"Heparin" (majekiseni): chikumbiro, mushandisi, ongororo, dose. Kushandisa majekiseni "Heparin" panguva pamuviri

Drug "Heparin" anogona kuderedza ropa anogona clot. Anosunungura medicated muiti mu girazi ampules uye ndiro 5 Rine mamiririta. Vane injectable mhinduro, sezvamakaropafadzwa kushingaira fuma iri 5,000 Iu.

pharmacological ehupfumi

Drug "Heparin" (majekiseni) chiri anticoagulant. It anogona kuderedza nedanho fibrin inotungamirwa, kuderedza kukurumidza zvikonzero ropa coagulation, uye makuru kuwanda - kuderedza basa thrombin. Kunyange mishonga diki zvinodhaka zvakakwana kuwedzera fibrinolytic basa ropa.

kushandisa "Heparin" majekiseni yokuderedza viscosity huru mutumbi zvipenyu mvura. Kushandisa (a dose kuti jekiseni anosarudza chiremba nomumwe) inobva chokwadi kuti izvi zvinoreva zviri vaunganidza pamusoro endothelium masero eropa uye anowedzera nokuchengeta kwavo kunaka. Nokuda pfuma iyi zvinoderedza adhesion uye aggregation pamusoro maplatelet, leukocytes uye erythrocytes.

Uyewo, "Heparin" kunodzivisa kukura atherosclerosis, ane Anti-sema uye munyoro vasodilator maturo. Izvi imhaka yokuti anobatanidza wandei zvenyaya mukwanisi maitiro uye anoderedza kwayakaita. Uyewo, kuti zvinodhaka kunodzivisa paumbwe immunoglobulins, lymphocyte Co runokusunganidzai histamine uye kweserotonin.

zvairatidza

Kazhinji, kana uine matambudziko kweropa varayire majekiseni "Heparin" chinodhaka. Majekiseni kana intravenous aizomupa inokurudzirwa muzviitiko izvi:

1) rakadzika tsinga thrombosis, coronary tsinga chirwere, pulmonary embolism;

2) myocardial infarction;

3) Kugadzikana angina;

4) Chikamu chokutanga DIC;

5) atrial fibrillation, icho pamwe thromboembolism.

Uyewo muzvipatara nokuda akavhiyiwa pamwe extracorporeal kuparadzirwa mitoo vanogona basa zvinoreva "Heparin". Majekiseni nomutsinga kana subcutaneously, kana zvakafanira dzinoita kuwedzerwa ropa, hemodialysis kudzivirira coagulation zvipenyu mvura.

Nzira dzinoshandiswa mishonga uye kudzivirira kusagadzikana microcirculation uye microthrombogenesis Somuenzaniso, thrombosis pamusoro renal mutsinga, lupus nephritis, glomerulonephritis, kwemabhakitiriya endocarditis, mitral mwoyo chirwere, gemolitikouremicheskom syndrome.

Chaizvoizvo zvinodhaka

Kana uri ushandiswe majekiseni "heparin" mudumbu, imi munoziva; vachafanira kuita kakawanda. Zvazvakaita zvinodhaka kunoitika nokukurumidza, asi zviri pfupi. Saka, kana dzakabatwa nomutsinga zvinoreva pakugwamba DZEMUNHU DZINODZORA anenge pakarepo, mugumisiro runogara maawa anenge 4-5. Kana achiita intramuscularly, zvainoita pashure maminitsi 15-30 uye rinovapo kwemaawa 6, uye kana jekiseni pasi ganda iri kuchengetwa pashure maminitsi 40-60 uye kunotora maawa 8. Kuchirapa chiito zvainanga kutadzisa paumbwe ropa clots, huchavapo yakareba.

