwiritsidwa ntchito popanga zamankhwala ali ndi kusiyana kwakukulu mu mphamvu yayikulu yothandizira, pharmacokinetics ndi kuwunika kwa zoyipa zomwe zimayenera kukumbukiridwa popereka mankhwala.

Glucocorticoids amagwiritsidwa ntchito ngati mankhwala okomoletsa mtima ndi zotsitsimutsa zotsatirazi: mu hypotension ndi magazi kwambiri ndi kufooka kwawoko, kupanikizika kwamphamvu mu mtima kulephera,

• zopweteka, zotupa
• mankhwala oopsa
• Matupi awo sagwirizana ndi anaphylactic (edema ya Quincke, uritisaria wa pachimake, mkhalidwe wa asthmatic, zotsatira za poizoni zoyipa, etc.),
• thupi lawo siligwirizana ndi narcotic analgesics kapena mankhwala ena a pharmacological,
• pachimake adrenal kuchepa.

Pochizira mwadzidzidzi mikhalidwe monga kugwedezeka, thupi lanu siligwirizana, kuledzera, glucocorticoids amathandizidwa iv. Mawu oyamba akhoza kukhala osakwatiwa kapena obwerezedwa kwa masiku angapo.

Chizindikiro chachikulu cha kugwiritsidwa ntchito kwa glucocorticoids panthawi ya opaleshoni komanso nthawi yoyambira ntchito ndikuchepa kwa SBP pansi 80 mm Hg. Art., Yomwe imatha kuonedwa m'mikhalidwe yambiri. Mitsempha yoyeserera ya corticosteroids panthawi yopanga mankhwala opatsirana komanso kukonza kwake imatilola kukwaniritsa kukhazikika kwa hemodynamics motsutsana ndi maziko a zovuta mankhwala mkati mwa mphindi 10 kuyambira kukhazikitsidwa kwa mlingo woyambirira.

Nthawi zambiri pochita opaleshoni, glucocorticoids amagwiritsidwa ntchito mosiyanasiyana: kuchokera 20 mpaka 100 mg akaŵerengeredwa pa mlingo wa prednisolone. Kuphatikiza apo, kugwiritsa ntchito kwawoko mu zovuta mankhwala kungafikire 96%. Pazaka zochepa chabe pomwe mankhwalawa samathandiza. Nthawi zambiri, kusowa kwa hemodynamic zotsatira kumaonedwa mwa odwala omwe amachepetsa kuthamanga kwa magazi poyankha kukhazikitsa kwa mankhwala oletsa kubwezeretsa (mwachitsanzo, trimecain). Panalibe zovuta zilizonse zaminyewa ya glucocorticoids mwa odwala omwe ali ndi chidakwa chachikulu ngati gwero lake lingasungidwe, komanso mwanjira zina, kukana koyamba kwa thupi ndi mankhwala osokoneza bongo.

Mu zovuta kuzungulira kwa magazi, achire zotsatira za glucocorticoids amadziwika kudzera kuwonjezeka minofu mafuta, kuwonjezeka venous kutuluka, matenda a zotumphukira kukana ndi ST, kukhazikika kwa maselo ndi lysosomal nembanemba. Ngakhale amagwiritsa ntchito glucocorticoids pachikhalidwe pa mitundu yosiyanasiyana yodabwitsayi, mphamvu yawo pamikhalidwe imeneyi idakhalabe yopanda chidwi. Ichi ndichifukwa chovuta kudziwa zowerengera pazinthu zosiyanasiyana, zomwe zimayambitsa kukhazikitsidwa kwa vuto komanso zomwe zimakhudza magwiridwe antchito. Kugwiritsa ntchito glucocorticoids mu izi ziyenera kuchitika palimodzi ndi zonse pharmacological chizindikiro kumbuyo kwa kukonza mavuto.

Kugwiritsa ntchito kwa glucocorticoids kumapezeka pothandizidwa ndi zovuta zomwe zimachitika panthawi yokhudzana ndi maopaleshoni oyendetsa opaleshoni. Woopsa milandu ya IV ziwombolo, makonzedwe a glucocorticoids okwanira ali ndi chodabwitsa chachikulu. Kukhazikika kwa glucocorticoids mu matupi awo sagwirizana ndi kuchepa. Chifukwa, mwachitsanzo, zotsatira zazikulu zamankhwala za hydrocortisone zimangokhala maola 2-8 pambuyo pokhazikitsa. Chifukwa chake, odwala omwe ali ndi mavuto ambiri amapewa kupewa bronchospasm amafunikira epinephrine mwachangu.

Glucocorticoids ali ndi mphamvu yotanthauzira kuperewera kwa adrenal, komwe kunayamba kale komanso panthawi ya opareshoni. Hydrocortisone, cortisone ndi prednisone amagwiritsidwa ntchito ngati mankhwala.

Makonzedwe aposachedwa a GCS omwe amagwira ntchito kwa nthawi yayitali amathandizira kupewa kupuma kwamatenda osakhazikika kwa ana akhanda asanakwane, omwe amachepetsa chiopsezo cha kufa ndi zovuta kuchokera pamenepa ndi 40-50%.

Carbohydrate kagayidwe

Chimodzi mwazinthu zofunika kwambiri za corticosteroids ndi mphamvu yawo yolimbikitsira gluconeogeneis. Glucocorticoids imapangitsa kuwonjezeka kwa kupangika kwa glycogen ndi kupanga shuga mu chiwindi, kuletsa zochitika za insulin ndikuchepetsa kukula kwa nembanemba mu glucose. Zotsatira zake, hyperglycemia ndi glucosuria zimayamba.

Kusinthana Kwama protein

Glucocorticoids amachepetsa kapangidwe ka mapuloteni ndikuwonjezera kuchepa kwake, komwe kumawonetsedwa ndi mulingo wopanda nayitrogeni. Izi zimatchulidwa makamaka mu minofu minofu, khungu ndi mafupa. Kuwonetsera kwa nitrogen moyenera ndikuchepa, kufooka kwa minofu, kuwoneka kwa khungu ndi minofu, striae, ndi kukha mwazi. Kutsika kwa kaphatikizidwe ka mapuloteni ndi chimodzi mwazifukwa zomwe zikuchedwa kuchepetseka. Mwa ana, mapangidwe a minofu, kuphatikizapo fupa, amasokonezeka, kukula kumachepetsedwa.

Lipid kagayidwe

Glucocorticoids amachititsa kugawa mafuta. Zokhudza mafuta a metabolism zimawonetsedwa ndi zochitika zapanyumba zam'magazi mu dera la miyendo, pomwe lipogenesis m'chigawo cha thunthu imapangidwanso. Zotsatira zake, ndikugwiritsa ntchito kwadongosolo kwamankhwala, mafuta ochulukirapo amadziunjikira kumaso, khungu la thupi, mapewa ndi kuchepa kwa minofu ya adipose yamapeto. Glucocorticoids imawonjezera kaphatikizidwe wamafuta acid ndi triglycerides, zomwe zimayambitsa hypercholesterolemia.

Kusinthanitsa mchere wamadzi

Kuyang'anira kwa GCS kwa nthawi yayitali kumapangitsa kuti azindikire zomwe amachita mineralocorticoid. Kuwonjezeka kwa kupatsanso mphamvu kwa ayoni a sodium kuchokera ku ma distal a rebu tubules komanso kuwonjezeka kwa katulutsidwe kazinthu ka potaziyamu kumawonedwa. Kuchepetsa kwa ayoni a sodium mthupi kumapangitsa kukwera pang'onopang'ono kwa bcc komanso kuwonjezeka kwa magazi. Zotsatira za Mineralocorticoid za GCS ndizachilengedwe mwachilengedwe GCS - cortisone ndi hydrocortisone ndipo, pocheperapo, GCS yapakati.

Glucocorticoids nthawi zambiri imayambitsa calcium m'magazi, kuchepetsa mayamwidwe am'mimba ndikuwonjezera kuchuluka kwa impso, zomwe zimayambitsa hypocalcemia ndi hypercalciuria. Ndi kukonzanso kwa nthawi yayitali, kuphwanya kagayidwe kazakudya, komanso kuphulika kwa mapuloteni a protein, kumabweretsa kukula kwa mafupa.

Maselo amwazi

Glucocorticoids amachepetsa kuchuluka kwa ma eosinophils, monocytes ndi lymphocyte m'magazi. Nthawi yomweyo, zomwe zimakhala m'maselo ofiira a m'magazi, ma reticulocytes, neutrophils ndi mapulateleti zimachulukana. Zambiri mwa zosinthazi zimadziwika mutatenga gawo limodzi la corticosteroids komanso kuuma kwambiri kwa zotsatira zake pambuyo pa maola 4-6. Kubwezeretsa kwa boma koyambirira kumachitika pambuyo pa maola 24.

Malinga ndi lingaliro la mayankho, glucocorticoids imakhumudwitsa gulu la hypothalamic-pituitary-adrenal system (GGNS), chifukwa chomwe kupanga kwa ACTH kumachepa. Kuperewera kwa ntchito ya adrenal cortex yomwe imapangika nthawi yomweyo kumatha kuchitika ndikulunjika kwa glucocorticoids. Chiwopsezo chokhala ndi kusakwanira kwa adrenal chimawonjezeka kwambiri ndikugwiritsa ntchito pafupipafupi glucocorticoids kwa milungu yopitilira 2.

Anti-nkhawa

Glucocorticoids ndi mahomoni osinthika omwe amalimbitsa thupi kukana kupsinjika. M'mikhalidwe yovuta kwambiri, kupanga cortisol kumawonjezeka kwambiri (nthawi 10). Pali umboni wa kulumikizana pakati pa pulogalamu ya katemera ndi GNSS. Izi zimatha kuyimira chimodzi mwazinthu zothandizira kutsutsana ndi nkhawa ya glucocorticoids. Zawonetsedwa kuti ntchito ya GNS imayendetsedwa ndi ma cytokines ambiri (IL-1, -2, -6, tumor necrosis factor TNF-a). Zonsezi ndizothandiza.Ambiri ali ndi zotsatilapo zosiyanasiyana. Mwachitsanzo, IL-1 imalimbikitsa kutulutsa kwa corticotropin-kumasula mahomoni ndi hypothalamic neurons, kumakhudza mwachindunji gland ya pituitary (kumawonjezera kutulutsidwa kwa ACTH) ndi gren adrenal (kumawonjezera kutulutsidwa kwa glucocorticoids). Nthawi yomweyo, glucocorticoids amatha kuletsa kufotokoza kwa magawo ambiri a chitetezo cha m'thupi, mwachitsanzo, kupanga ma cytokines. Chifukwa chake, GGNS ndi chitetezo cha mthupi chimalumikizana m'njira ziwiri panthawi ya nkhawa ndipo izi zimachitika ndikofunikira kwambiri pakusungira homeostasis ndikuteteza thupi ku zotsatira zoyipa zomwe zingayambike chifukwa cha kutupa.

Chovomerezeka

Glucocorticoids imatha kukhudza zochita za mahomoni ena, ndikuwonjezera kwambiri zotsatira zawo. Mphamvu iyi ya glucocorticoids pazovuta za mahomoni ena owongolera amatchedwa chololera ndipo chimawonetsa kusintha kwa kapangidwe kazitulo zomwe zimapangidwa ndi corticosteroids, zomwe zimasintha mayankho a minofu ina.

Chifukwa chake, Mlingo wocheperako wa glucocorticoids amachititsa kwambiri lipolytic zochita za catecholamines. Glucocorticoids imachulukitsanso chidwi cha ma adrenergic receptors ku catecholamines ndikuwonjezera mphamvu ya Pressor ya angiotensin II. Amakhulupirira kuti chifukwa cha izi, glucocorticoids amakhala ndi mphamvu yokhudza mtima. Zotsatira zake, kamvekedwe ka minyewa imapangidwa modabwitsa, mgwirizano wamkati wamkati ukuwonjezeka ndipo kuchuluka kwa capillary kumachepa. M'malo mwake, kuperewera kwa kupanga zachilengedwe GCS kumadziwika ndi SV yochepa, kukulitsa kwa arterioles, komanso kufooka kwa adrenaline.

Zinawonetsedwa kuti glucocorticoids imathandizanso kuchepa kwa bronchodilating catecholamines, kubwezeretsa chidwi cha beta-adrenergic receptors kwa iwo, omwe amalumikizidwa ndi kuwonjezeka kwa biosynthesis ya adrenergic receptors khoma lamitsempha.

Pharmacokinetics

Glucocorticoids ndi mamolekyu ang'onoang'ono a lipophilic omwe amadutsa bwino kudzera mu zotchinga za cell ndi kulowetsedwa kosavuta. Mukaperekedwa, glucocorticoids amatengeka bwino kuchokera ku jejunum yapamwamba. Cmax m'magazi imapangidwa mu maora a 0.5-1,5. Mlingo wa chitukuko cha zotsatira ndi nthawi ya zochita za GCS zimatengera mtundu wa mankhwala, solubility ndi metabolic rate.

Glucocorticoids amapangidwa mumitundu yambiri. Mawonekedwe a mitundu ya jakisoni ndi chifukwa cha mphamvu zonse za glucocorticoid palokha komanso ester yomwe imayanjana nayo. Kukula, hemisuccinates ndi phosphates ndi madzi sungunuka ndipo imakhala yofulumira, koma yochepa. Zitha kulowa mkati / m ndi / mkati. Ma acetates ndi acetonides ndi kuyimitsidwa kwakang'ono kwa makhristali, samatha madzi ndipo amatengedwa pang'onopang'ono kwa maola angapo. Ma esters osagwiritsa ntchito madzi amayenera kuyambitsa kulowa molumikizana ndi m'matumba ogwirizana. Zochita zawo zimafika patadutsa masiku 4-8 ndipo zimatha mpaka milungu 4.

M'magazi, glucocorticoids amapanga ma protein okhala ndi plasma - albin ndi transcortin. Ngati glucocorticoids achilengedwe amamangiriridwa ku transcortin ndi 90%, ndi albumin ndi 10%, ndiye kupanga glucocorticoids, kupatulapo prednisolone, amangiriza kwambiri ku albumin (pafupifupi 60%), ndipo pafupifupi 40% azungulira momasuka. 25-35% ya glucocorticoids yaulere imayikidwa ndi maselo ofiira amwazi ndi maselo oyera amwazi.

