Hauv Lavxias Lavxias, kwv yees li 45 feem pua ntawm cov neeg kuaj mob ntshav qab zib siv cov tshuaj insulin rau hauv lawv lub neej. Raws li cov txheej txheem ntawm kev kho mob, tus kws kho mob yuav muab tshuaj insulin rau luv, nruab nrab thiab ntev ntev.
Cov tshuaj tseem ceeb hauv kev kho mob ntshav qab zib yog insulins nruab nrab. Xws li cov tshuaj hormone siv tshuaj ib zaug lossis ob zaug ib hnub.
Txij li thaum nqus ntawm cov tshuaj yog qeeb heev, cov nyhuv hauv lub cev tsis tuaj yeem pib tsuas yog ib nrab ib teev tom qab txhaj tshuaj.
Hom mob insulin
- Kev siv tshuaj insulin sai sai pib txo qis ntshav qab zib kom 15-30 feeb tom qab nws txhaj rau hauv lub cev. Qhov siab tshaj plaws nyob rau hauv cov ntshav tuaj yeem ua tiav tom qab ib thiab ib nrab rau ob teev, ntawm qhov nruab nrab, xws li cov kua dej muaj peev xwm ua los ntawm 5 txog 8 teev.
- Ib nrab-lub sij hawm insulin txo qis ntshav qabzib hauv cov qib ib thiab ib nrab rau ob teev tom qab nws tswj hwm. Qhov siab tshaj plaws ntawm cov tshuaj nyob hauv cov ntshav tau pom tom qab 5-8 teev, cov nyhuv ntawm cov tshuaj nyob rau 10-12 teev.
- Cov tshuaj insulin ntev ua ntev li ob mus rau plaub teev tom qab kev tswj xyuas lub cev. Qhov siab tshaj plaws ntawm kev xav ntawm cov khoom hauv cov ntshav tau pom tom qab 8-12 teev. Tsis zoo li lwm hom tshuaj insulin, cov tshuaj no siv tau rau ib hnub. Tseem muaj cov insulins uas muaj cov nyhuv hypoglycemic rau 36 teev.
Tsis tas li, insulin, nyob ntawm txoj kev ntawm kev ua kom huv, tuaj yeem yog qhov dog dig, monopic thiab monocomponent. Hauv cov txheej txheem li niaj zaus, kev ua kom huv yog ua tiav siv chromatography, monopic ncov insulin yog tau los ntawm kev ua kom huv los ntawm gel chromatography. Rau monocomponent insulin, ion-txauv cov chromatography siv thaum ua kev huv.
Cov neeg kawm ntawv ntawm kev ua kom huv yog txiav txim los ntawm tus naj npawb ntawm proinsulin hais ib lab hais txog insulin. Lub sijhawm ntev ua haujlwm ntawm cov tshuaj insulin tuaj yeem ua tiav vim qhov tseeb tias cov tshuaj hormones yog raug kho tshwj xeeb thiab cov protein thiab zinc ntxiv rau nws.
Tsis tas li ntawd, cov tshuaj insulins tau muab faib ua ntau pawg, nyob ntawm tus qauv ntawm lawv cov kev npaj. Hom tshuaj tua neeg insulin yog tau los ntawm kev ua kom muaj kab mob sib kis thiab semisynthesis los ntawm nqaij npua ua kom yuag. Heterologous insulin yog synthesized los ntawm kev mob siab ntawm nyuj thiab npua.
Ib nrab hluavtaws tib neeg cov kua dej tau los ntawm kev hloov cov amino acid alanine nrog threonine. Xws li cov tshuaj insulin feem ntau siv yog tias cov mob ntshav qab zib muaj cov tshuaj tiv thaiv insulin, kev fab tshuaj rau lwm cov tshuaj.
