I-Lunaldin yisigaba sesithathu "sedidi lokukhululeka kobuhlungu" le-WHO. Lawa ma-analgesics ama-narcotic anamandla kakhulu asetshenziselwa ukudambisa izinhlungu ezijulile.
Igama Lezwe elingafanele
I-Fentanyl.
I-Lunaldin yisigaba sesithathu "sedidi lokukhululeka kobuhlungu" le-WHO.
I-ATX
Ikhodi ye-ATX - N02AB03 - Fentanil.
Khipha amafomu nokwakheka
Kutholakala ngesimo samaphilisi we-sublingual (wokuhlakazwa ngaphansi kolimi) we-imithamo ehlukene (mcg) nefomu:
- 100 - kuyindilinga;
- 200 - i-ovoid;
- 300 - unxantathu;
- 400 - i-rhombic;
- I-600 - i-semicircular (eyenziwe nge-D);
- 800 - isigaxa.
Ithebhulethi elilodwa liqukethe into esebenzayo - i-fentanyl citron micronized microsised and element asizayo.
Isenzo se-Pharmacological sikaLunaldin
Umuthi ungowesigaba se-opioid analgesics. Umuthi uvimba ama-µ-opioid receptors, abangela i-supraspinal (µ1 -ukucaciswa kwezakhiwo ezilawula ubuchopho) nomgogodla (µ2-ithonya ekuqondisweni kwezinzwa kwentambo yomgogodla) i-analgesia (ukuncishiswa kokuzwela kobuhlungu ngosizo lwezemithi).
Umuthi uphazamisa ukuhlanganiswa kwe-adenylate cyclase (AC) ne-cyclic adenosine monophosphate (cAMP), edlulisa amasiginali phakathi kwama-synapses of fibre nerve. I-Fentanyl ithinta ukuhlukaniswa kwama-membranes, umsebenzi weziteshi ze-ion, okuholela ekunciphiseni kokukhishwa kwabalamuli bezinhlungu.
Njengoba ama-receptors e-µ enziwe hhayi kuphela ebuchosheni nasentanjeni yomgogodla, kodwa nasezitho zangasese, umuthi:
- evimbela ukusebenza kwesikhungo sokuphefumula;
- kwandisa ithoni yezakhi zemisipha ebushelelezi yohlelo lokuchama, ukwandisa noma ukuvimbela ukuchama;
- kubangela ukugqama kwepheshana lebhiliyali;
- kwenyusa ithoni yemisipha ebushelelezi yethumbu lesisu, kunciphisa ukuhamba kwamathumbu;
- dilates izikebhe zokuthontelana;
- kuvusa hypotension ne-bradycardia.
Le ndlela iholele ekusetshenzisweni kwesidakamizwa ekwelashweni kwe-analgesic kwezimo zengqondo, kuhambisana nobuhlungu obukhulu nobungabekezeleleki.
I-Pharmacokinetics
Umuthi une-hydrophobicity ebaluliwe, ngakho-ke igxilwa ngokushesha emgodini womlomo kunasesigunjini sokugaya ukudla. Ukusuka esifundeni esiphansi, kuthathwa kungakapheli imizuzu engama-30. I-Bioavailability ingama-70%. Iqoqo eliphakeme egazini le-fentanyl lifinyelela ngokwethulwa kwe-100-800 μg yesidakamizwa ngemuva kwemizuzu engu-22- 24.
Inani elikhulu le-fentanyl (80-85%) lihlangana namaprotheni e-plasma, okubangela umphumela wayo wesikhashana. Umthamo wokusatshalaliswa kwalo muthi ngokulingana ngu-3-6 l / kg.
I-biotransformation ephambili ye-fentanyl ivela ngaphansi kwethonya le-enzymes ye-hepatic. Indlela enkulu yokuphuma emzimbeni ihamba nomchamo (85%) ne-bile (15%).
Isikhathi sokuphumula sempilo yomzimba sisuka emahoreni amathathu kuya kwayi-12,5.
Izinkomba zokusetshenziswa kweLunaldin
Isibonakaliso esiyinhloko sokusetshenziswa kweLunaldin yi-pharmacotherapy yesibonakaliso sobuhlungu ezigulini ezinomdlavuza ezithola ukwelashwa kwe-opioid ejwayelekile.
