Nrog cov tshuaj insulin tsis txaus, lawv mus rau qhov nce hauv nws qhov kev xav ntau. Cov tsim tawm ntawm sulfonylureas yog rau cov tshuaj uas ua rau muaj kev zais ntawm cov tshuaj hormones thiab ua rau muaj cov tshuaj tua hluavtaws hypoglycemic.
Lawv tsiag ntawv los ntawm cov lus pom zoo dua li piv nrog lwm cov tshuaj ntxiv nrog cov nyhuv zoo sib xws.
Luv luv txog cov tshuaj ntawm cov pab pawg
Sulfonylurea derivatives (PSM) yog ib pawg tshuaj tsim los kho ntshav qab zib. Ntxiv rau qhov hypoglycemic, lawv muaj cov nyhuv hypocholesterolemic.
Kev faib tawm cov tshuaj txij li kev qhia:
- Thawj tiam
sawv cev los ntawm chlorpropamide, Tolbutamide. Niaj hnub no lawv siv tsis tau siv. Lawv tsiag ntawv los ntawm kev ua luv luv, kom ua tiav cov txiaj ntsig lawv tau txiav txim siab hauv qhov ntau dua. - Qhov thib ob tiam yog Glibenclamide, Glipizide, Gliclazide, Glimepiride. Lawv tsis tshua pom muaj cov kev mob tshwm sim ntawm cov kev mob tshwm sim, yog cov kws kho me dua.
sawv cev los ntawm chlorpropamide, Tolbutamide. Niaj hnub no lawv siv tsis tau siv. Lawv tsiag ntawv los ntawm kev ua luv luv, kom ua tiav cov txiaj ntsig lawv tau txiav txim siab hauv qhov ntau dua.Nrog kev pab ntawm pab pawg rau cov tshuaj, kom them nyiaj zoo rau ntshav qab zib tuaj yeem ua tiav. Qhov no tso cai rau koj los tiv thaiv thiab qeeb cov kev txhim kho ntawm cov teeb meem.
PSM txais tos muab:
- ua rau lub siab ua cov ntshav qabzib ntau lawm;
- pancreatic cell-cell kev ua kom muaj zog txhawm rau txhim kho cov kua nplaum ua haujlwm hnyav;
- nce cov nqaij rhiab ua rau cov tshuaj hormones;
- txwv kev tsis pub leej twg paub ntawm somatostatin, uas suppress insulin.
Cov npe ntawm PSM npaj: Glibamide, Maninil, Glibenclamide, Teva, Amaril, Glisitol, Glemaz, Glisitol, Tolinase, Glibetik, Gliclada, Meglimid, Glidiab, Diabeton, Diazid, Reklid, Oziklid. Glibenez, Minidab, Movogleck.
Mechanism ntawm kev ua
Lub ntsiab tivthaiv cuam tshuam rau cov kis tshwj xeeb channel thiab nquag thaiv lawv. Muaj qhov depolarization ntawm daim nyias nyias ntawm β-hlwb, thiab vim li ntawd, qhov qhib cov calcium calcium. Tom qab qhov no, Ca ions nkag hauv beta hlwb.
Qhov tshwm sim yog qhov tso tawm cov tshuaj hormones los ntawm intracellular granules thiab nws tso rau hauv cov ntshav. Cov nyhuv ntawm PSM yog ywj siab ntawm cov piam thaj. Vim li no, ib qho kev mob hypoglycemic feem ntau tshwm sim.
Cov tshuaj muaj tshuaj nyob rau hauv txoj hnyuv, lawv cov nyhuv pib 2 teev tom qab kev tswj hwm. Kev txiav txim siab nyob rau hauv daim siab, ua rau tawm, tsuas yog siv Glycvidon, los ntawm ob lub raum.
Ib nrab-lub neej thiab sijhawm ntawm kev ua ntawm txhua qhov tshuaj hauv cov pab pawg sib txawv. Kev khi rau cov ntshav plasma protein - los ntawm 94 txog 99%. Txoj kev tshem tawm txoj kev, nyob ntawm cov tshuaj, yog lub raum, raum-mob hlwb, thiab mob rau lub siab. Kev rho tawm ntawm cov tshuaj nquag txo nrog kev noj mov uake.