Kugadzirira "Heparin" anowedzera renal ropa aibuda, anowedzera vascular mumweya muuropi, ane hypolipidemic mugumisiro. Kuwedzera kunoreva akazoita basa pulmonary surfactant kuchititadzisa kunyanya kwetunhu aldosterone ari adrenal cortex, anotowedzera kumukomborera kushingaira simba PTH anosunga adrenaline.

kushandisa Features

Kazhinji vanhu vachitambura nechirwere chomwoyo, akarayira "Heparin" (kwepfuti). Mutengo zvinodhaka izvi zvinoita kumusoro vamwe. Kavha 5 ampoules 5 Rine mamiririta ane basa 5000 Iu pa 1 ML varasikirwe 500-600 rubles. Asi kuramba chikumbiro chayo hazvibviri. Pashure pezvose, vari varwere ischemia rinoreva "Heparin" kunoderedza ngozi myocardial infarction, coronary tsinga thrombosis uye kufirwa. Uyezve, kushandisa zvinodhaka anogona kuderedza ndingangokuvara idzokororo mwoyo kurwiswa uye kuderedza kuti chikamu nzufu varwere izvi.

Kana venous thrombosis uye pulmonary embolism varayire yakakwirira dose "Heparin" gadziriro. Majekiseni (Murayiridzo kunoita kukurira sei kuti zvakanaka kuaisa) nangana imwe nguva. Asi, ichokwadi, mune zvimwe zviitiko, kuwana chakonzerwa kunodiwa kuti vachipe intravenous nzira.

Uyewo mishonga senzira "Heparin" nokuti kudzivirira thromboembolic zviitiko, zvakadai pashure kuvhiyiwa. Muchiitiko chino, zviri nezvaro mishonga diki.

Nzira kushandiswa

Sarudza inodiwa chipimo chemushonga uye nzira kushandiswa kwezvinodhaka vanofanira chiremba chete, zvichienderana murwere ezvinhu uye zvikonzero nei zvaanoda chinodhaka ichi. Agent anogona kupiwa nomutsinga sezvo chinoramba aizomupa kana nguva majekiseni. Uyewo, dzimwe nguva, subcutaneous, kana anogona akagadzwa nokuda intramuscular jekiseni.

Kuti adzivise thrombosis zvinodhaka anogona kupiwa subcutaneously ne 1 Rine mamiririta (5000 Iu) kaviri pazuva. On kudiwa dudziro iyi wanamatira mushonga "Heparin" mirayiridzo Chinyorwa. Majekiseni zvinowanzoitwa mudumbu, zvayo rusvingo anterolateral. Kuti aite izvi, tora tsono akanaka uye baya jekiseni nayo vanyura ganda muchirugu. Zvinonzi akaumba kana achingomutambudza pakati thumbs uye forefinger mudumbu nzvimbo iri guvhu nzvimbo. The jekiseni inofanira alternated. Pane dzimwe nguva, vakuru majekiseni zvinogona kuitwa rokumusoro chikamu yehudyu kana repamusoro ruoko.

chipimo chemushonga sarudzo

For kuchirapa zvinangwa panyaya inpatient kurapwa muzvipatara kazhinji ushandiswe intravenous aizomupa. Varwere mukuru, chipimo chemushonga kuti 1,000 Iu / awa. Asi vasati kugadzwa donhwe nokuda kunonyanyisa mugumisiro unogona kupinda bolus kuva tsinga iri uwandu 5,000 Iu. Pakusarudza chaiwo dose chinotarisirwa ari chiremba zvichienderana mamiriro ezvinhu uye murwere uremu.

Kana hazvibviri vanoitisa intravenous aizomupa, mapurisa anogona kupiwa subcutaneously: 2 ml mushonga (izvo anoenderana 10000 Iu) 4 nguva pazuva. The kunonyanyisa chipimo chemushonga rinowanzoshandiswa kushandiswa kugadzirira kuti mazuva 10.

The inodiwa chitsama zvinodhaka anosarudzwa pashure kunyatsoongorora pakuongororwa. Pfungwa iri rwakabhadharwa kuna APTT (kusashanda haasaruri thromboplastin nguva).

