ʻO nā hopena waiwai nui o ka glucocorticoids

ʻAʻole he mau makahiki o ka ʻike me nā lāʻau lapaʻau glucocorticoid i nā maʻi like ʻole i nā keiki i hōʻike ʻia ʻaʻole wale nō ka hopena maikaʻi, akā nā mea kino ʻole o kēia ʻano o ka hopena. Ua ʻike ʻia aia ma kekahi mau mea maʻi, he mau iki a me ka laha i ke ʻano a hemo ʻole ʻia.

I loko o nā keiki'ē aʻe, ma hope o ka hoʻopau ʻia ʻana o ka māka glucocorticoid, ʻo nā mea hoʻopiʻi i hōʻea ʻia, i kekahi manawa koʻikoʻi nui, hoʻomau i nā makahiki he nui, a i kekahi manawa i ke ola. ʻO ke ʻano a me ke kaumaha o nā hopena maikaʻi loa a me nā hoʻopiʻi kau ʻia e hilinaʻi i kēlā me kēia lā a me ka lōʻihi o ka papa o ka mālama ʻana me nā lāʻau lapaʻau glucocorticosteroid, ka makahiki o ke keiki a me nā hiʻohiʻona pilikino o ka hoʻohua ʻana o kona kino.

ʻO ka paʻakikī o nā mīkini e hoʻohālikelike ʻia e ka glucocorticosteroids, no ka mea ua komo kēia mau lāʻau i nā mea āpau o ke ʻano nui o ke kino o ke keiki. Eia nō naʻe, hiki ʻole i kekahi ke kamaʻilio e pili ana i ka hopena o ka ʻāʻī a me ka hopena o kēia mau lāʻau, e pili ana i ko lākou hiki ke hōʻole i ke ʻano o ka pale ʻana, e hōʻoli i ka wahī a pale aku i nā hana hoʻoponopono i loko o lākou, me ka huhū loa i ka metabolism. ʻO nā hopena maikaʻiʻole a me nā hōʻemi i ka mālamaʻana i nā keiki me nā glucocorticosteroids hiki ke like me lalo.

1.ʻO kekahi o nā hōʻike pinepine o ka lāʻau hypercorticism i kūkulu ʻia i loko o ke kino o ke keiki ʻo ia ʻo Cushoid syndrome: kaupaona momona me nā hōʻailona o kahi momona ʻokoʻa (ka puni i ka maka, ka hōʻemi ʻana i ka momona ma ka maka, ʻāʻī, nā poʻohiwi, ʻōpū) e hui pū me ka hypertrichosis, ka ʻeu ʻana a i ʻole ka maloʻo, kā kāna pigmentation, hoʻonui ʻia vascular pattern o ka ʻili, ke ʻano o ka huehue a me ka striae.

Hoʻonui ka momona o ka momona (male type obesity) a me ka hopena catabolic o nā huahana glucocorticosteroid, hoʻonui i nā kaʻina gluconeogenesis, a me ka hoʻololi ʻana o nā huikala i nā momona. ʻO ka hōʻikeʻana i nā kaʻina hoʻonaninani momona e hoʻoikaika ʻia e ka ulu ulu ʻana he mea nui nō hoʻi.

2. ʻO ka hopena hoʻonāukiuki pinepine e pili ana i ka hoʻokō ʻana o nā glucocorticosteroids ka mea i kapa ʻia ʻo ka gastritis steroid, ka mea i hōʻike ʻia e ke kīleʻe ʻana i ka ʻai, naʻau, ʻona, kekahi manawa ʻauʻau, ka waikamu waikawa, ʻehaʻeha ma ka wahi o epigastric.

ʻO kahi hoʻonāukiuki ma ke ʻano o ka ʻōpū a me nā ʻōpū o ka ʻōpū a me ka duodenum ka hiki nō (hiki pū nō hoʻi i loko o nā ʻāpana liʻiliʻi a me nā ʻōpū nui). ʻO nā ʻōpū a me ka ʻeha o ka ʻōpū, paʻakikī i kekahi manawa e ke koko a me ka perforation. Pono e haʻi ʻia he ʻōpū o ka ʻōpū a me ka ʻōpū ma ka papa mua o ko lākou kūkulu ʻana i ka asymptomatic, a me kahi hōʻailona o kā lākou ola he hopena kūpono i ke koko kulekele i ka pōpoki.

ʻO nā manawa pinepine aʻe, ʻike ʻia nā hōʻeha gastrointestinal ma hope o ka lawe ʻana i nā lāʻau lapaʻau glucocorticosteroid i loko, ʻoiai ko lākou hoʻomohala ʻia, ʻaʻole i haʻalele ʻia me ka hoʻoponopono makua makua o kēia mau lāʻau. ʻO ka ulu ʻana o ke kaʻina ulcerative i ka wā e kuhikuhi ai i ka prednisone a me ka prednisone, aemaise i ka hui pū me nā ʻaina ulcerogenic (immunosuppressants, acetylsalicylic acid, tetracyclines, etc.).

ʻO nā hana ʻē aʻe e kōkua i ka hiki ʻana o nā ʻōpala:

· K lawe ʻia nā glucocorticosteroids ma mua o ka ʻai,

ʻO ka mālama lōʻihi ʻana i nā papa kiʻekiʻe o nā lāʻau lapaʻau me ka ʻole ke alualu o ka mālama ʻana,

· Ke kāohi ʻole ʻole eʻai me ka meaʻai i ka wā o ka hopena o ka glucocorticosteroid therapy (ka komo ʻana o ka pā anuanu a me ka hoʻonāukiuki i nā meaʻai, nā mea ʻala, ke anuanu a me nā meaʻai wela, a).

