"Heparin" (tshuaj): daim ntawv thov, cov neeg siv, xyuas, koob tshuaj. Kev siv cov tshuaj "heparin" thaum lub sij hawm cev xeeb tub

Tshuaj "heparin" yog tau qeeb cov ntshav muaj peev xwm los khov rau ntawd. Tso tshuaj neeg sawv cev nyob rau hauv lub khob ampules thiab vials ntawm 5 ml. Lawv yog cov tshuaj tov, nyob rau lub active tshuaj yog 5,000 IU.

pharmacological

Tshuaj "heparin" (tshuaj) yog ib tug anticoagulant. Nws yog tau qeeb tus txheej txheem ntawm fibrin tsim, kom tsis txhob ceev yam ntawm cov ntshav coagulation, thiab nyob rau hauv loj ntau - mus txo cov kev ua ntawm thrombin. Txawm me me koob tshuaj ntawm cov tshuaj yog txaus kom fibrinolytic kev ua si ntawm cov ntshav.

siv "heparin" tshuaj kom txo tau cov viscosity ntawm lub cev lub ntsiab ntawm cov lom kua. Siv (ib koob tshuaj cov kev txhaj tshuaj xaiv tus kws kho mob ib lub zuj zus) raws li nyob rau hauv lub fact tias qhov no txhais tau tias yog sau rau lub endothelium ntawm cov ntshav thiab tsub kom lawv tsis zoo xwb. Vim cov cuab yeej txo adhesion thiab aggregation ntawm platelets, leukocytes thiab erythrocytes.

Nyob rau hauv tas li ntawd, lub "heparin" tiv thaiv cov kev loj hlob ntawm atherosclerosis, muaj anti-tsis haum thiab me me vasodilator nyhuv. Qhov no yog vim lub fact tias nws mus ib tug xov tooj ntawm cov ntsiab ntawm cov complement system thiab thiaj li nws ua si. Tsis tas li ntawd, cov tshuaj tiv thaiv tus tsim ntawm immunoglobulins, lymphocyte co uake histamine thiab serotonin.

indications

Raws li ib tug dav dav txoj cai, yog tias koj muaj teeb meem nrog cov ntshav txhaws muab tshuaj "heparin" tshuaj. Tshuaj los yog tso dej raws leeg Txoj kev lis ntshav yog pom zoo nyob rau hauv cov neeg mob:

1) sib sib zog nqus cov hlab ntsha thrombosis, coronary artery kab mob, koj muaj teebmeem kev embolism;

2) myocardial infarction;

3) ruaj tsis khov angina;

4) Cov thawj theem ntawm DIC;

5) atrial fibrillation, uas yog nrog los ntawm thromboembolism.

Tsis tas li ntawd nyob rau hauv tsev kho mob rau kev ua hauj lwm nrog extracorporeal kev hom kev kawm yuav muab txhais tau tias "heparin". Tshuaj intravenously los yog subcutaneously, yog tias tsim nyog ua ntshav, hemodialysis los mus tiv thaiv coagulation ntawm lub lom kua.

Lub txhais tau tias siv tau rau cov kev kho mob thiab kev tiv thaiv kev mob ntawm microcirculation thiab microthrombogenesis, piv txwv li, thrombosis ntawm lub raum leeg, lupus nephritis, glomerulonephritis, kab mob endocarditis, mitral kab mob plawv, gemolitikouremicheskom syndrome.

nyhuv ntawm cov tshuaj

Yog hais tias koj cov kws kho tshuaj "heparin" nyob rau hauv lub plab, koj paub: lawv yuav tau ua heev feem ntau. Nyhuv ntawm cov tshuaj no tshwm sim sai heev, tab sis nws yog luv luv. Yog li, thaum muab intravenously txhais tau tias txhaws slows sau yuav luag tam sim ntawd, cov nyhuv kav txog 4-5 teev. Thaum muab intramuscularly, nws cov nyhuv tom qab 15-30 feeb thiab kav rau 6 teev, thiab thaum twg txhaj cov nyob hauv daim tawv nqaij yog cai tom qab 40-60 feeb thiab kav 8 teev. Therapeutic txiav txim tswj tiv thaiv lub tsim ntawm cov ntshav txhaws, kav ntev npaum li cas.

