Biguanides: kahi wehewehe i ka papa o nā lāʻau lapaʻau no ka maʻi maʻi

Hāʻawi ʻia ka papa papa o nā lāʻau lapaʻau no kēlā me kēia maʻi i kēlā me kēia maʻi. ʻO Biguanides nā lāʻau i hoʻolālā ʻia e hoʻohaʻahaʻa i ke kiʻekiʻe o ka glucose koko o ka maʻi maʻi. ʻO ka lāʻau lapaʻau e hoʻoiho i nā papa. ʻO ka pinepine pinepine ʻia ka lāʻau lapaʻau i ala no ka hana adjuvant therapy no nā mea maʻi e loaʻa ana i ka maʻi mellitus type 2. Me ka monotherapy, ʻaʻole pono nā lāʻau lapaʻau (5-10% o nā hihia). E kau ana nā Biguanides i ka hoʻohana palena ʻia ma muli o nā hopena hopena o ka maʻi ma lalo. ...

Me ka monotherapy, ʻaʻole pono nā lāʻau lapaʻau (5-10% o nā hihia). E kau ana nā Biguanides i ka hoʻohana palena ʻia ma muli o nā hopena hopena o ka maʻi ma lalo. ʻO ka dyspepsia Gastric kahi hopena hoʻopiʻi maʻamau ma kahi i kau ʻia ai kahi lāʻau lapaʻau.

Ke ʻano o ka hana a ka lāʻau lapaʻau

Me ka type type sugar 2, ʻike nui ka poʻe i lawe i ka biguanides i ka insulin, akā ʻaʻole hoʻonui i loko o ka hopena pancreatic. E kū'ē i ke kua o nā loli, e loaʻa ka piʻi i lalo o ka pae ʻai o ka insulin i ke koko o kānaka. ʻO kekahi kumu kūpono e hoʻomaʻamaʻa ai me ka metformin he emi iho o ke kaumaha kino o ka mea maʻi. I ka mālamaʻana me ka sulfonylureas, i hui pū ʻia me ka insulin, ʻo ka hopena e kū'ē i ka nalo ʻana o ke kaumaha.

Nā papa inoa o nā contraindications

ʻO ka poʻe i hoʻopili ʻia i ka hana kino kino (ʻo nā mea hoʻokūkū, nā mea kūkulu, nā limahana limahana) e hāʻule ai i ka pūʻulu kūlana. Loaʻa nā poʻe koʻikoʻi i ka hopena o ka lawe ʻana i ka lāʻau lapaʻau. Hoʻolaha ka ʻoihana me ke aʻo ʻana e noʻonoʻo me ka hoʻomaʻamaʻa i ke ʻano o ka naʻau.

Pehea lākou e hana ai

Ua hoʻohana ʻia ʻo Biguanides no ka maʻi maʻi mai ka makahiki 1970. ʻAʻole lākou e hana i ka hilahila insulin e ka pancreas. ʻO ka hana a kēlā mau lāʻau lapaʻau ma muli o ke kaohi ʻana o ke kaʻina gluconeogenesis. ʻO ka mea maʻamau ka maʻi maʻamau o kēia ʻano ʻo Metformin (Siofor).

ʻAʻole e like me sulfonylurea a me nā mea pono o kēia ʻano, ʻaʻole nā Metformin i hoʻohaʻahaʻa i ka glucose a ʻaʻole i hoʻoulu i ka hypoglycemia. He mea koʻikoʻi kēia ma hope o ka wikiwiki wikiwiki. Hoʻopaʻa ka lāʻau lāʻau i ka hoʻonui o ke kō o ke koko ma hope o ka ʻai ʻana. Hoʻonui ka Metformin i ka ʻike ʻana i nā pūpū a me nā ʻili o ke kino i ka insulin. Eia kekahi, hoʻomaikaʻi ia i ka komo ʻana o ka glucose i nā loko a me nā ʻili, e hoʻolōʻihi i kona kahe ʻana o ka i loko o ka ʻōpū.

Me ka hoʻohana mau ʻana, loaʻa nā hopena biguanides i ka momona metabolism. Ke hoʻolōʻihi nei lākou i ke kaʻina o ka hoʻololi i ka glucose i nā momona momona, a ma kekahi mau mea e hōʻemi ai i nā mea o nā triglycerides, cholesterol i loko o ke koko. ʻAʻole ʻike ʻia ka hopena o nā biguanides i ka haʻalele ʻana o ka insulin.

