"Heparin" (imijovo): isicelo, umsebenzisi, ukubuyekezwa, umthamo. Ukusetshenziswa imijovo "Heparin" ngesikhathi sokukhulelwa

Izidakamizwa "Heparin" uyakwazi ukuthi lihambe kancane ikhono igazi ukuze ihlule. Ukukhipha i-ejenti medicated e ingilazi ampules futhi izitsha eziyisikhombisa 5 ml. Ziyakwazi isixazululo nemijovo, lapho izidakamizwa esebenzayo 5,000 IU.

izakhiwo kwemithi

Izidakamizwa "Heparin" (imijovo) kuyinto anticoagulant. Kuyinto lingehla inqubo kumiswa fibrin, ukunciphisa ijubane izici wegazi coagulation, futhi lokuhlala ezinkulu - ukunciphisa umsebenzi thrombin. Ngisho ngemithamo emincane zomuthi kwanele ukwandisa umsebenzi fibrinolytic kwegazi.

usebenzisa "Heparin" imijovo ukunciphisa viscosity umzimba omkhulu uketshezi begazi. Ukusetshenziswa (a umthamo umjovo ukukhethela udokotela ngamunye) esekelwe yokuthi lokhu kusho zanqwabelana ku endothelium kwamangqamuzana egazi futhi kukhulisa icala zazo ezimbi. Ngenxa yalesi impahla incipha adhesion futhi aggregation zegazi, leukocyte futhi erythrocyte.

Ngaphezu kwalokho, "Heparin" kuvimbela ukuthuthukiswa isifo sokuqina kwemithambo yegazi, ine anti-iguliswa nobumnene vasodilator umphumela. Lokhu kungenxa yokuthi uxhumanisa eziningi izakhi kohlelo umphelelisi futhi kunciphisa umsebenzi wayo. Futhi, izidakamizwa evimbela kumiswa immunoglobulin, ayisiza, lymphocyte co sibopha histamine kanye le-serotonin.

izinkomba

Njengoba ojwayelekile, uma unezinkinga igazi ekunqandeni batuse imijovo "Heparin" izidakamizwa. Imijovo noma ukumnika emthanjeni Kunconywa kulezi zimo:

1) vein ezijulile thrombosis, yenhliziyo Umthambo isifo, embolism yamaphaphu;

2) isilethikusebenza;

3) angina Ongasimeme;

4) Isigaba sokuqala DIC;

5) fibrillation atrial, okuyinto kuhambisana thromboembolism.

Futhi ezibhedlela imisebenzi nge amasu kwegazi extracorporeal bangakwazi ukunikeza izindlela "Heparin". Imijovo ngemithambo yegazi noma phansi kwesikhumba, uma kunesidingo ukwakheka igazi, hemodialysis ukuvimbela coagulation we uketshezi begazi.

Izindlela osetshenziselwa ukwelapha nokuvimbela izifo microcirculation futhi microthrombogenesis, isibonelo, thrombosis emithanjeni kwezinso, lupus nephritis, glomerulonephritis, endocarditis webhaktheriya, mitral isifo senhliziyo, gemolitikouremicheskom syndrome.

umphumela we izidakamizwa

Uma ebekiwe imijovo "heparin" esiswini, wazi: bazokwazi ukwenza njalo. Effect zomuthi kwenzeka ngokushesha, kodwa sifushane. Ngakho, lapho zaphathwa ngemithambo yegazi kusho ekunqandeni kubambezela cishe ngokushesha, umphumela sithatha amahora mayelana 4-5. Lapho iqondiswa intramuscularly, umphumela walo emva kwemizuzu 15-30 futhi kuthathe amahora 6, nalapho injected ngaphansi kwesikhumba is baphawula emva kwemizuzu 40-60 futhi ihlala 8 amahora. Isenzo oqabulayo kuvinjelwe ukwakheka amahlule, ihlala isikhathi eside kakhulu.