Isibonakaliso esiyinhloko sokusetshenziswa kweLunaldin yi-pharmacotherapy yesibonakaliso sobuhlungu ezigulini ezinomdlavuza ezithola ukwelashwa kwe-opioid ejwayelekile.
Contraindication
Umuthi uphambaniswe ku:
- izimo ezihambisana nokucindezelwa okunzima kokuphefumula;
- isifo esithinta amaphaphu;
- ukuphathwa kanyekanye komuthi one-blocker monoid oxidase (MAO) blockers noma ukuphathwa kwawo isikhathi esingaphansi kwamasonto amabili ngemuva kokuphela kokwelashwa;
- ukuthatha izidakamizwa ezixubile - izitha eziphikisayo kanye nama-agonists ama-opioid receptors;
- iminyaka yesiguli efinyelela eminyakeni eyi-18;
- ukusabela kokungezwani nezinto ezakhiwayo;
- ukuntuleka kokwelashwa kwangaphambili kwe-opioid.
Ngokunakekela
Ukuqapha okwengeziwe kuyadingeka lapho kunqunywa uLunaldin ezigulini othambekele ekubonisweni okubucayi ngokweqile kwe-CO₂ esegazini:
- ukukhuphuka kwengcindezi ye-intracranial;
- coma;
- ukwazi okungaphelele;
- neoplasms yobuchopho.
Izindlela zokuqapha ikakhulukazi ukusetshenziswa komuthi kufanele zibhekwe ekwelashweni kwabantu abalimala ekhanda, ukubonakaliswa kwe-bradycardia ne-tachycardia. Ezigulini esezikhulile futhi ezikhubazekile, ukuthatha lo muthi kungadala ukwanda kwempilo-nengxenye futhi kukhulise ukuzwela kwezithako. Kuleli qembu leziguli, kuyadingeka ukuthi ubonise ukubonakaliswa kwezimpawu zokudakwa futhi uguqule umthamo wehle.
Ezigulini ezinokungalingani kwe-renal ne-hepatic, umuthi ungadala ukwanda kwenani le-fentanyl egazini (ngenxa yokwanda kokuqina kwalo kwe-bioavailability kanye nokuvinjwa kokuqedwa). Umuthi kumele usetshenziswe ngokucophelela okukhulu ezigulini ezine:
- i-hypervolemia (ukukhuphuka kwevolumu ye-plasma egazini);
- umfutho wegazi ophakeme
- ukulimala nokuvuvukala kwe-mucosa yomlomo.
Dosing regimen Lunaldina
Yabela iziguli ngokubekezelela okumisiwe kuma-opioid, uthathe ama-60 mg we-morphine ngomlomo noma i-25 μg / h ye-fentanyl. Ukuthatha umuthi kuqala ngethamo lika-100 mcg, khuphula inani laso. Uma kungakapheli imizuzu eyi-15-30. ngemuva kokuthatha ithebulethi eyi-100 kg, izinhlungu azime, bese uthatha ithebhulethi yesibili ngenani elifanayo lezinto ezisebenzayo.
Ithebula libonisa izindlela eziyisibonelo zokudluliselwa komthamo weLunaldin, uma udosi lokuqala lungalethi impumuzo:
| Umthamo wokuqala (mcg) | Umthamo wesibili (mcg) |
| 100 | 100 |
| 200 | 100 |
| 300 | 100 |
| 400 | 200 |
| 600 | 200 |
| 800 | - |
Ukuthatha umuthi kuqala ngethamo lika-100 mcg, khuphula inani laso.
Uma ngemuva kokuthatha umthamo omkhulu wokwelapha, umphumela we-analgesic awutholakalanga, khona-ke kunqunywe umthamo ophakathi nendawo (100 mcg). Lapho ukhetha umthamo esigabeni se-titration, ungasebenzisi amaphilisi angaphezu kwangu-2 ngokuhlasela okukodwa kobuhlungu. Imiphumela yomzimba we-fentanyl emthanjeni wama-mcg angaphezu kwama-800 awakahlolwa.
Ngokubonakaliswa kwezigatshana ezingaphezu kwezine zobuhlungu obukhulu ngosuku, okuhlala ngaphezu kwezinsuku ezi-4 ezilandelanayo, kuchazwe ukulungiswa komthamo wezidakamizwa zesenzo eside. Lapho ushintsha usuka kwenye i-analgesic uye kwelinye, ukuhlolwa okuphindaphindwe kabili komthamo kwenziwa ngaphansi kokuqondisa kukadokotela nokuhlolwa kwelebhu ngesimo sesiguli.