Hoʻokuʻu maikaʻi ʻia ka Metformin mai ka huehue ʻana a komo i loko o ke koko koko, kahi e loaʻa ai kona kiʻekiʻe kiʻekiʻe i nā hola ʻelua ma hope o ka hoʻomaʻamaʻa ʻana. ʻO ka hoʻopau hapa-hapalua ke ola a hiki i ka 4,5 hola.

Nā hōʻailona a me nā contraindications

Malia paha e hoʻohana i nā biguanides i hui pū me ka insulin. Hiki iā ʻoe ke hana iā lākou i hui pū me nā lāʻau lapaʻau haʻahaʻa.

Hoʻokomo ʻia ka lāʻau i ia mau hihia:

ʻO ka maʻi diabetes i hilinaʻi ʻia (koe me ka wā i hui pū ʻia me ka obesity),
ʻoki ʻia ka hana o ka insulin,
ketoacidosis
hana kūlea, hana i waiho i nā ahoʻā,
cardiovascular a me ka hanu pohō,
ewaī
humuho waiwa,
lactic acidosis,
hapai, hapai
nā meaʻai haʻahaʻa-haʻahaʻa (emi iho ma lalo o 1000 kilocalories i kēlā me kēia lā),
nā makahiki o nā keiki.

Pono e mālama ʻia ka hoʻopiʻi ʻana i nā biguanides i nā kānaka he 60 a keu ke ʻano he mau makahiki nui lākou. I kēia hihia, aia ka pilikia nui o ka hoʻomohalaʻana i ka coma comact lactic.

Nā hopena ʻaoʻao a me ka overdose

Ma kahi o 10 a 25 paha ka nui o nā hihia, nā maʻi e lawe ana i nā biguanides e ʻike i nā hopena ʻaoʻao e like me ka mea nui o ka metallic o ka waha, ka nele o ka momona, a me ka hanu. No ka hōʻemiʻana i ka hoʻomakaʻana o ka hoʻomohalaʻana i kahi mau hōʻailona, he mea nui ke lawe i kēia mau lāʻau lapaʻau me a i ʻole hoʻi maʻa o ka ʻai. Pono hoʻonui ʻia ka nui dosage.

I kekahi mau hihia, hiki i ka hoʻomohalaʻana o ka anemia megaloblastic, ka hapa cyanocobalamin. Kuhi loa, ʻike ʻia nā rashes pakanu ma ka ʻili.

I ka hihia o kahi overdose, hele mai nā hōʻailona acidosis lactic. ʻO nā hōʻailona o ke kūlana kēia nāwaliwali, nā pilikia hanu, nā hiamoe, ka puʻuwai, a me nā maʻi. ʻO ka hoʻomoʻoʻana o nā hiʻona, bradycardia, hypotension ka hoʻomaikaʻi. Hoʻomaʻamaʻa ka mālama ʻana i ka acidosis lactic.

Pono ka hoʻonā ʻana o ka lāʻau i kēlā me kēia manawa i kēlā me kēia. Loaʻa mau ʻoe i kahi glucometer ma ka lima. He mea nui hoʻi ia e mālama i ka mālama pono: pinepine nā hopena ʻaoʻao i ka ulu wale ʻana ma o ka hewa kūpono.

Pono e hoʻoulu ʻia ka hānai me nā biguanides ma kahi haʻahaʻa haʻahaʻa - ʻaʻole iʻoi aku ma mua o 500-1000 g i kēlā me kēia lā (no laila, 1 a i ʻole 2 mau papa o 0.5 g). Inā ʻaʻole i ʻike ʻia nā hopena kūpono, a laila hiki ke hoʻonui ʻia ke ʻano. ʻO ka nui loa o ka nui o ka lāʻau lapaʻau ma kēlā lā he 3 grama.

No laila, he maikaʻi maikaʻi loa ʻo Metformin no ka mālama ʻana a me ka pale ʻana i ka maʻi maʻi. Pono e hahai pono i ka ʻōlelo aʻo no ka hoʻohana ʻana i ka lāʻau lapaʻau.