Kev npaj "heparin" tsub kom lub raum ntshav txaus, tsub kom vascular kuj nyob rau hauv lub hlwb, muaj hypolipidemic nyhuv. Tsis tas li ntawd txhais tau tias thiaj li cov kev ua ntawm pulmonary surfactant cheeb ntev synthesis ntawm aldosterone nyob rau hauv lub adrenal cortex, amplifies active cawv PTH uake adrenaline.

siv nta

Feem ntau cov neeg raug kev txom nyem los ntawm coronary mob plawv, muab "heparin" (txhaj tshuaj). Tus nqi ntawm cov tshuaj no mas siab rau ib txhia. Ntim ntawm 5 ampoules ntawm 5 ml nrog ib qho kev ua ntawm 5000 IU ib 1 ml nqi 500-600 rubles. Tab sis tsis kam nws daim ntawv thov yog tsis yooj yim sua. Tom qab tag nrho cov, nyob rau hauv cov neeg mob uas ischemia txhais tau tias "heparin" thiaj li muaj cov kev pheej hmoo ntawm myocardial infarction, coronary artery thrombosis thiab cia li tuag. Ntxiv mus, cov kev siv ntawm cov tshuaj yuav txo tau qhov tshwm sim ntawm recurrent lub plawv thiab txo cov feem pua ntawm cov neeg tuag nyob rau hauv cov neeg mob no.

Thaum venous thrombosis thiab pulmonary embolism muab siab koob tshuaj "heparin" kev npaj. Tshuaj (qhia pub rau nrog yuav ua li cas kom zoo zoo muab tso rau qhov lawv) ua nyob rau hauv ib tug tej lub sij hawm ntawm lub sij hawm. Tab sis, nws yog qhov tseeb, nyob rau hauv tej rooj plaub, kom tau tam sim ntawd cov nyhuv yog qhov kev kawm los muab tso dej txhais tau tias.

Tsis tas li ntawd muab ib tug txhais tau tias ntawm "heparin" rau kev tiv thaiv ntawm thromboembolic cov txheej xwm, xws li tom qab phais. Nyob rau hauv cov ntaub ntawv no, nws yog tshuaj nyob rau hauv me me koob tshuaj.

Txoj kev ntawm qhov kev siv

Xaiv qhov yuav tsum tau ntau npaum thiab tus qauv ntawm kev siv ntawm cov tshuaj yuav tsum tsuas tus kws kho mob, nyob ntawm seb tus neeg mob tus mob thiab yog vim li cas vim li cas nws yuav tsum tau cov tshuaj no. Tus neeg saib xyuas tej zaum yuav muab intravenously raws li ib tug tas mus li Txoj kev lis ntshav los yog tsis tu ncua tshuaj. Tsis tas li ntawd, nyob rau hauv tej rooj plaub, subcutaneous, los yog tej zaum yuav tau tsa los ntawm intramuscular txhaj tshuaj.

Yuav kom tiv thaiv thrombosis tshuaj tej zaum yuav muab subcutaneously nrog 1 ml (5000 IU) ob zaug ib hnub twg. Nyob rau hauv yuav tsum muaj cov no txhais yog txuas mus rau lub tshuaj "heparin" phau ntawv qhia. Tshuaj no feem ntau yog ua nyob rau hauv lub plab mog, nyob rau hauv nws cov anterolateral phab ntsa. Ua li no, siv sij hawm ib tug zoo koob thiab hno nws sib sib zog nqus rau hauv daim tawv nqaij quav. Nws yog tsim nyob rau thaum nias ntawm tus ntiv tes xoo thiab ob tug ntiv lub plab cheeb tsam nyob rau hauv lub puj ntaws cheeb tsam. Cov kev txhaj tshuaj yuav tsum tau alternated. Nyob rau hauv exceptional mob, cov tshuaj yuav ua tau rau hauv lub Upper ib feem ntawm tus ncej puab los yog caj npab.

ntau npaum xaiv

Rau kho lub hom phiaj nyob rau hauv cov nqe lus ntawm mus pw kho mob nyob rau hauv tsev kho mob feem ntau cov tshuaj tso dej Txoj kev lis ntshav. Rau cov neeg laus cov neeg mob, cov tshuaj ntawm 1,000 IU / teev. Tab sis ua ntej yuav txhim kho nrog rau ntau cov nyhuv nws yuav nkag mus rau lub bolus rau hauv cov hlab ntsha nyob rau hauv tus nqi ntawm cov 5,000 IU. Xaiv cov lub caij nyoog koob tshuaj yog muab nyob rau hauv ib tug kws kho mob nyob ntawm seb qhov teeb meem no thiab tus neeg mob hnyav.

Yog hais tias nws yog tsis yooj yim sua los xyaum ua ib tso dej Txoj kev lis ntshav, cov neeg tej zaum yuav muab subcutaneously: 2 ml ntawm cov tshuaj (uas sau raws nkaus Ii 10000 IU) 4 lub sij hawm ib hnub. Qhov siab tshaj plaws ntau npaum yog feem ntau yog siv kev npaj mus rau 10 hnub.

Qhov yuav tsum tau npaum li cas ntawm cov tshuaj no yog xaiv tom qab qhov kev luj xyuas kev xeem. Kev mloog yog them mus rau lub APTT (tshuab txais ib nrab thromboplastin lub sij hawm).

