Zodzikongoletsera ndizophatikiza zamagulu osiyanasiyana omwe, akamayamwa, amathandizira kuthetseratu madzimadzi. Kutengera gulu la zamankhwala, zomwe zimayambitsa diuretic zimachitika chifukwa cha njira zingapo.
Okodzetsa amapezeka kwambiri pochiza matenda amtima, impso ndi ziwalo zina. Kuphatikiza apo, amagwiritsidwa ntchito ndi othamanga kuti achotse mwachangu madzi amadzimadzi ndikupatsa thupi mphamvu.
Kodi diuretics ndi chiyani?
Mankhwala okodzetsa amagwiritsidwa ntchito ndi othamanga kuti achotse madzi m'thupi. Zotsatira zake zimakuthandizani kuti muchepetse magazi athunthu mumtsuko. Izi zimagwiritsidwa ntchito kuchepetsa kuthamanga kwa magazi kwa anthu omwe ali ndi matenda oopsa. Mwa kulephera kwamtima kosatha, pali kufooka kwa kupopa kwa mtima ndi kukhazikika mgulu laling'ono komanso lalikulu lamagazi. Chithunzi chachipatala chikuyimiridwa ndi edema ya kumapeto kwenikweni ndi nkhope, kuoneka kwa kupuma pang'ono ndi kupuma kwamadzi, komwe kumatsimikiziridwa ndi kukopa kwamapapu. Kutenga diuretics kumakuthandizani kuti muchotse madzi ochulukirapo ndikuthana ndi zizindikiro za CHF.
Osmotic ndi loop diuretics amagwiritsidwa ntchito pokonzanso kuti athetse ndi kuteteza m'mapapo mwanga komanso m'matumbo.
Komanso, okodzetsa amaperekedwa ngati mankhwala ochotsera poizoni wokhala ndi mchere wambiri wamafuta, mankhwala osokoneza bongo, zinthu za narcotic ndi poizoni wina. Iwo Kwenikweni mu nkhani ya chitukuko cha decompensated matenda enaake, amene amakhala ndi zipata matenda oopsa. Mankhwalawa amachepetsa kapena amachepetsa mphamvu ya edema, amachotsa madzimadzi m'mimbamo ndi ma ascites ochepa.
Ndikofunika kumwa diuretics ya eclampsia, matenda omwe amapezeka mwa amayi ali ndi pakati kapena pobereka. Matendawa amadziwonetsera ngati kuwonjezeka kwakukulu kwa kuthamanga kwa magazi, komwe kumabweretsa matenda osokoneza bongo ndi kusokonezeka kwa ubongo motsutsana ndi edema. Chithandizo chovuta, kuphatikiza pakupatsa okodzetsa, makamaka osmotic, amaphatikizira mpweya wabwino, kuwunika kwa magazi, kupumula kwa matenda oopsa ndi mankhwala a magnesium sulphate infusion, ndi njira zotsitsimutsira.
Kuwonjezeka kwa kupsinjika kwa intraocular (glaucoma) ndichizindikiro chogwiritsa ntchito ma carbonic anhydrase inhibitors. Enzyme imapangidwa m'matumba ambiri, kuphatikiza thupi la ciliary. Kugwiritsa ntchito kwa diuretic kwamtundu wa madontho kumachepetsa mawonekedwe a glaucoma.
Mitsempha ya Varicose imatsagana ndi kukula kwa edema, chifukwa chake, kuwonjezeka kwa mkodzo pogwiritsa ntchito mankhwala kumachepetsa zizindikilo za matendawa ndikupewa zovuta.
Chifukwa chiyani othamanga amafunikira diuretics?
Odzetsa amagwiritsidwa ntchito kwambiri kwa othamanga komanso omanga thupi. Kugwiritsa ntchito okodzetsa kumabweretsa kutuluka kwa madzimadzi, omwe samapezeka m'magazi ndi minofu yokha, komanso munthawi yamafuta ochepa. Chifukwa cha izi, thupi limapeza mpumulo.