Nā hōʻailona no ka hoʻohana ʻana

B. no ka mālama ʻana i ka maʻi mellitus no ka hoʻohana ʻana i: a) ma ke ʻano he ʻano kūʻokoʻa o ka mālama ʻana, b) i hui pū ʻia me ka mākaukau o sulfanylurea, c) i hui pū me ka insulin.

Ua hoʻokūpaʻa nā haʻawina hauoli i ka hiki o ka hoʻohana ʻana o B. no ka mālama ʻana i nā mea maʻi me nā ʻano like ʻole o ka maʻi mellitus, me ka ʻokoʻa o nā mea maʻi me ka ketoacidosis. Eia naʻe, ma ke ʻano he ʻano kūʻokoʻa o ka mālama ʻana B. hiki ke hoʻohana ʻia no nā ʻano maʻi ʻoluʻolu o nā maʻi maʻi i ka poʻe maʻi me ka momona nui.

Hoʻohana ʻia ka mālama ʻana o ka maʻi mellitus ʻoiola, e like me nā ʻano hana ʻē aʻe o ka mālama ʻana i kēia maʻi, ua hoʻokumu ʻia ma ke kānāwai o ka uku no nā maʻi metabolic. ʻAʻohe mea ʻokoʻa i ka papaʻaola a ka hāhai o ka papa maʻamau o nā mea maʻi me ka maʻi mellitus. I nā maʻi me nā kaupaona maʻamau, pono ia i piha i nā kalori a me nā mea hoʻohui, me kaʻole o ke kō a me nā huahana ʻē aʻe e loaʻa ana i ka hāmeʻomaʻu digestible (laiki, semolina, a me nā mea like) me ka ʻokoʻa o ke kō.

Hoʻomoʻa ʻia ka hopena hoʻohaʻahaʻa Sugar o B. i loko o kahi mau lā mai ka hoʻomaka ʻana o kā lākou hoʻohana.

I mea e loiloi ai i ka hopena o ka mālama ʻana, pono lākou e lawe no i ʻehiku mau lā. Inā ʻaʻole i alakaʻi ʻo B. ka hopena i ka uku o ka metabola, a laila pono e haʻalele ʻia ke ʻano o ke ʻano kūʻokoʻa.

Ka hana ʻana o ka lua ma kahi o B. i make: e like me ka Joslin Clinic (E. P. Joslin, 1971), i loaʻa ʻole ia ma ka 6% o nā maʻi. ʻO ka lōʻihi o ka hoʻokipa ʻana ʻana o B. i ka poʻe maʻi ʻokoʻa - 10 mau makahiki a ʻoi aku.

Ma ka hoʻomaʻemaʻe ʻana me ka hoʻomākaukau ʻana o ka sulfanylurea, hiki i ka hoʻohui o B. ke hoʻopiʻi i nā maʻi o ka metabola kahi o ka mālama ʻana me ka lālani sulfanylurea pono ʻole. Hoʻopau kēia mau lāʻau āpau i ka hana o nā mea ʻē aʻe: hoʻomākaukau ka sulfonylurea hoʻoikaika i ka huna ʻana o ka insulin, a me ka B. hoʻomaikaʻi i ka hoʻohana ʻana i peripheral glucose.

Inā hui ʻia ka hopena hui me ka sulfanylurea a me ka B. hoʻomākaukau, i hana ʻia i loko o 7-10 lā, ʻaʻole ia e hāʻawi i ka uku no ka maʻi metabolic, a laila pono e hoʻokaʻawale ʻia, a pono hoʻi e kuhikuhi ʻia ka insulin i ka mea maʻi. Ma ka hopena o ka hopena o ka hui pū ʻana me B. a me sulfonamides, hiki ke hōʻemi iki ʻia ka nui o nā hōʻuluʻulu ʻana o nā lāʻau ʻelua me ka hoʻohaʻihoʻi wikiwiki ʻana i ka B. ʻO ka nīnau no ka hiki ʻana o nā hōʻemi o nā lāʻau lapaʻau i lawe ʻia e kēlā me kēia os i hoʻoholo ʻia ma ke kumu o nā hōʻailona o ke kō a me ke kō a me ka urine.

I ka poʻe maʻi e loaʻa ana i ka insulin, hoʻohana nui ʻia ʻo B. hoʻohana i ka pono o ka insulin. I ka wā i kuhikuhi ʻia ai lākou i ka wā i hōʻea ai ke pae koko kōʻai maʻamau, pono ia e hoʻemi i ka nui o ka insulin i ka 15%.

