Dab tsi yog loj kho: cov nyhuv ntawm ib pawg tshuaj rau ntshav qab zib

Biguanides yog cov tshuaj tsim kom txo qis ntshav qab zib. Cov twj muaj nyob hauv daim ntawv ntawm cov ntsiav tshuaj.

Lawv siv, feem ntau, nrog hom 2 mob ntshav qab zib mellitus, ua ib qho adjuvant.

Raws li ib feem ntawm kev kho mob monotherapy, hypoglycemic tshuaj yog kho tsis tshua muaj neeg. Feem ntau qhov no tshwm sim hauv 5-10% ntawm tus neeg mob.

Biguanides suav nrog cov tshuaj hauv qab no:

• Bagomet,
• Avandamet
• Metfogamma,
• Glucophage,
• Metformin Acre
• Siofor 500.

Tam sim no, hauv Lavxias, thoob plaws ntiaj teb, ntawm cov loj loj tau siv, rau feem ntau, cov methylbiguanide derivatives, uas yog, metformin:

1. glucophage
2. Siofor
3. metpho-gamma,
4. dianormet
5. glyformin thiab lwm tus.

Metformin tawg tawm li ib thiab ib nrab rau peb teev. Cov tshuaj yog tsim nyob rau hauv cov ntsiav tshuaj ntawm 850 thiab 500 mg.

Kev siv tshuaj rau kho yog 1-2 g nyob rau ib hnub.

Koj tuaj yeem haus tau txog 3 g ib hnub twg rau ntshav qab zib.

Butylbiguanide derivatives:

• silubin
• buformin
• Adebite.

Thov nco ntsoov tias cov biguanides tau siv tsawg, vim muaj kev phiv loj heev, uas yog mob plab zom mov.

Tam sim no cov kws kho mob tsis pom zoo kom siv phenylbiguanide derivatives, vim nws tau ua pov thawj tias lawv ua rau kev txuam nrog hauv cov ntshav ntawm tus neeg:

• pyruvate
• lactate

Tshuaj ua

Cov kws tshawb fawb tau ua pov thawj tias cov piam thaj ua rau cov ntshav qab zib hauv metformin ua rau cov ntshav qab zib muaj feem cuam tshuam nrog qhov tshwj xeeb ntawm cov tshuaj ntawm pas dej ua ke thiab sib txuas. Cov suab thaj txo cov txiaj ntsig ntawm metformin yog txuam nrog cov piam thaj hauv kev nqa ntawm tes.

Qhov ntim ntawm cov piam thaj kev thauj khoom tuaj yeem nce vim yog cuam tshuam nrog cov loj loj. Qhov no yog ua kom pom kev txhim kho cov kua nplaum nyob thoob hauv lub cell membrane.

Cov nyhuv no piav qhia txog cov nyhuv ntawm ob qhov ua haujlwm ntawm lub cev insulin thiab insulin los ntawm sab nraud. Cov tshuaj tseem ua nyob rau hauv mitochondrial daim nyias nyias.

Biguanides inhibit gluconeogenesis, li no lawv ua rau muaj kev nce ntxiv hauv cov ntsiab lus ntawm:

1. lactate
2. pyruvate,
3. Alanine

Cov tshuaj no yog cov suab thaj nyob hauv cov ntsiab lus ntawm gluconeogenesis.

Qhov ntim ntawm cov piam thaj thauj ntau nce ntxiv hauv qab qhov kev txiav txim ntawm metformin hauv lub plasma daim nyias nyias. Nws yog hais txog:

• NTIAJ-4,
• NTIAJ-2,
• NTIAJ-1.

Cov qabzib thauj nrawm:

1. hauv leeg tshav cov leeg
2. endothelium
3. leeg lub plawv.

Qhov no piav qhia txog qhov txo qis hauv cov tshuaj insulin rau cov neeg uas muaj hom 2 mob ntshav qab zib mellitus nyob hauv qab ntawm metformin. Ib qho nce ntawm cov neeg mob tsis txaus siab rau cov kua dej tsis yog nrog los ntawm kev nce ntxiv hauv nws txoj kev zais cia los ntawm txoj cai txiav.

Tawm tsam tom qab ntawm qhov kev txo qis hauv insulin tsis kam, qhov theem pib uas qhia tau hais tias insulin hauv ntshav kuj poob qis. Qhov kev nce siab ntawm cov kab mob rau cov kua dej tsis yog nrog los ntawm kev nce ntxiv hauv nws txoj kev zais los ntawm cov kab mob qog, zoo li thaum siv sulfonylureas.

Thaum kho nrog metformin hauv tib neeg, kev tshawb pom kev hnyav yog pom, tab sis thaum kho nrog sulfonylurea tus neeg sawv cev thiab cov tshuaj insulin, qhov tshwm sim tuaj yeem yog. Ntxiv rau, metformin pab ua kom qis cov ntshav ntshiab.

