Anticoagulants yezvakananga uye zvisingaenzaniswi. Inoratidzika anticoagulants: urongwa hwezvinodhaka, nzira yekuita, kusarudzwa. Kunyanya kuderedza nekunyoresa anticoagulants

Nekushanda kwakakodzera kwe coagulated uye anti-convoluted blood systems, mukati mehutano hwehupenyu hunowirirwa. Ropa rinoyerera mukati memidziyo harina zvipingamupinyi uye zvisingakwanisi, uye thrombus yakagadzirirwa iri pakakodzera. Kana chikamu chekushanda kwemaitiro acho kukanganisa mukugadzirisa kuvhara ropa, mamiriro ezvinhu anooneka anogona kutungamirira kune zvakanyanya kupfeka mavara. Anticoagulants isina kukodzera - imwe yemapoka emishonga anoshandiswa kugadzirisa zvinetso zvemukati.

Chii chinonzi anticoagulants?

Anticoagulants vashandi vane anticoagulable effect uye vanoita kuti ropa ripenye. Izvi zvinokubvumira kuti udzorere rheological zvinhu uye kuderedza huwandu hwekuvandudzwa kweprombosi.

Mishonga iyi inowanika mupepeti, nenzira yemafuta, mafuta uye injection. Vanorayirwa kwete chete kurapwa kwezvirwere, asiwo nechinangwa chekudzivirira kuwedzera kwekugadzirisa ropa.

Vazhinji vevamiririri veboka iri remishonga havaiti pane zvakagadzirwa neropa, asi pane basa rekuvhara ropa. Ikoko kune nzira yekukonzera plasma zvinhu uye thrombin michina, iyo inononoka kugadzirisa maitiro ekugadzira.

Mishonga iyi yakakamurwa kuva mapoka maviri zvichienderana nezvinoitwa:

• Tungamirira anticoagulants;
• Indirect anticoagulants.

Kururamisira kuita zvinodhaka zvichibva pa heparin

Iboka iri remajini rinogadzirisa zvakakwana plasma cofactors inhibiting thrombin. Mumiririri mukuru ndiye heparin. Pamusoro paro, pane mishonga yakawanda inoshanda zvakafanana uye ine zita rinoshandiswa:

• "Ardeparin."
• "Nadroparin".
• "Cleaver".
• Longyparin.
• "Sandoparin".

Heparin kana zvigadzirwa zvinosanganiswa ne antithrombin-III, izvo zvinoita kuti kuve nekushandurwa kwegadziriro yemamolekoro ayo. Izvi zvinokurumidza kushamwaridzana nechofactor kuti inokonzera, uyezve kuisa maitiro ekuvhara.

Zviratidzo zvekushandiswa kwe "Heparin"

Chiito chezvinhu izvi chinangwa chekudzivirira kukura nekupararira kweropa clot. Makorekemu e heparin akaita svondo ne antithrombin, iyo inhibitor ye coagulation zvinhu. Chinhu chacho ndecheketani ye glycosaminoglycans. Chirwere chacho chinotarisirwa pasi pechishanu uye chinotanga kushanda mumaawa mashomanana.

Kana uchida chiito chekukurumidza, "Heparin" inorayirwa intravenously kuti ikurumidze kubudirira uye kuwedzera bioavailability. Kusarudzwa kweroji kunobva pane mamiriro ayo murwere ari. Mukuwedzera, kuvapo kwezvirwere zvinokonzera, kugamuchirwa kwakafanana kune mamwe mapoka emishonga, kudikanwa kwekupindira kwekuvhiya pamidziyo kunotorwa.

Oligopeptides

Mishonga inoshanda zvakananga pamucheto we thrombin activation inonzi yakasimba inhibitor chaiyo ye thrombogenesis system. Zvinhu zvinoshandiswa zvezvigadziro izvo pachazvo zvinowirirana ne coagulation zvinhu, kuchinja maitiro avo.

Iyi mishonga ndeye "Inogatran", "Hirudin", "Efegatran", "Tromstop" nevamwe. Yakashandiswa kudzivirira kukurudzirwa kwemwoyo kuAngina pectoris, ne varicose misa, yekudzivirira thromboembolism, kuiswazve panguva yekuvhiyiwa kwepurasitiki.

