Fraxiparin malangizo, ntchito, contraindication, mavuto, ndemanga

Anticoagulant mwachindunji ndi ochepa maselo kulemera kwa heparin.
Mankhwala: FRAXIPARINE
The yogwira mankhwala: calcium ya nadroparin
Code ya ATX: B01AB06
KFG: Anticoagulant wowongolera mwachindunji - heparin yochepa kwambiri
Nambala yolembetsa: P No. 015872/01
Tsiku lolembetsa: 07/28/06
Mwini reg. acc: GLAXO WELLCOME PRODUCTION

Tulutsani mawonekedwe a Fraksiparin, ma CD ndi ma CD.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

1 syringe
calcium ya nadroparin
2850 IU Anti-Ha

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid kwa pH 5.0-7.5, madzi d / ndi - mpaka 0,3 ml.

0,3 ml - ma syringes a single-2 (2) - matuza (1) - mapaketi a makatoni.
0,3 ml - ma syringes a single-2 (2) - matuza (5) - mapaketi a makatoni.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

1 syringe
calcium ya nadroparin
3800 IU Anti-Ha

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid kwa pH 5.0-7.5, madzi d / ndi - mpaka 0,4 ml.

0,4 ml - syringes yokhala limodzi (2) - matuza (1) - mapaketi a makatoni.
0,4 ml - syringes yokhala limodzi (2) - matuza (5) - mapaketi a makatoni.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

1 syringe
calcium ya nadroparin
5700 IU Anti-Ha

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid kwa pH 5.0-7.5, madzi d / ndi - mpaka 0.6 ml.

0,6 ml - ma syringes a single-2 (-) - matuza (1) - mapaketi a makatoni.
0,6 ml - ma syringes a single-2 (2) - matuza (5) - mapaketi a makatoni.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

1 syringe
calcium ya nadroparin
7600 IU Anti-Ha

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid kwa pH 5.0-7.5, madzi d / ndi - mpaka 0.8 ml.

0,8 ml - syringes yokhala limodzi (2) - matuza (1) - mapaketi a makatoni.
0,8 ml - syringes ya single-2 (2) - matuza (5) - mapaketi a makatoni.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

1 syringe
calcium ya nadroparin
9500 IU Anti-Ha

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid kwa pH 5.0-7.5, madzi d / ndi - mpaka 1 ml.

1 ml - ma syringes a limodzi - 2 - - matuza (1) - mapaketi a makatoni.
1 ml - ma syringes osakwatiwa (2) - matuza (5) - mapaketi a makatoni.

Kufotokozera kwa mankhwalawa kumatengera malangizo ovomerezeka omwe angagwiritsidwe ntchito.

Pharmacological kanthu Fraxiparin

Calcium nadroparin ndi heparin yochepa kwambiri (NMH) yomwe imapezeka kuchokera ku heparin yokhazikika, ndi glycosaminoglycan yokhala ndi kulemera kwakukulu kwa 4300 daltons.

Ikuwonetsa kuthekera kwakukulu kumangiriza mapuloteni a plasma ndi antithrombin III (AT III). Kumangiriza kumeneku kumabweretsa kuyendetsa patsogolo kwambiri kwa factor Xa, komwe kumachitika chifukwa cha kuthekera kwakukulu kwa nadroparin.

Njira zina zopereka antithrombotic zotsatira za nadroparin zimaphatikizanso kutsegula kwa minyewa ya kusintha kwa inhibitor (TFPI), kutsegula kwa fibrinolysis pomasulidwa mwachindunji kwa minofu ya plasminogen activell maselo a endothelial, ndikusintha kwamitsempha yamagazi ndi kuchepa kwamphamvu kwa kupatsidwa magazi kuundana.

Calcium nadroparin imadziwika ndi ntchito yapamwamba ya anti-Xa chinthu poyerekeza ndi anti-IIa factor kapena antithrombotic zochita ndipo imakhala ndi zochita komanso zotheka nthawi yayitali.

Poyerekeza ndi heparin yosasakanizidwa, nadroparin imakhala yocheperako pakugwira ntchito ya maplatelet ndi kuphatikiza, komanso samatchulidwira kwenikweni hepatasis yapamwamba.

Mu Mlingo wa prophylactic, nadroparin sayambitsa kuchepa kutchulidwa kwa APTT.

Ndi chithandizo cha mankhwala munthawi ya zochitika zapamwamba, kuwonjezeka kwa APTT pamtengo 1.4 nthawi zambiri kuposa momwe mungathere. Kutalika kotereku kumatsalira otsalira a antithrombotic mphamvu ya calcium nadroparin.

Pharmacokinetics wa mankhwala.

Facacokinetic katundu amatsimikiza pamaziko a kusintha kwa ntchito ya anti-Xa chinthu cha plasma.

Pambuyo subcutaneous makonzedwe a Cmax m'magazi am'madzi amatha pambuyo maola 3-5, nadroparin amadziwidwa pafupifupi kwathunthu (pafupifupi 88%). Ndi on / mukutulutsa ntchito yayikulu yotsutsana ndi XA imakwaniritsidwa mphindi zosakwana 10, T1 / 2 ili pafupifupi maola 2

Zimapangidwa makamaka mu chiwindi mwa kuwonongedwa ndi depolymerization.

Pambuyo pa utsogoleri wa SC T1 / 2 ili pafupifupi maola 3.5. Komabe, ntchito za anti-Xa zimapitilira kwa maola osachepera 18 pambuyo pobayira jekeseni wa nadroparin pa 1900 anti-XA ME.

Njira yokonzekera mankhwala Fraxiparin

subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0.6 ml, blister 2, bokosi (bokosi) 1,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 1 ml, chithuza 2, bokosi (bokosi) 5,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0.8 ml, blister 2, bokosi (bokosi) 5,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0.8 ml, chithuza 2, bokosi (bokosi) 1,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0.6 ml, blister 2, bokosi (bokosi) 5,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0,3 ml, chithuza 2, bokosi (bokosi) 1,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0.3 ml, blister 2, bokosi (bokosi) 5,
subcutaneous solution 3800 IU, syringe yotayika 0,4 ml, chithuza 2, bokosi (bokosi) 1,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 1 ml, chithuza 2, bokosi (bokosi) 1,
subcutaneous solution 3800 IU, syringe yotha 0.4 ml, chithuza 2, bokosi (bokosi) 5,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0.4 ml, blister 2, bokosi (bokosi) 1,
subcutaneous solution 9500 IU (anti-XA) / ml, syringe yotayika 0.4 ml, blister 2, bokosi (bokosi) 5,

Kupanga
Jekeseni 1 syringe
calcium nadroparin ME anti-Ha 2850
zotuluka: calcium hydroxide solution - q.s. (kapena kuchepetsa hydrochloric acid) kwa pH 5.0-7.5, madzi a jakisoni - q.s. mpaka 0,3 ml
mu matuza 2 syringes ya 0,3 ml zotayika, mu katoni ka 1 kapena 5 matuza.

Jekeseni 1 syringe
nadroparin calcium ME anti-Ha 3800
zotuluka: calcium hydroxide solution - q.s. (kapena kuchepetsa hydrochloric acid) kwa pH 5.0-7.5, madzi a jakisoni - q.s. mpaka 0,4 ml
mu chithuza china chake cha syringes imodzi ya 0,4 ml iliyonse, mu katoni 1 kapena 5 matuza.

Jekeseni 1 syringe
calcium ya nadroparin, ME anti-Ha 5700
zotuluka: calcium hydroxide solution - q.s. (kapena kuchepetsa hydrochloric acid) kwa pH 5.0-7.5, madzi a jakisoni - q.s. mpaka 0,6 ml

Jekeseni 1 syringe
calcium ya nadroparin, ME anti-XA 7600
zotuluka: calcium hydroxide solution - q.s. (kapena kuchepetsa hydrochloric acid) kwa pH 5.0-7.5, madzi a jakisoni - q.s. mpaka 0,8 ml
pachimake, ma syringe awiri otayika a 0.6 ml iliyonse, pabokosi la makatoni 1 kapena 5.

Jekeseni 1 syringe
calcium ya nadroparin, ME anti-Ha 9500
zotuluka: calcium hydroxide solution - q.s. (kapena kuchepetsa hydrochloric acid) kwa pH 5.0-7.5, madzi a jakisoni - q.s. mpaka 1 ml
pachimake, ma syringe awiri otayika a 1 ml iliyonse, pabokosi la makatoni 1 kapena 5.

Pharmacodynamics wa mankhwala Fraxiparin

Calcium nadroparin imakhala ndi anti-Xa chinthu chachikulu poyerekeza ndi anti-IIa factor kapena antithrombotic zochita. Chiwerengero pakati pa ntchito ziwiri za nadroparin ndi gawo la 2.5-5.

Mlingo wa prophylactic, nadroparin sayambitsa kuchepa kutchulidwa kwa gawo la thrombin nthawi (APTT).

Ndi njira ya chithandizo munthawi ya zochita zochuluka, APTT imatha kuwonjezeka mpaka mtengo wapatali maulendo 1.4 kuposa muyeso.Kutalikirana kotereku kumawonetsa zotsalira za antithrombotic mphamvu ya calcium nadroparin.

Ntchito mankhwala Fraxiparin pa mimba

Kuyesera kwanyama sikunawonetse mphamvu ya calcium nadroparin, munthawi yoyamba ya kubereka, ndikofunikira kupewa kuyang'anira Fraxiparin onse mu prophylactic mlingo komanso njira yothandizira.

Munthawi ya II ndi III trimesters ya mimba, Fraxiparin ingagwiritsidwe ntchito pokhapokha malinga ndi malingaliro a dokotala popewa venous thrombosis (poyerekeza zabwino zomwe mayi ali ndi chiwopsezo cha mwana wosabadwayo). Chithandizo cha maphunziro panthawiyi sichikugwiritsidwa ntchito.

Ngati pali funso lokhudza kugwiritsa ntchito mankhwala opha ululu, ndikulimbikitsidwa, momwe ndingathere, kuyimitsa chithandizo cha heparin prophylactic osachepera maola 12 musanachitike opaleshoni.

Popeza mayamwidwe a mankhwala am'mimba m'matumbo mwa makanda, makamaka, sizingachitike, chithandizo ndi Fraxiparin cha amayi oyamwitsa sichotsutsana.

Contraindication kugwiritsa ntchito mankhwala Fraxiparin

Hypersensitivity (kuphatikizapo thrombocytopenia) kupita ku Fraxiparin kapena LMWH ina ndi / kapena heparin mu anamnesis, zizindikiro za kutulutsa magazi kapena chiopsezo chotaya magazi chifukwa chokhudzana ndi hexpasis yodwala, kupatula DIC, yopanda chifukwa cha heparin, kuwonongeka kwa ziwalo zathupi ndikulakalaka magazi (mwachitsanzo, zilonda zam'mimba kapena duodenum), kuvulala kapena kulowererapo pazinthu zazikulu zamanjenje, septic endocarditis.

Zotsatira zoyipa za mankhwala Fraxiparin

Zotsatira zoyipa kwambiri ndikupanga kwa subcutaneous hematoma pamalo a jekeseni. Nthawi zina, pamawoneka timinofu tating'onoting'ono totanthauza kuti heparin encapsulation, yomwe imatha patangotha masiku ochepa.

Mlingo waukulu wa Fraxiparin umatha kutulutsa magazi m'malo osiyanasiyana komanso mtundu wofatsa wa thrombocytopenia (mtundu wa I), womwe nthawi zambiri umatha panthawi yothandizanso. Mwinanso kuchuluka kwakanthawi kwamphamvu kwa chiwindi michere (ALT, AST).

Khungu necrosis komanso khungu lawo siligwirizana. Milandu ingapo ya anaphylactic reaction komanso immune thrombocytopenia (mtundu II), wophatikizidwa ndi arterial ndi / kapena venous thrombosis kapena thromboembolism.

Mlingo ndi makonzedwe a mankhwala Fraxiparin

Lowani mu tinthu tating'onoting'ono tam'mimba, m'makulidwe amkhungu (singano ndiyowonekera pakhungu lanu). Khola limasungidwa nthawi yonse yoyendetsa. Kupewa kwa thromboembolism mu opaleshoni yayikulu: 0,3 ml 1 nthawi patsiku. 0,3 ml imayendetsedwa kwa maola 2-4 asanachite opareshoni. Njira ya mankhwala osachepera masiku 7. Mwa njira zochizira: kutumikiridwa 2 pa tsiku kwa masiku 10 pa 225 IU / kg (100 IU / kg), yomwe ikufanana ndi: 45-55 kg - 0,4-0.5 ml, 55-70 kg - 0.5-0.6 ml, 70 -80 makilogalamu - 0,6-0.7 ml, 80-100 kg - 0,8 ml, oposa 100 kg - 0,9 ml. Mu opaleshoni yamatsenga, mlingo umasankhidwa kutengera kulemera kwa thupi. Imaperekedwa kamodzi patsiku, tsiku lililonse: Mlingo wochepera 50 makilogalamu: munthawi ya opareshoni ndipo pakatha masiku atatu atachitidwa opaleshoni - 0,2 ml, mu nthawi ya postoperative (kuyambira masiku 4) - 0,3 ml. Ndi thupi lolemera 51 mpaka 70 makilogalamu: mu nthawi ya ntchito ndipo pakatha masiku atatu atachitidwa opaleshoni - 0,3 ml, munthawi ya ntchito (kuyambira masiku 4) - 0,4 ml. Ndi kulemera kwa thupi la 71 mpaka 95 makilogalamu: munthawi ya opareshoni ndipo pakatha masiku atatu opareshoni - 0,4 ml, munthawi ya ntchito (kuyambira masiku 4) - 0,6 ml. Pambuyo pa venograph, imayendetsedwa maola 12 aliwonse kwa masiku 10, mlingo umadalira thupi: ndi kulemera kwa makilogalamu 45 - 0.4 ml, 55 kg - 0,5 ml, 70 kg - 0,6 ml, 80 kg - 0.7 ml, 90 kg - 0,8 ml, 100 makilogalamu ndi zina - 0,9 ml. Mankhwalawa angina osakhazikika ndi myocardial infarction yopanda Q wave, 0,6 ml (5700 IU antiXa) imayendetsedwa kawiri pa tsiku.