Ma glucocorticoids omwe alibe mapuloteni okha ndi omwe amagwira ntchito. Amadutsa mosavuta nembanemba ndi zotchinga za histoeticological, kuphatikizapo magazi ndi ubongo,

Kagayidwe ka glucocorticoids limachitika makamaka mu chiwindi, zina mwa impso ndi ena zimakhala. Mu chiwindi, glucocorticoids ndi hydroxylated ndikugwirizana ndi glucuronide kapena sulfate.Masoka achilengedwe a cortisone ndi prednisone amapeza zochitika zamankhwala pokhapokha atapangidwa mu chiwindi ndikupanga hydrocortisone ndi prednisone, motero.

Kupanga mapangidwe a corticosteroids mu chiwindi kudzera kuchira ndi kuphatikizika kumayenda pang'onopang'ono poyerekeza ndi ma steroids achilengedwe. Kukhazikitsidwa kwa fluorine kapena chlorine halogen ions mu kapangidwe ka GCS kumachepetsa kagayidwe kamankhwala ndikudziyambitsa T1 / 2 yawo. Chifukwa cha izi, mphamvu ya corticosteroids yosinthika imatenga nthawi yayitali, koma panthawi imodzimodziyo imalepheretsa ntchito ya adrenal cortex.

Glucocorticoids amathandizidwa ndi impso kudzera mu kusefera kwa glomerular mu mawonekedwe a metabolites osagwira. Ma corticosteroids ambiri (85%) amawabwezeretsanso m'matumbu, ndipo ndi 15% yokha yomwe imachotsedwa m'thupi. Kulephera kwa aimpso, kusintha kwa mankhwalawa sikuchitika.

Machenjezo

Odwala omwe ali ndi hypothyroidism, cirrhosis, hypoalbuminemia, komanso odwala okalamba, zotsatira za glucocorticoids zimatha kupititsidwa patsogolo.

Glucocorticoids imalowa mu placenta bwino. Zipangizo zachilengedwe komanso zosasinthika nthawi zambiri zimakhala zotetezeka kwa mwana wosabadwayo ndipo sizitsogolera pakupanga matenda a Cushing's and inhibition of GNSS.

Kutalika kwa nthawi yayitali kwamakonzedwe a glucocorticoids kumatha kuyambitsa zosafunikira, kuphatikizapo ndi zoyipa. Mzimayi wogwira ntchito yemwe wakhala akumwa glucocorticoids mzaka 1.5-2 zapitazo, pofuna kupewa kuperewera kwa madzi am'mimba, hydrocortisone hemisuccinate 100 mg maola 6 aliwonse ayenera kuperekedwanso.

Mukamayamwitsa, milingo yochepa ya glucocorticoids, yofanana ndi 5 mg ya prednisone, siowopsa kwa mwana, chifukwa glucocorticoids amalowerera bwino mkaka wa m'mawere. Mlingo wapamwamba wa mankhwala osokoneza bongo komanso kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumatha kubweretsa nkhawa komanso kulepheretsa HHF.

Pochiza matenda angapo a musculoskeletal system, makamaka a kutupa, mankhwala monga glucocorticosteroids apezeka kuti agwiritsidwa ntchito. Musanamvetsetse zochizira, zotsatira ndi ma contraindication, muyenera kudziwa zomwe glucocorticosteroids (GCS) ndi.

Glucocorticosteroids ndi mankhwala omwe ali m'gulu la mahomoni a steroid ndipo ali ndi anti-yotupa, anti-allergic, anti-shock, immunosuppressive ndi katundu wina.

Kodi imagwiritsidwa ntchito liti?

Pochiza matenda a mafupa ndi msana, chisonyezo chachikulu chogwiritsa ntchito glucocorticosteroids amadziwika kuti ndi njira yotupa kwambiri, yomwe imakhala yolimba kwambiri ndipo samayankha mankhwala omwe si a antiidal. Zomwe mungagwiritsire ntchito palimodzi?

1. Nyamakazi (rheumatoid, post-traumatic, gouty, psoriatic, etc.).
2. Polyarthritis
3. Osteoarthrosis (pakakhala chizindikiro cha kutupa).
4. Ankylosing spondylitis.
5. Periarthritis.
6. Kutupa kwa thumba la synovial kapena articular.

Popereka mankhwala a GCS, dotolo amayesa kukwaniritsa njira yayitali yothira kugwiritsa ntchito mlingo wochepa wa mankhwalawa. Malangizo a glucocorticosteroid amathandizira makamaka kuwopsa kwa matendawa, mkhalidwe wa wodwalayo komanso mayankho ake ku chithandizo, kuposa zaka komanso kulemera.

Mphamvu zamankhwala

Kafukufuku waposachedwa wasayansi akuwonetsa kukhathamira kwa glucocorticosteroids pochiza matenda oopsa a kutupa. Kuchitika kwakanthawi kwamankhwala kumathandizanso ndikugwiritsa ntchito nthawi imodzimodzi ya GCS muyezo wotsika komanso mankhwala osapatsa-anti -idalidal. Zakhazikitsidwa kuti kwa odwala ambiri omwe ali ndi zilema chifukwa cha polyarthritis, zimakhala zosavuta pazochitika pambuyo poti athandizidwe masiku angapo ndi corticosteroids. Zomwe adokotala amawerengetsa pofotokoza glucocorticosteroids:

• Chepetsani kwambiri kupweteka kwam'malo omwe akukhudzidwa.
• Sinthani magwiridwe antchito.
• Chepetsani njira zowonongeka.
• Kuthana ndi kutupa.
• Chepetsani kufunika kwa mankhwala omwe si a antiidal.
• Kuonjezera luso la kugwiritsa ntchito mankhwala oyamba ndi kutupa.

Zochitika zamankhwala zawonetsa kuti odwala ambiri omwe ali ndi nyamakazi nthawi zambiri amakhala odalira glucocorticosteroid mankhwala ndipo amakakamizidwa kuti asinthe maphunziro awo, omwe mosakayikira amatsogolera pakupanga zovuta.

Momwe mungagwiritsire ntchito?

Njira zingapo zoyendetsera mankhwala a GCS ndizotheka. Monga lamulo, mankhwalawa amachititsa kutupa kwa minofu ndi mafupa, ma glucocorticosteroids amalowetsedwa molumikizana. Mwachindunji mogwirizana ndi cholinga cha kutupa, pazotheka achire kwambiri zimatheka.

Dziwani kuti nthawi zambiri, madzimadzi (exudate) amatha kudziunjikira mkati mwa malo akuluakulu. Zikatero, muyenera kuchotsa mankhwalawa, ndipo pokhapokha muzichita mankhwalawo. Nthawi zina, pofuna kukwaniritsa bwino, oyang'anira GCS mu ophatikizika amaphatikizidwa ndi glucocorticosteroid mankhwala mapiritsi. Chithandizo chofananacho chimagwiritsidwa ntchito pazovuta zamatenda omwe amadziwika kuti amapita patsogolo.

Jakisoni wa intra-articular wa mankhwala amachitika ndi dokotala wokhazikika yemwe ali ndi vuto losalala (chipinda chovala choyera).

Kukonzekera kwa GCS nthawi zambiri kumayikidwa pakamwa ngati mapiritsi kapena kutumikiridwa ndi makolo (mwa mtsempha kapena minofu).

Kutalika kwa maphunziridwe ake ndi kuchuluka kwa mankhwalawa zimatengera kuopsa kwa matendawo. Kwa odwala ena, maphunziro achirewo ndi miyezi ingapo kapena zaka. Ndi ntchito yayikulu ya pathological mu mafupa, mankhwala omwe amawatcha kuti amagwiritsa ntchito amagwiritsidwa ntchito. Pankhaniyi, mankhwalawa amaperekedwa kudzera m'mitsempha yamagazi 3 kwa masiku atatu otsatizana. Nthawi zambiri, kutsegula kwamankhwala ndi glucocorticosteroids kumakupatsani mwayi woletsa zochitika za kutupa.

Mitundu ya glucocorticosteroids

Glucocorticoids, monga cortisol, cortisone ndi corticosterone, ndi chilengedwe cha adrenal cortex. Kupanga kwawo kwakukulu kumachitika molingana ndi mtundu wa tsiku ndi tsiku. Kuchuluka kwake kumawonetsedwa ndi kufunikira kowonjezereka kwa mahomoni awa. Amatuluka kuchokera ku progesterone m'mitolo ndi ma mesh a adrenal cortex. Magazi amatengedwa kudzera mu transcortin. Glucocorticoids amachita kudzera mu zolandirira intracellular receptors. Zimakhudza kagayidwe ka chakudya, mapuloteni ndi mafuta. Ma mahormone amalepheretsanso njira zotupa, chifukwa chake amatchedwa anti-kutupa steroids. Ndizofunikira kuthana ndi zovuta zowopsa mthupi la munthu.

Zotsatira zoyipa

Malinga ndi kuwunika kwachipatala, ngakhale kuti zovuta zambiri zoyambira pakanthawi kogwiritsa ntchito GCS m'matenda otupa a msana ndi msana zimawerengedwa kuti ndi zowopsa, zina mwa izo zimawoneka kuti ndi zochulukirapo kuposa momwe zimakhalira ndi mankhwala ena odana ndi kutupa. Akatswiri ambiri amakhala ndi magawanidwe osagwirizana ndi kugwiritsa ntchito nthawi yayitali glucocorticosteroids m'magulu awiri:

• Amatha kuwongolera (shuga mellitus, kuchuluka kwa magazi, kusokonezeka kwa kugona, glaucoma, kulephera kwa mtima, zotupa zam'mimba, mafupa am'mimba).
• Kusalamulika (kuchuluka kwa thupi, kuchepa kwamatumbo, kusokonezeka kwa malingaliro, zotupa pakhungu, matenda osiyanasiyana, osteonecrosis, atherosulinosis).

Nthawi yomweyo, zidapezeka kuti kumwa mankhwala osapatsa mankhwala a anti-yotupa nthawi zambiri amakhumudwitsa kukula kwa zilonda zam'mimba komanso zam'minyewa zam'mimba kuposa kugwiritsira ntchito mankhwala ochokera ku gulu la GCS.Kuchiza ndi glucocorticoids moyenerera kumalumikizidwa ndi chiopsezo chowonjezereka cha matenda opatsirana, koma izi zimachitika makamaka kwa odwala omwe amalandira kuchuluka kwa mankhwalawa. Njira zosakwanira glucocorticosteroid mankhwala ziyenera kutchulidwa:

• Mkulu mlingo kapena, Mosiyana, otsika kwambiri.
• Njira yayitali yopanda chithandizo.
• Kuperewera kwa mankhwala oyamba ndi kutupa.

Ndi intraarticular makonzedwe a GCS, amodzi owopsa kwambiri, koma osowa, amatenga kachilomboka mkati mwa jakisoni. Kuphatikiza apo, katundu wa immunosuppress wa glucocorticoids amathandizira kukhazikitsa njira yotupa yoyipa. Nthawi zina, "post-jekeseni wovomerezeka" amatha kuwonedwa, jakisoni itatha, pakubwera mphamvu ya kutupa mkati mwa membrane wolumikizira, yemwe amatha maola angapo mpaka masiku awiri.

Kukhazikitsidwa kwa mankhwalawa minofu yam'mimba ndikosayenera kwambiri, chifukwa kupanga atrophic kapena necrotic njira ndizotheka.

Mahomoni opanga

Ma syntcheni glucocorticosteroids - ndi chiyani? Ma synthet glucocorticosteroids (corticosteroids) amagwiritsidwa ntchito ngati othandizira othandizira, colloquingly omwe amangotchedwa steroid. Amakhala ndi anti-kutupa kwambiri kuposa mankhwala achilengedwe.

Mu pharmacological mankhwala - makamaka nthawi zambiri - glucocorticosteroids amagwiritsidwa ntchito ngati mankhwala akale kapena a immunosuppression. Kugwiritsa ntchito kwawo mankhwalawa kuli ponseponse ngati vuto la adrenal cortex ndilosakwanira. Cholinga chawo chachikulu ndikulepheretsa zotupa, i.e., kuti tilepheretse phospholipase A 2, yomwe imatsogolera kuchepa kwa kupanga.

Monga lamulo, mu mankhwala a mahomoni, mulingo woyenera wa mankhwalawa umagwiritsidwa ntchito, zomwe sizimayambitsa zovuta zoyipa. Ndikwabwino kumwa mankhwalawa mu gawo limodzi komanso molingana ndi gawo lakuthupi la cortisol m'thupi, ndiye kuti m'mawa. Mankhwala a Glucocorticosteroid amaphatikizanso kuchepa kwapang'onopang'ono muyezo wa mahomoni omwe amaperekedwa kumapeto kwa chithandizo (kupewa adrenal cortical atrophy).

Ma steroid angagwiritsidwe ntchito pakamwa, komanso pamavuto owopsa (pamaso pangozi) - mwa jakisoni kapena kulowetsedwa m'mitsempha. Kugwiritsa ntchito kwawo kuyenera kuyang'aniridwa, i.e., kugwiritsidwa ntchito pokhapokha pali zifukwa zomveka bwino za izi, poganizira zotsatira zoyipa. Mlingo uyenera kusankhidwa payekhapayekha kwa wodwala aliyense, ayenera kusinthidwa malinga ndi kuopsa kwa matendawa.

Glucocorticosteroids ogwiritsidwa ntchito ku dermatology

Ma Horone a adrenal cortex ali ndi anti-yotupa, immunosuppressive ndi antipruritic zotsatira. Amagwiritsidwa ntchito kwambiri ku dermatology matenda a pakhungu. Topical glucocorticosteroids - ndalama zokhudzana ndi mankhwala omwe amagwiritsidwa ntchito kwambiri pochiza matenda a dermatological. Zitha kugwiritsidwa ntchito, makamaka, pochiza:

Mafuta a Glucocorticosteroid amagwiritsidwa ntchito pochiza psoriasis. Ma-gel, mafuta, ma lotion amagwiritsidwanso ntchito pothandiza kutsekeka kwa khungu ndi kuyabwa kwa khungu. Madzi amadzimadzi a Steroid amalimbikitsidwa kuti azigwiritsidwa ntchito pakhungu. Monga chithandizo chopitilira, komanso mwanjira zina, kugwiritsa ntchito mankhwala a steroid, ndikofunikira kugwiritsa ntchito mankhwala ofooka (kupewa mavuto oyambitsidwa).

