Izidakamizwa ze-diuretic zithinta ngqo ukusebenza kwezinso futhi zisheshise inqubo yokuphuma komchamo.
Amasu wokusebenza we-diuretics iningi, ikakhulukazi uma kungukuchitheka kwe-potasium, kususelwa emandleni wokucindezela ukufakwa kwe-inso ezinso, ngqo kuma-rebu tubules, ama-electrolyte.
Ukwanda kwenani lama-electrolyte akhishwe kwenzeka ngasikhathi sinye ngokukhishwa kwevolumu ethile koketshezi.
I-diuretic yokuqala yavela ngekhulu le-19, lapho kutholakala umuthi we-zebus, osetshenziswa kabanzi ukwelapha i-syphilis. Kepha maqondana nalesi sifo, umuthi awuzange usebenze, kepha umphumela wawo onamandla wokuguguleka komzimba wabonwa.
Ngemuva kwesikhathi esithile, ukulungiswa kwe-zebus kwathathelwa indawo ngento enobuthi engaphansi.
Kungekudala, ukuguqulwa kwesakhiwo se-diuretics kuholele ekwakhekeni kwezidakamizwa ezinamandla kakhulu ze-diuretic, ezinokuhlelwa kwazo.
Yini okokugaya?
Izidakamizwa ze-diuretic zivame ukusetshenziselwa:
- ngokwehluleka kwenhliziyo;
- nge-edema;
- ahlinzeke ngokuphuma komchamo uma kwenzeka umsebenzi we-renal ongasebenzi kahle;
- wehlise umfutho wegazi ophakeme;
- uma unobuthi, susa ubuthi.
Kumele kuqashelwe ukuthi ama-diuretics we-hypertension kanye nokwehluleka kwenhliziyo angabapheki abahle kakhulu.Ukwehla okuphezulu kungaba ngumphumela wezifo zenhliziyo ezahlukahlukene, ama-pathologies wehlelo lomchamo nolwemithambo yegazi. Lezi zifo zihambisana nokubambezeleka kwensodium yomzimba. Izidakamizwa ze-diuretic zisusa ukunqwabelana okwedlulele kwalokhu futhi ngaleyo ndlela kunciphisa ukuvuvukala.
Ngomfutho wegazi ophakeme, i-sodium eyeqile ithinta ithoni yemisipha yemithambo yegazi, eqala ukuncipha futhi ibe nenkontileka. Izidakamizwa ze-diuretic ezisetshenziswa njengama-antihypertensives zigeza i-sodium ngaphandle komzimba futhi zikhuthaze i-vasodilation, yona eyehlisa umfutho wegazi.
Uma kwenzeka unobuthi, obunye ubuthi buchithwa yizinso. Ukusheshisa le nqubo, ama-diuretics nawo ayasetshenziswa. Emithini yokwelashwa, le ndlela ibizwa ngokuthi "yi-diureis ephoqelelwe."
Okokuqala, inani elikhulu lezixazululo liphathwa ngaphakathi kweziguli, ngemuva kwalokho kusetshenziswa i-diuretic ephumelela kakhulu, ekhipha ngokushesha uketshezi emzimbeni, kanye nalo, ubuthi.
Ama-diuretics kanye nokuhlukaniswa kwawo
Kwezifo ezahlukahlukene kunikezwa ama-diuretics athile, enendlela ehlukile yokusebenza.
Ukuhlukaniswa:
- Izidakamizwa ezithinta ukusebenza kwe-renal tubule epithelium, uhlu: i-Triamteren Amiloride, i-Ethaconic acid, iTorasemide, iBumetamide, iFlurosemide, i-Indapamide, iClopamide, iMetolazone, iChlortalidone, iMethclothiazide, i-Bendroflumethiozide, iHydroclazolezid.
- I-Osmotic diuretics: IMonitol.
- I-potassium-sparing diuretics: I-Veroshpiron (Spironolactone) isho abaphikisi be-mineralocorticoid receptors.
Ukuhlukaniswa kwe-diuretics ngokusebenza kwe-sodium emzimbeni:
- Ayisebenzi - susa u-5% sodium.
- Ukusebenza okuphakathi - 10% we-sodium kukhishwe.
- Kusebenza kakhulu - susa ngaphezu kwe-15% sodium.