Ukulungiselela "Heparin" kwandisa kwezinso ukugeleza kwegazi, kwandisa semithambo ukumelana ebuchosheni, has umphumela hypolipidemic. Ukwengezwa kusho kunciphisa umsebenzi surfactant yamaphaphu kuvimbela zamagama ngokweqile aldosterone e cortex adrenal, icacisa asebenzayo ithonya PTH sibopha adrenaline.

ukusetshenziswa Izici

Ngokuvamile abantu abaphethwe isifo senhliziyo, ukunquma "Heparin" (isibhamu). Intengo yaleli izidakamizwa kubonakala okusezingeni eliphezulu kwabanye. Okufakiwe 5 ampoules 5 ml nge umsebenzi 5000 IU ngamunye 1 ml abiza ruble 500-600. Kodwa ukuze senqabele uhlelo lwayo lokusebenza akunakwenzeka. Phela, in iziguli ischemia kusho "Heparin" kunciphisa ingozi isilethikusebenza, yenhliziyo Umthambo thrombosis futhi ukufa okuzumayo. Ngaphezu kwalokho, ukusetshenziswa kwezidakamizwa kunganciphisa amathuba isifo senhliziyo yansukuzonke kanye kakhulu ukwehlisa amaphesenti ngokufa ezandleni kulezi ziguli.

Lapho thrombosis pooling eyeqile embolism yamaphaphu linqume umthamo omkhulu "Heparin" ukulungiselela. Imijovo (umyalelo ivumela ukubhekana kanjani ukubeka kahle kubo) zenziwa esikhathini esithile. Kodwa, iqiniso, futhi kwezinye izimo, ukuthola ngokushesha okunxanelekayo lokwamukelisa izindlela emthanjeni.

Futhi linqume esebenzisa "Heparin" nokuvimbela izenzakalo thromboembolic, ezifana emva kokuhlinzwa. Kulokhu, it is ebekiwe ngemithamo emincane.

Izindlela zokusebenzisa

Khetha umthamo edingekayo futhi indlela ukusetshenziswa kwezidakamizwa kufanele udokotela kuphela, kuye ngokuthi isimo lesiguli kanye izizathu ezenza idinga le izidakamizwa. Agent kungenzeka iqondiswa ngemithambo yegazi njengoba ukumnika okuqhubekayo noma imijovo njalo. Futhi, kwezinye izimo, ongama, noma angaqokwa ngomjovo esicutshini.

Ukuvimbela thrombosis izidakamizwa kungenzeka iqondiswa phansi kwesikhumba nge 1 ml (5000 IU) kabili ngelanga. On isidingo ngale ncazelo unamathele izidakamizwa "Heparin" imfundo manual. Imijovo ngokuvamile enziwa lapho esiswini, e nodonga lwawo anterolateral. Ukuze wenze lokhu, thatha inalidi esihle futhi bafake ke ezijulile emphecweni isikhumba. Kumiswa It is lapho sicindezelwe emkhatsini isithupha ne forefinger kwendawo isisu endaweni inkaba. Umjovo kumele alternated. Emacaleni angakajayeleki imijovo kungenziwa engxenyeni engenhla senyonga noma ingalo eliphezulu.

Ukukhetha Isikali

Ngenhloso zokwelapha ngokuya ukwelashwa inpatient ezibhedlela zivame ebekiwe ukumnika emthanjeni. Ezigulini omdala, umthamo 1,000 IU / ihora. Kodwa ngaphambi kokufaka ukuvuza ngoba umphumela esiphezulu kungaba faka bolus ku umthambo inani 5,000 IU. Ukukhethwa umthamo ngqo iqondiswa e udokotela kuye ngesimo kanye nesisindo lesiguli.

Uma kungenakwenzeka ukuba aqhube ukumnika emthanjeni, amanxusa kungenzeka iqondiswa phansi kwesikhumba: 2 ml izidakamizwa (okuhambelana 10000 IU) izikhathi 4 ngosuku. Umthamo esiphezulu ngokuvamile esetshenziselwa ukulungiselela izinsuku ezingu-10.

Isamba esidingekayo zomuthi kuyakhethwa emva Imiphumela kokuhlaziywa test. Ngokukhethekile ikhokhelwa kuze APTT (isebenze ngokwengxenye thromboplastin isikhathi).