Glucocorticosteroid osteoporosis

Chimodzi mwazinthu zovuta kwambiri za chithandizo cha glucocorticosteroid wa nthawi yayitali. Komabe, malinga ndi akatswiri ena, kuthamanga kwamatenda a nyamakazi komanso kuchepa kwa zochitika zolimbitsa thupi kumaonedwa ngati zinthu zosafunikira kwenikweni pakuwoneka kwa mafupa.kuposa chithandizo cha nthawi yayitali corticosteroids.

Kuti muchepetse chiopsezo chokhala ndi vutoli, madokotala ambiri amalimbikitsa kusintha kwambiri moyo wawo, makamaka kwa odwala omwe amalandila glucocorticosteroids kwa nthawi yayitali. Zomwe zikufunika kuchitidwa:

1. Siyani kusuta ndi kumwa mowa.
2. Chitani masewera olimbitsa thupi pafupipafupi.
3. Idyani zakudya zokhala ndi calcium komanso vitamini D.
4. Nthawi zambiri kukhala padzuwa.
5. Ngati ndi kotheka, imwani mankhwala omwe adokotala adalemba (, calcitonin, ndi zina).

Steroids pa matenda a kupuma dongosolo

Mankhwala a Hormonal a mankhwala onse omwe amagwiritsidwa ntchito pochiza matenda a bronchi ali ndi mphamvu kwambiri. Pambuyo kukhazikitsa kwawo, pali kuchepa kwa kutukusira kwa mucous membrane ndi secretion wa mucous, bronchial epithelium imabwezeretseka. Kukhazikitsidwa kwa ma steroids m'thupi kumachepetsa gawo lomaliza la chifuwa, komanso kuchuluka kwa bronchi. Kusiyanitsa:

1. Glucocorticosteroids mu mawonekedwe a inhaled opaleshoni. Ndiwo mtundu wa mankhwala omwe angagwiritsidwe ntchito kwambiri pochiza matenda onse amphumo a bronchial.
2. Glucocorticosteroids, amagwiritsidwa ntchito ngati jakisoni wambiri m'magazi. Mtunduwu umagwiritsidwa ntchito mwa mitundu yayikulu ya mphumu ya bronchial, pomwe njira zina zamankhwala sizipereka zotsatira.
3. Steroids yogwiritsira ntchito pakamwa ingagwiritsidwenso ntchito pochiza kwakanthawi kambiri panthawi yomwe matendawa amatha.

Mimba komanso kuyamwa

Kafukufuku wazowunikira wokhudzana ndi chitetezo cha glucocorticosteroid ntchito pa nthawi yomwe ali ndi pakati sanachitike. Komabe, madotolo amatha kupereka mankhwalawa kwa mayi wovomerezeka, pokhapokha ngati chithandizo chomwe chikuyembekezeredwa chamankhwala chitha kupitirira chiwopsezo cha mwana. Kuphatikiza apo, amayi oyamwitsa amalimbikitsidwa kuyimitsa kuyamwitsa panthawi ya glucocorticosteroid mankhwala.

Glucocorticoids muzochita zamankhwala

Kharkov Institute for Advanced Medical Maphunziro

Pansi pa zochitika zathupi, maselo a adrenal cortex bundle zone amatchingira glucocorticoids awiri akuluakulu m'magazi - cortisone ndi cortisol (hydrocortisone). Kubisalira kwa mahomoniwa kumayendetsedwa ndi corticotropin ya adenohypophysis (yomwe kale imatchedwa adrenocorticotropic mahomoni). Kuwonjezeka kwa cortisol m'magazi ndi momwe limagwirira ntchito kumalepheretsa kubisala kwa corticoliberin mu hypothalamus ndi corticotropin mu gland.

Kukula kwa kubisika kwa glucocorticoids m'magazi masana kumasiyana kwambiri. Zambiri zomwe zimakhala ndi mahomoni m'magazi zimawonedwa m'mawa kwambiri (maola a 6-8), ochepera - madzulo ndi usiku.

Zotsatira zathupi la glucocorticoids ndizosiyana kwambiri ndi zomwe zimayamba chifukwa cha insulin. Ma mahormone ali ndi mphamvu pa mapuloteni kagayidwe (i.e., amathandizira kugwetsa mamolekyulu ovuta a protein kukhala zinthu zosavuta) ndi anti-anabolic effect (i.e., kupewa biosynthesis ya mamolekyulu amapuloteni). Zotsatira zake, thupi limaphwanya mapuloteni ndikuwonjezera kuchuluka kwa zinthu za nayitrogeni. Kuphulika kwa mapuloteni kumachitika minofu, yolumikizika ndi mafupa. Magazi a albin amachepetsedwa.

Glucocorticoids imathandizira triglyceride catabolism ndikuletsa mafuta kaphatikizidwe kuchokera ku chakudya. Nthawi yomweyo, kuchepa kwa minofu ya adipose ya malekezero nthawi zambiri kumaphatikizidwa ndikuwonjezereka kwa chiwonetsero cha mafuta pakhoma lam'mimba komanso pakati pa masamba. Hyperglycemia motsogozedwa ndi mahomoni amachitika chifukwa cha kuchuluka kwa kupangika kwa glucose m'chiwindi kuchokera ku amino acid (gluconeogeneis) ndi kuponderezedwa kwa magwiritsidwe ake ndi minofu, komanso zomwe glycogen zili m'chiwindi zimakulanso. Glucocorticoids amachepetsa kukhudzika kwa minofu kumapangitsa insulin ndi syntic acid synthesis.

Ma mahomu amachititsa chidwi cha adrenoreceptors ku catecholamines, kuwonjezera mphamvu za Pressor za angiotensin II, kuchepetsa kupezeka kwa capillary, komanso kutenga nawo mbali pakukhalitsa kwamtundu wamtundu wa arteriole ndi contractility ya myocardial. Mothandizidwa ndi glucocorticoids, kuchuluka kwa magazi a ma lymphocyte, ma monocytes, ma eosinophils ndi basophils amatsika, ma neutrophils amatuluka kuchokera m'mphepete mwa mafupa ndikuwonjezereka kwawo kwa magazi owonongera. Ma mahomoni amasunga sodium ndi madzi m'thupi motsutsana ndi kutayika kwa potaziyamu, kuletsa kuyamwa kwa calcium, komanso amathandizira kuti amasulidwe am'mimba ndi mafupa ake. Glucocorticoids imawonjezera chidwi cha chidwi ndi kusefukira kwa mitsempha, kutenga nawo mbali pakukonzekera kupsinjika kwa zochitika, kumakhudza psyche yamunthu.

Ma glucocorticoids achilengedwe ndi mawonekedwe awo ophatikizira amagwiritsidwa ntchito kwambiri kuchipatalachi makamaka chifukwa ali ndi makhalidwe ena ofunikira: ali ndi anti-yotupa, immunosuppression, anti-allergic komanso anti-shock. Zotsatira zomaliza zamankhwala zimatengera zinthu zambiri, kuphatikizapo nthawi ya chithandizo, kuchuluka kwa mankhwalawa, njira ndi magwiritsidwe ake a chitetezo, zokhudzana ndi immunological ndi immunogenetic pamatenda omwewo, ndi zina. palibe ubale wolunjika. Chifukwa chake, dexamethasone ali ndi ntchito yotsutsa-yotupa komanso yotsika kwambiri ya immunosuppressive.

Makhalidwe oyerekeza glucocorticoids

Muzochita zamankhwala, glucocorticoids achilengedwe (cortisone ndi hydrocortisone) ndi zotumphukira zawo za semisynthetic zimagwiritsidwa ntchito. Omaliza, nawonso amagawidwa kukhala osagwirizana (prednisone, prednisolone, methylprednisolone) ndi fluorinated (triamcinolone, dexamethasone ndi betamethasone).

Ikaperekedwa, glucocorticoids imathamanga mwachangu ndipo imatsala pang'ono kulowa mu jejunum yapamwamba. Kudya sikumakhudza kuchuluka kwa mayamwidwe am'madzi, ngakhale kuthamanga kwa njirayi kumatsika pang'ono.

Zovuta zakugwiritsira ntchito mitundu yomwe ingabayidwe ndi chifukwa cha mphamvu zonse za glucocorticoid palokha komanso ester yomwe imalumikizana nayo. Mwachitsanzo, ma proinates, hemisuccinate ndi phosphates amasungunuka m'madzi ndipo, akaperekedwa ndi makolo, amakhala achangu koma osakhalitsa. M'malo mwake, ma acetates ndi acetonides ndi ma crystalline ayimitsidwe wabwino ndipo samasungunuka m'madzi. Zochita zawo zimayamba pang'onopang'ono kwa maola angapo, koma zimatenga nthawi yayitali (masabata). Mafuta osungunuka a glucocorticoid amatha kugwiritsidwa ntchito kudzera m'mitsempha;

Kutengera nthawi yayitali yothandizira, ma glucocorticoids onse amagawidwa m'magulu atatu (tebulo 1). Kudziwa mitundu yofanana ya corticosteroids imakupatsani mwayi wina ngati mukufunika. Mfundo yomwe idalipo kale - "piritsi la piritsi" (ndiye kuti ngati kuli koyenera kusamutsa wodwala kupita ku glucocorticoid wina, adamutsegulira mapiritsi ambiri a mankhwalawa monga momwe adalandirira kale) - pakadali pano sigwira ntchito. Ichi ndi chifukwa cha kuyambitsidwa kwamankhwala omwe ali ndi mitundu ya glucocorticoids omwe ali ndi mawonekedwe osiyanasiyana a mfundo yogwira.

Glucocorticoid mahomoni

Kutalika kwa chochita	Dzina lamankhwala	Mlingo wofanana
Zochita zazifupi	Hydrocortisone	20
	Cortisone	25
	Prednisone	5
	Prednisone	5
	Methylprednisolone	4
Triamcinolone	4
Dera lokwanira	2
Kuchita motalika	Dexamethasone	0,75
	Muthanga	0,6

Ma glucocorticoids achilengedwe amakhala ndi zochita za mineralocorticoid, ngakhale ali ochepa mphamvu kuposa mineralocorticoids.Ma glucocorticoids osaphatikizidwa ndi fluorocorticoids amakhalanso ndi zotsatira za mineralocorticoid (zovuta zake zomwe, ndizotsika, zomwe zimayambitsa zotsatira za glucocorticoids achilengedwe). Pokonzekera bwino, mineralocorticoid ntchito kulibe (gome 2). Ntchito ya glucocorticoid ya mankhwala a semisynthetic ndi yapamwamba kuposa ya cortisone ndi hydrocortisone, yomwe imafotokozedwa ndi zomanga mapuloteni ochepa poyerekeza ndi glucocorticoids achilengedwe. Chizindikiro cha mankhwala osinthika ndimachulukidwe kagayidwe m'thupi, omwe amafunika kuwonjezeka kwa nthawi ya mankhwala.

Makhalidwe oyerekeza a glucocorticoids pakugwiritsa ntchito kwadongosolo

Kutalika kwa chochita	Dzina lamankhwala	Gluco ntchito ya corticoid	Zachuma ntchito ya corticoid
Zochita zazifupi	Hydrocortisone	1	1
	Cortisone	0,8	1
	Prednisone	4	0,8
	Prednisone	4	0,8
	Methylprednisolone	5	0,5
Kutalika kwapakati	Triamcinolone	5	-
Kuchita motalika	Dexamethasone	30	-
	Muthanga	30	-

Amagwiritsidwe ntchito motere: mankhwala ena alionse). Mlingo wotere nthawi zambiri umaperekedwa kuti ukonzedwe. Ngati mlingo wa tsiku ndi tsiku wa prednisolone ndi 20-40 mg (mapiritsi a 4-8), amalankhula "mwapakatikati" Mlingo wa glucocorticoids, ndi oposa 40 mg / tsiku - la "mkulu". Miyezo yapafupi ndi yomwe idaperekedwayi imapezekanso powerengera tsiku lililonse la corticosteroids pa kilogalamu imodzi ya kulemera kwa thupi la wodwalayo. Malire a malire pakati pa Mlingo "wapakatikati" ndi "wapamwamba" ndi 0,5 mg wa prednisone pa 1 kg ya kulemera kwa thupi patsiku.

Pazaka 20 zapitazi, chipatalachi chagwiritsanso ntchito mankhwala othandizira kwambiri a glucocorticoids (osachepera 1 g ya methylprednisolone patsiku) kwa masiku angapo. Mankhwalawa amatchedwa "chithandizo cha zimachitika."

Mlingo wa glucocorticoids wodziwika koyambirira kwa chithandizo cha matenda ena ake zimadalira makamaka mawonekedwe a nosological ndi kuopsa kwa matendawa. M'badwo wa wodwala, kupezeka kapena kusapezeka kwa zodwala, kugwiritsa ntchito mankhwala munthawi yomweyo ndi zinthu zina zimakhudzanso mlingo.

Zisankho zazikulu pakugwiritsira ntchito mayeso a glucocorticoids zitha kuyimiridwa motere:

ma mndandanda> ma mndandanda> ma mndandanda> ma mndandanda> ma mndandanda> ma mndandanda> mndandanda> mndandanda> mndandanda> mndandanda>

kunja - khungu, maso, makutu (mwanjira ya mafuta onunkhira, madontho, mafuta, mafuta odzola, ma aerosols),

inhalation - m'mapapu kapena m'mphuno.

subshell (chapakatikati),

intradermal - m'mabala,

intracavitary - mu pleural patsekeke, intrapericardically, etc.,

intraarticular ndi periarticular,

ntchito yamakina:

mkati

mumakandulo (othandizira),

parenteral (makamaka intramuscularly komanso mtsempha wamagazi).

mndandanda>

Pankhani yakulimbikira ndi kuuma kwa njira yothanirana ndi kutupa, komanso kulekerera, prednisolone ndi methylprednisolone ndizabwino kwambiri.