Sab sij huam

Cov kev phiv loj los ntawm kev siv cov metformin yuav tsum raug sau tseg, qhov tshuab yog li nram no:

• raws plab, xeev ntuav, ntuav;
• nws yog xim hlau xim hauv lub qhov ncauj;
• tsis xis nyob hauv plab;
• txo thiab poob ntawm lub qab los, mus txog rau qhov tsis haum rau cov khoom noj;
• lactic acidosis.

Cov kev mob tshwm sim thiab cov kev coj ua, raws li txoj cai, sai sai mus nrog kev txo rau hauv kev noj ntau npaum. Kev mob zawv plab yog qhov qhia tias yuav tsum tau haus cov tshuaj metformin.

Yog tias koj noj Metformin 200-3000 mg ib hnub rau ib lub sijhawm ntev, tom qab ntawd koj yuav tsum nco ntsoov tias qhov nqus ntawm cov hnyuv yuav txo:

1. Cov vitamins B,
2. folic acid.

Nws yog ib qho tsim nyog yuav tau daws hauv txhua kis teeb meem qhov teeb meem ntawm kev teem caij ntxiv ntawm cov vitamins.

Nws yog qhov tsim nyog yuav tau khaws cov ntshav lactate cov ntsiab lus tswj, thiab tshuaj xyuas qhov no tsawg kawg ob zaug hauv ib xyoos. Qhov no yog qhov tseem ceeb muab lub peev xwm ntawm metformin los txhim kho tus mob anaerobic glycolysis nyob rau hauv txoj hnyuv me thiab inhibit glycogenolysis hauv daim siab.

Yog tias tus neeg muaj kev tsis txaus siab txog cov leeg mob thiab nws yog xim hlau hauv lub qhov ncauj, nws yuav tsum kawm txog qhov lactate. Yog tias nws cov ntshav cov ntsiab lus nce siab, ces cov kev coj ua rau kev kho mob nrog metformin yuav tsum nres.

Yog tias nws tsis tuaj yeem kawm txog qib ntawm lactate hauv cov ntshav, tom qab ntawd metformin tau raug muab tso tseg kom txog thaum tus mob tso rau qhov xwm txheej zoo, tom qab ntawd txhua qhov tshwm sim ntawm nws cov thawj coj raug soj ntsuam.

Lub ntsiab contraindications

Muaj tshwj xeeb contraindications rau kev siv cov metformin:

1. mob ntshav qab zib ketoacidosis, thiab raws li mob qa thiab lwm yam mob uas mob ntshav qab zib;
2. lub raum tsis ua haujlwm, nce creatinine hauv cov ntshav tshaj 1.5 mmol / l;
3. hypoxic tej yam kev mob ntawm txhua lub keeb (angina pectoris, lub plawv khiav tsis zoo, 4 FC, angina pectoris, myocardial infarction);
4. ua pa tsis ua haujlwm;
5. hlaus encephalopathy mob heev,
6. tus mob stroke
7. anemia
8. cov mob sib kis ceev, kab mob kev phais;
9. cawv
10. daim siab ua haujlwm;
11. cev xeeb tub
12. cov cim qhia ntawm keeb kwm ntawm cov kab mob lactic acidosis.

Hauv cov txheej txheem ntawm daim siab ua kom lub siab loj, biguanides yog cov tshuaj tiv thaiv thaum hepatomegaly tau lees paub tias yog vim li cas cov ntshav qab zib mob hepatostatosis.

Nrog kev sib kis-kev ua xua thiab dystrophic mob ntawm daim siab, cov nyhuv ntawm biguanides rau ntawm hepatic parenchyma tuaj yeem sau cia, uas tau hais hauv:

• cov tsos mob ntawm cholestasis, qee zaum mus txog rau qhov pom tawv nqaij daj,
• hloov pauv ntawm daim siab kuaj mob ua haujlwm

Hauv kab mob siab ntev mus ntev, cov tshuaj yuav tsum siv nrog ceev faj.

Tsis zoo li sulfonylurea derivatives, biguanides tsis muaj cov nyhuv ua rau mob hematopoietic ntawm cov hlwb pob txha thiab lub raum. Txawm li cas los, lawv nyob rau hauv contraindicated:

• mob raum uas txhawb kev txo qis hauv glomerular pom
• khaws cia ntawm nitrogenous slag
• anemia kev ua haujlwm hnyav, vim qhov txaus ntshai ntawm lactacidemia.

Cov neeg laus raug mob yuav tsum ua tib zoo sau tshuaj, vim tias qhov no cuam tshuam nrog kev hem thawj ntawm lactic acidosis. Qhov no siv rau cov neeg mob uas ua lub cev sib zog.

Muaj tshuaj, kev siv uas nyob rau hauv kev kho mob ntawm biguanides exacerbates lub mechanism ntawm lactic acidosis, cov no yog:

• fructose
• teturam
• antihistamines
• salicylates,
• barbiturates.