Lapho ukumpontshelwa igazi donor, ngokuvamile iqondiswa ayizinkulungwane 7.5-10. IU kusho "Heparin".

Ukwelashwa ezimweni ezikhethekile

Ngo-acute isilethikusebenza ngokushesha iqondiswa 10-15 izinkulungwane. IU ngemithambo yegazi ke ukusetshenziswa kwaso okuqhubekayo izibalo esinjalo, isiguli wathola 40 000 IU ngosuku lokuqala, kodwa umthamo ngqo is akhethiwe kuye ngokuthi isisindo lesiguli. Lokhu kuyadingeka ukuqinisekisa ukuthi amahlule igazi ngezikhathi 2.5-3 kancane. Kusukela ngosuku lwesibili umthamo kuyehla. Kubalulekile ukuthi isikhathi ekunqandeni kuyizikhathi 1.5-2 ephakeme kunaleyo evamile. Ukwelashwa nale izidakamizwa siyaqhubeka izinsuku 8. Ukuze ukhansele umthamo wansuku zonke kwehle ngo 5-10 ayizinkulungwane. IU, kodwa ngezikhathi phakathi imijovo musa ukwandisa. Ngemva ukuqedwa pass kuya anticoagulants ka engaqondile senzo. Kungaba indlela ezifana "Fenilin", "neodikumarina" nabanye.

lwemithambo olunamandla noma isimiso emithambo yegazi futhi kudinga indlela ekhethekile. Ngoba impatho ebekiwe heparin emthanjeni izinsuku 3-5 at umthamo 400-450 IU ngayinye kg isisindo nesineke. Okungukuthi, isiguli emncane aphakathi nendawo kanye ukuphakama kufanele uthole usuku ecishe ibe yizinkulungwane 30-40. IU "Heparin" izidakamizwa. Khona-ke uqhubekela wamaqhuzu yethula, kodwa umthamo luyanda mayelana 600 IU / kg, ne umjovo owodwa emzimbeni kufanele uthole 100 IU / kg. Ukwelashwa kungathatha izinsuku ezingu-16. Ezinsukwini ezimbalwa nje ngaphambi izidakamizwa ukuhoxiswa yakhe lemali kancane kancane. Treatment baqhubeka besebenzisa anticoagulants engesobala.

Izixwayiso

Naphezu kweqiniso lokuthi abanye ukukhuluma mayelana nokwenzeka ujove esicutshini zomuthi, lo is hhayi Kunconywa ngenxa yokuthi ngaleso hematoma umjovo indawo ngokuvamile kwakhiwa. Ukusebenzisa izidakamizwa dilutions 0.9% NaCl isixazululo.

Kubalulekile futhi ukwazi ukuthi ngesikhathi ekwelapheni "Heparin" kusho akudingekile ukuba enze noma iyiphi ujove esicutshini eziyishumi nemitshingo biopsy. Lapho uyisebenzisa, udinga ukuqapha isimo coagulation. Ngesonto lokuqala okwelashwa, igazi ihlolwe zonke izinsuku ezimbili, kusukela ngesonto lesibili ke kungenziwa njalo ezinsukwini ezingu-3.

Nakuba izindlela akusho ukungena ubisi lwebele, lactation ngesikhathi sokwelashwa, kuyinto efiselekayo sokuqeda. Kwatholakala ukuthi izidakamizwa kuholela kwezinye izimo ngokonakalisa yomgogodla kwamathambo. Izinkinga uqale ngemva kwamasonto 2-4 yokwelashwa.

Endaweni ehlukile, kuyafaneleka ukuthi ikhambi izidakamizwa angase phuzi, kodwa akunamthelela impahla yayo kwemithi noma ukubekezelelana kusho "Heparin". Imijovo, intengo ezingasetshenziswa kakhulu kuthinte isabelomali eyayimbeka ebulilini, kungenziwa ngisho bebodwa ekhaya.

Izimo

Njenganoma iyiphi enye indlela, awukwazi ukusebenzisa izidakamizwa "Heparin" uma hypersensitive. It is hhayi ezinqunyiwe nokopha. Okuhlukile nokopha ukuthi zenzeka lapho wamaphaphu esivimba amanzi (uzwakalise kwifomu hemoptysis) noma izinso (hematuria ephelezelwa).