Prednisone monga mankhwala wamba a pharmacodynamic mankhwala. Chiwerengero cha glucocorticoid ndi mineralocorticoid wa prednisolone ndi 300: 1.

Methylprednisolone Poyerekeza ndi prednisone, imakhala ndi zochita zambiri za glucocorticoid (pofika 20%) ndipo imakhala ndi mineralocorticoid yofooka. Ubwino wa mankhwalawa ndiwopatsa chidwi kwambiri ndi psyche ndi chilakolako chofuna kudya, zomwe zimapangitsa kukhazikitsidwa kwake kwa odwala omwe ali ndi psyche yosakhazikika komanso onenepa kwambiri.

Prednisone ndi hydroxylated m'chiwindi (komwe imasandulika kukhala prednisone), chifukwa chake sichilimbikitsidwa chifukwa cha matenda oopsa a chiwindi.Wosavuta kuposa prednisone, komabe, muzochita zamankhwala samagwiritsidwa ntchito pafupipafupi poyerekeza ndi ena.

Triamcinolone - wowonjezera glucocorticoid, wopanda mineralocorticoid ntchito. Chifukwa chake - zochepa poyerekeza ndi mankhwala ena, kuthekera kusunga sodium ndi madzi. Poyerekeza ndi prednisone, imatchulidwa kwambiri (20%) komanso glucocorticoid wautali. Komabe, nthawi zambiri zimayambitsa maselo osafunikira kuchokera ku minofu ya minofu ("triamcinolone" myopathy) ndi khungu. Chifukwa chake, kugwiritsa ntchito mankhwalawa kwa nthawi yayitali ndikosayenera.

Dexamethasone mu glucocorticoid ntchito imakhala yokwanira 7 kuposa prednisone. Ndi glucocorticoid wosinthika ndipo alibe mineralocorticoid. Poyerekeza ndi mankhwala ena, imachepetsa kugwira ntchito kwa adrenal cortex kwakukulu. Kugwiritsa ntchito nthawi yayitali sikulimbikitsidwa chifukwa choopsa cha zoyipa zoyipa (makamaka, kuletsa kwa hypothalamic-pituitary-adrenal axis, kusokonezeka kwa metabolic, zotsatira zoyipa za psycho.

Muthanga - glucocorticoid wosinthika, womwe uli pafupi ndi mphamvu komanso nthawi yayitali dexamethasone. Zimachulukitsa pang'ono kumapeto kwa ntchito ya glucocorticoid (8-10 kuchulukirapo kuposa ya prednisolone) ndipo pocheperako zimakhudza kagayidwe kazakudya. Betamethasone phosphate imasungunuka m'madzi ndipo imatha kutumikiridwa kudzera m'mitsempha ndi subconjunctively. Pa intramuscular, intraarticular and periarticular management, osakaniza awiri a betamethasone esters amagwiritsidwa ntchito - phosphate (odzipereka mwachangu) ndi dipropionate (odzipereka pang'onopang'ono). Kusakaniza uku ndi kuyimitsidwa koyenda bwino komwe sikungaperekedwe kudzera mkati. Phosphate imapereka zotsatira mwachangu (mkati mwa mphindi 30), ndipo diproprionate imakhala ndi nthawi yayitali, mpaka milungu 4 kapena kupitilira apo.

Cortisone pakadali pano sagwiritsidwa ntchito chifukwa chogwira ntchito pang'ono komanso kulolera kwambiri. Pamodzi ndi hydrocortisone, imakhala ndi ntchito yotchulidwa kwambiri mineralocorticoid pakati pa glucocorticoids onse. Mbali yayikulu yofunsira ndikulowa kwina kwa adrenal kusowa kwa odwala omwe ali ndi chiwindi chokhazikika (popeza cortisone imasandulika kukhala hydrocortisone mu chiwindi, kugwiritsa ntchito mankhwalawa sikulimbikitsidwa pakuwonongeka kwakukulu kwa chiwalo ichi).

Hydrocortisone Ndi pafupi glucocorticoid wokhawo yemwe angagwiritsidwe ntchito pochiritsa makolo kwa nthawi yayitali, koma amachepetsedwa kwambiri ndi mankhwala amakono kulolera. Wofowoka kuposa prednisone mu glucocorticoid zochita (maulendo 4), koma amangoipitsitsa chifukwa cha mineralocorticoid kanthu. Hydrocortisone nthawi zambiri imagwiritsidwa ntchito pochotsa chilengedwe komanso kuvundikira kozama mwa odwala omwe ali ndi vuto la hypothalamic-pituitary-adrenal axis. Mu pachimake adrenal insufficiency ndi zina mwadzidzidzi zinthu za hydrocortisone, hemisuccinate ndi mankhwala osankha.

Beclomethasone, flunisolid, budesonide, triamcinolone acetonide ndi fluticasone kutumikiridwa ndi inhalation. Beclomethasone (beclometh, becotide, etc.) nthawi zambiri amapatsidwa mankhwala ochizira matenda a mphumu. Imakhala ndi dongosolo pang'ono, ngakhale mu Mlingo waukulu (1000-2000 mcg / tsiku) imayambitsa mafupa ndi zina. Kugwiritsa ntchito kwa flunisolid (ingacort) poyerekeza ndi beclomethasone ndizotheka kuti kungayambitse candidiasis pamlomo wamkamwa. Mukapumira, budesonide (pulmicort) imakhala yothandiza kwambiri ndipo imakhudza ntchito ya impso kuposa beclomethasone. Fluticasone (flixotide, flixonase) yolumikizana ndi glucocorticoid receptors imakhala yokwera katatu kuposa prednisone komanso 2 nthawi yayitali kuposa budesonide. Imakhala ndi mphamvu yolimbana ndi kutupa kawiri konse kuposa beclomethasone.

Kugwiritsa ntchito kwachilengedwe kwa glucocorticoids

Mpaka pano, zokambirana zikupitilira pakusankhidwa kwa Mlingo wokwanira ndi mitundu yayitali ya mankhwala, njira zoyendetsera, nthawi yayitali ya mankhwala, mavuto. Pazonse, lingaliro la kugwiritsa ntchito kotakasa mankhwala a corticosteroids nthawi zambiri silibweretsa zovuta zazikulu kwa madokotala. Chifukwa chake, mu chiwonetsero chotsatirachi, cholinga chachikulu chikhala pakugwiritsa ntchito mahomoni mwadongosolo.

Ngati zokhudza zonse makonzedwe a glucocorticoids n`kofunika, m`kamwa makonzedwe amakonda. Ngati ndizosatheka kuyambitsa mankhwalawa mkati, angagwiritsidwe ntchito muma suppositories, mlingo mu nkhani iyi ukuwonjezeka ndi 25-50%. Glucocorticoids yomwe ilipo mu mitundu yovulaza imapangidwa mofulumira mu thupi mkati mwa intramuscular, makamaka, intravenous management, chifukwa chake zotsatira zake zimakhala zazifupi komanso nthawi zambiri zimakhala zosakwanira kwa nthawi yayitali. Kuti mupeze zofanana, poyerekeza ndi kutsekemera kwa pakamwa, njira yothandizira, mapiritsi a abereki amayenera kuperekedwa kawiri kawiri ndipo kubayidwa pafupipafupi. Mankhwala omwe alipo nthawi yayitali (mwachitsanzo, triamcinolone acetonide, kapena kenalog) sagwiritsidwa ntchito pochiza "othandizira", koma makamaka monga othandizira kapena am'deralo (mwachitsanzo, intraarticular).

M'mawa, Hypothalamic-pituitary-adrenal axis imakhala yocheperako makamaka pazovuta zoletsa za corticosteroids. Mukamagawa tsiku ndi tsiku glucocorticoids m'magawo atatu ndi kuwatenga pafupipafupi, chiopsezo chopondereza axel-pituitary-adrenal axis chimakulanso. Chifukwa chake, nthawi zambiri, mahomoni amapatsidwa mtundu wa mankhwala a m'mawa umodzi (makamaka mankhwala osokoneza bongo kwa nthawi yayitali), kapena 2 / 3-3 / 4 ya mlingo wa tsiku lililonse amatengedwa m'mawa, ndipo zotsalazo zimatengedwa masana. Njira yofunsira iyi imakupatsani mwayi wochepetsera chiopsezo cha matenda a hypothalamic-pituitary-adrenal axed ndikuchepetsa chiopsezo cha mafupa.

The achire dzuwa la glucocorticoids kumawonjezera ndi kuwonjezeka mlingo ndi pafupipafupi makonzedwe, koma zovuta zovuta Komanso. Ndi kusinthana kwamagwiritsidwe ntchito (masiku ena onse) mahomoni, kuchuluka kwa mayendedwe olakwika kumakhala kochepa, koma muzochitika zambiri makonzedwe awa sagwira ntchito mokwanira (mwachitsanzo, ndi matenda am'magazi, (nonspecific) ulcerative colitis, zotupa zoyipa, komanso milandu yayikulu yamatenda). Njira zina zochiritsira, monga lamulo, zimagwiritsidwa ntchito pambuyo pa kuponderezedwa kwa ntchito yotupa ndi ntchito ya kuchepa kwa magazi ndi kuchepa kwa mankhwalawa. Mu njira yosinthira, mlingo wa mahomoni ofunikira kwa nthawi ya maola 48 amatumizidwa tsiku lililonse lachiwiri m'mawa panthawi. Njirayi imalola kuchepetsa mphamvu ya ma glucocorticoids amkati pantchito ya adrenal cortex ndipo, chifukwa chake, kupewetsa kukwiya kwake. Kuphatikiza apo, kugwiritsa ntchito mitundu yosiyanasiyana ya glucocorticoids, chiopsezo cha matenda opatsirana chimachepa, ndipo kukula kwa ana sikumatchulidwanso ngati kudya kwama mahomoni tsiku ndi tsiku.

Nthawi zina, mwachitsanzo, omwe ali ndi nephrotic syndrome mu ana), njira zina zochiritsira zosagwiritsidwa ntchito masiku onse ndizomwe zimapangidwira kuchokera masiku oyambirira a chithandizo. Nthawi zambiri, dongosolo lotere la makonzedwe a mahomoni limasungidwa kwa odwala omwe atha kukwanitsa kukhazikika pogwiritsa ntchito glucocorticoids a tsiku ndi tsiku. Otsatirawa ndi chitsanzo chosamutsa wodwala ku njira ina yothandizira, momwe mlingo woyambirira wa prednisolone anali 50 mg.

Njira zina zochizira, ndi corticosteroids okhawo omwe amagwiritsidwa ntchito (prednisone, prednisolone, methylprednisolone). Mutatenga mlingo umodzi wa mankhwalawa, hypothalamic-pituitary-adrenal axis imapanikizika kwa maola 12 mpaka 65.Ndi kusankha kwa glucocorticoids omwe akhala akuchita kwa nthawi yayitali tsiku lililonse tsiku lililonse (triamcinolone, dexamethasone, betamethasone), chiopsezo cha kuponderezana kwa axothothic-pituitary-adrenal axis chatsala, motero sikokwanira kugwiritsa ntchito mankhwalawa. Malo ogwiritsa ntchito mahomoni achilengedwe (cortisone ndi hydrocortisone) pakali pano ali ndi malire m'malo mochizira matenda a adrenal insufficiency ndi suppressor adrenogenital syndrome.

Ngati mukuwonjezera kuchuluka kwa matendawa patsiku lachiwiri ("lopanda mahomoni"), tikulimbikitsidwa kuti muonjezere muyeso wa mankhwalawa tsiku loyamba, kapena mumwenso mlingo wachiwiri tsiku lachiwiri.

Mlingo waukulu (mwachitsanzo, 0,6-1.0 mg wa prednisolone pa 1 makilogalamu a thupi patsiku), kapena Mlingo womwe umagawidwa pakhungu zingapo tsiku lonse umasonyezedwa m'magawo oyamba a matenda ovuta kwambiri. Ndikofunikira kuyesetsa kusunthira wodwala mkati mwa masabata 1-2 kukhala gawo limodzi lam'mawa lonse tsiku lililonse. Kuchepetsa kwakukulu. Kuchepetsa pang'ono pang'onopang'ono kumaphatikizidwa ndikuwonjezeka kwa kuchuluka ndi zovuta za chithandizo cha glucocorticoid, komanso mwachangu kwambiri - chikuwonjezera kwambiri matendawa.

Kuti muchepetse mavuto, muyenera kulingalira za "kupulumutsa ma steroid." Mu rheumatology, mwachitsanzo, izi zimatheka pogwiritsa ntchito mankhwala osagwiritsa ntchito mankhwala a anti-yotupa kapena chithandizo choyambira (immunosuppressants, antimalarials, etc.). Kusinthana ndi njira ina yochepetsera zovuta za mankhwala a steroid.

Mankhwala omwe ali ndi Mlingo wambiri wa glucocorticoids akhoza kukhala osakhutira chifukwa chosagwira bwino ntchito komanso / kapena kuwoneka kwa zovuta kwambiri. Zikatero, muyenera kulingalira za njira yothandizira, monga, kulumikizana kwamitsempha yama mahomoni akuluakulu kwakanthawi kochepa. Ngakhale pakadali pano palibe tanthauzo lenileni la chithandizo chogwira mtima, liwuli limakonda kufotokozera mwachangu (mkati 30-60 mphindi) kukhazikitsa kwamkati waukulu wa glucocorticoids (1 g) kamodzi patsiku kwa masiku atatu. Mwanjira yodziwika bwino, chithandizo chamatsenga chimatha kuyimiridwa ngati mankhwala ophatikizira a methylprednisolone (mankhwalawa amagwiritsidwa ntchito ndi ena) pa mlingo wa 1 g / sq. thupi padziko mita 1-5. Pakadali pano, chithandizo cha zamkati ndi mahomoni a steroid nthawi zambiri chimagwiritsidwa ntchito kumayambiriro kwa chithandizo chamatenda angapo apakatikati ogwirika. Kupindulitsa kwa njira imeneyi pakukonzanso mankhwala kwa nthawi yayitali kumakhala kochepa.