Kana munhu wacho anopa ropa kuisirwa, kazhinji dzakabatwa 7.5-10 zviuru. Iu zvinoreva "Heparin".

Zvipatara zviri chaiyo zviitiko

In chenjera myocardial infarction pakarepo raitongwa 10-15 zviuru. Iu nomutsinga, ipapo ayo akaramba kushandisa kuverenga kwakadaro, murwere akagamuchira vanenge 40 000 Iu Nezuva rokutanga, asi chaiyo chipimo chemushonga anosarudzwa zvichienderana murwere uremu. Izvi zvakakodzera rekuona kuti ropa clots muna 2.5-3 nguva nomumugwagwa kwaitora nguva. Kubva pazuva rechipiri dose ipfupi. Zvakakosha kuti pakugwamba nguva yava 1.5-2 nguva kupfuura kwose kwose. Treatment pamwe mushonga uyu kuramba 8 mazuva. Kudzima zuva dose kuderedzwa 5-10 zviuru. Iu, asi zvikamu pakati majekiseni regai kuwedzera. Mushure abolition kuti vanopfuura kuti anticoagulants ose kunanga chiito. Zvinogona kuva nzira dzakadai se "Fenilin", "neodikumarina" uye vamwe.

Chenjera arterial kana venous mhingaidzo kunodawo rinokosha nzira. Nokuti kurapa waakaudzwa intravenous heparin kwemazuva 3-5 ari dose ine 400-450 Iu pa makirogiramu nokushivirira uremu. Kureva, murwere ane svikiro akavaka uye kukwirira vanofanira kuwana zuva vanenge zviuru 30-40. Iu "Heparin" chinodhaka. Zvadaro ita fractional sumo kwayo, asi uwandu husingakuvadzi ichiwedzerwa kusvika 600 Iu / makirogiramu, rimwe chete jekiseni kupinda muviri vanofanira kuwana 100 Iu / makirogiramu. Kunokwanisa kwenguva kusvika mazuva 16. Mumazuva mashoma asati zvinodhaka kushaya mari iri zvishoma nezvishoma shoma. Treatment ari mberi vachishandisa zvisina kunanga anticoagulants.

Zvokungwarira

Pasinei chokwadi kuti vamwe kutaura nezvomukana intramuscular jekiseni zvinodhaka, ichi hachisi yakarumbidza nokuti kuti panguva jekiseni nzvimbo hematoma kazhinji kuumbwa. Kushandisa zvinodhaka dilutions 0,9% NaCl mhinduro.

Zvinokoshawo kuziva kuti munguva pakurapa "Heparin" zvinoreva hazvina zvakakodzera kuti chero intramuscular jekiseni uye biopsy zvomukati. Kana kurishandisa, unofanira kuongorora mamiriro coagulation. In vhiki yokutanga yokurapa, ropa achiongorora mazuva maviri ose, kubvira svondo rechipiri zvinogona kuitwa ose 3 days.

Kunyange zvazvo nzira uye asingauyi pinda kupinda mukaka, lactation panguva pakurapwa, zviri chinodiwa kugumisa. It Vakawana kuti mushonga kunotungamirira dzimwe nguva kuti kukuvadza nomuzongoza uye osteoporosis. Matambudziko anotanga pashure pemavhiki 2-4 pakurapwa.

Oga, zvinokosha kuziva kuti zvinodhaka mhinduro azvidzore yero, asi haana sei ayo pharmacological ehupfumi kana kushivirira rinoreva "Heparin". Majekiseni, mutengo zvinogona yekudyidzana kukanganisa bhajeti iri paaimugadza pamatunhu mishonga, anogona kuitwa kunyange yavo kumba.

Contraindications

Kungofanana neimwe nzira, haugoni kushandisa zvinodhaka "Heparin" kana muri hypersensitive. It haungopiwi chero kubuda ropa. Anosiyiwa vari hemorrhages zvinoitika kana myocardial zvemapapu (kwakunoitwa muchimiro hemoptysis) kana itsvo (akaperekedza hematuria).