Izimo futhi zihlanganisa:

- oluhambisana diathesis nezinye izifo lapho kahle igazi ekunqandeni;

- anda permeability semithambo, ezifana Verlgofa isifo;

- endocarditis webhaktheriya ;

- ukopha emlandweni;

- hypoplastic futhi anaemia aplastic, leukemias chronic acute;

- ezinzima isibindi nezinso umsebenzi;

- esibhibhayo emithambo yegazi;

- ukuthuthukiswa acute inhliziyo useshonile.

izinyathelo zokuqapha

Ngaphezu Izimo oqondile, kukhona uhlu izimo lapho kuyadingeka ukuhlola zonke izingozi kungenzeka uma nithatha "Heparin" izidakamizwa. Imijovo futhi emthanjeni ukwenza kuphela ezimweni ezingavamile futhi ngaphansi kokuqondisa ongoti izimila kanye izilonda emathunjini yokusetshenziswa pheshana emathunjini, umfutho wegazi ophakeme, kwangemva kokubeletha kanye inkathi nasezinkingeni ezilandela ngemva kokuhlinzwa, ngaphandle angioplasty.

A amazwi ambalwa mayelana nokwelashwa lomama esizayo. Naphezu kweqiniso lokuthi ekwelapheni abesifazane ngendlela umndeni phambi kwethu kusho engathandeki (kungaholela ukuthuthukiswa yezinkinga), imijovo "heparin" esiswini ezinqunyiwe kwezinye izimo, ngesikhathi sokukhulelwa. Amathuba nesenzakalo nemiphumela engemihle ezisukela 10 kuya 21%. Nakuba isikhathi sokukhulelwa evamile ingozi yezinkinga lingaphansi kuka 3.6%.

Kufanele kuqashelwe ukuthi imiphumela thromboembolism kungenzeka e omama abakhulelwe eziyingozi kakhulu empilweni kunokwamukela izindlela "Heparin". Imijovo ngesikhathi sokukhulelwa ukwenza kuphela ngaphansi kweso lwezokwelapha kanye kuphela uma kunobufakazi ngokuphelele. Kodwa izidakamizwa kungabangela ukopha, thrombocytopenia kwamathambo. Kusho placenta akusho ukungena.

analogs Okungenzeka babo nesineke

Ngokuvamile labo abamiswe izidakamizwa "Heparin" (imijovo esiswini), intengo kubonakala kakhulu. Kodwa uma isetshenziswa njengoba isilinganiso izifo, 1 iphakethe kungase kwanele izinsuku ezimbalwa. Ngakho, isembozo lapho amabhodlela 5, kungase kube anele amaviki ambalwa. A ukulungiselela umthamo ephezulu isetshenziswa ngokuvamile izinsuku ezingu-10-14.

Noma kunjalo, abantu abaningi bafuna ukufunda kwezinye iziguli, kuwufanele ukuthenga umuthi, bafuna 'Heparin "ukulungiselela izibuyekezo. Analogue zomuthi nabo banesithakazelo. Ngakho, uma kukhona izinkinga kanye igazi ekunqandeni, ithuluzi siyasebenza kakhulu futhi ikuvumela ukuba kuzuzwe oyifunayo nomphumela oqabulayo ngokushesha okukhulu. Lokhu kuqinisekiswa kokubili kodokotela neziguli zabo.

Kodwa esikhundleni kungase zimise anticoagulants "Troparin", "Heparin Sandoz", "Heparin Sodium Brown", "Heparin-Verein" nezinye analogs. Umthamo le mithi kufanele kuphela ukhethe udokotela esekelwe imiphumela cwaningo esiguli, isimo sempilo yakhe futhi izinkomba lapho izidakamizwa lenikiwe.

Kwezinye izimo, odokotela batusa ongaphakeme yamangqamuzana isisindo heparins, ezifana "Fraksiparin", "Fragmin", "Tsibor", "Eniksum", "Fraksiparin Forte." umphumela yabo, njengoba kufakazelwa izimpendulo iziguli, cishe kuyafana nalokho zomuthi phambi kwethu.