ʻO ke Glucocorticosteroids ke kumu o ke kūkulu ʻana i nā ʻōpū o ka ʻōpū a me nā ʻōpū ma muli o nā kumu:

· Ke hoʻonui nei lākou i ka acidity a me ka hoʻokahe ʻana o ka wai gastric a i ka manawa like a hoʻonāukiuki i ka hoʻokumu ʻana o ka huile, ka mea e pale ai i ka membous mucous o ka ʻōpū a me nā ʻōpū mai nā hopena maikaʻi ʻole (ke ʻano o ka synthesis o ka polysaccharides e hoʻomālamalama i nā membrane o ka ʻōpū a me ka ʻāʻī ʻia i hoʻopā ʻia).

· Hoʻomaikaʻi ʻia ka Glucocorticosteroids i nā ʻōnaehana hoʻōla a nā ʻōpio a me nā ʻākio macro o ka ʻōpū a me nā ʻōpū, ʻo ia hoʻi, ma lalo o kā lākou mana ka hoʻomaʻamaʻa ʻana o nā sela o ka huapalapa a me ka hono o nā pā o kēia mau kino. ʻO ka ala asymptomatic (painless) o ke kaʻina ulcerative e wehewehe ʻia e ka ʻoiaʻiʻo no ka ulceration e kūʻē i ke kūmua o ka hopena anti-inflammatory o ka lāʻau glucocorticosteroid.

3. Ma ke kaʻina hana o nā lāʻau lapaʻau glucocorticosteroid, hiki ke ʻike i ka maʻi o ka maʻi puhipuhi (tonsillitis, sinusitis, decay niho, cholecystitis a me kekahi) ʻO nā hihia o ka maʻi pneumonia a me ka suppuration pulmonary o ka autoinfectious kumu, exacerbation o nā maʻi maʻi (hepatitis, cholecystitis, pancreatitis, tuberculosis a me nā mea ʻē aʻe) e wehewehe.

Ua hoʻomaopopo ʻia ka koho ʻana o nā glucocorticosteroids i kahi ala koʻikoʻi o nā maʻi o ka maʻi i nā keiki, ke hopohopo nui nei i ka hopena o ka pale ʻana. ʻO nā hopena ʻawaʻī i hōʻike ʻia ma luna nei e wehewehe ʻia ana e ka hiki o ka glucocorticosteroids e kāohi i ka ʻōnaehana o ka systemic a me nā kūmole pale pale.

4. I ka hopena me ka glucocorticosteroids, hiki ke loli i ka naʻau a me ka naʻau ʻana: ka hana ʻana i ka naʻau, logorrhea, ʻōpū psychomotor, hana hoʻomoe. Ua hoʻololi ʻia kēia mau loli i nā keiki.

5. ʻO ka hopena pākuʻi pinepine me ka glucocorticosteroid therapy he hoʻonui i ke koko. Ma hope o ka hoʻokuʻu ʻia mai ka haukapila, ka ulu ʻana o ka maʻi hypertension ma ka mea maʻi ma waena, ʻoiai i kekahi mau keiki ka nui o ka hoʻonui ʻana i ke koko ma o 15 - 20 mm RT. ʻAniā. e hoʻomau nei no 1 i 3 mau makahiki i ka hala ʻole ʻana o kekahi hoʻopiʻi (A. V. Dolgopolova, N. N. Kuzmina, 1963).

Ke hoʻomohala nei ka hana o ka hypertension arterial i ka lāʻau lapaʻau hypercorticism. ʻO ka pinepine pinepine ʻia ʻo ia ʻano hana ma ka prepubertal a me ka wā ʻōpiopio.

6. ʻO kekahi glukocorticosteroids (cortisone, hydrocortisone, prednisone, prednisone) i hiki ke paʻa i ka sodium a me ka wai i loko o ke kino o ka mea maʻi, ka mea i hāʻawi ʻia i ke ʻano o ka edema a hoʻonui i ke kaumaha o ke kino. Kēia huahana glucocorticosteroid lāʻau e like me dexamethasone, triamcinolone, methylprednisolone ke hoʻomake i ka sodium a me ka wai.

7.Me ka nunui a me ka lōʻihi o ka lāʻau glucocorticosteroid i nā kaikamahine ʻōpio, ʻike pinepine ʻia nā pilikia endocrine: ka lōʻihi o ke kau ʻana o ke menstruation mua, ko lākou ʻano liʻiliʻi, i ke kū ʻia ʻana. Pono e helu pū me kēia a me ka ʻole o nā hōʻike koʻikoʻi, ʻaʻole i kuhikuhi i nā lāʻau lapaʻau i nā kaikamahine i ka wā ʻōpiopio, e kāpae iā lākou i ka wā e kū ʻia mai ai nā hōʻailona mua o kēia mau hōʻino.

8. Hāʻawi ka puke i nā hōʻike ʻana ma lalo o ka mana o ka hoʻomohala lōʻihi o nā lāʻau glucocorticosteroid, hiki ke ulu ʻia ka ulu ʻana o ka kino o ke keiki. Ua wehewehe ʻia kēia ʻano hoʻohālikelike e ka hopena o ka pale o ka glucocorticosteroids ma ka hana ʻana o ka ulu ulu ʻana e ka gland pituitary a me ka hoʻokumu ʻana o somatomedin i loko o ka puʻuwai, he hoʻonui i nā kaʻina catabolic i loko o nā pā, a me ka iwi.