Ngokuqedwa kobuhlungu be-paroxysmal, iLunaldin iyamiswa. Umuthi uyakhanselwa, wehlise kancane kancane umthamo ukuze ungabangeli ukubonakala kwesifo sokuhoxiswa.
Ngoshukela
Nge-Lunaldin analgesia, iziguli ezinesifo sikashukela zinconywa ukuthi zisebenzise ukusetshenziswa kwayo okuhlangene nePropofol neDiazepam.
Umthamo wezidakamizwa ukhethwa ngamunye.
Imiphumela emibi
Ngesikhathi sokwelashwa, imiphumela emibi elandelayo ihlala ibonakaliswa:
- ukukhathala;
- ukozela
- ikhanda kanye nesiyezi;
- i-hyperhidrosis;
- isicanucanu
Ngamafrikhwensi ahlukile, imiphumela engemihle ibonakaliswa kusuka ezinhlelweni ezahlukahlukene zomzimba lapho ama-μ receptors enziwe khona.
Amapheshana wesisu
Imithi ingaba nomthelela ovimbelayo ekuhambeni kwamathumbu futhi ibangele ukuqunjelwa. Ngaphezu kwalokho, okulandelayo kuvame ukubonwa:
- umlomo owomile
- Ubuhlungu esiswini;
- ukuphazamiseka kwe-defecation;
- ukuphazamiseka kwe-dyspeptic;
- ukuvinjwa kwamathumbu;
- ukubonakala kwezilonda ku-mucosa womlomo;
- ukwephulwa kwesenzo sokugwinya;
- i-anorexia.
Okungaphansi kakhulu ukwakheka kwegesi ngokweqile, okudala ukuqhakaza kanye nokugcwala.
Isistimu yezinzwa ephakathi
Kusukela ohlelweni oluphambili lwezinzwa kuvame ukuvela:
- i-asthenia;
- Ukudana
- ukuqwasha
- ukwephulwa kokunambitheka, umbono, umbono we-tactile;
- imibono;
- delirium;
- ukudideka kokwazi;
- amaphupho amabi;
- ushintsho olubucayi bemizwa;
- ukukhathazeka okukhulayo.
Ukuzibona kungavamile.
Kusuka ohlelweni lomchamo
Umphumela we-Lunaldin kuma-receptors wesistimu ye-urinary ekhulisa ithoni yezicubu ezibushelelezi, ezihambisana nokuphazamiseka kokuchama - ukukhuphula umchamo okusheshayo noma ukubambezeleka, umgogodla wesinye, i-oliguria.
Kusuka ohlelweni lokuphefumula
Okuvame ukuphawulwa:
- ukucindezelwa kokuphefumula;
- ikhala eligobhozayo;
- pharyngitis.
Okungajwayelekile kakhulu, i-asthma ye-bronchial, hypoventilation yamaphaphu, ukuboshwa kokuphefumula, i-hemoptysis.
Kusuka ohlelweni lwezinhliziyo
Ukusabela kwe-pathological kungaba:
- ukuwa kwamathambo;
- ukuphumula kwemisipha yezindonga zemithambo yegazi (vasodilation);
- amagagasi;
- ukubomvu kobuso
- arrhythmia.
Ukushintshwa kwe-pathological kungabonakala njenge-hyperension ye-arterial, i-myocardial contractility, isigqi se-sinus senhliziyo (bradycardia) noma ukwanda kwesilinganiso senhliziyo (tachycardia).
Allergies
Ukusabela okungezwani nomuthi kungenzeka ngendlela:
- ukubonakaliswa kwesikhumba - ukuqubuka, ukulunywa;
- ubomvu nokuvuvukala endaweni yomjovo.
Ezigulini ezinezinkinga zohlelo lwe-hypobiliary, i-biliary colic, ukwephula ukuphuma kwe-bile, kungaphawulwa. Ngokusetshenziswa isikhathi eside, umlutha, umlutha ngokwengqondo nangokomzimba (ukuncika) kungaqala ukukhula. Umphumela ongemuhle emzimbeni ungadala ukungasebenzi kocansi kanye nokwehla kwe-libido.