Mankhwala osokoneza bongo a Fraxiparin

Mankhwala osokoneza bongo mwadzidzidzi / pakubweretsa waukulu Mlingo wama hematin ochepa amomwe amachititsa magazi.

Pankhani ya kumeza - ngakhale mlingo waukulu - wa ochepa maselo olemera heparin (osanenedwabe), zovuta zoyenera siziyenera kuyembekezeredwa, chifukwa cha kuyamwa kochepa kwambiri kwa mankhwalawa.

Chithandizo: kutulutsa magazi ochepa - chepetsani mlingo wotsatira.

Nthawi zina, kugwiritsa ntchito protamine sulfate kungasonyezedwe, poganizira izi: mphamvu yake imakhala yotsika kwambiri kuposa momwe inafotokozedwera pokhudzana ndi mankhwala osokoneza bongo a heparin osagwirizana, phindu / chiopsezo cha protamine sulfate ziyenera kuyesedwa mosamala chifukwa cha zovuta zake (makamaka anaphylactic shock )

Ngati aganiza kugwiritsa ntchito chithandizo chotere, kusalowerera kumachitika pang'onopang'ono ndi iv makonzedwe a protamine sulfate.

Mlingo wothandizila wa protamine sulfate umatengera: mlingo wa heparin (ma antiheparin magawo 100 a protamine sulfate angagwiritsidwe ntchito kuti athetse ntchito ya 100 IU anti-XA factor shughuli ya LMWH), nthawi idapita pambuyo pa kuperekedwa kwa heparin, ndi kuchepa kwa mphamvu ya mankhwala.

Komabe, sizingatheke kusokoneza ntchito ya anti-Xa chinthu.

Komanso, kinetics mayamwidwe otsika maselo kulemera heparin amatha kupereka kusakhalitsa kwakanthawi ndipo kungafunike kugawanitsidwa kwa chiwerengero chowerengera cha kuchuluka kwa protamine sulfate angapo jakisoni (2-5) yogawa patsiku.

Mogwirizana ndi mankhwala Fraxiparin ndi mankhwala ena

Kukula kwa Hyperkalemia kumatha kudalira kupezeka kofanana kwa zinthu zingapo zoopsa. Mankhwala omwe amachititsa hyperkalemia: mchere wa potaziyamu, okodzetsa a potaziyamu, zoletsa za ACE, ma angiotensin II receptor blockers, NSAIDs, heparins (ochepa maselo kapena osagwirizana), cyclosporine ndi tacrolimus, trimethoprim. Chiwopsezo cha hyperkalemia chimawonjezeka ndikuphatikiza ndalama zomwe zili pamwambapa ndi Fraxiparin.

Kugwiritsa ntchito kwa Fraxiparin ndimankhwala omwe amakhudza hemostasis, monga acetylsalicylic acid, NSAIDs, mavitamini a vitamini K, fibrinolytics ndi dextran, zimapangitsa kukulitsa zotsatira.

Kuphatikiza apo, ziyenera kukumbukiridwa kuti kuphatikizika kwa ma cell a platinamu (kuphatikiza acetylsalicylic acid ngati mankhwala a analgesic ndi antipyretic, i.e pa mlingo woposa 500 mg): NSAIDs, abciximab, acetylsalicylic acid mu antiplatelet doses (50-300 mg) pa. kuwonetsa kwa mtima ndi mitsempha, beraprost, clopidogrel, eptifibatid, iloprost, ticlopidine, tirofiban kumawonjezera mwayi wokhetsa magazi.

Malangizo apadera a kutenga Fraxiparin

Ngakhale kuti kuchuluka kwa mankhwala osiyanasiyana a hematin otsika kwambiri amamuwonetsedwa mu magulu apadziko lonse a anti-Xa factor, kulimbikira kwawo sikungokhala ndi ntchito ya anti-Xa factor. Kusintha momwe machitidwe a NMH amodzi alili ndi owopsa komanso osavomerezeka, chifukwa mtundu uliwonse wayesedwa ndi mayesero apadera azachipatala. Chifukwa chake, chisamaliro chapadera ndikutsatira malangizo ena ogwiritsira ntchito mankhwala aliwonse ndikofunikira.

Chiwopsezo chotaya magazi. Malangizo othandizira achire (Mlingo ndi nthawi yayitali ya chithandizo) ziyenera kuonedwa. Zikatero, magazi amatuluka, makamaka kwa odwala omwe ali pachiwopsezo (okalamba, odwala omwe ali ndi vuto la impso, ndi ena otero).

Kutaya magazi kwambiri kunawonedwa: mwa odwala okalamba, makamaka pokhudzana ndi kufooka kwa ntchito ya impso ndi msinkhu, ndi kulephera kwa aimpso, odwala omwe ali ndi zosakwana 40 makilogalamu, munthawi ya chithandizo chokwanira kuposa masiku omwe analimbikitsidwa (masiku 10), ngati simungagwiritse ntchito mikhalidwe yolimbikitsidwa yamankhwala ( makamaka nthawi yayitali komanso kumwa mankhwalawa potengera kulemera kwa thupi pophunzira ntchito), akaphatikizidwa ndi mankhwala omwe amalimbikitsa kuchepa kwa magazi.

Mulimonsemo, kuwongolera kwapadera ndikofunikira kwa odwala okalamba ndi odwala omwe ali ndi vuto la impso, komanso nthawi yayitali yogwiritsira ntchito mankhwalawa kwa masiku 10. Nthawi zina, zingakhale zothandiza kuyeza ntchito ya anti-Xa chinthu kuti mupeze kuchuluka kwa mankhwala.

Chiwopsezo cha heparin-ikiwaletsa thrombocytopenia (HIT).Ngati wodwala akulandila chithandizo cha LMWH (muyezo kapena prophylactic doses) ali ndi zotsatirazi: mphamvu zoyipa za thrombosis zomwe wodwalayo amathandizidwa, phlebitis, pulmonary embolism, pachimake mbali yam'mimba ischemia, infarction ya myocardial kapena stroko mawonetseredwe a heparin-anachititsa thrombocytopenia (GIT), ndipo pang'onopang'ono pang'anani kuchuluka kwa ma cell.

Gwiritsani ntchito ana. Chifukwa cha kusowa kwa deta, kugwiritsa ntchito LMWH mwa ana sikulimbikitsidwa.

Impso. Musanayambe chithandizo cha LMWH, ndikofunikira kuwunika ntchito zaimpso, makamaka kwa okalamba omwe ali ndi zaka zoposa 75. Kuvomerezeka kwa Creatinine kumawerengeredwa malinga ndi njira yodutsa ya Cockcroft ndipo zimatengera kulemera kwenikweni kwa thupi: mwa amuna, Cl creatinine = (wazaka zana limodzi) × thupi kulemera / (0,814 × serum creatinine), akuwonetsa zaka zazaka, kulemera kwa thupi makilogalamu, ndi serum / l (ngati creatinine ikuwonetsedwa mu mg / ml, kuchulukitsa ndi 8.8).

Mwa amayi, fomulayi imathandizidwa ndikuchulukitsa zotsatira ndi 0.85.

Kuzindikiritsa kulephera kwambiri kwa impso (Cl creatinine pafupifupi 30 ml / min) ndikutsutsana ndi kugwiritsa ntchito LMWH mu fomu yophunzirira (onani "Contraindication").

Kuwerengera

Chifukwa cha chiwopsezo chotukuka cha GIT, kuwongolera kwa ma platelet ndikofunikira, mosasamala kanthu ndi chisonyezo chogwiritsidwa ntchito ndi mlingo womwe wapatsidwa. Kuwerengera kwa mapulateleti kumachitika musanayambe chithandizo kapena osachedwa kuposa tsiku loyamba la chithandiziro mutangoyamba kumene, kenaka 2 kawiri pa sabata pamankhwala onse.

Kuzindikira kwa GIT kuyenera kuthandizidwa ngati kuchuluka kwa ma protein

Yogwira pophika: calcium ya nadroparin

1 ml 9500 anti-Xa nadroparin calcium

Syringe 1 yodzaza (0,3 ml) ili ndi calcium 2550 ya anti-Xa nadroparin

Syringe 1 yodzaza (0,4 ml) ili ndi 3800 ya anti-Xa nadroparin calcium

Omwe amathandizira: calcium hydroxide solution (kapena kuchepetsedwa hydrochloric acid), madzi a jakisoni.

Mankhwala

Nadroparin ndi ochepa maselo wolemera heparin wopangidwa ndi depolymerization ya muyezo heparin. Ndi glycosaminoglycan yokhala ndi kulemera pafupifupi mamiliyoni 4300 daltons. Nadroparin amawonetsa pamtunda wambiri womanga mapuloteni a plasma omwe ali ndi antithrombin ya III. Ubwenzi wotere umatsogolera pakupititsa patsogolo kwa china factor, ndiye gawo lalikulu pantchito yapamwamba ya antithrombotic ya nadroparin. Njira zina za antithrombotic ntchito ya nadroparin ndi kukondoweza kwa minofu chinthu njira inhibitor, kutsegula kwa fibrinolysis ndi kumasulidwa mwachindunji kwa minofu plasminogen activator kuchokera endothelial maselo, kusintha kwa hemorheological magawo (kuchepa kwa mamasukidwe amwazi ndi kuwonjezeka kwa madzi am'magazi a michere ndi granulocyte membranes. Nadroparin imakhala yolumikizana kwambiri pakati pa ntchito za anti-Xa ndi anti-IIa. Ili ndi antithrombotic mwachangu komanso nthawi yayitali. Poyerekeza ndi heparin yopanda kukonzekera, nadroparin imakhala yocheperako pakugwira ntchito ya maplatelet ndi kuphatikiza ndipo imakhala yochepa kwambiri pa hemostasis yapamwamba.

Pharmacokinetic katundu amatsimikiza poyesa anti-Xa factor ya magazi am'magazi.

Pambuyo pa subcutaneous makonzedwe, nsonga mu anti-Xa ntchito (C max) imatheka pambuyo maola 3-5 (T max). Bioavailability ali pafupifupi kwathunthu (pafupifupi 88%).

Pambuyo pa makonzedwe, nsonga ya anti-Xa (C max) imakwaniritsidwa osakwana mphindi 10 ndi theka la moyo wa 2:00.

Pambuyo subcutaneous makonzedwe, kuchotsa theka-moyo pafupifupi 3.5 maola. Komabe, ntchito ya anti-XA imapitilira kwa maola osachepera 18 pambuyo pa jekeseni wa nadroparin pa mlingo wa 1900 anti-XA ME.

Magulu apadera a odwala

Odwala okalamba

Popeza ntchito yachilengedwe ya impso imachepa ndi zaka, kuthetsedwera kwa mankhwalawa kumacheperachepera. Kuthekera kwa kukhazikika kwa impso m'gululi la odwala kuyenera kulemedwa ndipo mlingo wa mankhwalawa uyenera kusinthidwa moyenera.

Malinga ndi kafukufuku wa zamankhwala pama paracokinetic magawo a nadroparin, pomwe idaperekedwa kwa odwala omwe ali ndi madigiri osiyanasiyana a kulephera kwa impso, kulumikizana kunawonetsedwa pakati pa kuvomerezeka kwa nadroparin ndi chilolezo cha creatinine. Odwala omwe ali ndi vuto lochepetsa aimpso (creatinine chilolezo cha 36-43 ml / min), malo wamba omwe amakhala pansi pa ndende / nthawi yokhotakhota (AUC) ndi theka la moyo amawonjezeka ndi 52% ndi 39%, motsatana, poyerekeza ndi omwe ali odzipereka athanzi. Mwa odwalawa, pafupifupi plasma chilolezo cha nadroparin chatsika mpaka 63% pazomwe zimachitika. Kusiyanasiyana kwamunthu aliyense kunawonedwa. Odwala omwe amalephera kwambiri aimpso (kulengedwa kwa creatinine chilolezo cha 10-20 ml / mphindi), AUC ndi kuthetseratu theka la moyo limakula ndi 95% ndi 112%, motero, poyerekeza ndi omwe ali odzipereka athanzi. Chilolezo cha odwala omwe ali ndi vuto lalikulu laimpso chinatsitsidwa mpaka 50% poyerekeza ndi odwala omwe ali ndi vuto laimpso. Odwala omwe ali ndi vuto la aimpso kulephera (kulengedwa kwa creatinine chilolezo cha 3-6 ml / min) omwe anali pa hemodialysis, amatanthauza kuti AUC ndi kuthetseratu theka la moyo limakulitsidwa ndi 62% ndi 65%, motero, poyerekeza ndi odzipereka athanzi. Chilolezo cha odwala omwe ali ndi vuto la aimpso omwe akudutsa hemodialysis chatsika mpaka 67% mwa odwala omwe ali ndi vuto laimpso.