Ukusebenza kwesenzo se-diuretics
Ukusebenza kwesenzo se-diuretics kungafundwa ngesibonelo semiphumela yabo ye-pharmacodynamic. Isibonelo, ukwehla komfutho wegazi kungenxa yezinhlelo ezimbili:
- Kwehlisiwe ukugxilwa kwe-sodium.
- Umphumela oqondile emithanjeni yegazi.
Ngakho-ke, i-arterial hypertension ingamiswa ngokuncipha kwethamo lamanzi kanye nokugcinwa kwesikhathi eside kwetoni ye-vascular.
Ukwehla kwesidingo se-oxygen yemisipha yenhliziyo lapho usebenzisa ama-diuretics kuhlotshaniswa:
- ngokukhululeka kwengcindezi evela kumaseli e-myocardial;
- nge-microcirculation ethuthukisiwe ezinso;
- ngokuncipha kokunamathela kweplatelet;
- ngokuncipha komthwalo ku-ventricle yangakwesobunxele.
Amanye ama-diuretics, ngokwesibonelo, i-Mannitol, hhayi nje ukukhulisa inani lamanzi akhutshiwe ngesikhathi se-edema, kodwa futhi ayakwazi ukwandisa ingcindezi ye-osmolar ye-fluid engaphakathi.
Ama-diuretics, ngenxa yezakhiwo zawo, aphumuza izicubu ezibushelelezi zemithambo yegazi, i-bronchi, ne-bile ducts, anomphumela we-antispasmodic.
Izinkomba zokuqokwa kwama-diuretics
Izinkomba eziyisisekelo zokuqokwa kwe-diuretics yi-arterial hypertension, iningi lakho lokhu kusebenza ezigulini esezikhulile. Izidakamizwa ze-diuretic zibekelwe ukugcinwa kwe-sodium. Lezi zimo zifaka ama-ascites, ukuqina kwezinhlungu okungapheli kanye nokwehluleka kwenhliziyo.
Nge-osteoporosis, isiguli sinqunywe i-thiazide diuretics. Izidakamizwa ezisebenzisa i-potassium-sparing zikhonjiselwa i-congenital Liddle syndrome (ukuqedwa kwamanani amakhulu okugcinwa kwe-potassium kanye ne-sodium).
I-Loop diuretics inomthelela ekusebenzeni kwezinso, ichazwe ekucindezelweni okuphezulu kwe-intraocular, glaucoma, edema ye-cardiac, cirrhosis.
Ukwelashwa nokuvimbela umfutho wegazi ophakeme, odokotela banquma izidakamizwa ze-thiazide, ezithi ngemithamo emincane zibe nomphumela ongemuhle ezigulini ezinomfutho wegazi ophakathi. Kuqinisekisiwe ukuthi i-thiazide diuretics kumaphilisi e-prophylactic anganciphisa ubungozi bokushaywa unhlangothi.
Ukuthatha le mishanguzo ngemithamo ephezulu akunconyelwanga, kufakwe ukuthuthukiswa kwe-hypokalemia.
Ukuvikela lesi simo, i-thiazide diuretics ingahlanganiswa ne-potassium-sparing diuretics.
Ekwelapheni ama-diuretics, ukwelashwa okusebenzayo nokwelashwa okuxhasayo kuyahlukaniswa. Esigabeni esisebenzayo, kukhonjiswa imithamo elinganiselayo ye-potent diuretics (Furosemide). Ngokulashwa kwesondlo, ukusetshenziswa kwe-diuretics njalo.
Contraindication nokusetshenziswa kwama-diuretics
Iziguli ezine-cirrhosis ebunjiwe yesibindi, i-hypokalemia, ukusetshenziswa kwe-diuretics kuyaphulwa. I-loop diuretics ayinqunyelwe iziguli ezingabekezeleli ezinye ze-sulfanilamide derivatives (hypoglycemic kanye nemithi elwa ne-antibacterial).
Kubantu abanokwehluleka ukuphefumula nokuqina kwinso, ama-diuretics aqinisekisiwe. Ama-diuretics eqembu le-thiazide (Methiklothiazide, Bendroflumethiozide, uCyclatumazide, Hydrochlorothiazide) afakwa ku-Type 2 sikashukela mellitus, njengoba isiguli singakhuphula kakhulu amazinga kashukela egazi.