9. I ke wā kamaliʻi, hiki i ka diabetes mellitus ke ulu mai i ka hopena o nā glucocorticosteroids mai prediabetes.

Hoʻohālikelike ka hana o ke kūkulu 'ana o ka maʻi diabetes i nā hiʻohiʻona o nā hana a ka glucocorticosteroid lāʻau e pili ana i ka metabolism o ka paʻakai: pale lākou i ka hana o ka apana insular o ka pancreas, hoʻowalewale i ka hana ʻana o nā protein plasma i hoʻopaʻa ʻia, hoʻoneʻe i ke kaʻina hana o ka glucose mai nā waikina amino a i ka manawa like hoʻonāwaliwali i ka hoʻohana ʻana o nā mau kālaiia e nā kiko.

ʻO ka mea hope loa, hoʻomohala hyperglycemia a me glucosuria, a i loko o nā keiki me ka hoʻoilina hoʻoilina o ka mea hana insular - diabetes. I ka hapa nui o nā mea maʻi, ma hope o ka lawe ʻia ʻana o nā glucocorticosteroids, nā hana i hoʻoneʻe iki ʻia o ka pehu. Hiki iā Dexamethasone ke kumu i ka hoʻopiʻi nui ʻana i nā hana ʻino i ka hoʻoliʻi o ka hoʻoliʻi, ka liʻiliʻi ma mua o ka triamcinolone, methylprednisolone, prednisolone, prednisone. ʻO ka minamina diabetesogen ʻano ʻano o ka cortisone a me ka hydrocortisone.

10. Hoʻonui pinepine ʻia kahi hopena hoʻonāukiuki o ke kino o ke keiki i ka hoʻoponopono ʻana o ka glucocorticosteroids i ka excretion o ka pāima i loko o ka urine a me ka hoʻomohala ʻana i ka maʻi hypokalemic.

Nā hōʻailona o nā mea hope: ka manaʻo ʻana i nā nāwaliwali, malaise, nā nalowale o ke kani ikaika a me ka ikaika (i kekahi manawa paresis o nā manamana), nāwaliwali o ka hana myocardial, arrhythmia cardiac, nausea, luaʻi, constipation.

Hiki i ka ulu ʻana o ke ʻano hypokalemic hoʻonui me ka hoʻomoe ʻana o nā glucocorticosteroids i hui pū me ka glycosides cardiac a me ka diuretics, ʻoiai ke nānā ʻole ʻana i ka meaʻai me ka nui o ka uku pākōnika no ka pāʻai o ka pāpaʻomaʻi ma muli o ka hoʻokō hou ʻana o nā lāʻau haumanika i loaʻa i ka lāʻau chemotherapy.

11. Ua hōʻiliʻili ʻia nā ʻike loea he nui e hōʻike ana i nā hopena maikaʻi ʻole o nā lālani glucocorticosteroid ma ka ʻaoʻao o ka huelo o ke kino o kahi keiki e ulu nei. Hōʻike ʻia ka osteopathy Steroid i ka hiʻohiʻona o oopoporosis o nā iwi tubular lōʻihi loa, nā iwi a me nā kino vertebral. Hoʻomaka pinepine, hoʻomohala ʻia ka hoʻomohala ʻana o ka kartilage epiphyseal, i kekahi manawa ke ʻike ʻia nā hōʻailona o ka aseptic necrosis o nā iwi.

ʻO kahi hoʻopiʻi koʻikoʻi loa ʻo brevispondylia: ka hana ʻana o nā ʻāpana vertebrae (ma muli o ka luku ʻana i nā kino o ka vertebral a me nā disc intervertebral), i ukali ʻia ma ka hiki ke hōʻeha ʻana i nā aʻa o nā iwi, kahi kuʻi o ka kuʻi, a me ka hoʻopiʻi ʻana o ka mokuloka.

ʻO ka osteopathy Steroid ka hopena o ka hana hewa loa i ka hoʻopili ʻana o nā hoʻoponopono o ka protein i ka iwi o ka iwi (kahi hōʻemi i ka nui o ka kolagala, mucopolysaccharides, hexosamine), hoʻonui i nā kaʻina o ka reabsorption o ka calcium mai ka iwi ʻeha a me ka nui o ka excretion o ia a me ka phosphorus i ka urine. ʻO nā kaʻina reparative ma ka iwi o ka poʻe maʻi me ka osteopathy steroid e hōʻike ʻia e ka lethargy a me ka lōʻihi.

12. I kekahi mau mea maʻi, hoʻomohala ʻia myopathy ma lalo o ka hopena o nā lāʻau lapaola glucocorticosteroid.

Nā hōʻailona o kāna: nāwaliwali o ka naʻau (ma ka nui o nā haʻahaʻa haʻahaʻa haʻahaʻa a me nā ʻōpala o nā ʻōpala), hypotension, hoʻemi ʻia ka tendon reflexes. I ka hoʻokolohua, hiki iā ʻoe ke hoʻomaopopo i nā hōʻailona o ka hypertrophy o ka māla, ka mea nui o nā haʻahaʻa haʻahaʻa haʻahaʻa (ʻo nā kūmole glycogen ma ka nui o nā ʻōpū e hoʻonui). ʻO ka kipi ʻana o ka hoʻonohonoho o nā neuromuscular synapses i hōʻike ʻia. ʻO ka Triamcinolone e pili ana i ka fluorine pinepine i ka myopathy. ʻO Sopido myopathy ma hope o ka haʻalele ʻana i ka lāʻau e nalowale i ka nalo, a hoʻihoʻi ʻia ka hana a me nā ʻano o nā ʻōpū i ka ana.