Kupewa kwa zovuta za thromboembolic kawirikawiri kapena opaleshoni yamatsenga mwa odwala omwe ali ndi chiopsezo chachikulu cha zovuta za thromboembolic.

Chithandizo cha mitsempha yayikulu.

Kupewa kwa magazi kuundana pa hemodialysis.

Chithandizo cha matenda osakhazikika a angina pectoris komanso kulowetsedwa kwa myocardial popanda mafinya a Q osagwirizana pa ECG osakanikirana ndi acetylsalicylic acid.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Nadroparin iyenera kugwiritsidwa ntchito mosamala odwala omwe akutenga mankhwala opatsirana pakamwa, glucocorticosteroids, ndi dextrans. Ngati anticoagulants mkamwa ayenera kuperekedwa kuti athandize odwala omwe akutenga nadroparin, chithandizo ndi nadroparin chikuyenera kukulitsidwa kuti chizikhazikika pamlingo wokuyimira chiwembu cha mayiko wamba (INR).

Zolemba ntchito

Popeza pali chiwopsezo cha heparin thrombocytopenia, kuwerengetsa kwa ma protein kuyenera kuyang'aniridwa panthawi yonse ya chithandizo.

Milandu yapadera ya thrombocytopenia imanenedwapo, nthawi zina zoopsa, zomwe zimatha kutsatiridwa ndi arterial kapena venous thrombosis, zomwe ndizofunikira kwambiri kuziganizira zotsatirazi: ndi thrombocytopenia, kuchepa kulikonse kwa chiwerengero cha maselo a cell (kuyambira 30% mpaka 50% poyerekeza ndi gawo loyambira). Mphamvu ya thrombosis, yomwe mankhwala amalembedwa, ndi mawonekedwe a thrombosis pamankhwala, ndi matenda amtundu wamkati wosakanikirana. Zinthu ngati izi zikuchitika, chithandizo cha heparin chikuyenera kutha.

Zotsatira zomwe zili pamwambapa ndi immuno-allergen mwachilengedwe, ndipo ngati chithandizo chikugwiritsidwa ntchito koyamba, zimachitika pakati pa tsiku la 5 ndi la 21 la chithandizo, koma zimatha kuchitika kale kwambiri ngati wodwalayo ali ndi mbiri ya heparin thrombocytopenia.

Odwala omwe ali ndi thrombocytopenia omwe adayamba kumwa mankhwala a heparin (onse muyezo komanso otsika maselo) m'mbiri ya chithandizo ndi heparin sayenera kutumikiridwa ngati kuli kofunikira. Pankhaniyi, kuyang'ana mosamala zamankhwala ndikutsimikiza kwa kuchuluka kwamapulogalamu tsiku lililonse ndikofunikira. Pankhani ya thrombocytopenia, mankhwala a heparin ayenera kusiyidwa nthawi yomweyo.

Pankhani ya thrombocytopenia pa mankhwala a heparin (onse muyezo komanso otsika maselo), mwayi wofotokozera antithrombotic mankhwala a kalasi ina uyenera kuganiziridwanso. Ngati mankhwalawa sapezeka, mutha kuyeserera mankhwala ena pagulu lama hepatin ochepa, ngati kugwiritsa ntchito heparin ndikofunikira.Pankhaniyi, kuwerengetsa kwa mapulogalamu kuyenera kuyesedwa osachepera kamodzi patsiku ndipo chithandizo chiyenera kutha posachedwa ngati woyamba thrombocytopenia amalimbikira atachotsa mankhwalawo.

Chiyeso chophatikizira mu vitro cha mapulogalamu nchosafunikira kwenikweni pakufunika kwa kupezeka kwa heparin thrombocytopenia.

Zomwe zimapangitsa kuti magazi atuluke

Nadroparin iyenera kugwiritsidwa ntchito mosamala pazochitika zomwe zimagwirizanitsidwa ndi chiopsezo chowonjezeka magazi, monga

kulephera kwa chiwindi
matenda oopsa kwambiri
chilonda cham'mimba kapena zilonda zam'mimba kapena zotupa zina zomwe zingayambitse magazi,
chorioretinal mtima matenda,
nthawi pambuyo opareshoni ku ubongo ndi msana, m'maso.

Amadziwika kuti nadroparin amathandizidwa ndi impso, zomwe zimayambitsa kuchuluka kwa nadroparin kwa odwala omwe amalephera impso. Odwala omwe ali ndi vuto la aimpso, chiopsezo chakutuluka magazi chikuwonjezeka, ndipo ayenera kuthandizidwa mosamala.

Lingaliro la kuthekera kuchepetsa kuchepetsa kwa odwala omwe ali ndi chilolezo cha creatinine kuyambira 30 mpaka 50 ml / mphindi liyenera kutengera kuyesedwa kwa dokotala ndi zomwe zimapangitsa kuti wodwala aliyense azitulutsa magazi poyerekeza ndi chiwopsezo cha thromboembolism.

Heparin imatha kupondereza adrenal secretion ya aldosterone ndikuyambitsa hyperkalemia, makamaka odwala omwe ali ndi plasma potaziyamu wambiri kapena ali ndi chiwopsezo chotere cha kuchuluka kwa plasma kwa odwala omwe ali ndi matenda a shuga, odwala omwe amalephera kupweteka aimpso, omwe ali ndi metabolic acidosis kapena odwala omwe amamwa mankhwala osokoneza bongo zomwe zingayambitse hyperkalemia (mwachitsanzo, zoletsa za ACE, mankhwala osapweteka a antiidal).

Chiwopsezo cha hyperkalemia chimawonjezeka ndikutalika kwa chithandizo, koma nthawi zambiri Hyperkalemia imasinthidwanso. Odwala omwe ali pachiwopsezo, kuchuluka kwa plasma potaziyamu kuyenera kuyang'aniridwa.

Mankhwala a spinal / epidural anesthesia, punction lumbar punction ndi mankhwala ena okhudzana nawo

Chiwopsezo cha hematomas ya spinal / epidural hematomas imachulukirachulukira ndikugwiritsira ntchito catheter wothandizira kapena kugwiritsa ntchito mankhwala ena omwe angakhudze hemostasis, monga mankhwala osapweteka a antiidal, mapulogalamu ophatikizira am'magazi, kapena ma anticoagulants ena. Chiwopsezochi chimakulirakonso ndikuwopseza kapena kubwereza mobwerezabwereza kapena kuwongolera msana, chifukwa chake lingaliro pa kuphatikiza kwa neuroaxial blockade ndi anticoagulants limapangidwa pambuyo pofufuza phindu / chiopsezo pazochitika zonsezi.

mwa odwala omwe amathandizidwa kale ndi anticoagulant wothandizila, phindu logwiritsira ntchito neuroaxial blockade liyenera kukhala loyenera mosamala ndi chiopsezo chotheka,
Odwala omwe akukonzekera kukonzekera kuchitidwa opaleshoni ndi neuroaxial blockade, phindu logwiritsira ntchito anticoagulants liyenera kusamala mosamala ndi ngozi yomwe ingachitike.

Mukamachita mankhwalawa kwa msana, kubowoleza kwa msana kapena kuwonongeka kwam'mimba, nthawi iyenera kusungidwa nthawi ya 12:00 ndikugwiritsa ntchito nadroparin mu Mlingo wothana ndi maola 24 ndikugwiritsa ntchito nadroparin mu Mlingo wothandizirana pakati pa jakisoni wa nadroparin ndi kuyambitsa kapena kuchotsetsa catheter ya msana kapena ya sindano. Kwa odwala omwe ali ndi vuto la aimpso, nthawi imeneyi imapitilira.

Odwala ayenera kuyang'aniridwa bwino kuti azindikire zizindikiro za matenda amitsempha. Ngati zingachitike, chithandizo choyenera nchofunikira.

Salicylates, mankhwala osapweteka a antiidal komanso othandizira kuponderezana

Pofuna kupewa kapena kuchiza venous thromboembolic yamavuto komanso kupewa magazi kukomoka nthawi ya hemodialysis, kugwiritsa ntchito mankhwala acetylsalicylic acid, mankhwala ena osokoneza bongo, omwe si mankhwala a antiidal komanso odana ndi mapulogalamu ophatikizira mankhwala osakanikirana samalimbikitsidwa, chifukwa amatha kuchulukitsa magazi. Ngati kugwiritsa ntchito kuphatikiza koteroko sikungapeweke, kuyang'aniridwa mosamala kwa odwala kuyenera kuchitika.

Panthawi ya mayesero azachipatala pochiza matenda osakhazikika a angina pectoris ndi infarction ya myocardial yopanda mafunde a pathological Q, ECG nadroparin adagwiritsidwa ntchito limodzi ndi acetylsalicylic acid pa mlingo wa 325 mg / tsiku.

Nthawi zambiri za necrosis za khungu zanenedwapo. Izi zidayambitsidwa ndi kuwonekera kwa phenura kapena kulowetsedwa ndi zowawa za erythematous zokhala ndi zizindikiro wamba kapena zopanda umboni. Zikatero, chithandizo chiyenera kuyimitsidwa nthawi yomweyo.

Latex ziwengo

Chovala chotchingira pa singano ya syringe yodzazidwa kale ndi rabara kuchokera ku chilengedwe chachilengedwe, chimatha kuyambitsa mavuto pakati pa anthu oledzera.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Palibe maphunziro azachipatala pazotsatira za heparin pa chonde. Kafukufuku wazinyama sanawonetse teratogenic kapena fetotoxic mphamvu ya heparin. Komabe, zidziwitso zamankhwala zokhudzana ndi kulowa kwa placenta kwa nadroparin mwa amayi apakati ndizochepa. Chifukwa chake, kugwiritsa ntchito heparin pa nthawi yomwe ali ndi pakati sikulimbikitsidwa, pokhapokha ngati chithandizo chamankhwala chimaposa chiopsezo.

Zambiri pazakudya zam'mimba za nadroparin mu mkaka wa m'mawere ndizochepa, kotero kugwiritsa ntchito nadroparin panthawi yoyamwitsa sikulimbikitsidwa.

Kodi ndingagwiritse ntchito chiyani?

Ngakhale mayankho ochokera kwa madotolo ena akuti fakisi ya pexiparin ndi yotetezeka panthawi yapakati, simuyenera kuigwiritsa ntchito pokhapokha ngati pakufunika. Katswiriyo amaperekera mankhwalawo kwa wodwala ngati kuwopseza kwa moyo wa mayi ndiokwera kuposa chiwopsezo cha mwana wosabadwayo.

Chithandizo cha mankhwala pakhungu

Mankhwala amatchulidwa ngati prophylaxis ndi mankhwalawa omwe amapangitsa kuti magazi azitha kuchuluka. Dokotala payekhapayokha ndi amene amawona kutalika kwa mankhwalawa. Kutalika kwa maphunzirawa kumatengera kuwawa kwa zilonda.

Nthawi zina amayi oyembekezera amakakamizidwa kubaya mankhwalawa nthawi yonse yomwe ali ndi pakati. Chipangizocho chili ndi njira inayake yochitira, zomwe sizimadalira kuti zimayikidwa pakukonzekera kapena pobereka:

mankhwalawa amamangidwa ndi mapuloteni a plasma, amalepheretsa zinthu zina za magazi,
amachepetsa magazi
zimalepheretsa kuphatikizira magazi m'magazi.

Pali mikangano yolimba yokhudza kuchuluka kwa fakisi yodwala panthawi yomwe mayi ali ndi pakati kungakhale koopsa kwa mwana wosabadwayo ndi mayi woyembekezera. Akatswiri ena amakhulupirira kuti mankhwalawo sangathe kusokoneza mwana wosabadwayo, ndipo zaka zambiri zochitidwa zimatsimikizira izi.

Ena amakhulupirira kuti mankhwalawa amatha kuyambitsa magazi mkati, omwe ndi owopsa kwa thanzi la mkazi ndi mwana wake. Kuphatikiza apo, malangizowa akuwonetsa kuti asayansi sanachitepo kafukufuku aliyense pazokhudza mankhwalawa mwana wosabadwa, chifukwa chake sitinganene kuti ndiotetezeka kwathunthu.

Pa nthawi yoyembekezera, dokotala amamulembera jakisoni wa fungo la misempha pokhapokha ngati pali kuchuluka kwa magazi. Vutoli lingayambitse:

ntchito isanakwane
kufa kwamkati kwa mwana,
kuchotsa pamimba.

Nthawi zambiri, madokotala amapereka mankhwala pokhapokha wachiwiri kapena wachitatu wodula. Pali zifukwa zingapo.

The placenta limakula ndi mwana wosabadwayo kwa miyezi isanu ndi inayi. Amakhala ndi ma capillaries komanso mitsempha yamagazi yomwe imapatsa mwana zakudya. Ngati mzimayi wakula magazi, amayamba kuyenda pang'onopang'ono m'makutuwo.Zotsatira zake, pali thrombosis, njala yam'mimba ya mwana wosabadwayo. Izi sizingasinthe kukula kwake ndi thanzi lake.