Thaum lub pub ntshav, feem ntau yog muab 7.5-10 txhiab. IU txhais tau tias "heparin".

Kho nyob rau hauv tshwj xeeb mob

Nyob rau hauv mob myocardial infarction tam sim ntawd muab 10-15 txhiab. IU intravenously, ces nws tseem siv xws li ib tug xam, tus neeg mob tau txais txog 40 000 IU nyob rau hauv thawj hnub, tab sis lub caij nyoog ntau npaum yog xaiv nyob ntawm seb tus neeg mob hnyav. Qhov no yog tsim nyog los xyuas kom meej tias cov ntshav txhaws nyob rau hauv 2.5-3 lub sij hawm qeeb qeeb. Los ntawm cov thib ob hnub cov tshuaj yog txo. Nws yog ib qho tseem ceeb uas lub txhaws lub sij hawm yog 1.5-2 lub sij hawm ntau dua li cov coob. Kev kho mob nrog cov tshuaj no tseem 8 hnub. Yuav kom rho ib tug txhua txhua hnub koob tshuaj txo los ntawm 5-10 txhiab. IU, tab sis lub cov Team sib ntawm tshuaj tsis nce. Tom qab lub abolition ntawm pass mus rau lub anticoagulants ntawm indirect kev txiav txim. Nws yuav ua tau xws li "Fenilin", "neodikumarina" thiab lwm tus neeg.

Mob arterial los yog venous rhuav txhua kuj yuav tsum tau ib tug tshwj xeeb ze. Rau cov tshuaj tso dej heparin rau 3-5 hnub nyob rau ib koob tshuaj 400-450 IU ib kg ntawm tus neeg mob hnyav. Hais tias yog, ib tug neeg mob ntawm nruab nrab muaj thiab qhov siab yuav tsum tau ib hnub txog 30-40 txhiab. IU "heparin" tshuaj. Ces tsiv mus rau lub fractional nws kev taw qhia, tab sis ntau npaum yog nce mus txog 600 IU / kg, nrog ib tug hluas txhaj mus rau hauv lub cev yuav tsum tau 100 IU / kg. Kev kho mob yuav kav mus txog 16 hnub. Nyob rau hauv cia li ib tug ob peb hnub ua ntej nws cov tshuaj tshem nqi yog maj txo. Kev kho mob yog txuas ntxiv siv indirect anticoagulants.

ceev faj

Txawm tias muaj tseeb hais tias ib co tham txog tau intramuscular txhaj ntawm yeeb tshuaj, qhov no yog tsis pom zoo vim lub fact tias nyob rau hauv lub qhov koob hematoma feem ntau tsim nyob rau. Yuav kom siv cov tshuaj dilutions 0,9% NaCl tshuaj.

Nws yog tseem ceeb kom paub hais tias thaum lub sij hawm kev kho mob ntawm "heparin" txhais tau tias nws tsis yog tsim nyog los ua tej yam intramuscular txhaj tshuaj thiab kev kuaj kabmob. Thaum uas siv cov nws, koj yuav tau saib xyuas hauv lub xeev ntawm coagulation. Nyob rau hauv thawj lub lim tiam ntawm txoj kev kho, cov ntshav soj ntsuam txhua txhua ob hnub, pib los ntawm lub lim tiam thib ob nws yuav ua tau txhua txhua 3 hnub.

Txawm tias tus hais thiab tsis txeem mus rau hauv niam cov kua mis, lactation nyob rau ntawm lub lub sij hawm ntawm kev kho mob, nws yog ntshaw kom muaj cai. Nws twb pom tias cov tshuaj ua nyob rau hauv tej rooj plaub rau puas tus txha nqaj thiab txha. Cov teeb meem pib tom qab 2-4 lub lim piam ntawm kev kho mob.

Nyias, nws muaj nqis ntsoov teev tias cov tshuaj tov tej zaum yuav tig daj, tab sis nws twb tsis muaj ntxim rau nws cov khoom pharmacological los yog kam rau txhais tau tias "heparin". Tshuaj, cov nqi ntawm cov uas muaj peev xwm ho cuam tshuam rau cov nyiaj txiag nyob rau hauv appointing nws nyob rau hauv siab koob tshuaj, yuav ua tau txawm nyob rau lawv tus kheej nyob rau hauv tsev.

Contraindications

Zoo li lwm yam kev txhais tau tias, koj muaj peev xwm siv tsis tau cov tshuaj "heparin" yog hais tias koj yog hypersensitive. Nws tsis yog kws kho rau tej ntshav. Tsuav txhob yog cov hemorrhages uas tshwm sim thaum myocardial ntsws (qhia nyob rau hauv daim ntawv hemoptysis) los sis mob raum (nrog hematuria).