13. ʻO ka hoʻohana ʻana o ka glucocorticosteroids (ʻoi aku paha i nā hihia o ka hoʻokō lōʻihi o ka nui o nā lāʻau lapaʻau nui) me ka pōʻino o ka hoʻopiʻi ʻana mai nā kumumanaʻo o ka hihiʻo i ke ʻano o ke ao ʻana o ka manamana a me ka glaucoma. Hiki ke loli a hoʻololi ʻia i loko o ka lewa ma muli o ke hoʻopili ʻana o ka haʻalulu kūlohelohe, ka koi ʻana o ke kua o ia. ʻO ke kiʻi ʻo Glaucoma i kona wā kamaliʻi.

14. ʻOiai nā lāʻau lapaʻau glucocorticosteroid he mea ikaika i ka lāʻau lapaʻau i loko o nā maʻi āpau, i kekahi mau hanana a lākou iho e ulu ai i nā maʻi kūlohelohe, a hiki i ka anaphylactic shock. Hōʻike pinepine ʻia kēlā mau ʻano me ka hoʻāʻo hou ʻia o ka hoʻāla ai o ka glucocorticosteroid a hōʻike aku iā lākou iho i ke ʻano o ka urticaria, edema ʻo Quincke, erythema multiforme, ʻiliʻeha a me nā hōʻailona ʻē aʻe.

15. ʻO ka hoʻohana lōʻihi ʻana i ka lāʻau hoʻōla o ka glucocorticosteroid me ka hopena o ka hopena o ka hypercorticism pharmacogenic me ka pilikia o ka hoʻololi ʻana i ke hana o ke kōpili cortical o nā kelepa adrenal a me ka hoʻihoʻi hou ʻana i ka ʻoihana hypothalamic-gynephysial-adrenal.

E pale aku i kēia kiʻi, me ka hoʻokaʻawale koke ʻana i ka lāʻau, hiki i ka hōʻemi ke ala i ka ulu ʻana i ke ʻano o ka hoʻouka ʻana i ka nāwaliwali loa, nāwaliwali, ka ʻeha, ka hōʻemi o ka noʻonoʻo a me ka hana kino, a me ka hoʻonui ʻana i ka pākū.

Hoʻomaʻamaʻa iki ka hila hulihue i nā hihia ke pani ʻia ka hoʻomoka ʻana o nā dosis nui o ka glucocorticosteroids me ka ʻole o ka hoʻomākaukau hoʻomākaukau ʻana i ke kino o ka mea maʻi, ʻo ia hoʻi, me ka loaʻa ʻole o ka hoʻohaʻahaʻa iki i kēlā me kēia lā o ka lāka, ka hoʻopuka hou ʻana i nā aelike chemotherapeutic e hoʻoulu i ka hana o ka adrenal cortex.

No laila, ʻike ʻia ka hui o ka lāʻau glucocorticosteroid, ʻaʻole wale nō i nā hopena therapeutic ikaika i ke kino o ka mea maʻi, akā nō hoʻi he mau mea ʻino maikaʻi ʻole, koʻikoʻi a me ka ʻano maoli ia i pili i ka lāʻau lapaʻau iho, ka ʻano o kāna hoʻohana, ka makahiki a me nā kāne o ke keiki, a me nā mea'ē aʻe, akā ʻaʻole i aʻo ʻia.

Hiki i ke lapaʻau lāʻau lapaʻau no HA ke kūleʻa (pōkole), palena iki (no kekahi mau lā a mau mahina paha) a me ka lōʻihi (ʻo ka mālama ʻana no kekahi mau mahina, mau makahiki paha, a ʻo ke ola paha kekahi).

ʻAʻole i ʻike i ka mea āu e ʻimi nei? E hoʻohana i ka huli:

Nā hopena ʻokoʻa o nā glucocorticoids systemic

Papa o nā manaʻo

Nā hopena hopena
■ Hōʻike i ka hana a me ka hoʻopili o ka cortex adrenal, hiki i ka steroid dependence, "withdrawal syndrome" (exacerbation of the underlying disease, adrenal insufficiency). ʻO ka lōʻihi o ka hana me ka glucocorticoids systemic, i ka hoʻokō ʻia me ka ʻole e noʻonoʻo i nā puʻupuʻu circadian o ka pilikino o kā lākou huna, e alakaʻi i ka pale ʻana a me ka atrophy o ka cortex adrenal. No ka hoʻopau ʻana i ka cortex adrenal i ka maʻi pākeke, ʻo nā lā o kēlā me kēia lā o ka exogenous glucocorticoid e lilo i 10-20 mg e pili ana i ka prednisone. Hoʻomaka ka hana ma ka hana o ka cortex adrenal ma ka lā 4 - 7 ka lā o ka hoʻohana ʻana i kēlā me kēia lā i nā pona he nui o nā glucocorticoids i kuhikuhi ʻia i ke kakahiaka a mai ka lā 2 i kuhikuhi ʻia ai i ke ahiahi. ʻO kēia hopena ka hopena o ka hiʻohiʻona o ka glucocorticoids waha lōʻihi ka hana a me ka hoʻomākaukau ʻana i depot. E hoʻihoʻi i ka hana pilikino maʻamau o ka cortex adrenal, aia ka liʻiliʻi ma 69 mau mahina, a ʻo ka pane kūpono ʻana i ke kaumaha ma kahi o 1-2 mau makahiki.