Pazonse, kugwiritsa ntchito kwa mankhwala a steroid ochepa poizoni amayamba kuposa kugwiritsa ntchito kwadongosolo. Chiwopsezo chachikulu kwambiri chogwiritsa ntchito mahomoni mwadongosolo chimachitika ngati mlingo wa tsiku ndi tsiku wagawidwa ma Mlingo angapo. Mlingo wa tsiku ndi tsiku mukamamwa mlingo umodzi, kuchuluka kwake kumakhala kochepa, komanso njira zina zochiritsira ndi zomwe zimapatsa poizoni.

Pogwiritsa ntchito tsiku ndi tsiku, mapangidwe achilendo a glucocorticoid okhala ndi theka lalitali moyo (mwachitsanzo, dexamethasone) amayambitsa zotsatira zoyipa nthawi zambiri kuposa mankhwala omwe amakhala ndi theka lalifupi komanso pakati. Kukhazikitsidwa kwa Mlingo wapamwamba wa ma steroid ndi otetezeka ngati nthawi yayitali yogwiritsa ntchito osapitilira sabata imodzi, atamwa nthawi yayitali mankhwala oterowo, mbali zazikuluzikulu zamankhwala ndi zovuta za poizoni zitha kunenedweratu.

Kugwiritsa ntchito ma glucocorticoids achilengedwe komanso osasinthasintha panthawi yoyembekezera kumakhala kotetezeka kwa mwana wosabadwa. Pogwiritsa ntchito mankhwala osakanikirana kwa nthawi yayitali, zimachitika zosakhudzana ndi mwana wosabadwayo, kuphatikizapo zoperewera.Ngati mayi yemwe ali mu ntchito akhala akutenga glucocorticoids zaka 1.5-2 zapitazo, hydrocortisone hemisuccinate 100 mg maola 6 aliwonse amathandizidwa kuti athetse kuchepa kwa mphamvu ya adrenal.

Mukamayamwitsa, kuchuluka kwa mahomoni ofanana ndi 5 mg ya prednisone sikuvulaza mwana. Mlingo wapamwamba wamankhwala ungayambitse kudabwitsika ndi kulepheretsa matenda a hypothalamic-pituitary-adrenal axis. Chifukwa chake, amayi omwe amatenga mlingo waukulu wa glucocorticoids samalimbikitsidwa kuyamwitsa.

Pofuna kupewa kupuma movutikira mu makanda obadwa kale, mankhwala omwe amagwiritsidwa ntchito kwa nthawi yayitali amagwiritsidwa ntchito (nthawi zambiri dexamethasone). Mothandizidwa ndi makulidwe a dexamethasone kwa mayi wokhala ndi pakati mpaka milungu 34, tikulimbikitsidwa kuti pakhale maola 24-48 usanafike poyembekezera. Kukonzanso kwa mankhwalawa ndikotheka ngati kubadwa pasanachitike sikunachitike mwa masiku 7 otsatira.

Chiwembu chosinthira njira ina yochiritsira pang'onopang'ono kusiya kwa glucocorticoids

Tumizani njira zina zochiritsira		Glucocorticoid mlingo kuchepetsa
Tsiku	Prednisone mg	Tsiku	Prednisone mg	Tsiku	Prednisone mg
1	60	11	90	21	85
2	40	12	5	22	5
3	70	13	90	23	80
4	30	14	5	24	5
5	80	15	90	25	80
6	20	16	5	26	5
7	90	17	85	27	80
8	10	18	5	28	5
9	95	19	85	29	80
10	5	20	5	30	0

Kuphunzitsa wodekha

Wodwalayo ayenera kudziwa zovuta zomwe zingachitike chifukwa cha kusakwanira kwa axis ya hypothalamus-pituitary-adrenal gland, yomwe imatha kuchitika chifukwa cha kugwiritsa ntchito kwa glucocorticoids. Chenjezani wodwala za kusadziletsa kwina pakukwaniritsa chithandizo chamankhwala kapena kuchepetsa msanga muyezo wa mahomoni popanda upangiri woyenera wa kuchipatala. Kuyankha kwa hypothalamus-pituitary-adrenal axis kutha kupsinjika kumatha kuchepa ngakhale pambuyo pa kutsekemera kwa glucocorticoids tsiku lililonse. Ngati chithandizo chamankhwala cham'kamwa chokhazikika chimasokonezedwa kwa maola opitilira 24, ndiye kuti wodwalayo amatha kudwala mozungulira chifukwa cha kupsinjika kwa thupi, zoopsa, matenda, ndi opareshoni, zomwe nthawi zambiri zimafuna kukhazikitsidwa kwa glucocorticoids. N`zosatheka kulosera motsimikizika za kusowa kwa hypothalamic-pituitary-adrenal axis kapena ndi kuchuluka kwa mahomoni, kapena nthawi yayitali ya chithandizo, kapena ndi kuchuluka kwa cortisol posala plasma (ngakhale kusowa kwina kumayamba pamene kuchuluka kwa glucocorticoids kwalamulidwa.

Tiyenera kudziwa kuti mankhwalawa omwe ali ndi mahomoni amathandizira kuti azilakalaka komanso kuyambitsa kulemera ndikugogomezera kufunika kwa zakudya musanayambe mankhwala. Dokotala ayenera kufotokozera za matenda ashuga, steroid myopathy, neuropsychic, matenda ndi zovuta zina za glucocorticoid mankhwala kwa wodwala.

Kuchita ndi mankhwala ena

Mankhwala ena amatha kuthana ndi kuchuluka kwa glucocorticoids m'magazi. Chifukwa chake, phenobarbital ndi rifampicin amalimbitsa kagayidwe ka mahomoni m'chiwindi ndipo potero amachepetsa kuchiritsa kwawo. Kugwiritsidwa ntchito kophatikizira kwa ma steroid ndi thiazide diuretics kumachulukitsa chiopsezo cha hyperglycemia ndi hypokalemia. Makonzedwe a munthawi yomweyo a glucocorticoids ndi acetylsalicylic acid amachepetsa mphamvu yotsiriza m'magazi kuti ndende yake ndiyotsika poyerekeza ndi achire.

Pomaliza

Mahomoni a Glucocorticoid ali ndi malo oyenera pazachipatala. Nthawi zambiri, kugwiritsa ntchito mankhwalawa moyenera komanso moyenera kumapulumutsa miyoyo ya odwala, kumathandiza kupewa (kuchedwetsa) kuyambika kwa kulumala kapena kuchepetsa mawonekedwe ake. Nthawi yomweyo, m'magulu, kuphatikiza pazachipatala, kuopa "mahomoni" ndizofala kwambiri. Chinsinsi cha demthologization ya glucocorticoids ndikugwiritsa ntchito kwawo mwanzeru m'zochita zamankhwala.

1. Belousov Yu. B., Omelyanovsky V.V. Clinical pharmacology of matenda a kupuma.— M: Universum Publishing, 1996.— P. 119-130.
2. Bereznyakov I.G.Glucocorticosteroids: ntchito zamankhwala (kalozera wa madokotala) .- Kharkov, 1995.— 42 p.
3. Mfundo Zofunika za kuyendetsa thupi kwa anthu (motsogozedwa ndi B. I. Tkachenko) .- St. Petersburg: International Foundation for the Science of Science .- T. 1.- S. 178-183.
4. Sigidin Ya. A., Guseva N.G., Ivanova M.M. Diffuse matenda a minyewa yolumikizika.— M: Medicine, 1994.— 544 p.
5. Strachunsky L.S., Kozlov S. H. Glucocorticoid kukonzekera. - Smolensk, 1997 .- 64 p.
6. Buku lotsogolera achire la University of Washington (motsogozedwa ndi a M. Woodley, A. Whelan) .- M .: Kudziyesa, 1995.— 832 p.
7. Boumpas D. T., Chrousos G. P., Wilder R. L., Cupps T. R. Glucocorticoid chithandizo cha matenda opatsirana panjira yolimbana ndi matenda: zoyambirira ndi zamankhwala pazolumikizana. - Annals of medical mkati.1993. Vol.119, No. 12.- P. 1198-1208.

Tsambali limapereka chidziwitso pazachidziwitso chokha. Kuzindikira ndi kuchiza matenda kuyenera kuchitika moyang'aniridwa ndi katswiri. Mankhwala onse ali ndi contraindication. Kufunsira kwa akatswiri ndikofunikira!

Steroids pa matenda a matenda amitsempha

Mankhwala omwe amagwiritsidwa ntchito polimbana ndi matenda amisempha amaphatikiza glucocorticosteroids. Kodi ndi chiyani, ndi mankhwalawa omwe amagwiritsidwa ntchito pochotsa rheumatism, tikambirana mwatsatanetsatane. Matenda a rheumatoid ali ndi malire pamachitidwe azithandizo. Mankhwala a Steroid amatha kugwiritsidwa ntchito kwakanthawi kochepa. Komabe, nthawi zambiri amagwiritsidwa ntchito polimbana ndi chiwonetsero cha matenda (panthawi ya matenda). Mankhwala a gululi amagwiritsidwanso ntchito pochiza kutupa kwa mafupa a msana. Glucocorticosteroids omwe amagwiritsidwa ntchito pafupipafupi pochiza matenda amitsempha:

Glucocorticoids ndi kufunika kwake mu matenda a hematological

Glucocorticosteroids (cortisone, prednisone, prednisone, dexamethasone) ndi ena mwa mankhwala omwe amagwiritsidwa ntchito kwambiri masiku ano a immunosuppress matenda a hematopoietic system. Mu pathogenesis yake, zotupa zomwe zimachitika komanso zochitika za autoimmune ndizotheka. Prednisone, ndipo mwa milandu yayikulu, methylprednisone, imagwiritsidwa ntchito kudzera pachiwindi matenda a magazi ogwirizana ndi thrombocytopenia. Ma Steroid angagwiritsidwe ntchito kukhetsa magazi, chifukwa amatsogolera pakuwonjezeka kwa ma protein.

Mankhwala a Steroid a adrenal insufficiency

Pankhani ya matenda, ma glucocorticosteroids opangidwa amagwiritsidwa ntchito. Ndi chiyani, ndi zizindikiro ziti zomwe zimawonetsedwa mu matendawa? Amaphatikizidwa makamaka ndi kuchepa pakupanga mahomoni a corticoid. Corticosteroids amagwiritsidwa ntchito pochiza matenda osakwanira kapena odwala a adrenal. Mwa mankhwala omwe amagwiritsidwa ntchito - cortisol (kapena hydrocortisol).

Glucocorticosteroids amachititsa thupi lawo siligwirizana

Mankhwalawa thupi lawo limawonetsa glucocorticosteroids amagwiritsidwanso ntchito. Chithandizo chotere chitha kuchitidwa ndi zizindikiro zosavuta za matupi awo a chifuwa, conjunctivitis, komanso urticaria kapena zotupa zomwe zimakhudzana ndi kulumidwa ndi tizilombo. Pofuna kupewa kubwereza anaphylactic, hydrocortisone (200 mg kudzera m'mitsempha) kapena prednisolone (20 mg kudzera m'mitsempha) amagwiritsidwa ntchito. Ndipo mankhwala omwe amatchuka kwambiri ndi chimfine chifukwa cha ziwengo:

Anti-yotupa zotsatira

Ndili othokoza chifukwa champhamvu chotsutsa-yotupa chomwe mahomoni adapeza ndikugwiritsa ntchito niche yawo mwamankhwala. Makamaka nthawi zambiri amagwiritsidwa ntchito mu rheumatology.

Ntchito yayikulu ya corticosteroids pokhudzana ndi kutupa imawathandiza kuthana ndi matenda monga:

1. Matenda a mafupa.
2. SLE, kapena systemic lupus erythematosus.
3. ndi njira zina za autoimmune.

Glucocorticoids amalepheretsa njira zamkati ndi ziwonongeko zolumikizana, popanda zomwe palibe matenda amitsempha angachite. Orthopedic traumatologists amawapatsanso mankhwala a arthrosis omwe ali ndi ululu waukulu komanso ovuta chifukwa chotupa.

Kodi corticosteroids imakhala bwanji yotsutsa-kutupa?

Ma mahormoni amagwira ntchito yawo yotsutsa-kutupa pogwira ntchito ya enzyme yapadera - phospholipase A2. Molunjika, zimakhudza ntchito za zinthu zina zomwe zimayambitsa kukula kwa kutupa.

Kuphatikiza apo, corticosteroids amachepetsa kwambiri kutuluka kwamadzi kuchokera pakama lamitsempha chifukwa chochepetsedwa ndi capillaries, ndiye kuti, atseke edema.

Poyerekeza ndi zomwe achita, ma microcirculation mu lesion amathandizidwa, ndipo kubwezeretsa ntchito kwa chiwalo chowonongeka kumachitika mwachangu.

Ndi nyamakazi, glucocorticoids amateteza cartilage ndi mafupa ku chiwonongeko, amakupatsani mwayi wopanga mawonekedwe ndi magawo.

Immunomodulatory zotsatira

Mbali ya glucocorticoids imalepheretsa chitetezo cha m'thupi. Zimalepheretsanso kukula kwa minofu ya m'mimba. Izi zikufotokozera kuwonjezereka kwa chiwopsezo cha matenda a ma virus mu mankhwalawa a corticosteroids.

Komabe, mwa anthu omwe ali ndi chitetezo chamthupi chisanafike, ma mahomoni amatha, m'malo mwake, abwezeretsenso kuchuluka kwa chitetezo cha mthupi cha immunoglobulin.

Mphamvu yoletsa kupewera chitetezo chokwanira ndi glucocorticoids imagwiritsidwa ntchito kwambiri mu transplantology kuletsa wodwalayo kukana zimakhala zowonjezereka.

Zotsatira zoyipa

Limagwirira a chitukuko cha thupi lililonse siligwirizana kwenikweni. Zinthu zakunja zikaloŵa m'thupi, chitetezo chathupi chimayamba kupanga ma antibodies enaake - ma immunoglobulins.