Ama-arrhythmias we-Ventricular are also contraindication to the aphoyintimenti diuretics.
Ezigulini ezithatha usawoti we-lithium nama-glycosides e-cardiac, ama-loop diuretics anikezwa ngokunakekela okukhulu.
Ama-Osmotic diuretics awabekelwe ukwehluleka kwenhliziyo.
Imiphumela emibi
Ama-diuretics ohlwini lwe-thiazide angakhuphula amazinga wegazi uric acid. Ngalesi sizathu, iziguli ezitholakala ukuthi zine-gout zingabona isimo esandayo.
Ama-diuretics weqembu le-thiazide (hydrochlorothiazide, hypothiazide) angaholela emiphumeleni engathandeki. Uma kuthathwe umthamo ongalungile noma isiguli singabekezeleli, imiphumela emibi elandelayo ingavela:
- ikhanda
- isifo sohudo kungenzeka;
- isicanucanu
- ubuthakathaka
- umlomo owomile
- ukozela
Ukungalingani kwama-ion kufaka:
- kwehle i-libido emadodeni;
- komzimba
- ukwanda koshukela wegazi;
- imisipha yamathambo
- ubuthakathaka bemisipha;
- arrhythmia.
Imiphumela emibi ye-furosemide:
- ukwehla kwe-potassium, magnesium, calcium;
- Isiyezi
- isicanucanu
- umlomo owomile
- ukuchama njalo.
Ngokushintshwa kokushintshana kwe-ion, izinga le-uric acid, ushukela, ukukhuphuka kwe-calcium okubandakanya:
- i-paresthesia;
- imivimbo yesikhumba;
- ukulahleka kwezindlebe.
Imiphumela emibi ye-aldosterone antagonists ifaka:
- imivimbo yesikhumba;
- gynecomastia;
- iminyakazo
- ikhanda
- isifo sohudo, ukugabha.
Kwabesifazane abanezinhloso ezingalungile nomthamo ongafanele uyabonakala:
- i-hirsutism;
- ukungahambi kahle kokuya esikhathini.
Ama-ejenti we-diuretic adumile kanye nendlela yabo yokusebenza emzimbeni
Ama-diuretics athinta umsebenzi wama-tubules we-renal avimbela i-sodium ukuthi ingangeni emzimbeni futhi futhi igcobe into kanye nomchamo. Ama-diuretics wokusebenza okuphakathi kwe-Methiclothiazide Bendroflumethioside, iCyclanisweazide yenza kube nzima ukumunca i-chlorine, hhayi i-sodium nje. Ngenxa yalesi senzo, babizwa nangokuthi ama-saluretics, okusho ukuthi "usawoti".
I-Thiazide-like diuretics (Hypothiazide) ikakhulukazi ibekelwe i-edema, isifo sezinso, noma ukuhluleka kwenhliziyo. I-Hypothiazide idume kakhulu njenge-ejenti ye-hypotensive.
Umuthi ukhipha i-sodium eyeqile futhi wehlise ingcindezi emithanjeni yemithambo yegazi. Ngaphezu kwalokho, izidakamizwa ze-thiazide zithuthukisa umphumela wemithi, inqubo yesenzo sayo okuhloswe ngayo ukwehlisa umfutho wegazi.
Ngokuqokwa komthamo owengeziwe wale mishanguzo, i-fluid extretion ingakhula ngaphandle kokunciphisa umfutho wegazi. I-Hypothiazide nayo inqunyelwe isifo sikashukela kanye ne-urolithiasis.
Izinto ezisebenzayo eziqukethwe kulungiselelo zinciphisa ukugcwala kwama-calcium ion futhi zivikele ukwakheka kosawoti ezinso.
Ama-diuretics asebenza kahle kakhulu afaka iFurosemide (Lasix). Ngokuphathwa kwe-intravenous kwalesi sidakamizwa, umphumela ubonwa ngemuva kwemizuzu eyi-10. Umuthi ufanelekile;
- ukwehluleka okukhulu kwe-ventricle yesinxele yenhliziyo, kuhambisane ne-pulmonary edema;
- i-edema yangaphandle;
- i-arterial hypertension;
- ukuqedwa kobuthi.