Contraindications zvinosanganisirawo:

- Hemorrhagic diathesis nezvimwe zvirwere umo havachanyatsogoni kweropa;

- yakawedzera vascular permeability, akadai Verlgofa chirwere;

- kwemabhakitiriya endocarditis ;

- ropa munhau;

- hypoplastic uye aplastic kupererwa, chisingaperi uye rikwanise leukemias;

- chakakomba chiropa uye itsvo kushanda;

- venous neronda rinonyenga;

- kukura rikwanise mwoyo aneurysm.

matanho okudzivirira

Kuwedzera zvakananga contraindications, pane mazita ezvinhu umo zvakafanira kuongorora zvose zvinobvira njodzi apo achitora "Heparin" chinodhaka. Majekiseni uye intravenous kuita chete aakatipa nyaya uye pasi pokudzora unyanzvi mune namamota uye maronda maronda ari nemudumbu, BP, postpartum uye postoperative nguva, kunze angioplasty.

A mashoko mashoma pamusoro kurapwa vevanaamai ramangwana. Pasinei nokuti kurapwa yevakadzi mumhuri nzira pamberi pedu zvinoreva chisingadiwi (zvinogona kutungamirira kukudziri- yematambudziko), majekiseni "heparin" mudumbu iri ushandiswe dzimwe nguva, panguva yepamuviri. The ndingangokuvara panowanikwa nemigumisiro kubvira 10 kusvika 21%. Nepo kwenguva dzose pamuviri nengozi yematambudziko idukusa 3.6%.

Zvinofanira kucherechedzwa kuti migumisiro zvichibvira thromboembolism mu vanamai pamuviri vane ngozi kuupenyu pane kugamuchira rinoreva "Heparin". Majekiseni panguva pamuviri kuita chete pasi wezvokurapa achitarisirwa uye chete kana paine Mhedziso uchapupu. Asi mushonga unogona kukonzera kubuda, thrombocytopenia uye osteoporosis. Rinoreva placenta asingadi pinda.

Possible analogs uye anoshivirira uchapupu

Kazhinji vaya vakagadzwa zvinodhaka "Heparin" (majekiseni mudumbu), mutengo sokuti kukwirira. Asi kana rinoshandiswa kuzvidzivirira nechiyero, 1 pasuru anogona zvakakwana kwemazuva mashomanana. Saka, kavha umo hombodo 5, zvingava vaviri kwemavhiki. A gadziriro mukuru-dose rinoshandiswa kazhinji hapana mazuva anopfuura 10-14.

Kunyange zvakadaro, vanhu vakawanda vanoda kudzidza kubva vamwe varwere, zvinokosha kutenga mushonga, vari kutsvaka "Heparin" kugadzirira wongororo. Analogues zvinodhaka naivowo vanofarira. Saka, kana mune matambudziko kweropa, kuti chokushandisa unoshanda chaizvo uye anobvumira kuti kuzadzisa zvinodiwa kuchirapa mugumisiro nokukurumidza chaizvo. Izvi kunosimbiswa zvose vanachiremba uye varwere vavo.

Asi pachinzvimbo zvingakupawo ngaagadze anticoagulants "Troparin", "Heparin Sandoz", "Heparin Sodium Brown", "Heparin-Verein" uye dzimwe analogs. The chipimo chemushonga zvinodhaka izvi zvinofanira chete sarudza chiremba kwakavakirwa migumisiro Analyses murwere, mamiriro utano hwake uye zvairatidza kuti iyo zvinodhaka riri waakaudzwa.

Mune zvimwe zviitiko, vanachiremba vanoti yakaderera samolecular uremu heparins, akadai "Fraksiparin", "Fragmin", "Tsibor", "Eniksum", "Fraksiparin forte." Zvazvinoita, sezvinoratidzwa mhinduro wevarwere, anenge akangofanana kuti zvinodhaka pamberi pedu.