Umthelela ekhonweni lokulawula izindlela
Umuthi ungathinta kabi uhlelo oluphambili lwezinzwa nezitho zomizwa, ngakho-ke ngesikhathi sokulashwa uLunaldin kufanele enqabele ukushayela izimoto, asebenze ngezinqubo nemisebenzi ye-opharetha edinga ukunakwa, ijubane lokuthatha izinqumo nokubona okubukhali.
Umuthi ungathinta kabi uhlelo oluphambili lwezinzwa nezitho zomzimba, ngenxa yalokho, ngesikhathi sokwelashwa neLunaldin, kufanele wenqabe ukushayela izimoto.
Imiyalo ekhethekile
Ngokulashwa isikhathi eside nge-opioid analgesics, imiyalo enikezwe emiyalweni yomuthi kufanele ibonwe. Abantu abanakekela isiguli kufanele bafundiswe ngezimpawu zemiphumela yomuthi ezinhlotsheni ezahlukahlukene kanye nokuthi kungenzeka kwehle ngokweqile. Kufanele bakwazi ukuhlinzeka ngosizo lokuqala uma kungenzeka kube nezimpawu zokudakwa.
Sebenzisa ebudaleni
Kubantu beminyaka esehambile (ngenxa yokwehla kwezinga le-metabolic kanye nokuqedwa komuthi), izimpawu zokudakwa zingaphawulwa. Ngakho-ke, lapho kukhipha umlinganiso womuthi, kuyadingeka ukubheka isimo sezimpawu zomzimba nezeminyaka.
Isabelo sezingane
Ayinqunyelwe izingane ezingaphansi kweminyaka engu-18, noma zaphesheya, ukwelashwa kwe-pain pain syndrome, i-fentanyl ivunyelwe ukusetshenziswa unyaka owodwa.
Sebenzisa ngesikhathi sokukhulelwa nokukhishwa komzimba
Ukuthatha umuthi kudinga isinqumo esilinganiselayo. Ukwelashwa isikhathi eside nomuthi ngesikhathi sokukhulelwa kungadala ukuhoxa kosana. Umuthi ungena emgomeni we-placental, futhi ukusetshenziswa kwawo ngesikhathi sokubeletha kuyingozi emsebenzini wokuphefumula wosana nolusanda kuzalwa.
Umuthi utholakala obisini lwebele. Ngakho-ke, ukuqokwa kwayo ngesikhathi sokuncelisa ibele kungaholela ekwehlulekeni kokuphefumula kwengane. Umuthi osenkingeni yokuqunjelwa kanye nesikhathi sokumukelwa komzimba ubekwe kuphela lapho izinzuzo zokuwusebenzisa zedlula ubungozi enganeni nakunina.
Isicelo sokusebenza kokulimala kwezinso
Njengoba indlela enkulu yokuphuma kwesidakamizwa kanye nama-metabolites ayo kunomchamo, uma kwenzeka umsebenzi wezinso ungasebenzi kahle, ukubambezeleka kokuphuma kwayo, ukunqwabelana emzimbeni, kanye nokwanda kwesikhathi sokusebenza kungaphawulwa. Iziguli ezinjalo zidinga ukulawulwa kokuqukethwe kwe-plasma yesidakamizwa nokulungiswa kwamthamo ngokwenyuka kwevolumu yayo.
Sebenzisa umsebenzi wesibindi okhubazekile
Umuthi ukhishwa nge-bile, ngakho-ke, ngesifo sokuqina kwesibindi, i-hepatic colic, isenzo eside sesethi kungenzeka, okuthi, uma uhlelo lokuphatha umuthi lulandelwa, lungadala ukweqisa. Ezigulini ezinjalo, umuthi kufanele uthathwe ngokuqapha, uqaphela imvamisa nomthamo obalwa udokotela, futhi uhlolwe njalo.
Ukweqisa
Uma kwenzeka okweqile kweLunaldin, imiphumela ye-hypotension kanye nokucindezelwa kokuphefumula iyanda, kuze kube sekupheleni kwayo. Usizo lokuqala lwe-overdose yile:
- ukubuyekeza kanye nokuhlanzwa kwe-patity yomlomo (isikhala sangaphansi) kusuka ezinsaleleni zethebhulethi;
- ukuhlolwa kokwanela kweziguli;
- ukuphumula kokuphefumula, kuze kufinyelele ekushintsheni komoya wamaphaphu;
- ukugcina izinga lokushisa lomzimba;
- ukwethulwa koketshezi okwenzelwe ukulahleka kwalo.