Indirect anticoagulants (urongwa)

Anticoagulant yekutanga yakawanikwa muzana remakumi maviri nemazana makumi mashanu muAmerica, apo chirwere chitsva chemhou chakawanikwa chichiita kuti ropa riwedzere. Apo chinokonzera chirwere chechirwere chakanga chakajekeswa, zvakabva zvaitika kuti mhuka yemhuka inokanganiswa nehutu hwakatapukirwa nehutu, iyo iri kumashure. Kubva pane izvi zvakasvibirira, kutanga kwegadziriro ye antiaggregant isina kururamisa, "Dicumarol", yakagadzirwa.

Kusvika iye zvino, urongwa hwemari yakafanana, inopfuura zana mazita. Zvose izvi zvinodhaka hazvina kunyatsozivikanwa anticoagulants. Iyo nzira yekuita kweboka remishonga inobva pakudzivisa kwechiito che vitamini K.

Pane zvipfeko zvinodzivirira zvinoenderana ne vitamini iyi. Anrectoagulants asinganzwisisi anodzivisa kushandiswa kwekuvhara mapuroteni uye mavhitamisi-anovimbiswa. Kushandiswa kusingadzorwiki kwemishonga yakadaro kunorambidzwa, sezvo njodzi yezvinetso zvakanyanya inowedzera.

Iko kune mapoka maviri makuru ayo ose anticoagulants asinganzwisisi akaparadzaniswa. Kuenzanisa kwemari kunobva pane chinhu chinoshandiswa, icho chikamu chemishonga. Kusiyanisa:

• Coumarin derivatives;
• Nzira dzinobva pane zvisingabatsiri.

Kugadzirira kwekunyora

Mushure mekupedza huwandu hwezvidzidzo, masayendisiti akawana kuti mari inobva pane chinhu ichi chinoshanda haifaniri kushandiswa mukurapa. Mishonga iyi yaiva nehuwandu hwemigumisiro yakawanda muhutano hwehutano hwemagetsi. Kubudirira kwe-anti-coagulation system zvakare haina kuratidza zvibereko zvakasimba.

Iri boka remishonga rinosanganisira kugadzirira: "Fenindion", "Diphenindion", "Anisindion." Zvakasarudzwa kumira sarudzo huru pachikwata chechipiri che antiplatelet agents, uye chete "Fenilin" inoshandiswa kubva kune zvigadzirwa zve indandione panguva ino.

Iyo mishonga ine mari shoma, inowanikwa mufomu yebhetheni. Inoguma kwemaawa gumi, uye zvakakosha kumira nguva yakakodzera yerapi. Izvozvo zvinowanikwa chete maawa makumi mana mushure mekutanga kugamuchirwa. Kushandiswa kwemari kunowanikwa pasi pekuongororwa kwemamiriro emurwere nemubatsiro we laboratory blood indicators (coagulogram, kuongorora kukuru, biochemistry).

Chirongwa chekushandiswa kwe "Phenylin":

1. Zuva rokutanga - 1 bhetereti 4 nguva.
2. Zuva rechipiri - bhandi rimwe 1 katatu.
3. Zvose zverapi iyi ipiritsi imwe pazuva.

Hazvikurudzirwi kutora mushonga pamwe chete nemishonga inoderedza huwandu hweglucose mumuviri.

Coumarin derivatives

Kumarin chinhu chinowanikwa muzvirimwa uye chinogona kubudiswa chichigadzirwa pasi peb laboratory. Chokutanga, mushure mekubviswa kwacho, mushonga wacho wakashandiswa sehupfu hwekurwa nemakonzo. Chero bedzi mushure mekufamba kwenguva nguva yemishonga yakashandiswa kurwisana nehuwandu hwehutachiona.

Anticoagulants yezviito zvisingaoneki - mazano anovakirwa ne coumarin - anomiririrwa nemishonga inotevera:

• "Warfarin" (vanobatana navo "Marevan", "Warfarin sodium", "Warfarex").
• "Azenokumarol" (analog - "Sinkumar").
• "Neodikumarin" (analog - "Ethylbiskumacetate").

Warfarin: maitiro ekushanda

Anticoagulants yechinhu chisina kujeka (iyo urongwa inowanikwa munyaya yacho) inowanzomiririrwa ne "Warfarin". Ichi ndicho chigadzirwa cheplateti, chinowanikwa pa 2.5, 3 kana 5 mg. Izvo zvinoitika pamuviri wemunhu zvinowedzera mushure mezuva 1.5-3 kubva pahwendefa rekutanga. Zvose zvinowanzoitika pakupera kwesvondo rokutanga.

Mushure memugumo wekutora mishonga inonzi rheological blood count kudzokera kunyika yavo yakashure mushure memazuva mashanu kubva pazuva rekuregeswa kweWarfarin. Mushonga unoshandiswa kaviri pazuva pazuva imwe chete. Pazuva rechishanu kubva pakutanga kwerapi, ropa rinoverengeka rinoongororwa kuti rione zvakakodzera nekubudirira kwekushandiswa.

Nzira yekurapa inosarudzwa nenyanzvi mune imwe neimwe mamiriro ega ega. Zvimwe zvinokonzerwa nehutachiona (semuenzaniso, kushaya marwadzo emvura) zvinoda kushandiswa kusingaperi. Nekuvandudzwa kwe PE (pulmonary embolism), an antiggregant inorayirwa kwemwedzi mitanhatu kana yeupenyu.

Kana zvakakosha kuita chirwere, Warfarin inofanira kubviswa mazuva mashanu kusati kwaitwa. Izvi zvichaita kuti zviratidzo zveropa zvidzoke kune zvakasikwa. Kana pane chido chakanyanya chekushandisa kushandiswa kweanticoagulant therapy, mishonga iyi inotsiviwa nekusafractional heparin. Mvura yekupedzisira inotarisirwa maawa mana kusati kwapindira.

Mushure mokuvhiyiwa, mushure memaawa mana, nephraktic heparin inotorwa zvakare. Kugamuchira kwekunyoresa antiplatelet agents kunogona kudzorerwa mumazuva maviri, mushure mekutarisisa nyika yeropa nerubatsiro rwekuongorora ma laboratory.

Muzviitiko zvipi anticoagulants inorayirwa?

Kutungamira nekusaziva anticoagulants inoshandiswa kudzivirira kufambiswa kwetromboembolism, kugadzirisa kwakanyanya kwehutachiona hwehutachiona, mumamiriro ekugadzirwa kwemagetsi emwoyo valves uye nekuvandudzwa kwehutano hwehupenyu.

Zvirwere zvikuru, mukurudzirwa kweiyo anticoagulants yezviito zvakananga uye zvisina kurongeka zvinorayirwa, ivai nerudzi urwu muchikamu:

1. Thrombosis ye arterial system:
   • Myocardial infarction;
   • Thromboembolism yemapurmonary arteri;
   • Kurohwa nekuratidzwa kweIschemia;
   • Matambudziko anokonzera mishonga inopesana neshure re atherosclerosis.
2. Yakapararira intravascular coagulation :
   • Shock rinotaura;
   • Kukuvara kwakanyanya;
   • Kuvandudza sepsis.
3. Kugadzikana kwakanyanya kubva mumasurupa:
   • Kugadzirwa kweprombussi pane rutivi rwevaruri;
   • Thrombosis ye-hemorrhoidal venous plexous;
   • Kugadzirwa kwemafuti muzvinyorwa vena cava.

Basic Contraindications

Anrectoagulants asinganzwisisiki imishonga inorambidzwa zvachose muhupo hwekushaiwa kwelasise, kushaya simba kweglucose kana galactose. Kune huwandu hwemishonga isingagoni kushandiswa panguva imwe chete neyekunyorera anticoagulants. Nyaya yekugadzirira inosanganisira kwete-steroidal anti-inflammatory drugs: "Aspirin", "Dipiridamol", "Clopidogrel", "Penicillin", "Chloramphenicol", "Cimetidine".

Mamiriro ezvinhu ayo anticoagulants ekutungamira uye asinganzwisisiki haagoni kushandiswa:

• Zvirwere zvinotyisa zvemuviri wepamuviri;
• Aneurysms yemidziyo yeropa;
• Chiropa chechiropa;
• Kubuda ropa kwakanyanya;
• Thrombocytopenia;
• Kuora kweiyo;
• Ini ndinotora uye mwedzi wapera wekudzivirira;
• High level of creatinine.

