AmaBiguanides ayingxenye yesigaba sama-guanidines, asebenzayo kushukela. Ngemuva kwakho konke, leli banga lezidakamizwa lehlisa ngempumelelo ukugxila kweglucose egazini.
Lawa ma-ejenti ngu: L-butylbiguanide (Buformin), N, N-dimethylbiguanide (Metformin), Phenethylbiguanide (Fenformin).
Umehluko ekwakhekeni kwe-biguanides esekela ushukela ilele ekugayeni kwabo ngomzimba nangethamo lomthamo. Kepha umphumela wokuphuma kwe-guanidine kumetabolism uyefana ezimweni eziningi.
Kodwa-ke, ama-antihyperglycemic agents awasetshenziswa kaningi njenge-monotherapy. Njengomthetho, lokhu kwenzeka ngo-5-10% wamacala.
Kusebenza kanjani ama-biguanides?
Ukuthi le mishanguzo ithinta kanjani umzimba ayiqondakali ngokuphelele, noma ngabe kwenziwa izifundo eziningi. Kepha kwabhalwa ukuthi i-guanidine derivatives yehlisa ushukela wegazi kuhlobo 2 sikashukela, ikakhulukazi uma isiguli sinenkinga yokuba ngokweqile.
AmaBiguanides anomphumela "wokulondolozwa kwe-insulin", ngakho-ke ngokuhamba kwesikhathi isidingo sokuphathwa kwama-hormone okwenziwa sincipha. Futhi, le mishanguzo inciphisa ukukhuphuka kwegluconeogenesis kusuka kumaprotheni.
Ngaphezu kwalokho, imikhiqizo enjalo ithuthukisa ukuthathwa koshukela ngokuguqula ushukela ube lactate. Njengomphumela wokuvezwa kokutholakala kwe-guanidine, inqubo yokumuncwa kwezinto ezifana:
- amafutha
- uvithamini B 12№
- ama-amino acid;
- I-D-xylose.
Kunombono wokuthi lapho kwenzeka inqubo yokuvinjezelwa kokuphefumula kwezicubu, ukwakheka kwe-ATP kuyancipha, okunciphisa izinqubo ezi-metabolic eziningi lapho kudliwa khona amandla (ngokwesibonelo, gluconeogenesis). Ngokusobala, indlela yokusebenza kwe-Biguanides umphumela wabo ku-lipid metabolism.
Kwatholakala nokuthi le mishanguzo yesifo sikashukela esincike ku-insulin enesisindo ngokweqile ifaka ukwehla ngokulingana kwesisindo somzimba.
Kepha umphumela onjalo uphawulwa ekuqaleni kokwelashwa, lapho ezinye izinto zingangenwa emathunjini, futhi isifiso sokudla sesiguli sincishisiwe.
Imithamo nokuphatha
Isigaba se-Biguanides sifaka izidakamizwa ezinamagama alandelayo:
- Siofor 1000/850/500;
- I-Bagomet;
- I-Metformin Acre;
- Avandamet;
- IGlucophage;
- I-Metfogamma.
Namuhla, izithako ze-methylbiguanide zivame ukusetshenziswa, okuyi-metformin. Lokhu kufaka phakathi i-Gliformin, iGlucofag, i-Dianormet nezinye izinto.
Indlela yokusebenzisa ama-Biguanides amaningi iyafana. Ekuqaleni, kuthathwa imithamo emincane, kepha ngokubekezelela okuhle kuyanda njalo ngezinsuku ezingama-2-4. Ngaphezu kwalokho, i-polyhexamethylene biguanide kufanele idakwe ngemuva kokudla, okuzovimbela ukuthuthukiswa kwemiphumela emibi emgodini we-gastrointestinal.
Iqembu lama-Biguanides asetshenziselwa ukwelapha isifo sikashukela esinga-insulin linomphumela wehora leshumi nambili wokuelapha. Ngakho-ke, umthamo wansuku zonke kufanele uhlukaniswe ngemithamo emi-2.
Ekuqaleni kokwelashwa, iMetformin 850, iSiofor nokunye okunjalo, kuthathwa ngenani lama-500 mg kanye (kusihlwa). Ngemuva kwesonto, inqobo nje uma isiguli singenazinkinga nge-gastrointestinal, imithamo eyodwa yansuku zonke inyuswa yaba ngu-850 mg noma isiguli siphuze enye i-500 mg ekuseni.