Cov lus qhia rau kev teem caij
Cov tsim tawm ntawm sulfonylureas yog kho rau tus mob ntshav qab zib hom 2 hauv cov xwm txheej zoo li no:
- nrog cov kua dej tsis txaus tsim tawm;
- nrog ib qho kev txo qis hauv rhiab heev rau cov tshuaj hormones ntawm cov nqaij;
- nrog rau kev ua tsis tau zoo ntawm kev kho mob kev noj haus.
Cov kev thaiv tsis zoo thiab cov tshwm sim
Cov tshuaj sulfonylurea cov kev pauv muaj xws li:
- Ntshav Qab Zib Hom 1;
- daim siab ua haujlwm siab;
- cev xeeb tub
- pub niam mis;
- raum tsis ua hauj lwm;
- ketoacidosis;
- kev phais mob;
- cov tshuaj tiv thaiv sulfonamides thiab ntu sib txuam;
- intolerance rau PSM;
- anemia
- kev kis mob hnyav;
- hnub nyoog txog 18 xyoo.
Cov tshuaj tsis raug cai rau cov qib siab ua kom cov piam thaj ntau tshaj 14 mmol / L. Ntxiv thiab, tsis txhob thov rau cov tshuaj insulin txhua hnub ntawm ntau dua 40 units. Tsis pom zoo rau cov neeg mob ntshav qab zib hnyav 2 thaum muaj the-cell tsis txaus.
Cov kab loj Biguanide
Glycvidone tuaj yeem raug kho rau cov neeg uas muaj mob me me ntawm lub raum ua haujlwm. Nws tshem tawm yog nqa tawm (kwv yees 95%) los ntawm txoj hnyuv. Kev siv ntawm PSM tuaj yeem tsim ua cov kev tawm tsam. Txo rau cov xwm txheej zoo li no, lawv tuaj yeem ua ke nrog insulin thiab biguanides.
Ib pawg ntawm cov tshuaj feem ntau muaj kev tiv thaiv zoo. Ntawm cov kev mob tshwm sim, hypoglycemia yog nquag, mob ntshav qab zib tsawg kawg yog pom tsuas yog hauv 5% ntawm tus neeg mob. Tsis tas li, thaum lub sij hawm kho, kev hnyav nce pom. Qhov no yog vim kev zais ntawm cov tshuaj insulin endogenous.
Cov kev mob tshwm sim hauv qab no tsis tshua pom:
- mob dyspeptic;
- nws yog xim hlau xim hauv lub qhov ncauj;
- tshuaj tiv thaiv hyponatremia;
- hemolytic anemia;
- lub raum tsis ua haujlwm;
- kev tsis haum tshuaj;
- ua txhaum ntawm daim siab;
- leukopenia thiab thrombocytopenia;
- cholestatic mob daj ntseg.
Tsuas tshuaj thiab tswj hwm
Muab tshuaj PSM yog tus kws kho mob sau tseg. Nws yog txiav txim siab coj mus rau hauv tus account tsom xam ntawm lub xeev ntawm metabolism.
Nws raug nquahu kom pib kho nrog PSM nrog cov tsis muaj zog, thiab qhov tsis muaj txiaj ntsig, hloov mus rau cov tshuaj uas muaj zog. Glibenclamide muaj cov suab thaj ntau dua cov nyhuv suab thaj dua li lwm qhov ncauj tawm ntshav qab zib.
Noj cov tshuaj raws li pab tau los ntawm pawg no pib nrog kev txhaj tshuaj tsawg kawg. Tshaj li ob lub lim tiam, nws yog maj mam nce. PSM tuaj yeem muab tshuaj nrog insulin thiab lwm cov tshuaj tiv thaiv kab mob hypoglycemic.
Cov tshuaj hauv cov kis zoo li no yog txo, ntau qhov tseeb yog xaiv. Thaum kev them nyiaj tsis taus yog ua tiav, kev rov qab mus rau qhov kev kho mob ib txwm muaj tshwm sim. Yog tias qhov yuav tsum tau siv tshuaj insulin tsawg dua 10 units / hnub, tus kws kho mob hloov tus neeg mob mus rau sulfonylurea derivatives.