■ Kāneʻili o ka ʻili, striae, baldness.
■ Osteoporosis, hana hoʻopalapula a me nā nekrosis aseptic o nā iwi, hoʻoulu. Hoʻokumu ka Osteoporosis i ka 30-50% o nā maʻi a ʻo ka hoʻopiʻi koʻikoʻi loa ia o ka hopena glucocorticoid. ʻO ia ma muli o kā lākou hopena maikaʻi ʻana i ka hoʻokumu ʻana o nā iwi iwi a me ka hana ʻana o kona hoila hou ʻana. Hoʻou pinepine pinepine i nā wahine i ka wā postmenopausal. Ma ke ʻano he kānāwai, e pili ana ka osteoporosis i nā ʻāpana o ke kumulāʻau (spine, pelvic bone, rib) a me ka ulu iki ʻana i nā iwi peripheral (lima, wāwae, a ʻokoʻa). nā keʻena), nā iwi, nā ʻehā wahine, ke ala mai nā hōʻeha liʻiliʻi a i ʻole ke kīnā. No ka mālamaʻana i kēia hoʻopiʻi, ka hoʻomākaukau ʻana o ka calcium, nā vitamin D3, ka calcium selinin, a me nā bisphosphonates. Pono mau makahiki o ke ʻano ʻoi ʻana i nā makahiki he mau makahiki.
• Hoʻopau i nā mikopa, hoʻoulu ʻia ka mākala, myocardial dystrophy. Hōʻike ʻia ka myopathies Steroid e ka nāwaliwali a me ka hoʻohuihui o nā ʻili o nā iwi, a me nā ʻōpū o ka ea (intercostal muscles, diaphragm), ka mea i hāʻawi ʻia i ka hana hou ʻana o ka hanu. I ka manawa pinepine, ʻo kēia hoʻopiʻi e hoʻokau ai i ka triamcinolone. Hoʻohui ka hana o ka hoʻomohala ʻana i nā myopathies me ka hopena maikaʻi loa o ka glucocorticoids i ka protein a me ka metabolism mineral. Hoʻohana ʻia nā steroid anabolic a me nā hoʻomākaukau potassium no kā lākou mālama ʻana.
■ Hypokalemia, sodium a me ka mālama ʻana o ka wai, edema he mau hōʻike o ka hopena mineralocorticoid o nā glucocorticoids.
■ Hiki ke mālama ʻia kahi hoʻonui o ke koko i ka poʻe maʻi e lawe ana i nā glucocorticoids i nā manawa lōʻihi. ʻO ia ma muli o ka hoʻonui pinepine ʻana o ka paia vascular i catecholamines, sodium a me ka mālama o ka wai.
■ ʻO ka hōʻino i ka pā vascular me ka hoʻomohala ʻana i ka "steroid vasculitis" kuʻi pinepine ʻia e nā lāʻau lapaʻau (dexamethasone a triamcinolone). Hōʻano ʻia ia me ka hoʻonui ʻia o ka vascular permeability. Ua hōʻike ʻia e nā hemorrhages i loko o ka ʻili o ka manamana, nā mehameha o ka waha o ka waha, conjunctiva o nā maka, epithelium o ka ʻeha gastrointestinal. No ka mālamaʻana, hoʻohana ʻia nā huamina C a me P, a me nā mea hou anti-bradykinin.
■ Hiki i ka hoʻonui ʻana i ke kō me ke koko hiki ke alakaʻi i ka hoʻokumu ʻana o nā māho koko ma nā puʻu hohonu a me ka thromboembolism.
■ Ke hoʻolei nei i ka hoʻōla ʻana o ka kaila ma muli o nā hopena anti-anabolic a me ka catabolic i ka metabolism protein - hōʻemi i ka synthesis o ka protein mai nā waikena amino, e hoʻonui ai i ka hōʻea o ka protein.
■ O nā ʻōpū hōkē o ka ʻōpū a me nā puʻuwai, ka koko o ka gastrointestinal. ʻO nā ʻeha Steroid pinepine pinepine i ka asymptomatic a asymptomatic, hōʻike i ke koko a me ka perforation. No laila, ʻo nā mea maʻi e loaʻa ana i ka glucocorticoids waha no ka manawa lōʻihi e nānā pono ia iā ʻoe i kēlā me kēia manawa (fibroesophagogastroduodenoscopy, hoʻokolohua koko kulekele fecal). Hoʻohui ka hana ʻana o ka hana ulcerogenic o ka glucocorticoids me kā lākou hopena catabolic a me ka pani ʻana i ka synthesis o ka prostaglandin a ua hana i ka hoʻonui ʻana i ka huna ʻana o ka wai hydrochloric, e hōʻemi ana i ka hana o ka mucus a me ka hoʻohiolo ʻana i ka hoʻoponopono hou o ka epithelium. ʻO kēia hoʻonāukiuki pinepine pinepine ʻia e ka prednisone.
■ ʻO ka pancreatitis, ka momona momona, nā momona, ka hyperlipidemia, hypercholesterolemia, ka embolism momona ka hopena o ka hopena anabolic o glucocorticoids ma ka momona metabolism - hoʻonui i ka synthesis o ka triglycerides, momona momona a me ka kolamu, ka hāʻawi hou ʻana o ka momona.
■ Hoʻopili i ka CNS excitability, insomnia, euphoria, kaumaha, psychosis, hōʻailona o ka meningism, hopu ka mea maʻi i nā maʻi me ka epilepsy.
■ Uhiʻiʻi ʻia nā hua catapsular, glaucoma, exophthalmos.
■ ʻO ka maʻi diabetes, ka maʻi hyperglycemia. Hoʻonui ka Glucocorticoids i ka hoʻopoʻi o nā mea neʻe mai ka gastrointestinal tract, hoʻonui i ka gluconeogenesis, hoʻemi i ka hana o ka insulin a me ka hexokinase, a hoʻohaʻahaʻa i ka hoʻāʻo ʻana i nā io i ka insulin a me kā lākou hoʻohana ʻana i ka glucose. No ka mālamaʻana i ka maʻi diabetes, kahi lāʻau i hoʻopaʻa ʻia e ke kalaiwa ʻana, ka lāʻau hypoglycemic oral, a me ka insulin e hoʻohana ana.
■ ʻO ka hana hewa o ka hānō, ka hana moe, ka hoʻomohala ʻana i ka moekolohe, ka hana hoʻolimalima, ka ulu ʻana o ka hoʻouluulu ʻana i ka wahine pili me ka hoʻohaʻahaʻa ʻana i ka hana ʻana o nā hormones sex.
■ ʻO ka manaʻo o ke kūleʻa ʻana, ka hoʻomāhuahua ʻana i nā maʻi a me nā hana kūwaho, ʻo ia hoʻi ka maʻi pāpaʻi, ka maʻi lua, ka wā ākea o ka maʻi kūloko. Ma ke ʻano he kānāwai, he mau asymptomatic hoʻopiʻi ma muli o ka hopena anti-inflammatory o ka glucocorticoids. ʻO ka hoʻomohala o nā candidiasis o ka waha waha a me ka pharynx ka mea maʻamau.
■ Kaʻeha ʻana o Cush (ka hoʻoneʻe ʻana i ka momona mai ka momona o ka subcutaneous o nā wāwae, ka hoʻihoʻi nui ʻana o ka momona i ka maka, ʻāʻī, ke kāʻei poʻohiwi a me ka ʻōpū, hypertrichosis, striae, ʻeha, ka hoʻohaʻahaʻa i ka hoʻohaʻahaʻa glucose lā, a pēlā aku).
■ nā loli Hematologic.
■ Hōʻike ʻia e ka leukocytosis neutrophilic me ka loaʻa ʻole o kahi loli o ka leukocyte i hema. He manaʻoʻiʻo ia no ka hopena o ka hopena o nā steroid i ka granulopoiesis.