Nruab Nrab Sijhawm Insulin
Qhov siab tshaj plaws yuav pom tau tom qab 6-10 teev. Lub sijhawm sijhawm ntawm kev ua ntawm cov tshuaj yog nyob ntawm ntau npaum li cas xaiv.
Hauv qhov tshwj xeeb, nrog kev qhia ntawm 8-12 units ntawm cov tshuaj hormones, insulin yuav ua haujlwm rau 12-14 teev, yog tias koj siv ntau npaum ntawm 20-25 units, cov tshuaj yuav ua 16-18 teev.
Ib qho tseem ceeb ntxiv yog qhov ua tau ntawm kev sib xyaw nrog cov tshuaj insulin ceev. Nyob ntawm cov tsim khoom thiab muaj pes tsawg leeg, cov tshuaj muaj npe sib txawv. Cov paub zoo tshaj plaws yog insulins ntawm lub sijhawm nruab nrab:
- Insuman Bazal,
- Biosulin N,
- Berlinsulin-N basal,
- Homofan 100,
- Protofan NM,
- Humulin NRH.
Tsis tas li ntawd nyob rau hauv txee ntawm cov chaw muag tshuaj, niaj hnub siv yeeb tshuaj ntawm Lavxias teb sab ntau lawm Brinsulmi-di ChSP tau muaj, uas muaj cov ncua ntawm insulin thiab tshuaj tiv thaiv.
Insulins ncua sijhawm ntev yog qhia rau:
- Yam 1 ntshav qab zib mellitus;
- Yam 2 ntshav qab zib mellitus;
- Thaum muaj teeb meem rau cov ntshav qab zib ua mob ketoacidosis, acidosis;
- Nrog rau kev txhim kho ntawm cov mob hnyav, kis kab mob sib kis, kev phais mob ntev, tom qab lub sijhawm ntev, kev raug mob, kev ntxhov siab hauv cov neeg mob ntshav qab zib.
Daim ntawv thov lawm
Kev txhaj tshuaj yog ua tiav hauv plab, ncej puab. Lub xub pwg, pob tw. Qhov ntau npaum li cas tau txiav txim siab ntawm tus kheej, ntawm kev pom zoo ntawm tus kws kho mob tuaj koom. Kev tswj hwm qhov quav ntawm cov tshuaj yog txwv tsis pub.
Nws yog ib qho tseem ceeb kom ua raws txhua tus kws kho mob cov lus pom zoo rau xaiv hom tshuaj, tshuaj noj thiab lub sijhawm kis. Yog hais tias tus mob ntshav qab zib tau txav los ntawm nqaij npuas los yog nqaij nyug insulin rau tib neeg zoo sib xws, yuav tsum tau txhaj tshuaj.
Ua ntej qhia cov tshuaj, lub vial yuav tsum tau maj mam shaken kom cov kuab tshuaj tau zoo kiag li thiab ib cov kua turbid ua kua. Qhov xav tau qhov ntau ntawm cov tshuaj insulin yog tam sim ntawd kos rau hauv cov phwj thiab txhaj tshuaj.
Koj tsis tuaj yeem ua lub zog co ntawm lub raj mis kom cov npuas dej tsis tuaj yeem tshwm sim, qhov no tuaj yeem cuam tshuam nrog xaiv cov tshuaj kom raug. Cov tshuaj insulin yuav tsum sib haum nrog cov tshuaj hormone siv.
Ua ntej kev qhia ntawm insulin, qhov chaw txhaj tshuaj tsis tas yuav tsum ua kom tawm. Nws yog ib qho tseem ceeb ntawm lwm qhov chaw txhaj tshuaj. Saib xyuas yuav tsum tau ua tib zoo xyuas kom meej tias rab koob tsis nkag rau cov hlab ntshav.
- Kev tswj hwm ntawm cov tshuaj insulin hauv cov ntshav qab zib mellitus tau ua tiav 45-60 feeb ua ntej noj mov 1-2 zaug ib hnub.