Pa trimester yomaliza, chiberekero chimafika pamlingo wambiri, motero chimayika kwambiri mitsempha ya m'chiuno, zomwe zimayambitsa magazi m'miyendo. Magazi amayamba kuyendayenda m'munsi, kotero magazi amawonekera. Zotsatira zake ndi pulmonary embolism. Izi zikuwopseza imfa ya mkazi ndi mwana wake.

Anapatsidwa nthawi yokonzekera ndi kutenga pakati

Koma mulimonsemo, mukakhala ndi pakati, mankhwala a tranexam, a fxiparin ndi mankhwala ena ayenera kuyikidwa kokha ndi dokotala atakambirana ndi munthu wina. Nthawi zina mankhwala amatha kupulumutsa moyo wa mayi ndi mwana wake wosabadwa. Chifukwa chake, sitinganene kuti mankhwalawo ndi oletsedwa. Chilichonse chikuyenera kusankha pachokha.

Zotsatira zoyipa ndi contraindication

Pa mimba, muyenera kuwerenga mosamala malangizo ogwiritsira ntchito mankhwala osokoneza bongo a fraxiparin. Monga pafupifupi aliyense wamphamvu, wogwira ntchito popanga mankhwala, a ftyipiparin ali ndi zotsutsana ndi zoyipa zake. Chifukwa chake, musanagwiritse ntchito mankhwalawa, muyenera kuphunzirapo za vutolo mosamala ndikuwona zovuta zomwe zingachitike chifukwa chamankhwala. Mankhwala saloledwa pazochitika zotsatirazi.

Wodwala salekerera yogwira mankhwala nadroparin, yomwe ilipo mu mankhwala.
Coagulopathy imawonedwa, komwe ndi kuchepa kwa magazi.
Palibe zotsatira kuchokera ku mankhwala ndi mankhwala a antiplatelet gulu: Aspecard, Cardiomagnyl, Aspirin Cardio.
Pachimake matenda endocarditis.
Hemorrhagic cerebrovascular kuvulala.
Kukula kwa thrombocytopenia mutagwiritsa ntchito calcium ya nadroparin kale.

Pambuyo pa chithandizo, zotsatira zoyipa zimatha, komabe, kuweruza ndi ndemanga za adokotala, sizimawonekera kawirikawiri. Zimangotanthauza kuyipa kosiyanasiyana.

Kugwedezeka kwa anaphylactic.
Edema wa Quincke.
Urticaria.
Ziwengo mu mawonekedwe kuyabwa kapena zidzolo.

Mankhwala ayenera kumwedwa mosamala kwa amayi omwe ali ndi vuto la m'mimba, kuthamanga kwa magazi, kusokonezeka kwa magazi m'diso, impso kapena chiwindi. Dziwani kuti bongo wambiri amawopseza kuti atulutsa magazi. Mlingo wa ma enzymes a chiwindi (AST, ALT) ungakulenso.

Zizindikiro zogwiritsidwa ntchito

Kugwiritsa ntchito mitundu ya Fraxiparin pazinthu zotsatirazi:

Chithandizo cha myocardial infarction,
kupewa zovuta za thromboembolic, mwachitsanzo, pambuyo pa opaleshoni kapena popanda kuchitidwa opareshoni,
coagulation prophylaxis pa hemodialysis,
Chithandizo cha thromboembolic zovuta,
Chithandizo cha matenda osakhazikika angina pectoris.

Malangizo ogwiritsira ntchito

Fraxiparin imalowetsedwa pamimba m'matumbo a subcutaneous. Khola la pakhungu liyenera kusungidwa nthawi yonseyi pomwe yankho likuperekedwa.

Wodwala ayenera kunama. Ndikofunikira kuti singano ikhale yokhayo, osati pakona.

Opaleshoni yayikulu pakuletsa zovuta za thromboembolic, yankho limayendetsedwa ndi kuchuluka kwa 0,3 ml kamodzi patsiku. Mankhwalawa amatengedwa kwa sabata limodzi mpaka nthawi yangozi itadutsa.

Mlingo woyamba umaperekedwa musanachitike opaleshoni mu maola 2-4. Pankhani ya opaleshoni ya mafupa, mankhwalawa amaperekedwa maola 12 asanachitike ntchito ndi maola 12 atamaliza. Kupitilira apo, mankhwalawa amatengedwa kwa masiku osachepera 10 mpaka kutha kwa nthawi yangozi.

Mlingo wopewa umadalira malinga ndi kulemera kwa thupi la wodwala:

40-55 kg - kamodzi patsiku kwa 0,5 ml,
60-70 kg - kamodzi patsiku kwa 0,6 ml,
70-80 kg - kawiri pa tsiku, 0,7 ml iliyonse,
85-100 kg - kawiri pa tsiku kwa 0,8 ml.

Zochizira zotupa za thromboembolic, mankhwalawa amaperekedwa pafupipafupi kwa maola 12 kawiri pa tsiku kwa masiku 10.

Mankhwalawa thromboembolic zovuta, kulemera kwa munthu amathandiza kudziwa mlingo:

mpaka 50 kg - 0,4 mg,
50-59 kg - 0,5 mg
60-69 kg - 0,6 mg
70-79 kg - 0,7 mg,
80-89 kg - 0,8 mg
90-99 makilogalamu - 0,9 mg.

Popewa kugundana kwa magazi, mlingo uyenera kutumikiridwa aliyense payekha kutengera luso la dialysis. Mwachilengedwe, kuphatikizika kumalephereka, pogona ndiye mlingo woyamba wa 0,3 mg wa anthu mpaka 50 kg, 0,4 mg mpaka 60 kg, 0,6 mg woposa 70 kg.

Mankhwala a myocardial infarction ndi angina osakhazikika amalimbikitsidwa limodzi ndi Aspirin kwa masiku 6. Poyamba, mankhwalawa amapaka jakisoni wambiri. Mlingo wa 86 ME anti-Xa / kg umagwiritsidwa ntchito pa izi. Kenako, yankho limaperekedwa kawiri pa tsiku chimodzimodzi.

Kuyanjana kwa mankhwala osokoneza bongo

Kutenga franksiparin nthawi imodzi ndi mankhwala ena kumatha kubweretsa Hyperkalemia.

Izi zikuphatikiza: mchere wa potaziyamu, zoletsa za ACE, heparins, NSAIDs, potaziyamu - zothetsera m'mimba, Trimethoprim, angiotensin II receptor blockers, Tacrolimus, Cyclosporin.

Mankhwala omwe amakhudza hemostasis (indico anticoagulants, acetylsalicylic acid, NSAIDs, fibrinolytics, dextran), limodzi ndi wogwiritsa ntchito wothandizirazi, zimathandizira wina ndi mnzake.

Kuopsa kwa magazi kumachulukitsa ngati Abciximab, Beraprost, Iloprost, Eptifibatide, Tirofiban, Ticlopedin atengedwanso. Acetylsalicylic acid imathandizanso pamenepa, koma mwa ma antiplatelet Mlingo, 50-500 mg.

Fraxiparin iyenera kuthandizidwa mosamala kwambiri odwala akamalandira ma dextrans, anticoagulants, ndi systemic corticosteroids. Ngati mukumwa mankhwala osokoneza bongo limodzi ndi mankhwalawa, kugwiritsidwa ntchito kwake kumapitilizidwa mpaka chizindikiro cha INR chikasintha.

Kuphatikiza kwa Fraxiparin ndi mowa ndizabwino. Mankhwalawa amagwiritsidwa ntchito popewa zovuta za thromboembolic, ndipo mowa, mmalo mwake, umawonjezera ngozi zawo.

Zizindikiro Fraxiparin syringe ampoule

Kupewera kwa zovuta za thromboembolic panthawi ya opaleshoni ndi mafupa mkati mwa odwala omwe ali ndi chiopsezo chachikulu cha thrombosis (kupuma kwambiri komanso / kapena kulephera kwa mtima pazinthu za ICU, kusakhazikika kwa angina pectoris, infarction ya myocardial yopanda pathological Q wave pa ECG).
- Chithandizo cha thromboembolism.
- Kupewa kwa magazi kuundana pa hemodialysis.

Malangizo a Fraxiparin syringe ampoule

Thrombocytopenia yokhala ndi mbiri ya nadroparin.
- Zizindikiro za kutaya magazi kapena chiwopsezo chotaya magazi chifukwa chodwala (heparin), kupatula DIC, osati chifukwa cha heparin.
- Matenda a organic omwe amakonda kutuluka magazi (mwachitsanzo, chilonda cham'mimba kapena zilonda zam'mimba.
- Zowonongeka kapena kulowererapo kwa bongo ndi msana kapena kumaso.
- Kutuluka kwa magazi kwa intracranial.
- pachimake septic endocarditis.
- Kulephera kwakukulu kwaimpso (CC osakwana 30 ml / min) mwa odwala omwe amalandira Fraxiparin pochiza matenda a thromboembolism, angina osakhazikika ndi myocardial infarction popanda Q wave.
- Ana ndi achinyamata (mpaka zaka 18).
- Hypersensitivity ku nadroparin kapena zigawo zina za mankhwala.
Mochenjera, Fraxiparin iyenera kulembedwa pazochitika zokhudzana ndi chiwopsezo chowonjezeka magazi: ndi chiwindi, kulephera kwa impso, ndi matenda oopsa kwambiri, wokhala ndi mbiri ya zilonda zam'mimba kapena matenda ena omwe ali ndi chiopsezo chotaya magazi, omwe ali ndi vuto lotaya magazi mu choroid ndi retina , pambuyo pa ntchito pambuyo pa ntchito ku ubongo ndi msana kapena m'maso, odwala omwe ali ndi zolemera zosakwana 40 kg, omwe amakhala nthawi yayitali kuposa momwe amalimbikitsira Dowa (masiku 10) zinachitikira sanali kugwilizana ndi zinthu analimbikitsa mankhwala (makamaka kuwonjezera nthawi ndi mlingo maphunziro a ntchito), pamene pamodzi ndi mankhwala azitaya magazi.

Mimba ndi mkaka wa m`mawere Fraxiparin syringe ampoule

Pakadali pano, pali data yochepa pazilowedwe za nadroparin kudzera mu zotchinga zina mwa anthu.Chifukwa chake, kugwiritsa ntchito Fraxiparin pa nthawi yomwe ali ndi pakati sikulimbikitsidwa, pokhapokha ngati phindu lomwe lingakhalepo kwa mayi limaposa chiwopsezo kwa mwana wosabadwayo. Pakadali pano, pali zochepa zochepa pakugawidwa kwa nadroparin ndi mkaka wamawere. Pankhaniyi, kugwiritsa ntchito nadroparin pa mkaka wa m'mawere sikulimbikitsidwa. M'maphunziro oyesera nyama, palibe teratogenic mphamvu ya calcium nadroparin yomwe idapezeka.