Hoʻomaopopo ʻia ka hoʻohana ʻana o B. no nā ʻano like ʻole o ka maʻi o ka maʻi diabetes. Me kahi papa labile o ka maʻi i kekahi mau mea maʻi, hiki ke hoʻohana ʻia B. e hoʻokō i kekahi hoʻopaʻa ʻana i nā pae kōʻai koko, akā ma ka hapanui o nā mea maʻi ʻaʻole i emi ka hana o ka maʻi maʻi maʻi. ʻO nā kumu hypoglycemic B. ʻaʻole kumu.

Hoʻomākaukau ʻo Biguanide a me kā lākou hoʻohana

Ma muli o ka kokoke i ka hopena o ka hopena therapeutic o B. i nā mea huʻala, ʻo ka loiloi maʻamau o ka mālama ʻia ʻana o B. me ka hoʻohana ʻana i nā dosis liʻiliʻi i ka hoʻomaka ʻana o ka mālama ʻana me kā lākou ulu aʻe ma kēlā me kēia mau lā he 2-4 e pili ana i ka hoʻomanawanui maikaʻi. Pono e hoʻomākaukau koke i nā mākaukau āpau K. ma hope o ka ʻaina e pale ai i nā hopena mai ka ʻaoʻao o ka melemele. kalepa.

B. lawe ʻia ma ke poʻo. Hoʻomoʻa lākou i loko o ka wahī liʻiliʻi a hoʻoili koke ʻia i nā ʻāpana. ʻO ko lākou nānā ʻana i ke koko ma hope o ka loaʻa ʻana o nā dosis therapeutic e hōʻea wale ana i ka 0.1-0.4 μg / ml. Ka mālama nui ʻana o ka B. i mālama ʻia i nā ʻeha, nā ate, nā kelepaʻe adrenal, nā pancreas, nā kō. kope, ʻōlelo ʻana. A hoʻoholo i kekahi helu liʻiliʻi o lākou i ka lolo a me ka pili adipose.

Hoʻopili ka Phenethylbiguanide i nā N'-p-hydroxy-beta-fenethylbiguanide, dimethylbiguanide a me butylbiguanide ʻaʻole metabolized i loko o nā kānaka. Hoʻokahi hapa hapakolu o ka phenethylbiguanide i kahi mea metabolite, a ua loli ʻole nā hapakolu ʻelua.

B. kaomi i ka urine a me nā feces. Wahi a Beckman (R. Beckman, 1968, 1969), ke loaʻa ana ka fenethylbiguanide a me kāna metabolite i ka urine ma ka nui o 45-55%, a me ka butylbiguanide - ma ka nui o 90% o nā inika 50 mg i lawe hoʻokahi, ua hōʻike ʻia ka dimethylbiguanide i ka urine no 36 hola i ka nui o 63% o ka hapa nui i lawe ʻia ʻia, ʻaʻole e kau ʻia o ka ʻāpana o ka B. he excreted me nā feces, me kahi ʻāpana liʻiliʻi kekahi o lākou, ka mea i komo i loko o nā ʻāpana me ka bile. Ka hapalua biole hapalua, hana a B. i apono. 2.8 hola.

ʻO ka hopena o ke kōpaʻa haʻahaʻa o B., hana ʻia i loko o nā papa, hoʻomaka e hōʻike iā ia iho i loko o nā hola 0.5-1 ma hope o ko lākou hakina ʻana, e loaʻa ka hopena nui ma hope o nā hola 4-6, a laila e emi ka hopena a kū i nā hola 10.

Phenformin a me buformin i loaʻa i nā capsules a me dragees, hoʻolako i ka hoʻōla lohi ʻana a lōʻihi ka lōʻihi. B. ʻO ka mākaukau o ka hana lōʻihi hiki ke emi iki i nā hopena.

Phenethylbiguanide: Phenformin, DBI, nā papa papa 25 mg i kēlā me kēia lā he 50-150 mg no nā dosis he 3-4, DBI-TD, retard Dibein, nā kāpena Dibotin, Insoral-TD, retard o DBI, nā kālele Diabis, DB retard (capsules a i ʻole dragees no 50 mg, kahi meli o kēlā me kēia lā o 50-150 mg, kēlā, ma 1-2 mau lā i kahi lā me kahi manawa o 12 mau hola.).