- Cov neeg laus rau cov neeg uas tau muab tshuaj rau thawj zaug yuav tsum tau txais thawj zaug ntawm 8-24 units ib hnub ib zaug.
- Nyob rau hauv qhov muaj qhov siab rhiab heev rau lub cev, cov menyuam yaus thiab cov neeg laus raug tswj tsis pub ntau tshaj 8 chav nyob rau ib hnub.
- Yog tias rhiab heev rau cov tshuaj hormones raug txo qis, nws raug tso cai siv ntau tshaj 24 units ib hnub.
- Qhov ntau npaum li cas ib cov tshuaj yuav yog 40 units. Tshaj li cov kev txwv no tsuas yog ua tau rau hauv rooj plaub tshwj xeeb nkaus xwb.
Ib nrab-lub sij hawm tshuaj insulin tuaj yeem siv ua ke nrog insulin luv luv. Hauv qhov no, insulin ceev yog sau ua ntej daim ntaub qhwv. Qhov kev txhaj tshuaj yog ua tiav tam sim ntawd tom qab cov tshuaj sib tov.
Hauv qhov no, nws yog ib qho tsim nyog yuav tau soj ntsuam cov tshuaj muaj zog ntawm cov kua dej, vim nws yog txwv tsis pub tov zinc npaj nrog phosphate-uas muaj cov tshuaj hormones.
Ua ntej siv cov tshuaj, lub raj mis yuav tsum tau kuaj xyuas kom zoo. Yog tias plaub ya ri los yog lwm qhov tshwm sim hauv nws thaum tov, tsis pub tshuaj insulin. Cov tshuaj yog muab raws li cov lus qhia txuas nrog tus cwj mem syringe. Txhawm rau zam kom tsis txhob ua txhaum, tus kws kho mob yuav tsum qhia koj kom siv cov cuab yeej nkag mus rau hauv qhov tshuaj hormones.
Cov poj niam uas kuaj mob ntshav qab zib thaum lub caij xeeb tub yuav tsum saib xyuas lawv cov ntshav qab zib. Hauv txhua peb lub hlis ntawm kev xeeb tub, nws yog ib qho tsim nyog yuav tau kho cov tshuaj ntau npaum li cas, nyob ntawm qhov xav tau ntawm lub cev.
Tsis tas li, kev hloov pauv ntawm koob tshuaj yuav tsum muaj thaum lub sijhawm pub niam mis.
Contraindications thiab kev siv ntau dhau
Nrog rau kev muab tshuaj tsis yog, tus neeg mob yuav muaj cov tsos mob ntawm lub qog ua kom ntshav tawm hws, txias tsis muaj zog, blanching ntawm daim tawv nqaij, lub plawv dhia, lub cev tshee tshee, poob siab, xeev siab, tingling nyob rau ntau qhov chaw ntawm lub cev, mob taub hau. Tus neeg kuj tseem tuaj yeem ua lub cev ua ntej thiab ua pa tsis xeev.
Yog tias kuaj pom ntshav qog ntshav me lossis nruab nrab, tus neeg mob yuav tsum tau txais cov koob tshuaj nyob rau thaj chaw ntawm cov ntsiav tshuaj, kua txiv, zib ntab, qab zib thiab lwm yam khoom uas muaj suab thaj.
Yog tias kuaj tau tus mob ntshav qab zib tsawg kawg, tus neeg tsis nco qab lawm los yog tsis nco qab lawm, 50 ml ntawm 50% kua dej qabzib yog txhaj rau tus neeg mob sai. Tom ntej no yog qhov txuas ntxiv txuas ntxiv ntawm 5% lossis 10% aqueous kua nplaum. Tib lub sijhawm, ntsuas ntawm qab zib, creatinine, thiab urea hauv cov ntshav yuav raug saib xyuas.