Uma kwenzeka ukusabela okubi, umthamo kumele wehliswe, bese kuthi ngemuva kwesikhashana uzame futhi ukuwukhulisa. Ukuqoqwa okukhulu kwento emzimbeni kutholakala ngemuva kwezinyanga eziyi-1-2 zokwelashwa.
Ukusekela umthamo - kuze kufike ku-2000 mg ngosuku. Isilinganiso esivumelekile esiphezulu yi-3000 mg ngosuku, kodwa iziguli ezisencane kuphela. Umthamo omkhulu weziguli esezikhulile awudluli kuma-1000 mg.
I-Polyhexamethylene biguanide ingahlanganiswa nama-secretogens (sulfonylureas kanye ne-ironides), i-insulin nama-glitazones. Ngakho-ke, izinkampani zemithi zikhiqiza amalungiselelo enhlanganisela eyenziwe ngomumo anomphumela we-hypoglycemic ku-dosage ephansi, enciphisa ubungozi bemiphumela emibi:
- Ama-Glucovans (metformin ne-glibenclamide);
- I-Glibomet.
Uma uthatha umkhiqizo ohlanganisiwe, khona-ke ukugcwala koshukela egazini kuvamile ngemuva kwamahora ama-2, futhi umphumela uzohlala kuze kube ngamahora ayi-12.
Izidakamizwa ezinjalo zithathwa ngethebhulethi elingu-1 ngosuku ngokukhuphuka okulandelayo komthamo kuya kumaphilisi ama-2 ngosuku.
Ukusabela Okubi Nokuxhunyaniswa
I-Polyhexamethylene biguanide nezinye izinto ezivela kuleli qembu zingadala inani lezenzo ezingezinhle. Okuvame kakhulu kufaka ukwehluleka endaweni yokugaya ukudla, isifiso sokudla esingesihle, ukuba khona kokunambitheka kwensimbi emlonyeni nokukhula kwe-lactic acidosis.
Isinkomba sokumisa ukubanjwa kwezinto kwezinto ochungechungeni lwe-guanidine ukuhlasela kwesifo sohudo. Kodwa-ke, ngokulungiswa komthamo, imiphumela emibi eminingi iyanyamalala.
I-Metformin ivunyelwe emacaleni alandelayo:
- ukwehluleka ukuphefumula;
- i-anemia yesifo sikashukela;
- izinkinga zesibindi
- isifo sohlangothi;
- ukukhulelwa
- ukutheleleka kakhulu;
- i-encirchalatory encephalopathy;
- ukungasebenzi kahle kwe-renal, lapho izinga le-creatinine egazini lingaphezu kwe-1.5 mmol / l.
Futhi, izidakamizwa azinakuthathwa ngesifo sikashukela, kufaka phakathi i-ketoacidosis futhi, uma kunomlando we-lactic acidosis. Ngaphezu kwalokho, izidakamizwa ezinjalo ziphikisana ngezimo ze-hypoxic (ukushaya kwenhliziyo, i-angina pectoris, ukuhamba kwegazi okungekuhle).
IMetformin ayihambelani notshwala. Futhi uma isibindi sikhulisiwe, khona-ke izidakamizwa ezinjalo zichazwa kuphela lapho i-hepatomegaly yenzeka ngokumelene nesizinda se-hepatostatosis yesifo sikashukela.
Endabeni yezilonda ze-dystrophic, allergic noma ezithathelanayo, ama-biguanides angathinta i-hepatic parenchyma. Ngenxa yalokhu, kubonakala kuzinguquko ezivivinyweni ezisebenzayo. I-Cholestasis nayo ingaqala ukukhula, ibe nezimpawu ezicacile ze-jaundice.
Uma kuqhathaniswa nokususelwa kokunye kwe-sulfonylurea, izidakamizwa ezivela kuma-guanidine amaningana azinamphumela onobuthi ezinsweni nasemnkantsheni wethambo. Noma kunjalo, zihambisana ne-contraindicated uma kwenzeka uphethwe i-anemia kakhulu, ukugcinwa, ubuthi be-nitrogen kanye nasezifweni zezifo zezinso ezibangela ukuncipha kokuhlunga kwe-glomerular.
Futhi, uma ukwelashwa nge-Biguanides kuhlanganiswa ne-fructose, ama-antihistamines, ama-barbiturates, i-teturam nama-salicylates, lokhu kuzokhulisa i-lactic acidosis.
Inkulumo ngezidakamizwa zesifo sikashukela inikezwe kuvidiyo ekulesi sihloko.