Amalumikizana ndi zida zina - ma cell ma cell. Chifukwa cha njirayi, zinthu zingapo zomwe zimagwira bwino ntchito zamasamba zimamasulidwa, chimodzi mwa izo ndi histamine. Ndiye amene amayambitsa kupezeka kwa zinthu zosasangalatsa komanso zowopsa zomwe zimakhala ndi ziwengo.

Glucocorticoids imalepheretsa kulumikizana kwa ma immunoglobulin omwe ali ndi minyewa ndikulepheretsa kukula kwa sayanjana. GCS imagwiritsidwa ntchito kuthana ndi anaphylactic mantha, edema ya Quincke, urticaria ndi mitundu ina ya chifuwa.

Zotsatira zaabolism

Mahomoni a Steroid amakhudza mitundu yonse ya kagayidwe. Komabe, kutenga nawo gawo kwa kagayidwe kazakudya kumakhala kowopsa. Zili ndi zotsatirazi:

1. Kuchulukitsa shuga m'magazi - kumabweretsa kukula kwa hyperglycemia.
2. Zithandizirani pakuwoneka shuga mkodzo - glucosuria.
3. Amayambitsa matenda a shuga, omwe amatchedwanso kuti steroid.

Zovuta za mahomoni pazomwe zimapanga mapuloteni zimakhalanso zopanda chitetezo kwa odwala. Zimalepheretsa kaphatikizidwe kake ndipo zimathandizira kuwola. Njirazi zimatchulidwa makamaka mu minofu ndi khungu.

Zotsatira za catabolic iyi ya glucocorticoids ndi minyewa yolimbitsa, kuwongola miyendo, kuchepa thupi, khungu lotupa, kuchiritsa pang'onopang'ono mabala.

Chifukwa cha zotsatira zoyipa za GCS pa metabolism yamafuta, kugawa kwama asymmetric pamafuta amkati mwa thupi kumachitika. Mwa odwala, imakhala palibe miyendo, koma imayikika mopitirira muyeso, khosi, ndi chifuwa.

Mahomoni a Steroid amasungabe madzi ndi sodium m'thupi, koma nthawi yomweyo amalimbikitsa kutulutsa kashiamu ndikuchotsa mafupa. Pamodzi ndi kuwonongeka kwa mapuloteni, hypocalcemia imatsogolera.

Zokhudza mtima

Mphamvu ya glucocorticoids pamtima ndi njira zovuta komanso zosiyanasiyana. Koma kwa wodwala, kuthekera kwawo kopapatiza mitsempha yamagazi ndi kuwonjezeka kwa kuthamanga kwa magazi ndikofunikira. Mphamvu yosindikiza iyi itha kuthandiza onse odwala komanso kuwonongeka.

Ndi kuponya kwakuthwa m'magazi, vasodilation, mantha, ndiko kuyambitsa kwa mahomoni omwe nthawi zambiri amapulumutsa moyo. Koma nthawi imodzimodzi, kugwiritsa ntchito kwawo mwadongosolo kumathandizira kukulitsa matenda oopsa komanso kuwonongeka kwa mtima.

Zotsatira pa endocrine dongosolo

Kugwiritsa ntchito kwakanthawi kwamahoroni a matenda ophatikizika kapena ma pathologies ena amachititsa njira yamayankho. Mu ubongo, kapangidwe kazinthu kamene kamapangitsa chidwi mahomoni kumalepheretsa, gland ya adrenal imasiya kugwira ntchito zawo.

Chifukwa cha kusalinganika pantchito ya endocrine glands, njira zonse za metabolic m'thupi zimasokonezeka. Kuphatikiza apo, GCS imalepheretsa kupanga mahomoni ogonana.Izi zimatha kuyambitsa mavuto osiyanasiyana mu moyo wogonana komanso kubereka. Kuchepa kwa mahomoni ogonana kumayambitsanso mafupa am'mimba.

Momwe mungathane ndi zosafunika za corticosteroids?

Zotsatira Zoyipa

Ngakhale pali mndandanda wosangalatsa wazotsatira zoyipa, mahomoni akupitiliza kukhala chithandizo chodziwika bwino cha matenda ambiri - mafupa, khungu, ndi chitetezo chathupi.

Nthawi zina GCS ndi mankhwala osankha. Izi zimadziwika kawirikawiri m'matenda a autoimmune, pamene mankhwala ena amalephera.

Kuchepetsa pafupipafupi komanso kutha kwa zovuta zoyipa kumalola kusankha mosamala mlingo ndi mtundu wa chithandizo chomwe. Pali chithandizo mu milingo yayikulu, koma yochepa - zimachitika. Momwemonso, mankhwala a mahomoni amatha kumwa m'moyo wonse, koma muyeso wochepetsedwa.

Ndikofunika kuti chithandizocho chikuchitika moyang'aniridwa ndi dokotala yemwe amayeza pafupipafupi momwe mtima ndi minofu, shuga ndi magazi, ndi mawonekedwe a wodwalayo.

Monga lamulo, ndi mlingo wosankhidwa bwino wa mankhwalawa, glucocorticoid chithandizo sichimapweteketsa wodwalayo, koma zimamuthandiza kukhala bwino komanso thanzi.

Thupi laumunthu ndilovuta, limagwirira ntchito mosalekeza ndipo limatha kupanga zinthu zogwira ntchito pakudziyimira pawokha kwa zizindikiro za matenda ndikudzitchinjiriza pazinthu zoipa zakunja ndi mkati. Zinthu zoterezi zimatchedwa mahomoni ndipo, kuwonjezera pa ntchito yoteteza, zimathandizanso kuwongolera njira zambiri mthupi.

Kodi glucocorticosteroids ndi chiyani

Glucocorticosteroids (glucocorticoids) ndi mahomoni acorticosteroid opangidwa ndi adrenal cortex. Chiwalo cha pituitary chomwe chayambitsa kutulutsidwa kwa mahomoni a steroid awa ndi chomwe chimapangitsa kupanga chinthu chapadera m'magazi - corticotropin. Zimapangitsa chidwi cha adrenal cortex kuti chisegule kuchuluka kwa glucocorticoids.

Akatswiri akukhulupirira kuti mkati mwa maselo amunthu mumakhala oimira ena apadera omwe amachititsa kuti maselo azigwira zomwe amapanga. Umu ndi momwe amafotokozera momwe amagwirira ntchito pamahomoni aliwonse.

Glucocorticosteroids ali ndi mphamvu zochuluka thupi:

• ali ndi anti-nkhawa komanso anti-shock,
• sinthani machitidwe a makina a anthu,
• imathandizira kupanga maselo m'magazi,
• onjezerani zamphamvu za myocardium ndi mitsempha yamagazi, kwezani kuchuluka kwa magazi,
• kuchuluka ndikuwathandiza pa gluconeogeneis omwe amapezeka m'chiwindi. Thupi limatha kuyimitsa kuukira kwa hypoglycemia, kupangitsa kutulutsa kwa mahomoni a steroid m'magazi,
• onjezani mafuta abulism, thamangitsani kusinthana kwa ma electrolyte opindulitsa m'thupi,
• ali ndi chitetezo champhamvu chogwiritsa ntchito,
• sinthani kumasula kwa oyimira pakati, ndikupereka antihistamine zotsatira,
• ali ndi mphamvu yotsutsa-yotupa, kuchepetsa ntchito za ma enzymes omwe amayambitsa njira zowonongeka m'maselo ndi minofu. Kuponderezedwa kwa oyimira pakati otupa kumayambitsa kuchepa kwa kusinthana kwa madzimadzi pakati pa maselo athanzi komanso okhudzidwa, chifukwa chomwe kutupa sikumakula ndipo sikupita patsogolo. Kuphatikiza apo, GCS simalola lipocortins kuchokera ku arachidonic acid kuti ipangidwe - mndandanda wazotupa,

Maluso onsewa a mahomoni a steroid a adrenal cortex adapezeka ndi asayansi mu labotale, chifukwa chomwe panali kuyambitsa kwabwino kwa glucocorticosteroids mu munda wama pharmacological. Pambuyo pake zidadziwika kuti antipruritic mphamvu yamahormoni yogwiritsa ntchito kunja.

Kuphatikiza kwa ma glucocorticoids m'thupi la munthu, kaya mkati kapena kunja, kumathandiza thupi kuthana ndi mavuto ambiri mwachangu.

Ngakhale magwiridwe antchito ali ndi mphamvu zambiri, mafakitale amakono azomwe amagwiritsa ntchito maupangiri wawo wokhawo, popeza mahomoni a ticantosteroid omwe amagwiritsidwa ntchito mwa mawonekedwe awo oyera amatha kupweteketsa mavuto ambiri.

Zisonyezo za kutenga glucocorticosteroids

Glucocorticosteroids ndi mankhwala madokotala omwe thupi limafunikira othandizira. Mankhwalawa nthawi zambiri samatchulidwa ngati monotherapy, amaphatikizidwa makamaka mu zovuta za matenda enaake.

Nthawi zambiri, zomwe zikuwonetsa kugwiritsidwa ntchito kwa mahomoni opanga a glucocorticoids ndi awa:

• thupi, kuphatikizapo vasomotor rhinitis,
• ndi mikhalidwe isanafike mphumu ,.
• zotupa za khungu zamitundu mitundu. Glucocorticosteroids amagwiritsidwa ntchito ngakhale zotupa zapakhungu, kuphatikiza ndi mankhwala omwe amatha kuthana ndi ma microorganism omwe adatsitsa matenda,
• Zachikhalidwe chilichonse, kuphatikizapo zowawa, zoyambitsidwa ndi magazi,
• , ndi mawonetsedwe ena a pathologies ofunikira amisempha,
• kuchepa kwakukulu chifukwa cha matenda amkati,
• kuchira kwa nthawi yayitali pambuyo poti chiwalo ndi minyezi yazisamba, kuikidwa magazi. Mahoroni a Steroid amtunduwu amathandizira thupi kuzolowera thupi ndi maselo akunja, zomwe zimakulitsa kulolerana kwakukulu,
• glucocorticosteroids akuphatikizidwa mu kuchira koopsa pambuyo ndi radiation ya oncology,
• kuchepa kwa mphamvu ya kotekisi yawo kuti ayambe kuchulukitsa kuchuluka kwa mahomoni ndi matenda ena amtundu wa endocrine m'magawo owopsa komanso osachiritsika,
• matenda ena am'mimba:
• matenda a chiwindi a autoimmune,
• matenda edema,
• matenda a maso: keratitis, cornea iritis.

Muyenera kumwa ma glucocorticosteroids pokhapokha ngati dokotala amupanga, chifukwa ngati mumamwa molakwika ndipo mankhwalawo amawerengedwa molakwika, mankhwalawa amatha kuyambitsa zovuta zoyipa.

Mahomoni opanga a steroid amatha kuyambitsa zizindikiro zosiya - kuwonongeka mu thanzi la wodwala atasiya kumwa mankhwala, mpaka kufupika kwa glucocorticoid. Kuti izi zisachitike, adotolo sikuti amangowerengera kuchuluka kwa mankhwalawa othandizira omwe ali ndi glucocorticoids. Afunikanso kupanga njira yochizira matendawa pochulukitsa pang'onopang'ono kuchuluka kwa mankhwala osokoneza bongo popuma pachimake cha matenda, komanso kuchepa kwa mankhwalawo mpaka osachepera kusintha kwa matendawa.

Gulu la glucocorticoids

Kutalika kwa zochita za glucocorticosteroids anayeza ndi akatswiri popanga, mwa mphamvu ya mlingo umodzi wa mankhwala woletsa adrenocorticotropic timadzi tambiri, timene timayendetsedwa pafupifupi onse pazomwe zili pamwambapa. Izi zimagawa mahomoni amtunduwu m'mitundu iyi m'mitundu:

1. Mitundu yayifupi - letsa ntchito ya ACTH kwa nthawi yoposa tsiku limodzi (Cortisol, Hydrocortisone, Cortisone, Prednisolone, Metipred),
2. Kutalika kwapakati - nthawi yovomerezeka pafupifupi masiku awiri (Traimcinolone, Polcortolone),
3. Kugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali - matendawa amakhala nthawi yayitali kuposa maola 48 (Batmethasone, Dexamethasone).

Kuphatikiza apo, pali gulu la mankhwala osokoneza bongo kudzera mu njira yawo yobweretsera thupi la wodwalayo:

1. Oral (m'mapiritsi ndi makapisozi),
2. mphuno imagwa ndikusuluka
3. mitundu ya mankhwala (omwe nthawi zambiri amagwiritsidwa ntchito ndi asthmatics),
4. mafuta odzola ndi mafuta ogwiritsira ntchito zakunja.

Kutengera mkhalidwe wamthupi ndi mtundu wa matenda, mitundu 1 ndi mitundu ingapo ya mankhwala omwe ali ndi glucocorticosteroids atha kutumikiridwa.

Mndandanda wa mankhwala otchuka a glucocorticosteroid

Mwa mankhwala ambiri omwe ali ndi glucocorticosteroids, madotolo ndi akatswiri a zamankhwala amasiyanitsa mitundu ingapo ya magulu osiyanasiyana omwe ndi othandiza kwambiri ndipo ali ndi chiopsezo chochepa chakubweretsa mavuto:

Kutengera momwe wodwalayo alili ndi gawo la kukula kwa matendawa, mtundu wa mankhwalawa, mlingo ndi nthawi yogwiritsira ntchito amasankhidwa. Kugwiritsa ntchito kwa glucocorticosteroids kumachitika moyang'aniridwa ndi dokotala kuti aziwunika kusintha kulikonse pamachitidwe a wodwala.

Natural Corticosteroids

Corticosteroids amagwira ntchito zofunika kwambiri mthupi.

Glucocorticoids gwirizana ndi ma steroid kukhala ndi anti-kutupa kwenikweni, amatenga nawo gawo pazochitika zama kagayidwe kazakudya, mafuta ndi mapuloteni, kuwongolera kutha msanga, ntchito ya impso, kuyankha kwa thupi pakukhumudwa, kumathandizira pakapita nthawi yayitali. Corticosteroids m'chiwindi samapangidwira ndipo amamuchotsa mkodzo.