Kākoʻo o nā Hoʻopau

■ Hoʻohana o ka lāʻau lapaʻau hana waena (alternating).
■ Ka hoʻohana ʻana o nā glucocorticoids systemic i ka liʻiliʻi liʻiliʻi e pono ai. No kēia, i loko o ka maʻi bronchial asthma, pono hui ʻia ko lākou ʻoihana me ka hoʻohana ʻana i ka glucocorticoids inhaled i hui pū me nā mea hoʻomau lōʻihi β2-adrenergic, theophylline, a i ʻole nā ​​lāʻau antileukotriene.
■ Hoʻomoe o nā glucocorticoids e like me ke mele o ka physiological o kēlā me kēia lā o ka neʻe cortisol.
■ Ka hoʻohana ʻana o ka papaʻai me ka momona o ka waiū a me ka calcium, me ka hoʻohaʻahaʻa ʻana i nā hāmeʻa kūwau maʻalahi, paʻakai (a hiki i 5 g i kēlā me kēia lā) a me ka wai (a hiki i 1.5 lita no kēlā me kēia lā).
■ Ka lawe ʻana i nā papa glucocorticoids ma hope o ka ʻaina e hōʻemi i ka hopena ulcerogenic.
■ Hoʻomau i ka inu a me ka inu ʻona.

■ Hoʻololi kūleʻa i ka hana ʻana-traumatic.

ʻO ka manaʻo o ka glucocorticoids, kā lākou hoʻohana e like me nā lāʻau lapaʻau, ka helu ma ka ʻano a me ka hana. Nā ala o ka hoʻoponopono ʻana i ke kō a me ka huna ʻana o nā hormones o ka adrenal cortex ʻO ka hana o ka hana o nā glucocorticoids, nā hopena koʻikoʻi mai ka hoʻohana ʻana.

He maʻalahi ka unuhi ʻana i kāu hana maikaʻi ma ka waihona ʻike. E hoʻohana i ka palapala i lalo

Mahalo nui iā ʻoe nā haumāna, nā haumāna puka kula, nā ʻepekema ʻōpio e hoʻohana nei i ke kumu ʻike i kā lākou aʻo ʻana a me ka hana.