Butyl Biguanide: Buformin, Adebit, nā papa o 50 mg, nā pākaukau o 100-300 mg i kēlā me kēia lā no 3-4 mau dosis, Silubin retard, dragee o 100 mg, pākana o 100-300 mg i kēlā me kēia mea, 1-2 mau manawa i ka lā me kahi wā o 12 mau hola. . ^ E Ha yM.

Dimethylbiguanide: Metformin, Glucofag, nā papa o 500 mg, kēlā me kēia lā - 1000-3000 mg in 3-4 dosis.

Loaʻa i ka hopena o nā biguanides hiki ke hōʻike ʻia e nā ʻano mau ʻāhewa mai ke alo o ka melemele-quiche. pāwili - ka ʻaha metallic i loko o ka waha, ka nalowale o ka makemake, nausea, luaʻi, nāwaliwali, nā ʻeha ʻana. Pau loa kēia mau hewa i ka haʻalele ʻana i ka lāʻau. Ma hope o kekahi manawa, hiki ke hoʻokele ʻia ke alakaʻi ʻana o B., akā ma nā haʻahaʻa haʻahaʻa.

ʻO ka hōʻeha hōʻino ma nā palu a me nā pēpē i ka mālama ʻana o B. ʻaʻole i wehewehe.

Ua ninaninau ka puke i ka nīnau o ka hiki ke hoʻomohala ʻana i ka hoʻōla lactic ma nā mea maʻi me ka maʻi mellitus no ka mālama ʻana i ka B. ʻO ke Kōmike no ka Nānā Non-ketonemic Metabolic Acidosis ma Diabetes Mellitus (1963) i hoʻomaopopo i ka mālama ʻana o B. ka pae o ka hoʻōla lactic i ke koko o nā mea maʻi e hoʻonui iki aʻe.

ʻO ka acidosis Lactic me kahi kiʻekiʻe o ka waikawa lactic i loko o ke koko a me ka hoʻokahe ʻana i ke koko pH i nā maʻi maʻi maʻi diabetes loaʻa ka B. he loaʻa - ʻaʻole pinepine loa i loko o nā mea maʻi ʻaʻole i loaʻa kēia mau lāʻau.

ʻO ka maʻi, ʻo ka maʻi lactic acidosis e hōʻike ʻia e kahi kūlana koʻikoʻi o ka mea maʻi: kahi kūlana o ka prostration, Kussmaul ka hanu, ka piko, hiki ke hoʻopau i ka make. ʻO ka pilikia o ka hoʻomohalaʻana i ka acidosis lactic i nā mea maʻi me ka maʻi diabetes i ka wā o ka mālamaʻana i ka B. e ala inā he ketoacidosis, cardiovascular a i ʻole kaulike, a me kekahi mau kumuhana ʻē aʻe e ulu pū me nā maʻi microcirculatory a me ka hypoxia kiko.

Nā Hoʻohui

B. contraindicated i ka hihia o ka ketoacidosis, ka huhū cardiovascular, hoʻokō ʻole o ka pilikia, nā maʻi febrile, i nā wā preoperative a postoperative, i ka wā hāpai.

Pūnaewele: ʻO Vasyukova E.A. a me Zephyr o v a G.S. Biguanides i ka mālama ʻana i ka maʻi diabetes. Klin, miki., T. 49, Helu 5, p. 25, 1971, bibliogr., Diabetes mellitus, ed. V.R. Klyachko, p. 142, M., 1974, bibliogr., Me z i z at k A. a. e pili ana. Hopena o nā biguaniaes ma ka hoʻopiʻi ʻana o ka pōpū o glu-kose, Diabetes, v. 17, p. 492, 1968, K r a 1 1 L. P. Ka hoʻohana kino ʻana i nā ʻaina hypoglycemic waha, i: Diabetes mellitus, ed. na M. Elienberg a. H. Rifkin, p. 648, N. Y. a. o., 1970, Williams R. H., Tanner D. C. a. E pili ana i d e 1 1 W. D. Hypoglycemic hana o ka phenethylamyl, -and isoamyl-diguanide, Diabetes, v. 7, p. 87, 1958, Williams R. H. a. o. ʻO nā haʻawina e pili ana i ka waogogogogogogogiko o ka pethethyldiguanide, Metabolism, v. 6, p. 311, 1957.