Contraindications kuj muaj xws li:

- hemorrhagic diathesis thiab lwm yam kab mob nyob rau hauv uas impaired cov ntshav txhaws;

- nce vascular permeability, xws li Verlgofa kab mob;

- kab mob endocarditis ;

- los ntshav nyob rau hauv keeb kwm;

- hypoplastic thiab aplastic anemia, mob thiab mob leukemias;

- mob loj heev siab thiab raum muaj nuj nqi;

- venous gangrene;

- txoj kev loj hlob ntawm mob plawv aneurysm.

precautionary ntsuas

Nyob rau hauv tas li ntawd mus ncaj contraindications, muaj yog ib daim ntawv teev xwm txheej nyob rau hauv uas nws yog tsim nyog los soj ntsuam tag nrho cov tau txaus ntshai thaum noj "heparin" tshuaj. Tshuaj thiab tso dej ua xwb nyob rau hauv exceptional tus neeg mob thiab nyob rau hauv lub saib xyuas ntawm cov kws tshwj xeeb nyob rau hauv hlav thiab ulcerative txhab ntawm tus mob huam, ntshav siab, tom qab thiab postoperative lub sij hawm, tshwj tsis yog rau angioplasty.

Ob peb lo lus hais txog cov kev kho mob rau yav tom ntej leej niam. Txawm tias muaj tseeb hais tias cov kev kho mob ntawm cov poj niam nyob rau hauv lub tsev neeg txoj kev ua ntej peb txhais tau tias undesirable (nws yuav ua tau kom txoj kev loj hlob ntawm cov teeb meem), tshuaj "heparin" nyob rau hauv lub plab yog tshuaj nyob rau hauv tej rooj plaub, thaum lub sij hawm cev xeeb tub. Qhov ntau yam ntawm tshwm sim ntawm phiv los xws li los ntawm 10 mus rau 21%. Thaum rau ib qho uas cev xeeb tub cov kev pheej hmoo ntawm cov teeb meem yog tsawg tshaj li 3.6%.

Nws yuav tsum tau muab sau tseg hais tias lub txim ntawm kev ib tug ua tau thromboembolism nyob rau hauv expectant niam yog ntau txaus ntshai rau lub neej tshaj tau txais txhais tau tias "heparin". Tshuaj thaum lub sij hawm cev xeeb tub ua xwb nyob rau hauv kev kho mob saib xyuas thiab tsuas yog hais tias muaj yog tsis muaj pov thawj. Tab sis cov tshuaj yuav ua rau los ntshav, thrombocytopenia thiab txha. Nws txhais tau tias lub tsev me nyuam tsis mus rau.

Tau analogs thiab tus neeg mob testimonials

Feem ntau cov neeg uas yog tsa tshuaj "heparin" (tshuaj nyob rau hauv lub plab), tus nqi mas, siab dhau heev lawm. Tab sis thaum nws yog siv raws li ib tug tiv thaiv kev ntsuas, 1 pob tej zaum yuav txaus rau ib tug ob peb hnub. Yog li ntawd, lub ntim nyob rau hauv uas lub fwj 5, tej zaum yuav txaus rau ib tug ob peb lub lis piam. Ib tug high-koob tshuaj npaj siv feem ntau tsis muaj ntau tshaj li 10-14 hnub.

Cuaj kaum, muaj coob tus neeg xav kom kawm tau los ntawm lwm tus neeg mob, nws yog tsim nyog yuav cov tshuaj, lawv tab tom nrhiav rau "heparin" kev npaj ntawm xyuas. Analogues ntawm cov tshuaj lawv kuj xav. Yog li ntawd, yog hais tias muaj teeb meem nrog cov ntshav txhaws, lub cuab tam yog zoo heev thiab tso cai rau koj mus cuag tej yam kho nyhuv heev sai sai. Qhov no yog paub tseeb hais tias los ntawm ob qho tib si cov kws kho mob thiab lawv cov neeg mob.

Tab sis es tsis txhob nws yuav taw anticoagulants "Troparin", "heparin Sandoz", "heparin Sodium Brown", "heparin-Verein" thiab lwm yam analogs. Cov tshuaj ntawm cov tshuaj yuav tsum tsuas xaiv ib tug kws kho mob raws li kev soj ntsuam ntawm analyses ntawm tus neeg mob, hauv lub xeev ntawm nws noj qab haus huv thiab lub indications uas cov tshuaj yog tshuaj.

Nyob rau hauv tej rooj plaub, cov kws kho mob pom zoo kom tsawg molecular yuag heparins, xws li "Fraksiparin", "Fragmin", "Tsibor", "Eniksum", "Fraksiparin forte." Lawv ua hauj lwm, raws li evidenced los ntawm cov lus teb ntawm cov neeg mob, zoo tib yam li hais tias ntawm cov tshuaj ua ntej peb.