Mankhwala othandiza, omwe amaphatikizapo kudya pang'ono mchere ndi madzi, amawonetsa zotsatira kwakanthawi, pomwe mankhwalawa amakulolani kukwaniritsa zomwe mukufuna. Izi ndizowona makamaka madzulo a mpikisano.
Kumwa mankhwala osokoneza bongo kumatha kukhala kwa makolo, ndiye kuti, kudzera mu kulowa kwa syringe mumtsempha. Ntchitoyi imapereka zotsatira zofulumira. Komabe, njirayi imatha kuyambitsa kuthamanga kwa magazi, kuwonongeka kwa ubongo ndi zovuta zina. Akatswiri othamanga amakonda mapiritsi okodzetsa, chifukwa kukonzekera kwa mankhwala kumatsimikizira kuyamwa kwa yunifolomu ya chinthu chogwira ntchito komanso chosavuta.
Ochita masewera othamanga ambiri atengeka ndi matenda amadzimadzi omwe amayamba chifukwa cha kuchuluka kwa urea, matupi a ketone, uric acid; chifukwa chake, kugwiritsa ntchito diuretics ndi njira yopewera matendawa.
Gulu ndi njira yogwiritsira ntchito okodzetsa
Magulu a okodzetsa amatengera mawonekedwe a mankhwala.
Zodzikongoletsera zomwe zimalimbikitsa kutuluka kwamadzimadzi motsutsana ndi kuwonongeka kwa kuyambiranso kwa ion:
Kubwerera kumbuyo
Odzetsa a loop ndi othandiza kwambiri. Mfundo yogwiritsira ntchito mankhwalawa ndi gawo lakuda la gawo lokwera la Henle. Amachepetsa kubwezeretsanso kwa sodium, potaziyamu ndi klorini poletsa mayendedwe. Pamodzi ndi ma electrolyte omwe adatchulidwa, othandizira amachotsa calcium ndi magnesium m'malo ochepa, komabe, chithandizo chamankhwala chimatha kubweretsa ku hypomagnesemia. Kugwiritsa ntchito nthawi yayitali kumabweretsa kusintha kwa magazi a impso, chifukwa chake amagwiritsidwa ntchito osakwanira kwa zida za glomerular.
Zina mwa mankhwala omwe ali mgululi: Furosemide, Lasix, Bumex, Ethacrynic acid, Torasemide.
Thiazide
Zotulutsa za Thiazide zimakhudza kagayidwe kake ka ayoni koyambirira kwa ma tubules ophatikizika a nephron. Mankhwalawa amatseka mapuloteni ena omwe amatsimikizira kuyambiranso kwa sodium ndi chlorine. Izi zimabweretsa kuwonjezeka kwa kutuluka kwa madzi ndi ma electrolyte kuchokera mthupi. Komanso, thiazide diuretics imatchinga pang'ono carbonic anhydrase, yomwe imathandizira kukodzetsa.
Mankhwala mu gulu lino: Naklex, Dichlorothiazide.
Kupulumutsa potaziyamu
Mankhwala osungira potaziyamu amagwira ntchito kumapeto kwa ma tubules, komanso malo osonkhanitsira. Ngakhale zotsatira zake ndizofooka, okodzetsa am'magulu azachipatalawa amagwiritsidwa ntchito kwambiri ngati mankhwala chifukwa cha machitidwe awo apadera. Mankhwalawa amachulukitsa kutulutsa kwa sodium, koma nthawi yomweyo amakhala ndi potaziyamu ndi magnesium, yomwe imapewa kusowa kwa ma electrolyte m'magazi, ndipo chifukwa chake, kusokonezeka kwa mtima.
Mndandandawu muli Spironolactone, Veroshpiron, Triamteren.
Mwina akhoza kukhala otsutsana ndi aldosterone. Yoyamba ikuphatikizapo Spironolactone, Veroshpiron. Izi zikutanthauza kuti kukwezeka komanso kupanga kwa aldosterone (hormone mineralocorticosteroid yopangidwa ndi adrenal cortex) m'thupi, kumakulitsa ntchito zake zochiritsira. Izi zimalimbikitsa kuyambiranso kwa sodium. Mankhwala a gululi amapikisana nawo poteteza mahomoni, kuwachotsa pamalumikizidwe ndi mapuloteni olandila. Otsutsana ndi Aldosterone amachepetsa kuyambiranso kwa ayoni wa sodium, potero kumawonjezera kutuluka kwa madzi amthupi.