Mlingo ndi makonzedwe a mankhwala a syxiparin syringe

Pamene / kumayambiriro kwa mankhwala makamaka kutumikiridwa kwa wodwala supine, mu s / c minofu ya anterolateral kapena posterolateral padziko pamimba, mbali yomweyo kumanja ndi kumanzere. Adaloledwa kulowa ntchafu. Pofuna kupewa kuwonongeka kwa mankhwalawa pogwiritsa ntchito syringes, thovu la mpweya sayenera kuchotsedwa jakisoni.
Singano iyenera kuyikidwira paliponse, osati pakona, pakhungu lopendekeka pakati pa chala chachikulu ndi chofiyira. Khola liyenera kusungidwa nthawi yonse ya mankhwala. Osapukuta tsamba la jakisoni mutatha jakisoni.
Pofuna kupewa thromboembolism ambiri opaleshoni mchitidwe Mlingo wovomerezeka wa Fraxiparin ndi 0,3 ml (2850 anti-Xa ME) s / c. Mankhwala chikuyendetsedwera 2-4 mawola asanachitike opaleshoni, ndiye - 1 nthawi / tsiku. Chithandizo chimapitilizidwa kwa masiku osachepera 7 kapena nthawi yonse ya chiwopsezo cha thrombosis, kufikira wodwalayo atakonzedwa.
Kuletsa thromboembolism pa mafupa ntchito Fraxiparin imayang'aniridwa sc pamankhwala omwe amatsimikiziridwa malinga ndi kulemera kwa thupi la wodwala pamlingo wa 38 anti-XA IU / kg, omwe amatha kuwonjezeka mpaka 50% patsiku la 4 la ntchito. Mlingo woyambirira umaperekedwa maola 12 asana opaleshoni, mlingo wa 2 - maola 12 atatha opareshoni. Kupitilira apo, Fraxiparin imagwiritsidwanso ntchito 1 nthawi / tsiku lonse la chiwopsezo cha thrombosis kufikira wodwala atamuika kumalo ena. Kutalika kochepa kwa mankhwala ndi masiku 10.
Odwala omwe ali pachiwopsezo chachikulu cha thrombosis (ndi kusakhazikika kwa angina, infarction ya myocardial yopanda Q wave) Fraxiparin ndi mankhwala sc 2 nthawi / tsiku (maola 12 aliwonse). Kutalika kwa mankhwala nthawi zambiri 6 masiku. M'maphunziro azachipatala, odwala omwe ali ndi vuto losakhazikika la angina pectoris / myocardial infarction popanda Q wave Fraxiparin adayikidwa limodzi ndi acetylsalicylic acid pa mlingo wa 325 mg / tsiku. Mlingo woyambirira umaperekedwa ngati jekeseni imodzi yamkati, Mlingo wotsatira umaperekedwa. Mlingo umayikidwa kutengera kulemera kwa thupi pamlingo wa 86 anti-XA IU / kg.
Mankhwalawa thromboembolism, pakamwa anticoagulants (pakalibe contraindication) ayenera kutumikiridwa posachedwa. Chithandizo cha Fraxiparin sichimayimitsidwa mpaka zomwe zimatsimikiziridwa pazotsimikizira nthawi ya prothrombin zitheke. Mankhwala wolembedwa 2/2 kawiri / tsiku lililonse (maola 12 aliwonse), nthawi yomwe maphunzirowa ali masiku 10. Mlingo umatengera kulemera kwamthupi la wodwala pamlingo wa 85 anti-XA ME / kg thupi.
Kupewa kwa kuchulukana kwa magazi mu njira ya kufalikira kwa masana pa hemodialysis: Mlingo wa Fraxiparin uyenera kukhazikitsidwa payekhapayekha wodwala aliyense, potengera luso la dialysis. Fraxiparin imabayidwa kamodzi ndikumalowetsa mzere wampweya wozungulira kumayambiriro kwa gawo lililonse. Kwa odwala osakhala ndi vuto lotaya magazi ambiri, Mlingo woyambira woyeserera umakhazikitsidwa kutengera kulemera kwa thupi, koma wokwanira gawo la dialysis la maola anayi.
Odwala omwe ali pachiwopsezo chotaya magazi Mutha kugwiritsa ntchito theka la mankhwalawa omwe amavomerezeka. Ngati dialysis gawo limatenga maola opitilira 4, ndiye kuti muthandizanso kuchuluka kwa Fraxiparin. Nthawi yotsatira ya dialysis, mlingo uyenera kusankhidwa malinga ndi zotsatira zake.Wodwala amayenera kuyang'aniridwa pa nthawi ya dialysis chifukwa cha kutuluka kwa magazi kapena zizindikiro za thrombosis mu dialysis system.
Odwala okalamba kusintha kwa mankhwala sikofunikira (kupatula odwala omwe ali ndi vuto laimpso). Musanayambe chithandizo ndi Fraxiparin, tikulimbikitsidwa kuwunikira zizindikiro zaimpso.
Odwala omwe ali ndi vuto lochepa kwambiri la impso (creatinine chilolezo ≥ 30 ml / mphindi ndi ochepera 60 ml / min): popewa thrombosis, kuchepetsa kwa mankhwalawa sikofunikira; odwala omwe ali ndi vuto lalikulu laimpso (creatinine chilolezo chochepera 30 ml / min), mlingo uyenera kuchepetsedwa ndi 25%.
Odwala omwe ndi ofatsa komanso ochepa aimpso kulephera: mankhwalawa thromboembolism kapena kupewa thromboembolism odwala omwe ali ndi chiopsezo chachikulu cha thrombosis (wokhala ndi vuto losakhazikika la angina ndi myocardial infarction popanda Q wave), mlingo uyenera kuchepetsedwa ndi 25%, mankhwalawa amatsutsana ndi odwala omwe amalephera kwambiri aimpso.

Malangizo apadera Fraxiparin syringe ampoule

Iyenera kuthandizidwa makamaka pa malangizo alionse oti mugwiritse ntchito pa mtundu uliwonse wa mankhwala omwe ali mgululi itha kugwiritsidwa ntchito m'magawo osiyanasiyana a mankhwala (ma unit kapena mg). Chifukwa cha chomwe, kusinthana kwa Fraxiparin ndi LMWH kwina sikuvomerezeka ndi chithandizo cha nthawi yayitali. Ndikofunikanso kutengera chidwi ndi mankhwalawa omwe amagwiritsidwa ntchito - Fraxiparin kapena Fraxiparin Forte, chifukwa izi zimakhudza dongosolo lamankhwala. Ma syringe omaliza amapangidwa kuti asankhe mlingo kutengera kulemera kwa thupi la wodwalayo.
Fraxiparin silinapangidwe kuti lizipanga makonzedwe amkati. Popeza thrombocytopenia (heparin-indened thrombocytopenia) ndikotheka pogwiritsa ntchito heparins, ndikofunikira kuyang'anira kuwerengera kwamapulogalamu onse munthawi yonse ya chithandizo ndi Fraxiparin. Zowopsa za thrombocytopenia zidanenedwapo, nthawi zina zoopsa, zomwe zimatha kuphatikizidwa ndi arterial kapena venous thrombosis, zomwe ndizofunikira kuziganizira pazotsatira zotsatirazi: ndi thrombocytopenia, kuchepa kwakukulu kwa chiwerengero cha maselo am'magazi (mwa 30-50% poyerekeza ndi mtengo wamba) kuchokera ku thrombosis, pomwe wodwala amalandila chithandizo, ndi DIC. Muzochitika izi, chithandizo ndi Fraxiparin ziyenera kusiyidwa. Thrombocytopenia ndi immuno-allergen mwachilengedwe ndipo nthawi zambiri imawonedwa pakati pa 5 ndi 21st masiku othandizira, koma zimatha kuchitika koyambirira ngati wodwalayo ali ndi mbiri ya heparin-induction thrombocytopenia.
Pamaso pa heparin-inachititsa thrombocytopenia mu anamnesis (motsutsana ndi kugwiritsa ntchito kwa ma heparin amisala kapena otsika maselo), Fraxiparin ikhoza kutumikiridwa ngati kuli kofunikira. Komabe, munthawi imeneyi, kuwunika kokhazikika kwamankhwala ndipo, osachepera, kuwerengera kwamapulogalamu amasiku onse kumasonyezedwa. Ngati thrombocytopenia ikuchitika, kugwiritsa ntchito Fraxiparin kuyenera kuyimitsidwa nthawi yomweyo. Ngati thrombocytopenia ikupezeka motsutsana ndi maziko a heparins (abwinobwino kapena otsika maselo), ndiye kuti mwayi wofotokozera anticoagulants wamagulu ena uyenera kuganiziridwanso. Ngati mankhwala ena mulibe, mungagwiritse ntchito heparin ina yochepa kwambiri. Pankhaniyi, muyenera kuwunika tsiku lililonse kuchuluka kwa mapanelo. Ngati zizindikiro za thrombocytopenia koyamba zikupitilizabe kuthandizidwa pambuyo pothana ndi mankhwala, chithandizo chikuyenera kutha posachedwa.
Tiyenera kukumbukira kuti kuwongolera kwa kuphatikiza kwa maselo othandiza magazi kuphatikiza pa mayeso a vitro ndikosafunikira kwenikweni pakuwonetsa matenda a heparin-ikiwa ndi thrombocytopenia. Odwala okalamba, asanayambe mankhwala ndi Fraxiparin, ndikofunikira kuyesa impso.Heparins imatha kubisa kubisalira kwa aldosterone, komwe kumayambitsa hyperkalemia, makamaka kwa odwala omwe ali ndi kuchuluka kwa potaziyamu m'magazi kapena odwala omwe ali pachiwopsezo chotenga matenda a hyperkalemia (omwe ali ndi matenda osokoneza bongo, kulephera kwaimpso, metabolic acidosis kapena kugwiritsidwa ntchito kwa munthawi yomweyo kwa mankhwala omwe angayambitse hyperkalemia nthawi yayitali Odwala omwe ali ndi chiopsezo cha hyperkalemia, kuchuluka kwa potaziyamu m'magazi kuyenera kuyang'aniridwa.
Chiwopsezo cha hematomas ya msana / epidural imachulukanso mwa anthu omwe ali ndi catheters a pesical kapena kugwiritsa ntchito mankhwala ena omwe amakhudza hemostasis (NSAIDs, antiplatelet agents, anticoagulants ena). Chiwopsezochi chikuwonjezerekanso ndikuwonjezereka kapena kuwononga kawiri kawiri kapena kuwongolera msana. Funso la kuphatikiza kwa neuroaxial blockade ndi anticoagulants liyenera kulingaliridwa payekhapayekha, mutawunika momwe magwiridwe antchito / oopsa alili. Odwala omwe akulandira kale anticoagulants, kufunikira kwa msana kapena opaleshoni yam'mimba kuyenera kuvomerezedwa. Odwala omwe ma opaleshoni osankhika omwe adakonzekera kuti agwiritse ntchito msana kapena opaleshoni yam'mimba, kufunika koyambitsa ma anticoagulants kuyenera kukhala koyenera. Wodwalayo akapatsidwa chithandizo chodzidzimutsa kapena kuwonetsa msana kapena kupweteka kwa msana, nthawi yayitali iyenera kuchitika pakukhazikitsidwa kwa Fraxiparin ndikuwongolera kapena kuchotsetsa catheter ya msana / singano kapena singano. Kuyang'anira wodwalayo ndikofunikira kuti muzitha kudziwa zizindikiro ndi zovuta zamitsempha. Ngati kuphwanya kwa mitsempha ya wodwalayo kwapezeka, chithandizo chofunikira chofunikira chikufunika.
Mu prophylaxis kapena mankhwalawa a venous thromboembolism, komanso popewa kuphatikizira kwa magazi mu extracorporeal circulation system pa hemodialysis, mgwirizano wa Fraxiparin ndi mankhwala monga acetylsalicylic acid, salicylates ena, NSAIDs ndi antiplatelet agents. izi zitha kuwonjezera ngozi yotuluka magazi.
Fraxiparin iyenera kugwiritsidwa ntchito mosamala odwala omwe amalandira anticoagulants pamlomo, corticosteroids pakugwiritsa ntchito kwadongosolo, komanso dextran. Mukamapereka mankhwala othandizira pakamwa kwa odwala omwe amalandira Fraxiparin, kugwiritsidwa ntchito kwake kuyenera kupitilizidwa mpaka chizindikiro cha nthawi ya prothrombin chikukhazikika pamtengo womwe mukufuna.

Mankhwala ochulukirapo a Fraxiparin Syringe Ampoule

Zizindikiro Chizindikiro chachikulu cha mankhwala osokoneza bongo ndi kutuluka magazi, ndikofunikira kuyang'anira kuchuluka kwamapulatifomu ndi magawo ena a dongosolo la magazi.
Chithandizo: magazi ochepa safunikira chithandizo chapadera (nthawi zambiri chimakhala chokwanira kuchepetsa mlingo kapena kuchedwetsa makonzedwe ena). Protamine sulfate yatchulidwanso kuti ingasokoneze zotsatira za heparin, komabe, nthawi zina, zinthu zotsutsana ndi Xa zimatha kuchira pang'ono. Kugwiritsa ntchito protamine sulfate ndikofunikira pokhapokha ngati pali zovuta. Tiyenera kudziwa kuti 0,6 ml ya protamine sulfate neutralates pafupifupi 950 anti-Xa ME nadroparin. Mlingo wa protamine sulfate amawerengedwa poganizira nthawi yomwe yatha pambuyo pa makonzedwe a heparin, ndikuchepera kwa mlingo wa mankhwala.

Fraxiparin syringe ampoule

Mankhwalawa amayenera kusungidwa kuti asawafikire ana, kutali ndi magetsi othandizira kutentha osaposa 30 ° C, osazizira.

Fraxiparin Syringe Ampoule ndichisankho chabwino. Zonthu zonse zomwe zimapezeka pafakitala FARM-M, kuphatikizapo Fraxiparin syringe ampoule, zimapereka chiwongolero cha katundu ndi omwe amatipatsa. Mutha kugula ma syringe la syringe ya Fraxiparin pa tsamba lathu ndikudina "batani". Tidzakhala okondwa kukupatsani ma syringe a Fraxiparin ku adilesi iliyonse mkati mwa gawo

Malangizo azachipatala

Momwe mungabayitsire mankhwala

Dokotala asanafotokozere jakisoni wa fungo la m'mimba m'mimba nthawi yapakati, ayenera kulamula wodwalayo kukayezetsa magazi kuti adziwe cholozera cha magazi. Mlingo wa mankhwalawa umapangidwira payekha pokhapokha ngati mayeso awonetsa kufunika kwa chithandizo. Kutalika ndi nthawi ya mankhwalawa zimatengera kulemera kwa thupi komanso kuchuluka kwa matenda.

Ndikofunika kwambiri kudziwa momwe jekeseni wa fungo la mankhwala osokoneza bongo wakati wa pakati. Amapangidwa kuti azigwiritsa ntchito poyang'anira komanso mkati mwa kasitomala, amapezeka mu syringe. Mavoliyumu awiri amaperekedwa: 0,3 ml ndi 0,6 ml.

Pa nthawi yoyembekezera, ndibwino kuti musayang'ane kanema wamomwe mungadzibweretsere wekha mankhwala osokoneza bongo, koma kuti mupereke nkhaniyi kwa akatswiri. Katemera amafunika kuchitika kamodzi patsiku. Koma sikuti aliyense ali ndi mwayi wopita kuchipatala tsiku lililonse, chifukwa odwala ena amakonda kudzisamalira mnyumba moyenera.