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Ke Keena Oihana o Ukraine

Ke Kulanui Kauʻāina ʻo Zaporizhzhya

Ke Keʻena o ka lāʻau lapaʻau a me nā kauka kauka

E ke kumu: "Pharmacology"

I ke kumuhana: "Nā hopena pae o ka glucocorticoids"

ʻAmaʻa: ka haumāna 3 makahiki

Saiko Roman Eduardovich

1. Ka papa helu o nā glucocorticoids

2. Ka hana o ka hana o nā glucocorticoids

3. Ka hoʻohana ʻana o nā glucocorticoids

4. ʻO nā hopena koʻikoʻi nā hopena o ka glucocorticoids

5. Kāohi i nā hopena ʻaoʻao o ka glucocorticoids

Nā papa inoa o nā kuhikuhi

1.Ka papa helu Glucocorticoidi loko

ʻO nā chucocorticoids he mau hua a kahi steroid i hoʻākoakoa ʻia e ka cortex adrenal. ʻO nā glucocorticoids kūlohelohe a me kā lākou synthetic analogue e hoʻohana ana i ka lāʻau lapaʻau no ka nele o adrenal. Eia kekahi, hoʻohana kekahi mau maʻi i ka anti-inflammatory, immunosuppressive, anti-allergic, anti-shock a me nā mea ʻē aʻe o kēia mau lāʻau.

ʻO ka hoʻomaka ʻana o ka hoʻohana ʻana o nā glucocorticoids e like me nā lāʻau lapaʻau (PM) i hoʻi mai i nā 40s. ʻO XX makahiki. Hoʻihoʻi hou i ka 30s. o nā kenekulia i hala, ua hōʻike ʻia ua hoʻokomo ʻia nā pūlima o ke kūkaʻu hormonal i loko o ke ʻano cortex adrenal. I ka makahiki 1937, ua hoʻokaʻawale ʻia ka mineralocorticoid deoxycorticosterone mai ke cortex adrenal, i nā makahiki 40. - glucocorticoids cortisone a me hydrocortisone. ʻO kahi ākea o nā hopena o ka lāʻau lapaʻau e pili ana i ka hydrocortisone a me cortisone i koho mua i ka hiki ʻana o ko lākou hoʻohana ʻana i nā lāʻau. Ua hala, ua lawe ʻia ko lākou synthesis.

ʻO ka glucocorticoid nui a me ka hana nui i kūkulu ʻia i loko o ke kanaka he hydrocortisone (cortisol), nā mea ʻē aʻe o ka hana a ka poʻe cortisone, corticosterone, 11-deoxycortisol, 11-dehydrocorticosterone.

ʻO ka hana ʻana o nā hormones e ka ʻenima adrenal ma lalo o ke kaomi o ka nenela sentral a pili pono i ka hana o ka a ka puna pituitary (ʻike i ka Fig. 2). ʻO ka nehococorticotropic pituitary hormone (ACTH, corticotropin) kahi mea hoʻoikaika o ka physiological o ka cortex adrenal. Hoʻonui ka Corticotropin i ka hoʻokumu ʻana a me ka hana huna ʻana o ka glucocorticoids. ʻO ka mea hope, e hoʻopili i ka lime pituitary, ke kāpae nei i ka hana o ka corticotropin a no laila e hōʻemi ai i ka hoʻoulu hou ʻana o nā kihi adrenal (e ke ʻano o ke ʻano o ka pane maikaʻi ʻole). ʻO ka lōʻihi o ka hoʻokele ʻana o ka glucocorticoids (cortisone a me nā mea i hoʻopili ʻia ai ia) i ke kino ke hiki ke alakaʻi i ka pale a me ka atrophy o ka cortex adrenal, me ka pale ʻana i ka hoʻokumu ʻana ʻaʻole wale nō ka ACTH, akā, pū kekahi me nā guitadroprop gonadotropic a me ka hoʻōla.

Kuhi.Ka helu ʻana o nā glucocorticoids a me nā ʻano hana no kā lākou hoʻohana

Kuhi.Nā ala o ka hoʻoponopono ʻana i ka synthesis a me ka huna ʻia o nā hormones o ka adrenal cortex

Mai ka makahiki o 50 o ke kenekulia i hala, ua noho ka glucocorticoids i kahi kūlana koʻikoʻi i nā ʻano lāʻau lapaʻau a ʻoi aʻe o nā mea āpau, ma ka hoʻomaʻamaʻa therapeutic. ʻO ke kāpili ʻana o nā ʻano o nā glucocorticoids no ka hoʻokō intravenous a me ka intramuscular e hoʻonui i nā hiki o ka hopena o ka glucocorticoid. I nā makahiki i hala aku nei he 15-20, ua hoʻonui nui ko mākou mau manaʻo e pili ana i nā hana a nā hana o ka glucocorticoids, a he nui nō hoʻi nā loli koʻikoʻi o ka hana o ka glucocorticoids, e pili ana i nā hewa, nā alanui o ka ʻoihana, ka lōʻihi o ka hoʻohana a me nā hui me nā lāʻau lapaʻau ʻē aʻe.

ʻO ka hoʻohana ʻana o nā glucocorticoids i ka hana lapaʻau i ka lā i ka makahiki 1949, i ka manawa i hōʻike mua ʻia ai ka hopena pōkole o ka cortisone ma nā maʻi nā maʻi me ka haukapila rheumatoid. I ka makahiki 1950, hōʻike ka hui like like me nā hopena maikaʻi o ka mālama ʻana o ka lāʻau rheumatoid, rheumatism a me nā maʻi ʻē aʻe me ka cortisone a me ka hormone adrenocorticotropic (ACTH). ʻAʻole i liʻuliʻu, hōʻike ʻia kahi hōʻike o ka hopena o ka hopena o ka hopena o ka glucocorticoid therapy no ka systemus lupus erythematosus (SLE), dermatomyositis, a me ka vasculitis systemic.