Osmotic
Iwo amachita mu lumen wa tubules nephron. Mankhwala amapanga mphamvu yayikulu yama hydrostatic kuti madzi asabwererenso m'magazi ndikutulutsidwa mthupi. Kuphatikiza apo, mankhwalawa amathandizira kutayika kwa matupi, kuphatikiza omwe amatetezedwa ndi chotchinga cha histohematogenous. Izi zimagwiritsidwa ntchito kuthetsa mapapu ndi ubongo.
Mwa mankhwala omwe ali mgululi, ndikuyenera kuwunikira Mannitol.
Mpweya wa anhydrase inhibitors
Zimayambitsa kuphwanya kutsika kwa bicarbonate, komwe kumatulutsa kutulutsa kwa sodium ndi madzi.
Gulu ili likuphatikiza Diakarb, Fonurit.
Mercury
Diuresis yawonjezeka posakhazikitsa njira zoyendera za sodium. Kutsika kwa kuyambiranso kwa ion kumabweretsa kuwonjezeka kwa madzi ndi impso. Pali chiphunzitso chakuti mankhwala a gulu la zamankhwala amathandizanso pakagwa impso. Mankhwalawa amalembedwa ngati njira zina sizingagwire ntchito, chifukwa mankhwala okhudzana ndi mercury ndi owopsa kwambiri.
Zina mwa mankhwalawa ndi Novurit, Merkuzal.
Kukhazikitsidwa kwa okodzetsa ena kumadalira matendawa. Nthawi zina, kuphatikiza njira zingapo zimagwiritsidwa ntchito kuti zikwaniritse bwino.
M'masewera, othamanga nthawi zambiri amagwiritsa ntchito mankhwala osokoneza bongo komanso thiazide, chifukwa amawonetsa mwachangu zotsatira za diuretic. Othandizira potaziyamu nawonso amapezeka - kugwiritsa ntchito kwawo nthawi zambiri kumabweretsa chisokonezo cha electrolyte.
Ma diuretics apamwamba kwambiri mu 2018
Furosemide ndiwothandiza kwambiri pakati pa ma diuretics ozungulira. Mankhwalawa amadziwika ndi kuchitapo kanthu kwakanthawi kochepa. M'madera azachipatala, mankhwalawa amagwiritsidwa ntchito ngati ambulansi kuti ithetse edema yayikulu, zizindikilo zoyipa zakulephera kwa mtima komanso edema ya ubongo ndi mapapo.
Mphamvu yotchuka kwambiri mgulu la potaziyamu-osalekerera okodzetsa ali ndi aldosterone wotsutsana ndi Veroshpiron. Mankhwalawa amapewa zovuta zamatenda zomwe zimayambitsa kusowa kwa ma electrolyte, koma zomwe zimawoneka zimatheka pang'onopang'ono kuposa momwe mumagwiritsira ntchito ma diuretics. Kachiwiri, mutha kuyika Amiloride.
Mtsogoleri pakati pa diuretics wa thiazide ndi Hydrochlorothiazide. Chidacho chimachotsa bwino madzimadzi mthupi mwa kulepheretsa kubwezeretsanso ma electrolyte. Mankhwalawa amatchulidwa moyenera komanso zotsatira zake kwakanthawi.
Anthu okodzetsa
Mankhwala ena achikhalidwe amakhala ndi diuretic.
- Kuchotsa madzi owonjezera mthupi, masamba a birch amagwiritsidwa ntchito. Kukonzekera mankhwala, 300 ml ya madzi otentha amathiridwa supuni imodzi ya chomeracho ndikuumirira kwa mphindi 30. Tengani mankhwala 100 ml tsiku limodzi kwa sabata.
- Mphamvu ya diuretic imawonetsedwa ndi tincture yokonzedwa pamaziko a bearberry, komanso masamba a lingonberry ndi mphesa.