I-Ethacrinic acid (Ureghit) isondele esenzweni sayo neLasix, kodwa isebenza isikhathi eside.
I-Monitol ejwayelekile ejwayelekile ihanjiswa ngaphakathi. Umuthi ukhulisa ingcindezi ye-osmotic ye-plasma kanye nokwehlisa ingcindezi ye-intracranial ne-intraocular. Ngakho-ke, lesi sidakamizwa sisebenza kakhulu ku-oliguria, esiyimbangela yokushiswa, i-trauma noma ukulahleka kwegazi okukhanyayo.
Abaphikisi be-Aldosterone (Aldactone, Veroshpiron) bavimbela ukumuncwa kwama-ion e-sodium futhi bavimbele ukucashelwa kwe-magnesium ne-potassium ions. Izidakamizwa zaleli qembu zikhonjiswa i-edema, umfutho wegazi ophakeme kanye nokwehluleka kwenhliziyo okuguquguqukayo. Ama-diuretics we-potassium-sparing empeleni awangeni ngaphakathi kolwelwesi.
I-diuretics kanye nohlobo 2 sikashukela
Nakani! Kumele kukhunjulwe ukuthi ngohlobo lwe-2 yesifo sikashukela, kuphela ama-diuretics athile, okungukuthi, ukuqokwa kweziguli ngaphandle kokunaka lesi sifo noma ukuzilapha kungaholela emiphumeleni engenakuphikiswa emzimbeni.
Ama-Thiazide diuretics wohlobo lwe-2 mellitus anqunywa ikakhulu ukwehlisa umfutho wegazi, we-edema kanye nokwelashwa kokungalingani kwenhliziyo.
Futhi, i-thiazide diuretics isetshenziselwa ukwelapha iziguli eziningi nge-hypertension ye-arterial ehlala isikhathi eside.
Le mishanguzo inciphisa kakhulu ukuzwela kwamangqamuzana kuyi-hormone insulin, okuholela ekwandeni kwamazinga wegazi glucose, triglycerides ne-cholesterol. Lokhu kubeka imikhawulo ebalulekile ekusetshenzisweni kwalezi diuretics ezinhlobo 2 sikashukela.
Kodwa-ke, ucwaningo lwakamuva lwezemitholampilo ngokusetshenziswa kokugaya isifo sikashukela sohlobo 2 luye lwabonisa ukuthi le miphumela engemihle ibonwa kakhulu ngemithamo ephezulu yemithi. Ngomthamo ophansi, imiphumela emibi empeleni ayenzeki.
Kubalulekile! Ezigulini ezinesifo sikashukela sohlobo 2, lapho sinquma i-thiazide diuretics, iziguli kufanele zidle imifino nezithelo eziningi ngangokunokwenzeka. Lokhu kuzosiza ukulungisa ukulahleka okukhulu kwe-potassium, sodium, ne-magnesium. Ngaphezu kwalokho, ubungozi bokwehlisa umuzwa womzimba ku-insulin kufanele ubhekwe.
Kuhlobo 2 sikashukela i-mellitus, isidakamizwa esisetshenziswa kakhulu yi-Indapamide, noma, i-Arifon yaso. Bobabili i-Indapamide ne-Arifon cishe ayinawo umthelela kuma-carbohydrate kanye ne-lipid metabolism, ebaluleke kakhulu kusifo sikashukela sohlobo 2.
Eminye imishanguzo yesifo sikashukela sohlobo 2 inqunyelwe kaningi kakhulu futhi kuphela uma kunezimo ezithile:
- i-loop diuretics yohlobo 2 lwesifo sikashukela isetshenziswa kuphela kanye kuphela kulezo zimo lapho kunesidingo ukufezekisa ukwanda okuvamile kwengcindezi yegazi;
- kuhlanganiswe i-thiazide ne-potassium-sparing diuretics - lapho kudingekile ukunciphisa ukulahleka kwe-potassium.
Iziguli ezinokulawulwa okungafanele kweshukela legazi kudingeka ziqonde ukuthi ukuthatha noma yisiphi isidakamizwa se-diuretic kungadala imiphumela emibi kakhulu - ukwehla kokuzwela kwe-insulin ye-hormone. Ngaphezu kwalokho, ukwelashwa kwe-hypertension ye-arterial kungenzeka kungabi isikhathi eside.