I-antidote to opioid analgesics yiNaloxone. Kepha singasetshenziswa kuphela ukuqeda ukusetshenziswa kwe-overdose kubantu abangakaze basebenzise ama-opioid ngaphambili.
Nge-hypotension enzima, izidakamizwa ezifakwa esikhundleni se-plasma zithunyelwa ukuze kube nomfutho wegazi ngokwejwayelekile.
I-antidote to opioid analgesics yiNaloxone.
Ukuxhumana nezinye izidakamizwa
Umuthi wenziwa ngama-enzymes wesibindi, ngakho-ke izidakamizwa ezithinta umsebenzi wazo (i-Erythromycin, i-Ritonavir, i-Itraconazole) zandisa i-bioavailability yomuthi futhi ziholele ekwandisweni komphumela.
Inhlanganisela namanye ama-analgesics, ama-antipsychotic, amaphilisi okulala kanye ne-sedative kukhuphuka komphumela wokuvimbela nokuphumula, umsebenzi wokuphefumula okhubazekile, ukwehla okukhulu komfutho wegazi. Ngakho-ke, ukuhlanganiswa kwabo kusetshenziswa ngokucophelela okukhulu.
Akunconyelwe ukuthatha abaphikisi / ama-agonists ama-opioid receptors ngasikhathi sinye nomuthi, ngoba ezigulini ebezithathe lo muthi isikhathi eside, le nhlanganisela ibangela izimpawu zokuhoxa.
Ukuhambisana notshwala
I-ethyl alcohol ikhulisa umphumela wokudambisa umuthi, ngakho-ke ukuhlanganisa isidakamizwa notshwala akunconywa.
Ama-Analog
Izithonjana zikaLunaldin yilezi:
- UDolforin;
- Fentavera;
- Matrifen;
- I-Fendivia
- Carfentanil.
Imibandela yekhefu lekhemisi
Ngokusebenzisa umuthi.
Ngingakwazi ukuthenga ngaphandle kadokotela?
Cha.
Intengo ye-Lunaldin
E-Russia, umuthi ubiza kusuka kuma-ruble ayi-4000. zamathebhulethi ayi-10 No. 100, 4500 rub. ukupakishwa No. 200 kanye 5000 ruble. ngenombolo 300.
Izimo zokugcina zomuthi
Umuthi ufakwa kuhlu A, futhi kufanele ugcinwe kwikhabethe elivalekile, kude nezingane emazingeni okushisa asekamelweni.
Isikhathi sokuphelelwa yisikhathi
Akudluli iminyaka emithathu.
Umuthi ugcinwa iminyaka engaphezulu kwemithathu.
Umkhiqizi
"I-Recipharm Stockholm AB", eSweden.
Ukubuyekezwa mayelana neLunaldin
UTatyana Ivanova, oneminyaka engama-45, uP Pskov: "Ukulungiselela okuhle kakhulu. Kusize kakhulu ngemuva kokuhlinzwa. Izinhlungu beziqine kakhulu futhi akusizanga ngalutho. Ukuphathwa kukaLunaldin kuphela okungisindisile ekuhlushweni."
UMikhail Prokopchuk, oneminyaka engama-48, i-emerovo: "Ngisebenza njenge-anesthetist esibhedlela esincane. Ekusebenzeni kwami, ngivame ukusebenzisa i-anesthesia neLunaldin. Umuthi omuhle okhombisile ukuphepha nokusebenza kahle kokusebenza. Ubuhlungu buyeka ngokushesha, futhi bekungekho miphumela emibi, ngaphandle kwenhliziyo. "
U-Ekaterina Filippova, oneminyaka engu-36 ubudala, uKostroma: "Umama wezwa ubuhlungu obukhulu emdlavuza webanga. Kwaze kwaba usuku lokugcina, amaphilisi kaLunaldin kuphela asophula. Akukho sidingo semijovo, iphilisi ngaphansi kolimi, futhi izinhlungu zabuya ngokushesha."