- Green tiyi kumawonjezera mkodzo linanena bungwe. Mutha kuwonjezera timbewu tonunkhira, birch, currant kapena mphesa kumowa kuti izi zitheke.
- Zitsamba zina zitha kugulidwa ku pharmacy, mwachitsanzo, Kanefron, yomwe ili ndi mankhwala azitsamba - centaury, rosemary ndi lovage.
Zisonyezero
Kutenga diuretics kumawonetsedwa kuti:
- matenda oopsa;
- edema;
- glaucoma monga mankhwala kapena kukonzekera opaleshoni yamaso;
- preeclampsia ndi eclampsia pofuna kuchepetsa kuthamanga kwa magazi;
- matenda a impso.
Zotsutsana
Kutenga okodzetsa kumatsutsana ndi:
- kwambiri aimpso kulephera, limodzi ndi anuria;
- kutsekeka kwa kutuluka kwa mkodzo wa etiology iliyonse;
- Kuwonjezeka kwa kupanikizika mu mitsempha yopitirira 10 mm Hg;
- hypertrophic cardiomyopathy;
- chisokonezo electrolyte;
- kusowa kwa madzi m'thupi motsutsana ndi kusanza, kutsegula m'mimba ndi matenda ena.
Sikoyenera kuwonjezera diuresis pachimake m'mnyewa wamtima infarction, cerebral artery stenosis, matenda ashuga osagwiritsa ntchito mankhwala, komanso matenda amthupi.
Pakati pa mimba, mankhwala okodzetsa ochokera ku gulu la thiazide amalembedwa, koma pachiyambi magulu ena a mankhwala amagwiritsidwa ntchito. Kafukufuku wambiri wazachipatala awonetsa kuti pakuchepetsa magazi pozungulira komwe kumagwiritsidwa ntchito okodzetsa, chiopsezo chokhala ndi nthawi yayitali ya gestosis chimawonjezeka.
Zotsatira zoyipa
Zotsatira zoyipa kwambiri ndikukula kwa hypokalemia mukamamwa thiazide ndi kuzungulira okodzetsa. Kusagwirizana kumeneku kwamagetsi kumabweretsa ma arrhythmias. Furosemide ndi zofananira zake zimawonetsa zotsatira za ototoxic, ndiye kuti, amachepetsa kumva. Izi zimachitika chifukwa chazindikiritso zosamveka bwino zamakutu mkatikati chifukwa chakusintha kwamagetsi a electrolyte. Mankhwala atachotsedwa, ntchito yoyimitsa imabwezeretsedwanso. Thiazide okodzetsa amachulukitsa chiopsezo cha glaucoma kapena myopia wosakhalitsa.
Mankhwala a Osmotic amatha kuyambitsa kuchepa kwamadzi, komwe kumawonetseredwa ndi khungu louma, ludzu, chikumbumtima chofooka, komanso kuchepa kwa kuthamanga kwa magazi ndi kuchepa kwa madzi m'thupi. N'zotheka kukhala ndi vuto la electrolyte, kupweteka pachifuwa monga angina pectoris.
Poyankha kumwa mankhwala okodzetsa, vuto lawo limatha.
Kugwiritsa ntchito mankhwala pafupipafupi kuchokera pagulu la omwe amatsutsana ndi aldosterone kumayambitsa mapangidwe a gynecomastia ndi kuwonongeka kwa erectile mwa amuna, kusabereka komanso zovuta zamayendedwe azimayi mwa akazi.
Pofuna kupewa zovuta, muyenera kuwerenga mosamala malangizo ogwiritsira ntchito mankhwalawa. Kuledzera kumawopseza ndi zovuta zoyipa kuchokera kumimba.
Ochepetsa okodzetsa
Kugwiritsa ntchito ma diuretics kuti muchepetse kunenepa ndi malingaliro olakwika omwe nthawi zambiri amatsogolera ku zotsatira zoyipa. Njira yogwiritsira ntchito diuretics ndikuchotsa madzi m'thupi, chifukwa chake, akatengedwa, thupi limachepa chifukwa cha kuwonjezeka kwa diuresis.