Thaum tus mob ntshav qab zib rov qab nco qab, nws tau muab zaub mov noj nplua nuj hauv cov khoom noj uas yog carbohydrate kom qhov mob ntawm hypoglycemia tsis rov mob ntxiv.
Nruab nrab-lub sij hawm insulin yog contraindicated nyob rau hauv:
- ntshav tshuaj qis;
- insuloma;
- hypersensitivity rau lub cev hormone insulin lossis rau ib qho twg ntawm cov tshuaj.
Nws yog ib qho tseem ceeb uas yuav tau txiav txim siab tias cov tshuaj tuaj yeem ua rau muaj kev phiv uas feem ntau tshwm sim nrog kev noj ntau dhau, tshem tawm lossis noj zaub mov tsis zoo, ua haujlwm lub cev hnyav, thiab kev txhim kho ntawm tus kab mob kis loj. Hauv qhov xwm txheej no, cov tsos mob tau nrog ua ke nrog hypoglycemia, lub paj hlwb tsis meej, tshee tshee, pw tsis tsaug zog.
Qhov kev tawm tsam tsis haum yog feem ntau pom yog tias tus neeg mob tau muaj kev nkag siab ntau ntxiv rau insulin ntawm tsiaj keeb kwm. Tus neeg mob muaj kev ua pa luv, anaphylactic ceeb, tawm pob xoo ntawm daim tawv nqaij, ua xoo nqaj tawv, ua pa nyuaj. Cov mob uas tsis haum heev tuaj yeem ua rau tib neeg lub neej.
Yog tias cov tshuaj siv tau ntev, kab mob lipodystrophy yuav raug pom ntawm qhov chaw txhaj tshuaj ntawm cov tshuaj insulin.
Nrog rau lub qog ntshav qab zib, qhov kev kub siab ntawm kev saib xyuas feem ntau cuam tshuam thiab qhov ceev ntawm qhov kev tawm tsam psychomotor txo qis, yog li thaum lub sijhawm rov qab los koj yuav tsum tsis txhob tsav lub tsheb lossis tsav cov teeb meem loj.
Kev cuam tshuam nrog lwm yam tshuaj
Kev ncua, uas suav nrog zinc, yuav tsum tsis txhob tov nrog phosphate muaj cov tshuaj insulin, suav nrog lawv tsis xyaw nrog lwm cov tshuaj zinc-insulin.
Thaum siv cov tshuaj ntxiv, koj yuav tsum sab laj nrog koj tus kws kho mob, vim tias ntau yam tshuaj yuav cuam tshuam rau cov piam thaj ntau lawm.
Txhim kho cov tshuaj hypoglycemic ntawm lub cev hormone insulin thiab nce qhov kev pheej hmoo ntawm hypoglycemia cov tshuaj xws li:
- tetracyclines
- monoamine oxidase inhibitors
- cov tshuaj hypoglycemic qhov ncauj,
- ifosfamides, alpha-blockers,
- sulfonamides,
- angiotensin hloov mus rau enzyme inhibitors,
- tritoxylin,
- disopyramids
- fibrates
- clofibrate
- fluoxetines.
Kuj, pentoxifyllines, propoxyphenes, salicylates, amphetamines, anabolic steroids, thiab triphosphamides ua rau muaj cov nyhuv zoo sib xws.
Ua kom muaj zog lossis ua kom cov ntshav hauv lub ntsej muag muaj zog ntawm lub cev hormone salicylates, lithium ntsev, beta-blockers, reserpine, clonidine. Ib yam li ntawd cuam tshuam rau lub cev thiab dej cawv.
Diuretics, glucocorticosteroids, sympathomimetics, tshuaj tiv thaiv qhov ncauj, tricyclic antidepressants tuaj yeem ua rau qaug zog ntawm kev ua haujlwm ntawm insulin.
Hauv qhov yeeb yaj kiab hauv tsab xov xwm no, cov ntaub ntawv hais txog Protafan insulin yog qhia meej.