Aldosterone imayendetsa kusinthana kwa sodium ndi potaziyamu. Adawalimbikitsa motero mineralocorticoids Na + imasungidwa m'thupi ndipo maselo a K + ion ochokera mthupi amakula.

Zopanga corticosteroids

Corticosteroids imayambitsa kusokonezeka ndi kupsinjika kwa thupi, ndipo izi zimayambitsa kuchepa kwa chitetezo chokwanira, chifukwa chitetezo chokwanira chimaperekedwa pamlingo wokwanira pokhapokha pokhazikika. Popeza pamwambapa, titha kunena kuti kugwiritsa ntchito corticosteroids kumathandizira kuti matendawa aperekedwe, kumatsekereza kusinthika.

Kuphatikiza apo, mapangidwe a corticosteroids amalepheretsa kugwira ntchito kwa mahomoni achilengedwe a corticosteroids, omwe amatsogolera kuwonongeka kwa adrenal ntchito ambiri. Corticosteroids imakhudza kugwira ntchito kwa glands zina za endocrine, kuchuluka kwa mahomoni amthupi kumasokonekera.

Mankhwala a Corticosteroid, kuthetsa kutupa, amakhalanso ndi mphamvu ya analgesic. Ma corticosteroids ophatikizika amaphatikizapo Dexamethasone, Prednisolone, Sinalar, Triamcinolone ndi ena. Mankhwalawa ali ndi ntchito yapamwamba ndipo amayambitsa zotsatira zoyipa zochepa kusiyana ndi zachilengedwe.

Kukonzekera kwa ntchito zam'deralo (zamtundu)

• Prednisone (mafuta),
• Hydrocortisone (mafuta),
• Lokoid (mafuta),
• Cortade (mafuta),
• Afloderm (kirimu),
• Laticort (kirimu),
• Dermoveit (kirimu),
• Fluorocort (mafuta),
• Lorinden (mafuta ophikira, mafuta odzola),
• Sinaflan (mafuta),
• Flucinar (mafuta, gel,),
• Clobetasol (mafuta), etc.

Topical corticosteroids amagawidwa pambiri kapena mochepa.
Zofooka zikutanthauza: Prednisone, Hydrocortisone, Cortade, Lokoid,
Wogwira ntchito pang'ono: Afloderm, Laticort, Dermoveit, Fluorocort, Lorinden,
Wogwira ntchito kwambiri: Akriderm, Advantan, Kuterid, Apulein, Kutiveyt, Sinaflan, Sinalar, Sinoderm, Flucinar.
Wogwira ntchito kwambiri: Clobetasol.

Momwe mungagwiritsire ntchito corticosteroids?

Mlingo wothandizidwa ndi dokotala. Kukonzekera kwa piritsi kuyenera kutengedwa kuchokera ma 6 koloko m'mawa (mlingo woyamba) osati pasanathe maola 14 pambuyo pake. Mikhalidwe yovomerezeka ndiyofunika kulingalira mphamvu zolimbitsa thupi za glucocorticoids m'magazi popanga ndi adrenal cortex.

Nthawi zina, pamlingo waukulu komanso kutengera mtundu wa matendawa, mlingo umagawidwa ndi adokotala kuti akalandire yunifolomu masana a 3-4.

Mapiritsi amayenera kumwedwa ndi chakudya kapena atangodya ndi madzi pang'ono.

Chithandizo cha corticosteroid

Kuchepetsa chithandizo yogwiritsidwa ntchito kwa njira zazitali, zopatsirana - mitundu ya piritsi nthawi zambiri imagwiritsidwa ntchito kwa miyezi ingapo kapena zaka.

Kuchepetsa mphamvu ya inhibitory pa ntchito ya endocrine tiziwalo timene timatulutsa

• Njira zochizira - glucocorticoids okhala ndi nthawi yochepa komanso yapakati (Prednisolone, Methylprednisolone) amagwiritsidwa ntchito kamodzi kuyambira 6 mpaka 8 m'mawa uliwonse 48,
• chithandizo chapakati - zazifupi, maphunziro a masiku atatu a kumwa mankhwalawa ndi masiku 4 yopuma pakati pawo,
• zimachitika mankhwala - mwachangu mtsempha wa magazi waukulu 1 mg wa mankhwalawa. Mankhwala osankhidwa pa mankhwalawa ndi Methylprednisolone (ndiwofikira kwambiri kumadera omwe akukhudzidwa ndikupatsanso zovuta zina).

Mlingo wa tsiku ndi tsiku wa mankhwala (ponena za prednisone):

• Otsika - ochepera 7.5 mg
• Yapakatikati - 7.5-30 mg,
• Mkulu - 30-100 mg
• Kwambiri kwambiri - pamwamba 100 mg,
• Mankhwala a pulse ali pamwamba pa 250 mg.

Kuchiza ndi corticosteroids kuyenera limodzi ndi kuikidwa kwa calcium, mankhwala a vitamini D popewa mafupa. Zakudya za wodwala ziyenera kukhala ndi mapuloteni ambiri, calcium ndi kuphatikiza ochulukirapo wa calcium ndi sodium chloride (mpaka 5 g patsiku), madzi (mpaka 1.5 l patsiku).

Kwa prophylaxis zosavomerezeka za corticosteroids pamatumbo am'mimba musanamwe mapiritsi, kugwiritsa ntchito Almagel ndi jelly kungalimbikitsidwe. Ndikulimbikitsidwa kupatula kusuta, kuledzera, masewera olimbitsa thupi.

Corticosteroids aana

Ana omwe amadalira mahomoni (mphumu ya bronchial, mwachitsanzo) pambuyo pa mtsempha wa mtsempha wa magazi amapatsidwa pang'onopang'ono kupita ku mankhwala osokoneza bongo a prednisolone. Ndi kupuma pafupipafupi kwa mphumu, Beklamethasone dipropionate imagwiritsidwa ntchito m'njira ya inhalation - mlingo umasankhidwa payekha. Mukalandira vutoli, mlingo umachepetsedwa pang'onopang'ono kukhala mlingo wokonzanso (aliyense payekha).

Topical Glucocorticoids (mafuta, mafuta ophikira, mafuta odzola) amagwiritsidwa ntchito machitidwe a ana, koma ana ali ndi kuthekera kwakukulu kwazinthu zamankhwala kuposa odwala achikulire (kukula kochedwa ndi kukula, matenda a Itsenko-Cushing's, kuletsa ntchito ya endocrine glands). Izi ndichifukwa choti mwa ana chiŵerengero cha malo owonekera kwa thupi ndi chachikulu kuposa akulu.

Pazifukwa izi, glucocorticoids okhala ndi ana ayenera kugwiritsidwa ntchito pokhapokha komanso nthawi yochepa. Izi ndizowona makamaka kwa akhanda. Kwa ana a chaka choyamba cha moyo, mafuta okhaokha okhala osaposa 1% hydrocortisone kapena mankhwala am'badwo wachinayi - Prednicarbat (Dermatol) angagwiritsidwe ntchito, ndipo mpaka zaka 5 - Hydrocortisone 17-butyrate kapena mafuta okhala ndi mankhwala apakatikati.

Zochizira ana azaka zopitilira 2, Mometasone angagwiritsidwe ntchito monga momwe adanenera dokotala (mafuta, amakhala ndi mphamvu kwa nthawi yayitali, amagwiritsidwa ntchito 1 r. Patsiku).

Palinso mankhwala ena othandizira atopic dermatitis mwa ana omwe sanatchulidwe mozama momwe, mwachitsanzo, Advantan. Itha kugwiritsidwa ntchito mpaka milungu 4, koma kugwiritsidwa ntchito kwake kumakhala kocheperako chifukwa cha kuthekera kwazomwe zimachitika (kuuma komanso kuwonda kwa khungu). Mulimonsemo, kusankha kwa mankhwala ochizira mwana kumakhalabe ndi adokotala.

Corticosteroids pa mimba ndi mkaka wa m`mawere

Zotsatira zoyipa izi za glucocorticoids zimakulitsidwa chifukwa choti mankhwala amakono omwe akhala akuchita kwa nthawi yayitali (Metipred, Dexamethasone) samatulutsa michere ya placenta ndipo amakhala ndi vuto lalitali kwa mwana wosabadwayo. Glucocorticoids, yoletsa chitetezo cha mthupi, imathandizira kuchepetsa kukana kwa amayi apakati ku matenda oyambitsidwa ndi bakiteriya komanso ma virus, omwe angayambenso kusokoneza mwana wosabadwayo.

Mankhwala a Glucocorticoid amatha kulembedwa kwa mayi wokhayo pokhapokha ngati kugwiritsidwa ntchito kwawo kumapitirira kuchuluka kwa zotsatira zoyipa kwa mwana wosabadwayo.

Zizindikiro zotere zitha kukhala:
1. Kuwopseza kubadwa isanakwane (njira yochepa ya mahomoni kumapangitsa kuti mwana asabadwe asanabadwe), kugwiritsa ntchito mankhwala ochulukirapo kwa mwana pambuyo pobadwa kwapangitsa kuti kuchepetsa kugwiritsa ntchito mahomoni muzizindikiro izi.
2. Rheumatism ndi matenda a autoimmune omwe amagwira ntchito.
3. Hereditary (intrauterine) hyperplasia mu fetus ya cortical wosanjikiza wa adrenal gland ndizovuta kudziwa matenda.

M'mbuyomu, panali chizolowezi chopereka glucocorticoids kuti asunge mimba. Koma zambiri zowonetsa pakukhudzika kwa njira yotere sizinapezeke, chifukwa chake, sizigwiritsidwa ntchito pano.

Mu zochita Metipred, Prednisone, ndi Dexamethasone amagwiritsidwa ntchito kwambiri. Amalowa mu placenta mosiyanasiyana: Prednisolone imawonongedwa ndi ma enzymes omwe ali mu placenta mokulira, ndipo Dexamethasone ndi Metipred kokha ndi 50%. Chifukwa chake, ngati kukonzekera kwa mahomoni kumagwiritsidwa ntchito pochiza mayi wapakati, ndikofunikira kupangira prednisolone, ndipo ngati mukumuthandizira mwana wosabadwayo - Dexamethasone kapena Metipred. Pankhani imeneyi, prednisolone ndi zovuta zomwe zimachitika mu fetus sizachilendo.

Glucocorticoids woopsa thupi lawo siligwirizana mankhwala onse jakisoni (jekeseni kapena mapiritsi), ndipo wamba (mafuta, miyala, madontho, inhalations). Amakhala ndi mphamvu yoletsa kukalamba. Mankhwala otsatirawa amagwiritsidwa ntchito makamaka: Hydrocortisone, Prednisolone, Dexamethasone, Betamethasone, Beclomethasone.

Mwa glucocorticoids apakhungu (mankhwala am'deralo), nthawi zambiri, ma erosos a intranasal amagwiritsidwa ntchito: ndi hay fever, matupi awo amatsenga, kutsekeka kwa mphuno. Nthawi zambiri amakhala ndi zotsatira zabwino. Fluticasone, dipropionate, propionate ndi ena apeza anthu ambiri akugwiritsa ntchito.

Mu conjunctivitis ya mziwi, glucocorticoids sagwiritsidwa ntchito kawirikawiri chifukwa chokhala pachiwopsezo cha mavuto. Mulimonsemo, ndikuwonetsa thupi lanu, sizingatheke kugwiritsa ntchito mankhwala a mahomoni ndekha kuti mupewe mavuto.

Corticosteroids a Psoriasis

Glucocorticoids yogwiritsira ntchito mitundu yamafuta (mafuta, mafuta,) nthawi zambiri imagwiritsidwa ntchito 2 p. patsiku: mafuta masana osavala, ndipo usiku ndi phula lamala kapena anthralin pogwiritsa ntchito kavalidwe kotsalira. Ndi zotupa zambiri, pafupifupi 30 g ya mankhwalawa amagwiritsidwa ntchito pochiritsa thupi lonse.

Kusankhidwa kwa glucocorticoid kukonzekera molingana ndi kuchuluka kwa ntchito zomwe apolisi amathandizira zimatengera kuopsa kwa njira ya psoriasis ndi kuchuluka kwake. Pamene maziko a psoriasis amachepa nthawi ya mankhwalawa, mankhwalawa ayenera kusinthidwa kuti asagwire ntchito (kapena osagwiritsidwa ntchito kwambiri) kuti achepetse kupezeka kwa mavuto. Momwe mankhwalawo akapezeka pakadutsa pafupifupi milungu itatu, ndibwino kusintha m'malo mwa mahomoni ndi wofewetsa kwa milungu iwiri.

Kugwiritsa ntchito ma glucocorticoids m'malo ambiri kwakanthawi kumatha kukulitsa njirayi. Kubwerezanso kwa psoriasis pambuyo pakutha kwa mankhwalawa kumachitika kale kuposa nthawi ya chithandizo popanda glucocorticoids.
, Coaxil, Imipramine ndi ena) kuphatikiza ndi glucocorticoids angayambitse kuwonjezeka kwa kukakamiza kwa intraocular.

Glucocorticoids (yogwiritsidwa ntchito nthawi yayitali) imathandizira kukonza kwa adrenergic agonists (Adrenaline, Dopamine, Norepinephrine).

Theophylline kuphatikiza ndi glucocorticoids amalimbikitsa kuoneka ngati mtima ndi vuto, kumawonjezera mphamvu yotsutsa-yotupa ya glucocorticoids.

Amphotericin ndi ma diuretics osakanikirana ndi corticosteroids amawonjezera chiopsezo cha hypokalemia (kutsika kwa potaziyamu m'magazi) komanso kuwonjezeka kwa diuretic zotsatira (ndipo nthawi zina posungira sodium).

Kuphatikizidwa kwa mineralocorticoids ndi glucocorticoids kumathandizira hypokalemia ndi hypernatremia. Ndi hypokalemia, zotsatira zoyipa za mtima glycosides zimatha kuchitika. Zotupa zitha kukulitsa hypokalemia.

Ma anticoagulants osadziwika, Butadion, Ethacrynic acid, Ibuprofen osakanikirana ndi glucocorticoids angayambitse chiwonetsero cha hemorrhagic (magazi), ndipo ma salicylates ndi Indomethacin angayambitse zilonda zam'mimba.