Ndikofunikira kutenga syringe kuti singano yake ikhale yolowera mmwamba, kenako pang'onopang'ono kufafaniza mpweya wonse.
Ganizirani zala ziwiri kuchokera ku navel mmwamba (palibe mitsempha yamagazi).
Pukutani khungu ndi mankhwala ophera tizilombo toyambitsa matenda.
Tengani khungu kuti mawonekedwe ofukula.
Ikani singano pakhungu pamalo a 90 degrees.
Lowetsani mankhwala pang'onopang'ono.
Kanikizani singano ndikulimbira ubweya wa thonje pamalo ophatikizidwa.

Pambuyo jakisoni, kutupa pang'ono kumapangika. Palibe zifukwa zosangalalira, izi ndizabwinobwino. Ngati mukuwona mawonekedwe oyipa, muyenera kusiya chithandizo chamankhwala ndikufunsani katswiri. Pa nthawi ya pakati, ndi iye amene ayenera kukulangizani mwatsatanetsatane momwe mungayambire prxiparin molondola.

Dokotala yekha ndiye ayenera kupereka mankhwala

Mndandanda wa mankhwalawa

Pali mitundu ingapo yodziwika pa fakitipodi yodziwika bwino. Koma pakubala, muyenera kufunsa dokotala nthawi zonse, osadzipatsa mankhwala. Mankhwalawa ali mgulu limodzi la mankhwalawo ndipo ali ofanana potengera momwe amagwirira ntchito:

Zibor 2500 kapena 3500 (jekeseni wanjira),
Flagmin (jekeseni wovomerezeka ndi wamkati),
Piyavit (makapisozi),
Clexane (jekeseni wanjira),
Heparin sodium (makina ophatikizika ndi ozungulira),
Heparin-Ferein (makina ophatikizira ndi ozungulira),
Heparin Sandoz (jekeseni wofunda),
Heparin (jekeseni wamkati komanso wamkati),
Heparin (amphora ufa),
Hemapaxan (jekeseni wanjira),
Vesel Douay F (njira yothetsera kulowetsedwa kwamkati ndi makina ogwirira, makapisozi),
Antithromin 3 lyophilisate (kulowetsedwa),
Angioflux (jekeseni wamkati ndimitsempha),
Antioflux (makapisozi).

Ngakhale kuti njira zogwirira ntchito za fraxiparin, clexane, kapena heparin ndi zofanana, dokotala yekha ndi amene ayenera kusankha zomwe zingakhale bwino kwa mtsikanayo panthawi yoyembekezera. Kudzichiritsa nokha kumangowopseza kuwonongeka kwaumoyo komanso kukulitsa zoyipa.

Anatenga fakisiparin kumayambiriro kwa mimba yake. Mankhwalawa anali okwera mtengo kwambiri, koma palibe chochita: mu sabata lachisanu ndi chimodzi panali magazi akulu kwambiri kotero kuti ndimagona. Ndinkachita mantha kwambiri, chifukwa mankhwalawa anali oopsa kwambiri. Kusanthula kwa chibadwa kunawonetsa kutaya magazi, amayenera kuthandizidwa. Anakwapulidwa pamwezi kamodzi patsiku.

Adatenga fraksiparin atanyamula mimba yachiwiri. Izi zisanachitike, panali azisanu awiri, motero ndinayamba jakisoni mankhwala atangokhala ndi pakati. Kutulutsa kowopsa kwambiri kotseguka, sikunathe kuyimitsidwa, kotero mwana adatayika. Dotolo adati mankhwalawa ndi omwe amayenera kuimbidwa mlandu, chifukwa amatha kupweteka pakatha masabata 7.

Ndimamwa mankhwala onunkhira pamene anali woyembekezera kuti ndinali ndi cholowa chobadwa nacho. Mtengo sunasangalatse, koma zisanachitike panali zolakwika ziwiri, ndipo D-dimer adawonetsa zotsatira zoyipa pamasabata a 8. Ndinayenera kubaya 0,3 tsiku lililonse kwa miyezi 9 yonse. Dokotala adaimitsa tsiku lisanabadwe, pomwe adapita kukapulumutsa.Panalibe kuchepa kwa magazi pakubala; mwana wanga wamwamuna anabadwa wathanzi. Patatha milungu ina iwiri iye anapitabe.

Palibe pakati, monga lamulo, chokwanira popanda kugwiritsa ntchito mankhwala. Amayi oyembekezera nthawi zambiri amakhala ndi nkhawa ndi izi, makamaka pamene dokotala akupereka mankhwala amphamvu, malangizo omwe amafotokoza momveka bwino kuti: "simungagwiritse ntchito mukakhala ndi pakati." Imodzi mwa mankhwalawa ndi Fraxiparin. Pakadali pano, asayansi alibe chidziwitso chokhudzana ndi mphamvu ya zomwe zimachitika pa mwana wosabadwayo, kotero asanapereke mankhwala kwa Fraxiparin kwa mayi woyembekezera, adotolo ayenera kuonetsetsa kuti phindu lomwe lingapezeke limaposa ngozi zomwe zingachitike kwa mwana.

Fraxiparin, womwe ndi heparin yotsika kwambiri, imakhudza mwachindunji heestasis ya thupi la munthu - imatsitsa. Hemostasis ndi chuma cha kuphatikizana kwa magazi. Zachilengedwe zapatsa anthu chida choteteza ichi kuti akhale ndi mwayi wopulumuka nthawi zowopsa komanso zosayembekezereka. Kwa mayi woyembekezera, zizindikiro za heestasis ndizofunikira kwambiri: kuchepa kochepa kwa zinthu zomwe zimachitika nthawi zambiri kumabweretsa chiopsezo ku moyo wa fetal. Ichi ndichifukwa chake madokotala, amawunikira kusinthasintha kwa hemostasis m'thupi la akazi, amalamula Fraxiparin posachedwa ndikuwabwezeretsa mwakale.

Zomwe muyenera kudziwa za Fraxiparin

Mankhwala mu mawonekedwe a yankho la subcutaneous makonzedwe ali mu kutaya syringe. Mtundu wina wa mankhwalawa, monga mapiritsi, mulibe. Pali mitundu ingapo ya mankhwalawa: Fraxiparin 0,3 ml, 0,4 ml, 0,6 ml, 0,8 ml, 1 ml, komanso Fraxiparin Forte.

Chithandizo chophatikizika cha mankhwalawa ndi calcium calcium. Izi zimagwira mwachangu komanso moyenera zomanga thupi m'magazi am'magazi, zomwe zimalepheretsa mapangidwe osafunikira a magazi. Komanso, Fraxiparin imathandizira magazi, kupondaponda mphamvu zake, ndipo salola kupindika kwa magazi a m'magazi.

Kugwiritsidwa ntchito kwa Fraxiparin pakati pa amayi oyembekezera kumachitika pokhapokha - zinthu zikavuta kwambiri ndikuwopseza mayi wapakati ndi zovuta zosintha mwanjira yoti abadwe asanabadwe, kutenga pathupi kapena kufa kwa fetal. Kuchulukitsa kwa magazi kumatha kubweretsa zotsatirapo zoyipa ngati zoterezi sizinakonzedwe panthawi. Amayi ena oyembekezera amakakamizidwa kuthandizidwa ndi Fraxiparin kwa miyezi isanu ndi inayi yoyembekezera khanda. Izi ndizofunikira ngati m'mbuyomu odwala otaya ana adataya chifukwa cha matenda amisempha ya magazi.

Mutha kugula Fraxiparin mu pharmacy kokha mwa mankhwala. Alumali moyo wa mankhwala ndi zaka 3. Zingwe ziyenera kusungidwa komwe ana sangathe kufikira, kutentha osapitirira 30 0 C.

Akatswiri a Hemostasi akutsimikiza kuti zikavuta, kugwiritsa ntchito jakisoni wa Fraxiparin nthawi yayitali sikubweretsa vuto kwa mayi wapakati, pomwe kukana mankhwala osachepera tsiku limodzi kungachititse kuti mwana wamwamuna abadwe. Nanga bwanji potsatira malangizo a mankhwalawa amalimbikitsa kuti amayi apakati azikana kugwiritsa ntchito mankhwalawa? Funso lachitetezo cha mankhwalawa kwa mayi woyembekezera limakhalabe lotseguka masiku ano.

Madokotala omwe amathandizira Fraxiparin ali ndi chidaliro kuti mankhwala amakono alibe vuto lililonse kwa mayi ndi mwana wake. Ena amakayikira, popeza kafukufuku wazokhudza zomwe zimachitika ndi Fraxiparin pa mayi wapakati sizinachitike. Chilichonse chomwe chinali, koma mu magawo oyamba a malo "osangalatsa", mankhwalawa sanalembedwe. Kuchiza ndi kupewa ndi chithandizo chake kumachitika kuyambira wachiwiri ndi wachitatu, pokhapokha ngati mayi wam'tsogolo alibe zotsutsana.

Ngati mumazolowera zachilengedwe mwatsatanetsatane, ndiye kuti mafunso okhudzana ndi kufunika kwa Fraxiparin panthawiyi samatulukira.Pakupita miyezi 9 yokha yoberekera mwana, placenta imapangidwa ndikukula mosalekeza, yomwe imateteza. Tsiku lililonse mu chipolopolochi limawonekera ndimitsempha yamagazi ndi ma capillaries ambiri omwe amadyetsa mwana wosabadwayo. Ngati, pazifukwa zina, heestasis imachulukana, mapangidwe amwazi m'magazi, zomwe zimapangitsa kuti mwana asafe ndi njala.

Pakumapeto kwa mimba, chiberekero chimatsika ndipo chimakanikizira mwamphamvu pachifuwa chaching'ono, kufinya mitsempha m'derali. Zotsatira zake, kutuluka kwa magazi kuchokera m'mitsempha yam'munsi yakutali kumakulirakulira, yomwe ndiyofunikira kuti pakhale mapangidwe amwazi. Vutoli limawopseza mayi woyembekezera ndi vuto lalikulu lotchedwa pulmonary embolism. Kulakwira kungayambitse imfa ya mkazi ndi mwana wake.

Mwachidule, tikuwona kuti Fraxiparin, ndi mfundo zake zonse, zomwe zikuwonetsedwa ndi malangizo a mankhwalawa, imagwiritsidwabe ntchito panthawi yomwe ali ndi pakati, komabe, mwayi wakugwiritsira ntchito umawunikiridwa mosamala ndi dokotala munthawi iliyonse.

Pamene mayi woyembekezera ayenera Fraxiparin

Fraxiparin pa mimba zotchulidwa zingapo:

popewa kuchulukana kwa magazi, komwe kungayambitse mapangidwe wamagazi,
kuteteza magazi kuundana pa opaleshoni,
munjira yochotsa myocardial infarction ndi angina osakhazikika,
pa mankhwala a thromboembolism,
kuteteza chitukuko cha zovuta za thromboembolism.

Fraxiparin pa nthawi yapakati. Contraindication ndi zoyipa

Malangizo kwa Fraxiparin amachenjeza kuti mankhwala amphamvu ali ndi zotsutsana zina ndi zoyipa zake. Mankhwala ali osavomerezeka kwa odwala omwe ali ndi izi:

kukhudzidwa kwambiri ndi zinthu za Fraxiparin,
coagulopathy - magazi osavomerezeka chifukwa cha magazi,
kusowa kwa zotsatira zabwino za mankhwala a antiaggregant: Aspirin Cardio, Cardiomagnyl, Aspecard,
kuwonongeka kwa zida zamagetsi za mtima (endocarditis),
mawonekedwe a thrombocytopenia atagwiritsidwa ntchito calcium nadroparin kale,
matenda amisala.

Mwa zina zomwe zingachitike mutagwiritsa ntchito Fraxiparin, tati:

zidzolo ndi kuyabwa pa jekeseni malo,
urticaria
Edincke's edema,
anaphylactic mantha - mwapadera.

Ndipo uwu ndi mndandanda wa zinthu zomwe Fraxiparin amalembedwa kuti azikhala ndi pakati mosamala kwambiri:

chiwindi ndi vuto la impso,
kusokonezeka kwamagazi m'maso
kuthamanga kwa magazi
pafupipafupi matenda am'mimba thirakiti asanamwali.

Kugwiritsa ntchito mankhwala osokoneza bongo kwambiri kumawonjezera mwayi wotulutsa magazi kwambiri.

Kugwiritsa ntchito Fraxiparin pa nthawi yomwe muli ndi pakati

Chithandizo cha mayi wamtsogolo ndi mankhwalawa ndizotheka pokhapokha atapenda kuwunikira kwa mawonekedwe a magazi. Kugwiritsa ntchito Fraxiparin kokha kumayang'aniridwa ndi adokotala. Mlingo ndi nthawi ya chithandizo kwa wodwala aliyense ali ndi pakati.

Mankhwala osokoneza bongo omveka bwino, osapangidwa mabatani amangiriridwa ndi syringe yotayidwa ndi singano yopyapyala ya jekeseni wofinya. Malangizo ogwiritsira ntchito Fraxiparin akuti jakisoni wa mankhwalawa amachitika m'mimba, m'dera lomwe lili pamwamba pa navel. Kuchita kumawonetsa kuti chithandizo cha jakisoni nthawi zambiri chimaloledwa ndi amayi apakati. Ochepa okha chifukwa chogwiritsa ntchito Fraxiparin amapanga mseru komanso malaise wamba. Ngati wodwalayo ali ndi chithandizo chambiri, amatha kudzipangira jakisoni.