Mob ntshav qab zib Hom 2
Cov tshuaj ntawm cov tshuaj tshwj xeeb yog qhia hauv cov lus qhia rau kev siv. Cov cim tsim thiab yam ntxwv ntawm cov tshuaj nws tus kheej (cov tshuaj muaj yees) raug coj mus rau hauv tus lej. Cov koob tshuaj txhua hnub rau chlorpropamide (tiam 1 tiam) - 0.75 g, Tolbutamide - 2 g (tiam 2 koob), Glycvidona (tiam 2 koob) - txog 0.12 g, Glibenclamide (tiam 2 koob) - 0.02 g. Cov neeg mob uas tsis zoo mob raum thiab mob siab, cov neeg laus kev muab tshuaj rau txo kom tsawg.
Tag nrho cov nyiaj ntawm PSM pab pawg tau noj li ib nrab teev lossis ib teev ua ntej noj mov. Qhov no muab cov tshuaj zoo dua thiab, vim li ntawd, txo qis hauv postprandial glycemia. Yog tias pom tseeb dyspeptic cuam tshuam, PSM noj tom qab noj mov.
Kev tiv thaiv kev nyab xeeb
Hauv cov neeg laus, qhov pheej hmoo ntawm kev txhim kho hypoglycemia yog ntau dua. Rau cov pawg no ntawm cov neeg mob, cov tshuaj nrog cov sij hawm luv tshaj plaws tau sau tseg los tiv thaiv yam tsis muaj qhov xav tau.
Nws raug nquahu kom tso tseg cov tshuaj ua haujlwm ntev (Glibenclamide) thiab hloov mus rau kev ua yeeb yam luv luv (Glycvidone, Glyclazide).
Kev noj sulfonylurea derivatives ua rau muaj kev pheej hmoo ntawm kev mob ntshav qab zib. Thaum kho, nws yog qhov yuav tsum tau soj ntsuam cov qib qab zib. Nws raug nquahu kom koj ua raws li txoj kev khomob tau tsim los ntawm koj tus kws khomob.
Nrog nws qhov sib txawv, cov piam thaj tuaj yeem hloov pauv. Thaum muaj kev txhim kho lwm yam kabmob thaum siv PSM kev kho, nws yog qhov tsim nyog yuav tsum qhia rau tus kws kho mob.
Hauv kev kho mob, cov ntsuas hauv qab no raug saib xyuas:
- cov zis qab zib theem;
- glycosylated hemoglobin;
- ntshav qab zib
- lipid theem;
- daim siab kuaj.
Nws tsis pom zoo kom hloov cov tshuaj, hloov mus rau lwm cov tshuaj, nres kev kho mob yam tsis tau sab laj. Nws yog ib qho tseem ceeb uas yuav tau siv tshuaj nyob rau lub sijhawm kom raug.
Tshaj dhau cov koob tshuaj uas tau noj tshuaj tuaj yeem ua rau lub qog ntshav qab zib. Txhawm rau tshem tawm nws, tus neeg mob yuav siv 25 g suab thaj. Txhua qhov xwm txheej zoo sib xws thaum muaj kev nce hauv qhov ntau npaum li cas ntawm cov tshuaj tau qhia rau tus kws kho mob.
Hauv cov ntshav qog ntshav hnyav, uas nrog tus neeg tsis nco qab, nws yuav tsum nrhiav kev pab kho mob.
Cov piam thaj yog muab tshuaj rau hauv lub cev. Koj tuaj yeem xav tau cov tshuaj ntxiv ntawm glucagon hauv / m, hauv / hauv. Tom qab tau txais kev pabcuam thawj zaug, koj yuav tsum saib xyuas tus mob rau ob peb hnub nrog kev ntsuas ntsuas qab zib tas li.
Yees duab ntawm hom 2 tshuaj mob ntshav qab zib:
Kev sib cuam tshuam ntawm PSM nrog lwm yam tshuaj
Hauv kev coj ntawm lwm cov tshuaj, lawv kev sib raug zoo nrog sulfonylurea derivatives yog coj mus rau hauv tus account. Cov tshuaj hormones anabolic, tshuaj tiv thaiv kab mob siab, beta-blockers, sulfonamides, clofibrate, txiv neej cov tshuaj hormones, roj ntsha, tetracycline tshuaj, miconazole, salicylates, lwm yam tshuaj hypoglycemic thiab insulin nce hypoglycemic effect.
PSM txo cov nyhuv ntawm corticosteroids, barbiturates, glucagon, laxatives, estrogens thiab gestagens, nicotinic acid, chlorpromazine, phenothiazine, diuretics, thyroid hormones, isoniazid, thiazides.