Glucocorticoids imachulukitsa chiwindi cha paracetamol.

Kukonzekera kwa retinol kumachepetsa mphamvu ya anti-yotupa ya glucocorticoids ndikukonzanso machiritso a bala.

Kugwiritsa ntchito mahomoni limodzi ndi Azathioprine, Methandrostenolone ndi Hingamine kumawonjezera mwayi wokhala ndi matenda amtundu wamatsenga ndi zovuta zina.

Glucocorticoids amachepetsa mphamvu ya cyclophosphamide, antiviral zotsatira za idoxuridine, mphamvu ya mankhwala ochepetsa shuga.

Ma estrogens amalimbikitsa mphamvu ya glucocorticoids, omwe amachepetsa mlingo wawo.

Androgens (mahomoni ogonana amuna) ndi kukonzekera kwachitsulo kumathandizira erythropoiesis (mapangidwe a maselo ofiira am'magazi) akaphatikizidwa ndi glucocorticoids, amachepetsa njira ya kutulutsa kwa mahomoni, ndikuyambitsa mavuto (kuchuluka kwa magazi, kuchuluka kwa sodium, kusamba kwa msambo).

Gawo loyamba la opaleshoni yogwiritsa ntchito glucocorticoids kutalika ndipo nthawi ya opaleshoni yafupika, Mlingo wa Fentanyl wafupika.

Corticosteroid malamulo ochotsera

Ngati nthawi ya glucocorticoid nthawi yayitali ingathe miyezi ingapo, ndiye kuti mlingo wa prednisolone ungathe kuchepetsedwa ndi 2.5 mg (mapiritsi 0,5) pakapita masiku onse atatu. Ndi njira yotalikirapo, mlingo umachepetsa pang'onopang'ono - mwa 2,5 mg pakapita masabata atatu alionse. Ndi chisamaliro chachikulu, mlingo umachepetsedwa pansipa 10 mg - 0,25 mapiritsi tsiku lililonse la 3-5-7.

Ngati mlingo woyambirira wa prednisolone unali waukulu, ndiye kuti kuchepa kumakhala kochulukira: mwa 5-10 mg tsiku lililonse la 3. Mukafika tsiku lililonse mlingo wofanana ndi 1/3 ya mlingo woyambirira umachepetsedwa ndi 1.25 mg (mapiritsi 1/4) pakadutsa milungu iwiri iliyonse. Chifukwa cha kuchepa kotero, wodwalayo amalandira Mlingo wa kukonza kwa chaka chimodzi kapena kupitirira.

Dotolo amakupatsani njira yochepetsera mankhwalawa, ndipo kuphwanya mankhwalawa kumatha kubweretsa matendawa kuonjezereka - chithandizo chikuyenera kuyambiranso ndi mlingo waukulu.

Mitengo ya Corticosteroid

Mthupi la munthu, zochita za mankhwala ndi zamankhwala amuzolengedwa zimachitika nthawi zonse, chifukwa chake zinthu zina zimapangidwa. Zimakhudza magwiridwe antchito a ziwalo ndi machitidwe, njira zonse zomwe zimachitika pamaselo a ma cell. Kafukufuku wazinthu zoterezi - mahomoni, amalola kuti azingomvetsetsa magwiridwe ake ndi momwe amagwirira ntchito, komanso kuti agwiritsidwe ntchito pochiritsa. Kuthandizira kwa mahormone kwa odwala ambiri ndiyo njira yokhayo yoperekera matenda omwe samayankha pochiza ndi mankhwala ena. Glucocorticosteroids amagwiritsidwa ntchito pazinthu zam'mano, zamankhwala, urological, dermatological ndi zina. Ndiye glucocorticosteroids, ndi chiyani?

Pharmacological zochita za corticosteroids

Glucocorticosteroids (dzina lina - glucocorticoids) ndi zinthu za m'madzi za m'thupi zomwe ndi gawo limodzi la corticosteroids omwe amapangidwa m'thupi ndi adrenal cortex. Ichi ndi cortisol (ali ndi zochita zapamwamba kwambiri), corticosterone, etc.

Ndizofunikira kudziwa: glucocorticoids ali ndi mphamvu yotsutsa kupsinjika, zotsatira zama anti-shock. Kuphatikizika kwawo m'mwazi kumawonjezeka kwambiri motsutsana ndi maziko a vuto, zoopsa, limodzi ndi kutaya magazi. Kuwonjezeka kwa mahomoni pazithunzi zoterezi kumalumikizidwa ndikusintha kwa thupi kutaya magazi kwambiri, kugwedezeka, zotsatirapo za zovuta komanso zovuta zina.

Mavuto a mahomoni am'madzi a glucose pamthupi la munthu ali motere:

• Thandizani kuwonjezeka kwa kupanikizika kwa systolic ndi diastolic,
• Kuchulukitsa chiwopsezo cha zipupa za khungu la minofu ya mtima ku zotsatira za ma catecholamines,
• Pewani kutayika kwa receptor chiwopsezo chokhala ndi katekisimu wambiri,
• Yambitsani kupanga kwamagazi oyera mthupi,
• Onjezani kapangidwe ka shuga m'chiwindi,
• Kuchulukitsa kuchuluka kwa shuga
• Letsani kulowetsedwa kwa glucose kuzinthu zotumphukira,
• Imathandizira kupanga glycogen
• Pewani njira zopangira mapuloteni, kuphulika kwawo,
• Glucocorticosteroids amachotsa calcium ndi potaziyamu, zimapereka kuchuluka kwa madzi, chlorine ndi sodium m'thupi,
• Pang'onopang'ono chitukuko cha thupi lawo siligwirizana.

Glucocorticoid mahomoni "amalamulira" kumwa kwa lipids mu maselo a minyewa yodutsa, kumakhudza chiwopsezo cha minyewa yofewa chifukwa cha mahomoni ena. Kuphatikiza apo, zinthu izi zimakhudza ntchito ya chitetezo cha mthupi - zimalepheretsa zochitika zama antibodies ena, koma zimathandizira mapangidwe a maselo ena, etc. Mndandanda wazinthu za mahomoni umapitilirabe. Ndizotheka kuti akuchita nawo machitidwe ena, omwe sakudziwika.

Ndiye glucocorticosteroids, ndi chiyani? Awa ndi mahomoni omwe amapangidwa m'thupi la munthu aliyense. Ali ndi katundu wambiri. Koma imodzi mwazinthu zofunikira kwambiri zomwe zimapangitsa kugwiritsa ntchito GCS ndi anti-yotupa. GCS imalepheretsa kugwira ntchito kwa zinthu zina za enzyme m'thupi, zomwe zimabweretsa kupumula kwakanthawi kwamankhwala otupa.

Ma mahormoni amateteza kupangika kwa edema poyang'ana kutupa, chifukwa amapereka kuchepa kwa kuvomerezedwa kwa makoma a mtima. Zimayambitsanso kupanga zinthu zina zomwe zimadziwika ndi zinthu zotsutsana ndi kutupa.

Chofunikira: glucocorticosteroids ndi mankhwala omwe ali ndi zotsatira zosiyanasiyana, kugwiritsa ntchito komwe kumaloledwa pazifukwa zachipatala zokha. Kugwiritsa ntchito pawokha kumakhala ndi zovuta zambiri.

Zizindikiro zogwiritsidwa ntchito

Glucocorticosteroids amadziwika kuti athandizire adrenal gland pathologies. Ndikofunika kuti muwatenge motsutsana ndi mitundu yovuta kwambiri yaimpso kapena matenda a impso, ndi hyperplasia ya cortical wosanjikiza chibadwa chamkati. Ndi matenda awa, mapangidwe achilengedwe a mahomoni amasokonezeka, chifukwa chake, kugwiritsa ntchito mankhwala kuti abwezeretse kuchuluka kwa mahomoni kumafunika.

1. Chithandizo cha matenda a autoimmune chikhalidwe (mwachitsanzo, ndi rheumatism, sarcidosis). Cholinga chawo chimakhala chifukwa chofulumira kapena kupondaponda njira zina za chitetezo chathupi. GCS imalembera mankhwalawa.
2. Therapy of pathologies a kwamikodzo dongosolo, kuphatikizapo kutupa chikhalidwe (kuikidwa chifukwa cha anti-yotupa katundu).
3. GCS panthawi yomwe thupi lawo siligwirizana limagwiritsidwa ntchito ngati mankhwala omwe amakhudza kupanga kwa zinthu zomwe zimathandizira kusalolera kwakuthupi - zotupa.
4. Hormone m'malo tikulimbikitsidwa matenda a kupuma dongosolo (motsutsana maziko a mphumu, matupi awo sagwirizana, chibayo. Dziwani kuti mankhwala a mahomoni amasiyana mumakanidwe ndi kuthamanga kwake. Mankhwala ena amagwira ntchito mwachangu, pomwe ena amagwira ntchito pang'onopang'ono. Mankhwala othandizira pang'onopang'ono sangagwiritsidwe ntchito kupumitsa chipatala chovuta kwambiri.
5. Pochita mano, corticosteroids ndi mankhwala amtundu wa pulpitis, periodontitis ndi matenda ena.
6. Chithandizo cha matenda a dermatological. Monga lamulo, kirimu kapena mafuta omwe amachokera ku mahomoni a zinthu amapatsidwa. Amathandizira kuchepetsa njira yotupa m'matumbo, kumasuka ku chipatala chosasangalatsa - zotupa, zotupa pakhungu, zilonda zam'mimba, etc.
7. Chithandizo cha matenda ammimba (matenda a Crohn).
8. GCS imalembedwa chifukwa cha kuvulala, komwe kumakhazikika pazochitika zotsutsana ndi kutupa ndi anti-shock.
9. Mu zovuta kuchitira motsutsana maziko a ubongo edema.

Kutengera mankhwala omwe ali mgulu la glucocorticosteroid mahomoni ambiri apangidwa. Amabwera ndi mitundu yosiyanasiyana ya mankhwalawa - mafuta odzola, mafuta, mafuta, mafuta odzola, miyala ikuluikulu, mapiritsi ogwiritsira ntchito mkati.

Mayina a kukonzekera kwa glucocorticosteroid: Cortisone, Triamcinolone, Hydrocortisone, Prednisolone, Beclomethasone, Dexamethasone, etc. Horormone m'malo mwake ili ndi mawonekedwe ake, katswiri wazachipatala yekha ndi amene amapereka mankhwala omwe ali ndi zinthu za m'thupi.

Zotsatira zoyipa za glucocorticosteroids

Mankhwala a Glucocorticosteroid amagwiritsidwa ntchito chifukwa chogwira ntchito bwino pochiza matenda ambiri. Amathandizira kubwezeretsanso mahomoni m'thupi, omwe amachepetsa ma pathologies angapo. Koma chithandizo cha mahomoni sichikhala chotetezeka nthawi zonse, chifukwa nthawi zambiri chimabweretsa zovuta zoyipa. Ichi ndichifukwa chake mankhwala amakhala ndi zofunikira kwambiri.

Zochitika zoyipa zomwe zimapezeka kwambiri ndi izi:

• Kuwonongeka kwa khungu, tsitsi, maonekedwe a thumba lakuthwa, ziphuphu zakumaso, zithupsa,
• Kukula kwakakulidwe ka tsitsi mwa akazi m'malo a thupi (mwachitsanzo, pachifuwa, kumaso, ndi zina).
• Kuzindikira kwamphamvu kwamitsempha yamagazi (mphamvu, kupanikizika ndi kuchepa mphamvu),
• Zotsatira zoyipa zamagetsi zamkati. Amawonetsedwa ndi kusokonezeka kwa tulo, kutengeka mtima, kusokonekera mosadziwika, neurosis, mphwayi, kukhumudwa ndi zochitika zina zamatenda.
• Zowonongeka.

Zambiri: glucocorticosteroids angayambitse kukula kwa matenda osokoneza bongo (shuga) m'mimba (shuga), zilonda zam'mimba, matenda oopsa (kuthamanga kwa magazi), kuchepa kwa thupi, kunenepa kwambiri, ndi zina zambiri.

Muzochita zamankhwala, milandu yazindikirika pamene GCS idayambitsa kudwala kwamatenda m'thupi. Izi ndichifukwa choti motsutsana ndi kumbuyo kwa kukhalapo kwa tizilombo tating'onoting'ono, mankhwala amayamba kutsika, chifukwa, mabakiteriya amayamba kuchulukirachulukira, chifukwa chitetezo cha mthupi sichitha kuthana nazo.

Zochitika zoyipa sizimangokhala chifukwa chogwiritsa ntchito nthawi yayitali kapena chifukwa cha mankhwala osokoneza bongo, komanso ngati wodwala amamwa mankhwalawa malinga ndi malangizo. Komanso, kukula kwawo kumachitika motsutsana ndi maziko a kuchotsedwa kwa mankhwalawa (kuchoka mu mankhwala), chifukwa mahomoni akamalandira kuchokera kunja, gland ya adrenal siyipanga yokha.

Pamapeto pa mankhwala a mahomoni, zizindikiro zotsatirazi zimakonda kuonedwa:

1. Minyewa.
2. Anachepetsa chilako.
3. Lethargy, mphwayi.
4. Kuwonjezeka kwa kutentha kwa thupi.
5. Kuchulukitsa kwa matenda osachiritsika m'mbiri.

Zotsatira zowopsa kwambiri za kugwiritsidwa ntchito kwa glucocorticosteroid ndikuchitika kwa kusoŵa kwachulukidwe kwa adrenal. Amadziwika ndi kuchepa kwambiri kwa kuthamanga kwa magazi, kuphwanya kwam'mimba, kupweteka kwam'mimba, kuperewera, komanso kupweteka.

Glucocorticosteroids ali ndi zizindikiro zakudziyimira, kotero kuyimitsa kugwiritsa ntchito pawokha sikwensowopsa kuposa mankhwala omwewo. Malizani kumaliza kuyang'aniridwa ndi dokotala. Mlingowo umachepetsedwa pang'onopang'ono, womwe umachepetsa zovuta zake zoyipa.