Momwe mungagwiritsire Fraxiparin m'mimba

Zachidziwikire, poyamba zimakhala zovuta kuti mayi woyembekezera aziganiza momwe angathanirane ndi udindo komanso, chomwe chimabisala, ntchito yoyipa - jakisoni wansanja.Koma ngati palibe wina yemwe angachite izi, ndipo chithandizo sichingasiyidwe, inde, mutha kudziwa maluso otere, makamaka chifukwa palibe chovuta kuphatikizira jakisoni wansanja.

Tsopano ife pang'onopang'ono tifotokozere momwe mungabayitsire Fraxiparin:

Tengani syringe ndikuyiyika molunjika (singano mmwamba), kenako, pang'ono pang'ono ndikumakankhira pistoni, pofinya mpweya mu syringe. Chizindikiro choti muimire ndichowoneka pa nsonga ya singano ya dontho laling'ono.
Bodza ndi nsana wanu pamalo olimba. Dera lanu "lochita" ndi dera lozungulira msomali pamtunda wa 1 - 2 cm.
Gwirani khungu ndi zala ziwiri za dzanja limodzi, ndikuyika singano apo kumbali yakumanja (singano ikhale pamalo oyang'anizana ndi khola).
Kanikizani pang'onopang'ono pa plunger ndikubowola pang'onopang'ono mankhwalawo pansi pa khungu, ndiye kuti chotsani ndi singano ndikuwongoletsa malo a jekeseni.

Kutupa pang'ono pang'onopang'ono kumatha kupezeka m'dera la jakisoni - ichi ndichizolowezi chomwe sichiyenera kuvutitsa mayi woyembekezera.

Fraxiparin: mawonekedwe a mankhwala

Makampani opanga mankhwala ochokera kunja ndi akunja amapereka mitundu ingapo ya Fraxiparin. Onsewa ndi a mgulu limodzi, komanso ali ndi kakhazikidwe kofananira ka thupi. Odziwika kwambiri ndi awa:

Zibor 2500 ndi Zibor 3500 (jakisoni wa makonzedwe a subcutaneous),
Clexane (jakisoni wa makonzedwe a subcutaneous),
Heparin ndi heparin sodium (jakisoni wa makonzedwe amkati ndi msana),
Flagmin (jakisoni wa makonzedwe a subcutaneous and intravenous management).

Zachidziwikire, azimayi poyesetsa kuti amvetsetse amafunsira dokotala mafunso ambiri. Mwachitsanzo, ndi mankhwala ati omwe ali otetezeka komanso othandizira - Fraxiparin kapena Clexane? Tikukulimbikitsani kuti mu nkhani yovomerezeka musamadalire kwathunthu katswiri. Chowonadi ndi chakuti Fraksiparin ndi Kleksan (monga Zibor, Flagmin, ndi zina), pokhala analogues, ali ndi zofananira pakugwiritsa ntchito ndikugwirira ntchito pazomwezo. Ndipo popeza palibe maphunziro apadera omwe adachitidwa kuti adziwe phindu la mankhwala amodzi kuposa lina, chinthu cholondola kwambiri chomwe mayi wamtsogolo angachite ndikudalira dokotala. Katswiri wodziwa bwino, atasanthula chithunzi cha matendawa komanso momwe mayi wapakati adzaonekera, adzalembera chithandizo chokwanira potengera zomwe adakumana nazo.

Pa expanses of a virtual network, mutha kupeza ndemanga zambiri za Fraxiparin. Zoona zake, ena a iwo akhoza kukhala oyipa kuposa okhutiritsa. Kodi zifukwa zoterezi ndi ziti? Amayi ambiri amadera nkhawa hematomas omwe amapezeka pamalo opangira jakisoni. Komabe, izi ndizotsatira za njira yolakwika ya jakisoni, palibenso. Pankhaniyi, muyenera kufunsa adotolo kuti afotokozere mwatsatanetsatane ndikuwonetsa momwe angagwiritsire ntchito mankhwalawa syringe. Popeza mwaphunzira kuperekera jakisoni wa Fraxiparin m'mimba moyenera, simudzakumana ndi zotsutsana ndi mawonekedwe a mikwingwirima ndi mabala.

Amayi ena amtsogolo ali ndi nkhawa kwambiri ndi mavuto azachuma, chifukwa chithandizo chotere sichotsika mtengo. Chifukwa chake, mtengo wa Fraxiparin 0.3 umachokera ku ruble 300. kwa 1 syringe mpaka 2600 - 3000 rubles. pa paketi 1 limodzi pomwe pali ma syringe khumi. Komabe, azimayi omwe adapulumuka m'mbuyomu mobwerezabwereza amawona kuti chisangalalo cha kukhala mai ndi chamtengo wapatali ndipo ali okonzeka kupereka ndalama zilizonse kuti apeze mwayi wopirira mwana wathanzi. Kuphatikiza apo, mwambiri zochuluka, zimapezeka kuti majekeseni atatu a Fraxiparin ndi omwe amatha kugawidwa. Kuphatikiza apo, nthawi zonse mutha kufunsa dokotala kuti asankhe maulalo amtengo wapatali a mankhwalawa.

Mankhwala ena onse, malinga ndi amayi apakati, amalekeredwa bwino. Pambuyo pa jekeseni, azimayi ambiri oyembekezera amayambiranso kumva kuwawa kapena kuwawa. Komabe, zovuta zazing'ono zimatha kuthana nawo mosavuta ngati nthawi yonse yomwe mukuganiza kuti moyo ndi thanzi la zinyenyeswazi zomwe zakhala zikuyembekezeredwa kwa nthawi yayitali zili pachiwopsezo.

Momwe mungapangire jakisoni wotsekemera molondola. Kanema

Kupewera kwa thrombosis panthawi yopangira opaleshoni, kuchuluka kwa magazi m'magazi a kunja kwa hemodialysis kapena hemofiltration, zovuta za thromboembolic kwa odwala omwe ali ndi chiopsezo chachikulu cha thrombosis (kupuma kwambiri komanso / kapena kulephera kwa mtima m'chipinda chothandizira kwambiri).

Chithandizo cha thromboembolism, angina osakhazikika ndi infarction ya myocardial yopanda Q wave.

Kutulutsa mawonekedwe, kapangidwe kake ndi ma CD

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid (mpaka pH 5.0-7.5), d / i madzi (mpaka 0.4 ml).

0,4 ml - syringes ya single-2 (-) - matuza (1) - matumba a makatoni; 0,4 ml - syringes imodzi (2) - matuza (5) - mapaketi a makatoni.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid (mpaka pH 5.0-7.5), d / i madzi (mpaka 0.6 ml).

0,6 ml - syringes ya single-2 (-) - matuza (1) - makatoni a katoni; 0.6 ml - syringes imodzi (2) - matuza (5) - mapaketi a makatoni.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid (mpaka pH 5.0-7.5), d / i madzi (mpaka 0.8 ml).

0,8 ml - syringes yokhala ndi limodzi (2) - matuza (1) - mapaketi a makatoni; 0,8 ml - syringes imodzi (2) - matuza (5) - mapaketi a makatoni.

Njira yothetsera kuyang'anira sc ndi yowonekera, pang'ono opalescent, wopanda mtundu kapena kuwala wachikaso.

Omwe amathandizira: calcium hydroxide solution kapena kuchepetsa hydrochloric acid (mpaka pH 5.0-7.5), madzi d / i (mpaka 1 ml).

1 ml - ma syringes a limodzi - 2 - - matuza (1) - matumba a makatoni 1 ml - ma syringes amodzi (2) - matuza (5) - mapaketi a makatoni.

FRAXIPARINE: DOSAGE

Pofuna kupewa kuwonongeka kwa mankhwalawa pogwiritsa ntchito syringes, thovu la mpweya sayenera kuchotsedwa jakisoni.

Singano iyenera kuyikidwira paliponse, osati pakona, pakhungu lopendekeka pakati pa chala chachikulu ndi chofiyira. Khola liyenera kusungidwa nthawi yonse ya mankhwala. Osapukuta tsamba la jakisoni mutatha jakisoni.

Pofuna kupewa matenda a thromboembolism ambiri, muyezo wa Fraxiparin ndi 0,3 ml (2850 anti-Xa ME) s / c. Mankhwala chikuyendetsedwera 2-4 mawola asanachitike opaleshoni, ndiye - 1 nthawi / tsiku. Chithandizo chimapitilizidwa kwa masiku osachepera 7 kapena nthawi yonse ya chiwopsezo cha thrombosis, kufikira wodwalayo atakonzedwa.

Pofuna kupewa thromboembolism pa nthawi ya mafupa, Fraxiparin imayang'aniridwa pang'onopang'ono pamtengo womwe umayikidwa malinga ndi kuchuluka kwa thupi la wodwala pamlingo wa 38 wotsutsa XA IU / kg, womwe ukhoza kuwonjezeka mpaka 50% patsiku la 4 la ntchito. Mlingo woyambirira umaperekedwa maola 12 asana opaleshoni, mlingo wa 2 - maola 12 atatha opareshoni. Kupitilira apo, Fraxiparin imagwiritsidwanso ntchito 1 nthawi / tsiku lonse la chiwopsezo cha thrombosis kufikira wodwala atamuika kumalo ena. Kutalika kochepa kwa mankhwala ndi masiku 10.

Odwala omwe ali ndi chiopsezo chachikulu cha thrombosis (nthawi zambiri imakhala m'chipinda chothandizira kwambiri / chipinda chothandizira kwambiri / kupuma movutikira komanso / kapena kupuma kwa matenda amtundu ndi / kapena kulephera kwa mtima /) Fraxiparin imalembedwa s / c 1 nthawi / tsiku pa mlingo wokhazikika malinga ndi kulemera kwa thupi wodwala. Fraxiparin imagwiritsidwa ntchito nthawi yonse ya chiwopsezo cha thrombosis.

Pochiza matenda osakhazikika a angina pectoris ndi myocardial infarction yopanda dzino, Qraxiparin imayikidwa sc 2 nthawi / tsiku (maola 12 aliwonse). Kutalika kwa mankhwala nthawi zambiri 6 masiku.M'maphunziro azachipatala, odwala omwe ali ndi vuto losakhazikika la angina pectoris / myocardial infarction popanda Q wave Fraxiparin adayikidwa limodzi ndi acetylsalicylic acid pa mlingo wa 325 mg / tsiku.

Mlingo woyambirira umaperekedwa ngati jekeseni imodzi yamkati, Mlingo wotsatira umaperekedwa. Mlingo umayikidwa kutengera kulemera kwa thupi pamlingo wa 86 anti-XA IU / kg.

Mankhwalawa thromboembolism, pakamwa anticoagulants (pakalibe contraindication) ayenera kutumikiridwa posachedwa. Chithandizo cha Fraxiparin sichimayimitsidwa mpaka zomwe zimatsimikiziridwa pazotsimikizira nthawi ya prothrombin zitheke. Mankhwala wolembedwa 2/2 kawiri / tsiku lililonse (maola 12 aliwonse), nthawi yomwe maphunzirowa ali masiku 10. Mlingo umatengera kulemera kwamthupi la wodwala pamlingo wa 85 anti-XA ME / kg thupi.

Kupewa kwa kuchulukana kwa magazi mu njira yotulutsa magazi kunja kwa nthawi ya hemodialysis

Mlingo wa Fraxiparin uyenera kukhazikitsidwa payekhapayekha kwa wodwala aliyense, poganizira luso la dialysis.

Fraxiparin imabayidwa kamodzi ndikumalowetsa mzere wampweya wozungulira kumayambiriro kwa gawo lililonse. Kwa odwala osakhala ndi vuto lotaya magazi ambiri, Mlingo woyambira woyeserera umakhazikitsidwa kutengera kulemera kwa thupi, koma wokwanira gawo la dialysis la maola anayi.

Odwala omwe ali ndi chiopsezo chowonjezereka cha magazi, mutha kugwiritsa ntchito theka la mankhwalawa.

Ngati dialysis gawo limatenga maola opitilira 4, ndiye kuti muthandizanso kuchuluka kwa Fraxiparin.

Nthawi yotsatira ya dialysis, mlingo uyenera kusankhidwa malinga ndi zotsatira zake.

Wodwala amayenera kuyang'aniridwa pa nthawi ya dialysis chifukwa cha kutuluka kwa magazi kapena zizindikiro za thrombosis mu dialysis system.

Okalamba odwala, kusintha kwa mankhwala sikofunikira (kupatula odwala omwe ali ndi vuto laimpso). Musanayambe chithandizo ndi Fraxiparin, tikulimbikitsidwa kuwunikira zizindikiro zaimpso.

Odwala omwe ali ndi kufatsa kwambiri aimpso (CC ≥ 30 ml / min ndi.)

Kulemera kwa thupi (kg)
Mlingo wa Fraxiparin kutumikiridwa maola 12 asanafike ndi maola 12 atachitidwa opaleshoni, ndiye 1 nthawi / tsiku mpaka tsiku la 3 atachitidwa opaleshoni
Mlingo wa Fraxiparin kutumikiridwa nthawi 1 / tsiku, kuyambira tsiku la 4 mutachitidwa opaleshoni
Gawo (ml)
Anti-Ha (ME)
Gawo (ml)
Anti-Ha (ME)
0.2
1900
0.3
2850
50-69
0.3
2850
0.4
3800
>70
0.4
3800
0.6
5700
Kulemera kwa thupi (kg)
Mlingo wa Fraxiparin ndikuyambitsa 1 nthawi / tsiku
Voliyumu ya Fraxiparin (ml)
Anti-Ha (ME)
≤ 70
0.4
3800
> 70
0.6
5700
Kulemera kwa thupi (kg)
Mlingo woyamba wa iv
Mlingo wa jekeseni wotsatira (maola 12 aliwonse)
Anti-Ha (ME)
0,4 ml
0,4 ml
3800
50-59
0,5 ml
0,5 ml
4750
60-69
0,6 ml
0,6 ml
5700
70-79
0,7 ml
0,7 ml
6650
80-89
0,8 ml
0,8 ml
7600
90-99
0,9 ml
0,9 ml
8550
≥ 100
1.0 ml
1.0 ml
9500
Kulemera kwa thupi (kg)
Mlingo kutumikiridwa 2 kawiri / tsiku, masiku 10
Gawo (ml)
Anti-Ha (ME)
0.4
3800
50-59
0.5
4750
60-69
0.6
5700
70-79
0.7
6650
80-89
0.8
7600
≥ 90
0.9
8550
Kulemera kwa thupi (kg)
Arterial mzere jakisoni wa dialysis kuzungulira koyambirira kwa gawo dialysis
Gawo (ml)
Anti-Ha (ME)
0.3
2850
50-69
0.4
3800
≥ 70
0.6
5700

Mimba komanso kuyamwa

Pakadali pano, pali zochepa zochepa pakugawidwa kwa nadroparin ndi mkaka wamawere. Pankhaniyi, kugwiritsa ntchito nadroparin pa mkaka wa m'mawere sikulimbikitsidwa.

M'maphunziro oyesera nyama, palibe teratogenic mphamvu ya calcium nadroparin yomwe idapezeka.

FRAXIPARINE: ZOTHANDIZA ZOTHANDIZA

Zotsatira zosayenera zimaperekedwa malinga ndi kuchuluka kwa zomwe zimachitika: nthawi zambiri (> 1/10), nthawi zambiri (> 1/100, 1/1000, 1/10 000,

Kuchokera pakupanga kwamagazi magazi: nthawi zambiri - magazi amtundu wosiyanasiyana, nthawi zambiri odwala omwe ali ndi zifukwa zina.

Kuchokera hemopoietic dongosolo: kawirikawiri - thrombocytopenia, kawirikawiri - eosinophilia, kusintha pambuyo atasiya mankhwala.

Kuchokera pamatumbo am'mimba: nthawi zambiri - zochulukitsa za hepatic transaminases (nthawi zambiri zimakhala zachilengedwe).

Zotsatira zoyipa: kawirikawiri - edema ya Quincke, kusintha kwa khungu.

Zomwe zimachitika mdera: nthawi zambiri - kupangika kwa hematoma yaying'ono pamalo opangira jakisoni, nthawi zina pamakhala mawonekedwe a mafupa owonda (sizitanthauza kuti heparin encapsulation) yomwe imatha pakatha masiku ochepa, osowa kwambiri - khungu necrosis, nthawi zambiri pamalowo. Kukula kwa necrosis nthawi zambiri kumakhazikitsidwa ndi phenura kapena malo owonongeka a erythematous, omwe mwina kapena sangatsatidwe ndi zizindikiro zofala (mwanjira zina, chithandizo ndi Fraxiparin ziyenera kuyimitsidwa nthawi yomweyo).

Zina: kawirikawiri kwambiri - priapism, hyperkalemia yosinthika (yolumikizidwa ndi kuthekera kwa heparins kupondereza katulutsidwe ka aldosterone, makamaka kwa odwala omwe ali pachiwopsezo).

Migwirizano ndi magwiritsidwe akusungidwa

Mndandanda B. Mankhwalawa amayenera kusungidwa kuti ana asawafikire, kutali ndi magetsi othandizira kutentha osapitirira 30 ° C, osazizira. Moyo wa alumali ndi zaka zitatu.

kupewa zovuta za thromboembolic (munthawi ya opaleshoni ndi mafupa, mwa odwala omwe ali ndi chiopsezo chachikulu cha thrombosis mu kupuma kwapakati komanso / kapena kulephera kwa mtima pazinthu za ICU),
chithandizo cha thromboembolism,
kupewa magazi kuundana pa hemodialysis,
mankhwalawa angina osakhazikika ndi myocardial infarction popanda Q wave.

The ntchito aimpso kuwonongeka

Odwala omwe ali ndi kufatsa kwambiri aimpso (CC ≥ 30 ml / min ndi.)

Odwala omwe ali ndi vuto lochepa kwambiri laimpso, pochiza matenda a thromboembolism kapena kupewa thromboembolism mwa odwala omwe ali pachiwopsezo chachikulu cha thrombosis (osakhazikika angina ndi infarction ya myocardial yopanda Q wave), mankhwalawa amayenera kuchepetsedwa ndi 25%, mankhwalawa amaperekedwa kwa odwala omwe ali ndi vuto la aimpso.

Pharmacokinetics mwapadera matenda milandu Fraxiparin syringe ampoule

Odwala okalamba, chifukwa cha kuchepa kwa thupi kwa impso, kuchepa kwa nadroparin kumachepera. Mukamagwiritsa ntchito mankhwala a prophylaxis m'gulu lino la odwala, palibe chifukwa chosintha mankhwalawa chifukwa cha kufooka kwa impso.

M'maphunziro a zamankhwala pa pharmacokinetics ya nadroparin ndi iv makonzedwe kwa odwala omwe ali ndi vuto la impso losiyanasiyana, kuphatikiza kunakhazikitsidwa pakati pa kuvomerezeka kwa nadroparin ndi chilolezo cha creatinine. Poyerekeza zomwe zapezedwa ndi zomwe odzipereka athanzi labwino, zidapezeka kuti AUC ndi T1 / 2 zimakwera mpaka 52-87%, ndikupanga chilolezo cha creatinine mpaka 47-64% ya mfundo zabwinobwino. Kafukufukuyu adawonanso kusiyana kwakukulu pamunthu aliyense payekha.

Odwala omwe ali ndi vuto lalikulu la impso, T1 / 2 yayikulu, nadroparin adakwera mpaka maola 6. Ndikupeza zotsatira za kafukufukuyu. 60 ml / min). Zotsatira zake, mlingo wa Fraxiparin uyenera kuchepetsedwa ndi 25% mwa odwala omwe amalandila Fraxiparin pochiza matenda a thromboembolism, osakhazikika angina pectoris / myocardial infarction popanda Q wave. Odwala omwe ali ndi vuto lalikulu laimpso amalephera.

Odwala omwe amalephera kupweteka aimpso, kapena kugwiritsa ntchito Fraxiparin pofuna kupewa thromboembolism, kudzikundikira kwa nadroparin sikupitirira kuti odwala omwe ali ndi vuto laimpso, amatenga Fraxiparin pamankhwala othandizira. Mukamagwiritsa ntchito Fraxiparin kuti muchepetse kuchepetsedwa kwa gawo lino la odwala sikufunika. Odwala kwambiri aimpso kulephera kulandira prophylactic fraxiparin, kuchepetsa 25% ndikofunikira.

Low maselo wolemera heparin amayamba mu ochepa mzere wa dialysis kuzungulira muyezo wokwanira kuteteza magazi kuundana mu dialysis kuzungulira.Magawo a pharmacokinetic sasintha kwenikweni, kusiyapo ndi mankhwala osokoneza bongo, pomwe kudutsa kwa mankhwalawo m'magazi kungayambitse kuchuluka kwa ntchito ya anti-Xa, chifukwa cha gawo lomaliza la kulephera kwa impso.

Clinical Pharmacology

Calcium nadroparin ndi heparin yochepa kwambiri (NMH) yomwe imapezeka kuchokera ku heparin yokhazikika, ndi glycosaminoglycan yokhala ndi kulemera kwakukulu kwa 4300 daltons.

Calcium nadroparin imadziwika ndi ntchito yapamwamba ya anti-Xa chinthu poyerekeza ndi anti-IIa factor kapena antithrombotic zochita ndipo imakhala ndi zochita komanso zotheka nthawi yayitali.

Poyerekeza ndi heparin yosasakanizidwa, nadroparin imakhala yocheperako pakugwira ntchito ya maplatelet ndi kuphatikiza, komanso samatchulidwira kwenikweni hepatasis yapamwamba.

Mu Mlingo wa prophylactic, nadroparin sayambitsa kuchepa kutchulidwa kwa APTT.

Zotsatira zoyipa

Zosafunika zimayendetsedwa molingana ndi kuchuluka kwa zomwe zimachitika

Nthawi zambiri (zopitilira 1/10), nthawi zambiri (zoposa 1/100, zosakwana 1/10), nthawi zina (zoposa 1/1000, zosakwana 1/100), kawirikawiri (kuposa 1/10 000, zosakwana 1/1000), kwambiri kawirikawiri (zosakwana 1/10 000).

Kuchokera pamagazi othandizira magazi
- Nthawi zambiri - magazi amtundu wosiyanasiyana, nthawi zambiri mwa odwala omwe ali pachiwopsezo china.

Kuchokera pa hematopoietic dongosolo
- Nthawi zambiri, thrombocytopenia.
- Osati kawirikawiri - eosinophilia, amasintha pambuyo pakutha kwa mankhwalawa.

Kuchokera m'mimba
- Nthawi zambiri - zochulukitsa zochitika za hepatic transaminases (nthawi zambiri zimakhala zachilengedwe).

Thupi lawo siligwirizana
- Osowa kwambiri - edema ya Quincke, kusintha kwa khungu.

Zomwe zimachitika mdera lanu
- Nthawi zambiri - kupangika kwa hematoma yaying'ono pamalo opukusira, nthawi zina pamakhala mawonekedwe a mafupa owonda (sizitanthauza kuti heparin encapsulation), omwe amasowa patatha masiku angapo.
- Osowa kwambiri, khungu necrosis, nthawi zambiri pamalowa jakisoni. Necrosis nthawi zambiri amatsogozedwa ndi phenura kapena malo ena obowoka kapena opweteka kwambiri, omwe mwina kapena sangatsatidwe ndi zizindikiro wamba (mwanjira zotere, chithandizo ndi Fraxiparin ziyenera kuyimitsidwa nthawi yomweyo).

Mitundu ina ya Fraxiparin Syringe Ampoule

Osowa kwambiri - priapism, hyperkalemia yosinthika (yogwirizana ndi kuthekera kwa heparins kupondeleza katulutsidwe ka aldosterone, makamaka kwa odwala omwe ali pachiwopsezo).

Nambala zolembetsa

Njira yothetsera makonzedwe a 9500 IU anti-Xa / 1 ml: syringes 1 ml 2 kapena 10 ma PC. P N015872 / 01 (2018-06-09 - 0000-00-00) yankho la makonzedwe a 9500 IU anti-Xa / 1 ml: ma syringes 0,6 ml 2 kapena 10 ma PC. P N015872 / 01 (2018-06-09 - 0000-00-00) yankho la makonzedwe a 9500 IU anti-Xa / 1 ml: ma syringes 0,8 ml 2 kapena 10 ma PC. P N015872 / 01 (2018-06-09 - 0000-00-00) yankho la makonzedwe a 9500 IU anti-Xa / 1 ml: ma syringes 0,3 ml 2 kapena 10 ma PC. P N015872 / 01 (2018-06-09 - 0000-00-00) yankho la makonzedwe a 9500 IU anti-Xa / 1 ml: ma syringes 0,4 ml 2 kapena 10 ma PC.P N015872 / 01 (2018-06-09 - 0000-00-00)

Mavuto ndi kuwundana kwa magazi, zovuta za thromboembolic ndi matenda oopsa omwe amafunikira chithandizo chamthawi yomweyo.

Nthawi zambiri muzochitika izi, madokotala amatiuza mankhwala a Fraxiparin. Zotsatira zoyipa ndi zotsutsana ndikugwiritsa ntchito zimapezeka, ndipo ndikofunikira kudziwa za iwo.

Izi, komanso chidziwitso pakugwiritsa ntchito mankhwalawa, momwe zimachitikira ndikuwunikiranso tidzakambirana pambuyo pake.

Fraxiparin imakhala ndi heparin yotsika maselo, mapangidwe ake omwe adachitika mu depolymerization. Gawo lodziwika bwino la mankhwalawa limatchulidwa kuti likuchitika pokhudzana ndi kusokonekera kwa chinthu Xa, komanso ntchito zopanda mphamvu za Pa.

Ntchito za Anti-Xa ndizodziwika bwino kuposa momwe amathandizira pakuyambitsa mbali ya thrombotic mbale nthawi. Izi zikuwonetsa ntchito ya antithrombotic.

Mankhwalawa ali ndi zotsutsa-kutupa komanso immunosuppressive. Kuphatikiza apo, zochita za wothandizira zitha kuzindikiridwa mwachangu kwambiri, ndipo zimatenga nthawi yayitali. Mkati mwa maola 3-4, mankhwalawa amamwa kwathunthu. Amawachotsa pamodzi ndi mkodzo kudzera mu impso.

Musanayambe kugwiritsa ntchito, ndikofunikira kuyang'ana momwe chiwindi chimagwirira ntchito komanso impso, kuchuluka kwa kuchuluka kwa magazi, komanso zomwe zili m'mafuta a cholesterol.