I kēia mau lā, ʻo glucocorticoids, ʻoiai ke kiʻekiʻe o ka hopena o nā ʻaoʻao (me ka nui o nā mea koʻikoʻi), e waiho nei i ka poʻokela ma ka mālama ʻana i ka maʻi pathogenetic o nā maʻi āpau. Eia kekahi, ua hoʻohana nui ʻia lākou i nā maʻi hematological he nui, ka glomerulonephritis primata a me ke kula, a me ka nui o nā maʻi ʻeha a me ka hanu, nā ʻano maʻi, kūwili i nā ʻano o nā ʻano a me nā mea ʻē aʻe. ʻO ka hana o nā glucocorticoids no ka hoʻohana intravenous, intramuscular a me ka hana intraarticular ua hoʻonui i ke ʻano o ke ʻano a me nā hana aʻoaʻo o kā lākou hoʻohana.

Ua hoʻokaʻawale ʻia nā corticosteroids adrenal i ʻelua māhele nui - glucocorticoids a me mineralocorticoids. Aia ka mea i ka hopena ma mua o nā ʻāpana āpau a me nā ʻōnaehana o ke kino, ma o ke kaohi ʻana i nā kaʻina metabola waena, nā hana pale a me nā hopena maʻi. ʻO ka hana nui o nā mineralocorticoids ke hoʻoponopono i ka kaohi wai-paʻakai.

Hoʻohana pinepine ka hoʻohana ʻana i nā glucocorticoids e ko lākou ikaika anti-inflammatory, immunosuppressive a me anti-allergic effects.

I ka 1st European Symposium ma ka glucocorticoid therapy, ʻoi aku e hoʻohana i nā huaʻōlelo o ka glucocorticoids a i ka glucocorticosteroids. ʻO nā huaʻōlelo ʻē aʻe - "steroid", "corticosteroids", "corticoids" ākea a i ʻole pololei ʻole paha, a no laila, ʻaʻole i kauoha ʻia e hoʻohana iā lākou.

Ma ka hana lapaʻau i kēia lā, e hoʻohana ʻia nā glucocorticoids kūlohelohe maoli, kahi i kūlohelohe nui anti-inflammatory, immunosuppressive a me anti-alia me ka nāwaliwali a ʻaʻole hoʻi i nā hopena mineralocorticoid, a no laila aia nā mea i hoʻohana i nā lāʻau lapaʻau maʻamau i nā ʻano lāʻau o ka lāʻau.

Ka papa helu ʻana o nā glucocorticoids e ka hoʻolālā kemika

Nā Halepole (endogenous) glucocorticoids:

* cortisol * hydrocortisone * hydrocortisone acetate

ʻO nā mea hinu aila glucocorticoids:

* prednisolone * prednisone * methylprednisolone

ʻO nā mea momona e pili ana i ka glucocorticoids:

* dexamethasone * triamcinolone * betamethasone

Ka helu ʻana o nā glucocorticoids ma o ka lōʻihi o ka hana

ʻO nā lāʻau lapaʻau pōkole (8-12 mau hola):

ʻO nā lāʻau lapaʻau o ka lōʻihi lōʻihi o ka hana (12-36 hola):

* prednisolone * methylprednisolone * triamcinolone

Nā lāʻau lapaʻau lōʻihi (36-72 hola):

* parameterazone * betamethasone * dexamethasone

Hōʻike ʻia ka Depot glucocorticoids e ka lōʻihi o ke kau ʻana (hoʻopau ʻia i loko o kekahi mau pule).

2.Puaglucocorticoid anism

ʻO ke koena hypothalamic-pituitary-adrenal i kahi ʻōnaehana paʻakikī e hoʻoponopono i ka hoʻokuʻu ʻana i nā glucocorticoids i nā kūlana o ka physiological a i nā kūlana pathological. Hoʻopili ʻia ka hana ʻana o ka cortisol e ka cortex adrenal e ACTH, huna ʻia e ka aniani pituitary gland. ʻO ka hoʻokuʻu a ACTH, ka mea, e hoʻoponopono ʻia e ka hormone corticotropin-hoʻokuʻu i ke ʻano, ʻo ka huna ʻana o ka mea i mālama ʻia e nā ʻōnaehana neurological, endocrine a me nā cytokine i ka pae o ka nucleus periventricular o ka hypothalamus. Ke lawe ʻia nei ka hormone Corticotropin i hoʻokuʻu ʻia i nā wahi liʻiliʻi i ka neʻe ʻana o ke kaila wai kūloko o ka gluitary gland, a laila ma ka limu o mua, kahi i hoʻoulu ʻia ai ka hormon corticotropin-hoʻokuʻu i ka huna ʻana o ACTH. glucocorticoid lāʻau lapaʻau

ʻO ka ʻōlelo huna basal o kēlā me kēia lā o cortisol i nā kānaka e pili ana i 20 mg. Eia kekahi, ʻike ʻia kāna peʻe e ka loli i ke ao me nā pae kiʻekiʻe ma ke kakahiaka nui a me nā helu haʻahaʻa i ke ahiahi. ʻO ka hapa nui o ka cortisol (e pili ana i 90%) ka neʻe me nā globulins koko corticoid. ʻO ke cortisol hāmeʻa kahi hana biologically ʻano o ka hormone.

ʻO ka Hyperreactivity o ke koