Kugadzirira "Ketamine": mirayiridzo yekushandisa, tsanangudzo, kuumbwa nekuongororwa

Kuti aite upiyona chero upi zvake, chiremba anoda chirwere chakakosha chinenge chiine mutsara unogadzirisa. Izvi zvinoreva kuti, unesthetic inodiwa. Chimwechete chakadai ndicho Ketamine. Mirayiridzo yekushandiswa kwechirwere ichi inofanira kunyatsodzidzwa isati yapiwa kumurwere.

Zvose zvinotsanangurwa nekugadzirwa kwemishonga

Chinhu chinhu chakasvibiswa chine zvishoma kana kuti hapana ruvara. Mune 1 ml yemugoja uyu ane 57.6 mg ye ketamine hydrochloride. Zvimwe zvinosanganisa zvinosanganisira benzalkonium chloride, sodium chloride , uye injection mvura.

Chirwere ichi chinoshandiswa pakushandura kwemajeri kana kutengesa. Kana zvakakosha kushandisa "Ketamine", mirayiridzo yekushandiswa inoratidza maitiro akadaro ekubudiswa:

- Ampoules, ane zvinyorwa zvinenge 2 ml. Iyo purafura ine mabhodhoro mashanu.

- Mabhodhoro e 5 ml.

Pharmacological action yezvinodhaka

Izvo zvinhu zvinopiwa zvinoratidzika zvakanaka, izvo zvisinei, zvisingaregi kwenguva refu. Mukuwedzera, "Ketamine" (murayiridzo wekushandisa kwechigadzirwa uri muhomwe) haikwanisi kupa urongwa hwakakodzera hweanesthesia nokuda kwebasa. Munguva yekugamuchira chirwere ichi, ruzivo haruna kudzivirirwa zvachose, uye kumedza, kufukidzwa uye kugadzikana kwemvura kunodzivirirwa. Mushure mokutungamira kwechirwere ichi, zviratidzo zvinotevera zvinowanikwa muvarwere: kuwedzerwa ropa, myocardial contractility. Iko rinokonzerwa nemasumbu emakumbo munyaya iyi haisi kuderera.

Mushure memugumo wemishonga mumunhu kune kurohwa, izvo zvinogona kukanganisa kuonekwa kwekufungidzira, kurota kwakanyatsojeka. Mukuwedzera, mushure mokunge anesthetic effect yapera, murwere angave akavhiringidzika munzvimbo. Iyi nguva inogona kusvika maawa masere. Kana iwe ukatora chinhu pamwe chete neuroleptics, izvo zvose zvinokonzera kuderedza kushanda kwavo uye kupenya. Nguva yakawanda yekutendeka ndeyemaawa maviri.

Nejojo yepamuviri, izvi zvinogona kuwedzerwa. Chiitiko chemishonga inotanga mushure memaminitsi gumi. Inofanira kuonekwa kuti mishonga mune imwe chirwere che1 mg / kg inogona kudzivisa kusikwa kwemaminitsi matanhatu chete. Kuti uwane maminitsi makumi maviri nemashanu anesthetic action, zvakakosha kuti utange 4-8 mg / kg. "Ketamine" (mirayiridzo yekushandiswa - iyi nhungamiro yekuita) inoparidzirwa mumutumbi wose uye inopinda muropa reuropi. Uye anosunga mapuroteni eplasma chete ne12%. Iyo hafu-hupenyu hwehutori iyi maawa maviri. Mushonga wacho wakanyanyiswa kubva mumuviri pamwe nemuviri, kunyange zvazvo zvishoma zvishoma zvemetabolite zvinogona kuonekwa mumutumbi kwemazuva akawanda.

Zviratidzo zvekushandiswa

Kana chiremba akasarudza kugadza "Ketamine hydrochloride", mirayiridzo yekushandiswa ichabatsira kunzwisisa zviratidzo zvekushandiswa kwemishonga. Pakati pavo tinogona kusiyanisa zvakadai:

• Kuita mabasa ekuvhiya, anozivikanwa nekupfupika kwenguva. Muchiitiko ichi, kudiwa kwemisasa yekuzorodza hazvina basa. Kunyanya inoratidzwa kuvanhu ivavo vane ropa rekudzivirira.

• Kutakura varwere kuenda kune mamwe masangano ekurapa.

• Kukosha kwekuita anesthesia inokosha.

• Batidza kurapwa.

• Ita maitiro anobatsira anogona kukonzera kurwadziwa kwakanyanya.

• Chido chekuvhiyiwa kwekukurumidzira kunokonzerwa nekutyisa kunetseka, kubuda ropa kwakanyanya.

• Kuiswa kwecatheter pamwoyo.

• Chikamu cheKesariya kana kushanda kwevakadzi.

• Kuvhiya kushandiswa mumhuka.

Contraindications

Kana iwe wakanzi "Ketamine", mirayiridzo yekushandiswa (mumishonga yezvokurapa kushandisa mushonga uyu inobvumidzwawo) inotaura nezvekupikisa kwakadaro:

1. Kunyanya kunzwisisika kune zvikamu zvechirwere.

2. Arterial hypertension, apo pane kuwedzera kunowedzera mukudzvinyirira.

3. Myocardial infarction kana angina mumwedzi mitanhatu yapfuura.

4. Kuora kukuru kwepso.

5. Kuvhiringidzwa kweropa kupararira muuropi.

6. Kushungurudzika nemamiriro ekufa, kusanganisira vana.

7. Kuberekwa uye lactation.

8. Kunwa doro.

Iyo yakangwarira zvikuru kuva iyo varwere vane moyo usingagumi kusakundikana, uye vanoda kuvhiyiwa pa pharynx kana larynx. Muchiitiko ichi, musikana unozorodza unogona kuwedzerwa kushandiswa.

Dosage uye Administration

Mushonga uyu unogona kuiswa muvheini (ingava jet kana kukonzera) kana kuti intramuscularly. Kana kushanda kunoitwa nomunhu mukuru, ipapo iyo inofanira kupiwa mukati. Chiyero chemishonga ndeye 2-3 mg / kg wehutatu hwemuviri. Kana chirwere chinokonzerwa nemakumbo chigadzirirwa, 4-8 mg / kg wehutano hwakatodiwa. Kuti urambe uchiita manzwiro ekutema, zvakakosha kupinza mhinduro ye "Ketamine" pachiyero che 2 mg / kg paawa. Kana kudonhedzera kushandiswa, chirongwa che 0.11% chinoshandiswa pamutengo wemadonji 20-50 paminiti.

Tsanangudzo uye mirayiridzo ye "Ketamine" inofanira kunge yakatsanangurirwa kuvabereki kana basa racho richiitwa kumwana. Muchiitiko ichi, mishonga inogona kushandiswa sechinhu chinokosha kana kuti chekutanga chekushongedza. Kana sarudzo yechipiri inosarudzwa, zvino mushonga unofanirwa kuiswa mukati memamuscularly kana intravenously. Chirwere ichi chinoenderana nezera remwana uye 8-12 mg / kg kune vacheche, 6-10 mg / kg kumwana kubva pa1 kusvika kumakore matanhatu, anenge 4-8 mg / kg kune vakwegura nevechiri kuyaruka. Kana zvirwere zvinoputika zvinoshandiswa, zvino kakatova 2-3 mg / kg inofanira kugoverwa, uye kuwedzerwa nguva nenguva kwechirwere munguva yese yekushanda.

Simbisai mhizha yemishonga inogona kuva nekubatsirwa kwe "Fentanyl", "Promedola", "Droperidol". Muchiitiko ichi, chirwere che "Ketamine" chinoderera.

Ndezvipi zvisingadiwi zvinogona kuitika?

Kana chiremba achida kushandisa Ketamine, mirayiridzo yekushandiswa (mutengo wemishonga inenge anenge makumi matanhatu nemazana matanhatu) inokuyambira pamusoro pezvinoitika kuitika kwekusateerera kwakadaro kusingadiwi:

• Tachycardia uye kuwedzera kwezvinetso.

• Kunyanyisa kunetseka.

• Chiitiko chekunyengedza, pamwe chete nekushungurudza kwakasimba kwepfungwa panguva yekubva kune anesthesia.

• Kupfupika kwemhepo uye kufema kuora mwoyo.

• Zvinorwadza zvinorwadza.

• Panogona kuva nehutsvuku panzvimbo yejojo.

• Kushungurudza munzvimbo.

Kana kudarika kwechirwere ichi kuchiitika, kuora mwoyo kunogona kuitika. Muchiitiko ichi, zvakakosha kuita chimiro chekuita mapapu. Kana pane chirwere chinoputika, zvino chinogona kubviswa nekubatsira kwechigadzirwa chakadai se "Diazepam".

Special instructions

Mushure mokutungamira kwechirwere, murwere haagoni kuita mune chero zvinhu zvinokuvadza mukati mezuva, izvo zvinoda kuwedzerwa kutarisirwa. Usafambisa motokari zvachose. Mukuwedzera:

• Inorambidzwa zvachose kutora mishonga pamwe nemabhakiti pamwe chete.

• Shandisa chete chiremba anokwanisa. Iwe haugone kuutenga mu pharmacy pasina mushonga. Chirwere ichi chinoshandiswa chete mu ambulensi kana muchipatara.

• Kuti uderedze salivation, unogona kushandisa Atropine.

• Munguva yekushandiswa kwemishonga iyi, munhu anofanira kugara achicherechedza kufema kwomurwere, kunyanya basa repamusoro rekupumha, kubva pakatsvaira mutsvuku kunogona.

• "Diazepam" haibatsiri chete kugadzirisa mukana wekunyengedzera kwematumbo, asiwo kunodzivirira chigumbu chepfungwa.

Kana iri yekubatanidzwa nemimwe mishonga, "Ketamine" inokwanisa kusimbisa chiito cheanalgicsics yemhando yezvinonyangadza , antipsychotics, runyararo uye zvimwe zvinhu zvinogona kuderedza kushanda kwenheyo yenheyo.

Ongororo, zvakafanana uye zvikamu zvekuchengetedza

Kana uchida kuvhiyiwa, anesthesiologist ane kodzero yekushandisa mushonga wakadai seKetamine. Mirayiridzo yekushandiswa (mumaboules ane 2 ml mishonga inowanzoshandiswa) inopawo kuvepo kwezvienzaniso zvinogona kunge zvakafanana. Zvichida mamwe mishonga ine chinhu chimwe chete chinoshanda, achakutorera zvakanyanya. Pakati pemifananidzo inogona kunzi yakadaro: "Calypso", "Ketanest", "Ketalar".

Chengetedza chigadzirwa munzvimbo inotonhorera iyo vana vasingagoni kusvika. Mishonga inobudiswa chete pamutemo wechiremba, asi pamba inorambidzwa zvachose kuishandisa. Kuchengetedza kwekuchengetedza hakufaniri kuve kudarika madigiri makumi matatu. Kuiswa kwechirapa kunofanira kunge kwakanyatsovharwa. Sirifu hupenyu hwezvinhu izvi mwedzi 24.

Kana ari maonero avarwere, ivo vakasiyana chaizvo. Semuenzaniso, kubudirira kwechirwere ichi kunofungidzirwa kuva nguva yakanaka, sezvo murwere asinganzwi kurwadziwa. Zvisinei, migumisiro yeanesthesia haina kufadza zvikuru. Kurega kubva kune anesthesia, maererano nevarwere vakawanda, kwakaoma zvikuru.

Iye zvino unoziva zvose zvese pamusoro pe "Ketamine" kugadzirira. Mirayiridzo yekushandiswa, mutengo, kuongororwa haisi chakavanzika kwauri. Iva noutano!