Indapamide amatha kuwonjezera katulutsidwe enieni prostaglandins, imbaenda kuchepa kwa ndende otsika kachulukidwe lipoproteins mu magazi, ndiko kuti, mafuta, amene amachititsa mapangidwe atherosclerotic zolengeza. Koma izi sizikhudzana ndi kuchepa thupi, mosiyana ndi zomwe ambiri amakhulupirira.
Izi zikutanthauza kuti kugwiritsa ntchito diuretics sikumabweretsa zomwe mukufuna, popeza kuonda kumachitika kokha chifukwa cha kutuluka kwa madzimadzi. Kudya nthawi zonse kwa okodzetsa popanda chifukwa kumawonjezera chiopsezo chokhala ndi zotsatira zosafunikira.
Mitundu ya okodzetsa othamanga
Odzetsa okodzetsa kwambiri. Ma pharmacokinetics awo amadziwika ndi mayamwidwe am'mimba mwachangu. Pazipita zotsatira zimatheka mu theka la ora ndipo amakhala ndi kuwonjezeka mkodzo linanena bungwe ndi mofulumira kuwonda. Gulu la okodzetsa thiazide limayamwa pang'ono, zotsatira zake ndizofatsa kuposa zamankhwala osokoneza bongo. Gulu lazamalonda limakonda kugwiritsidwa ntchito pakati pa othamanga chifukwa cha zovuta zochepa zoyipa.
- Pomanga thupi, kugwiritsa ntchito Furosemide kumapereka kutuluka mwachangu kwamadzimadzi kuchokera munthawi yamafuta yamafuta, zomwe zimabweretsa kusintha kwakunja - thupi limadziwika kwambiri. Tikulimbikitsidwa kugwiritsa ntchito mankhwalawa mu mapiritsi kuti mupewe zovuta. Zotsatira zake zimakwaniritsidwa mkati mwa mphindi 30 mutatha kumwa mankhwala, nthawi yayitali imasiyanasiyana mphindi 90 mpaka maola atatu. Bumetanide imagwiranso ntchito nthawi yayitali. Monga lamulo, limagwiritsidwa ntchito ngati Furosemide siyothandiza.
- Mankhwala azitsamba Canephron, omwe amaphatikizapo zaka zana, rosemary ndi lovage, ndioyenera kuti azigwiritsidwa ntchito, chifukwa zimayambitsa kuchepa pang'ono.
M'zaka zaposachedwa, zowonjezera zowonjezera za othamanga zayamba kutchuka, zokhala ndi diuretic, mavitamini ndi ma electrolyte. Izi zikuphatikiza:
- Hydrazide kuchokera ku MuscleTech
- Xpel kuchokera ku MHP;
- Nthawi Yowonetsera ndi SciVation.
Hydrazide ndi MuscleTech
Kuphatikiza kwa chakudya chamasewera ndi okodzetsa munthawi yochepa kumapereka mpumulo kwa thupi la wothamanga.
Njira yobisa kudya kwa anabolic steroid
Amakhulupirira kuti kutulutsa kwamadzi m'thupi kumatha kuchotsa ma metabolites omwe amapangidwa pakutha kwa anabolic steroids. Mawuwa ndi nthano chabe, chifukwa kugwiritsa ntchito mankhwala osokoneza bongo kwambiri kumayikidwa m'matumba ndipo sikungathe kutulutsidwa m'madzi.
Kugwiritsa ntchito zodzitetezera kumatchuka pakati pa othamanga:
- Probenecid ndi wothandizira yemwe amalimbikitsa kutulutsa kwa uric acid. Ankagwiritsa ntchito gout.Komabe, pamasewera ndikoletsedwa ndi anti-doping system, popeza wothandizirayo amalimbikitsa kuchotsa ma steroids mthupi.
- Epitestosterone ndi chinthu chapakatikati chomwe chimapangidwa pakutha kwa testosterone. Kugwiritsa ntchito mankhwala opangira mankhwala kumalepheretsa kuzindikira kuti anabolic steroid imadya.
Pofuna kubisa vuto la kugwiritsa ntchito mankhwala osokoneza bongo, othamanga amagwiritsa ntchito mankhwala a polycyclic - maantibayotiki ena, mankhwala a immunotropic kutengera bromantane.