Zvakaipa zvinokonzera antiplatelet agents

Imwe yemishonga iri muboka iri remishonga ine mimwe migumisiro yakafanana. Zvinoratidzirwa nokuzvipa-kurapa, kusarudzwa nenzira isina kururama kana kukanganisa mazano ekushandiswa.

Zvimwe zvinokonzera zvinosanganisira kukura kwekubuda ropa, zviratidzo zvinoratidzika nenzira yekurutsira, kuora mwoyo uye chirwere. Iko kunorwadza kwakasimba mukati mamuviri, yega yega yeganda rashes yakafanana nemingano kana eczema. Inogona kukura necrosis, kupera bvudzi, kuchenesa kweganda.

Usati watanga kurapwa, murwere anofanira kupfuurira mutsva miedzo yekuona kuti inogona kushandisa madhiragi akadaro. Murwere anopa kuongorora ropa rose, biochemistry, urine urongwa hukuru, urine neNechiporenko, coagulogram. Inokurudzirwawo kuti iite ultrasound kuongororwa kweeitsvo uye kuisa mhuka kune rimwe ropa risati rasvika.

Kunyanya kuderedza nekunyoresa anticoagulants

Mhosva yekuwedzeresa kweboka iri remishonga haigoneki. Izvi zvinogona kuitika kana mwana muduku awana mishonga pamba uye anoedza kuri mukanwa. Kazhinji kuiswa kwezvinhu zvakaderera, saka piritsi imwe haisi yakaipa. Muchiitiko chekushandiswa kana kusingabatsiri kwemahombekombe makuru ezvinhu, coagulopathy uye kubuda ropa kunogona kuitika.

Kliniki yepamusoro yekare haina zviratidzo zvakananga, saka zvakaoma kufungidzira kuti yakawanda yemishonga yakatorwa. Zviratidzo zvezviratidzo zvakafanana nezvirwere zvakasiyana-siyana uye mamiriro ezvinhu epanyama. Murwere anoratidzika:

• Chiedza chinopwanya paganda;
• Kuonekwa kweropa mumuginho kana mbesa;
• Uterine kubuda ropa;
• Hematomas mumutsipa;
• Kuchengetedza kurwisa kwemvura.

Kupera kwepakuvara, kukwegura, kushaya ropa mukati mezvakaitika uye pasi hematocrit zvinokonzera zvinhu zvinogona kuderedza kukanganisa kwemuviri wemishonga.

Therapy ye antiaggregant overdose

1. Kuchenesa kana kushambidza mudumbu maawa mashomanana mushure mokunge mishonga isinganzwisisi.
2. Murwere anopiwa mafuta anokonzerwa nemukati.
3. Kana zvikaitika kudarika kwe "Warfarin" kana mifananidzo yayo, "Cholestyramine" inorayirwa mukati.
4. Murwere anogadziriswa mumagariro anorwadza kuti asave nekuonekwa kwehutemas idzva uye kushaya ropa.
5. Nekukosha kurasikirwa kweropa, ropa kana kuwedzerwa kweplasma kunoitwa, dzimwe nguva ropa rose. Erythrocytic mass, cryoprecipitate, prothrombin complex is effective in use.
6. "Phytomenadion", kugadzirira kunobva mavitamini K.
7. Kana pasina chikonzero chekupa antiplatelet therapy, ipapo kugadzirira "Phytomenadion" inorayirwa nekodzero yekurapa, uye kwete seyokutanga rubatsiro.

Kana chirwere chacho chiri chekare, asi anoda kuramba achishandisa zvisina kufanira anticoagulants, saka "Warfarin" inofanira kushandiswa kwechinguva nemishonga ye heparin series.

Mhedziso

Kushandiswa kwema antiggregant madhiragi hakubvumiri kungoita kuti rheological blood standards zvivepo, asiwo kugadzirisa mamiriro ezvinhu ehurwere uye kudzivirira kuvepo kwekuita zvirwere zvakakomba.

Kucherechedza kushandiswa kweanticoagulants, kusarudzwa kweroji uye kutarisa mamiriro emurwere kunobatsira kuderedza ngozi yezvinetso uye kubudirira. Nyanzvi dzinoshandisa boka iri rezvinodhaka mumitambo yavo dzinoda kuvandudza ruzivo rwadzo uye kunyatsoteerera mazano ezvehutano enyika.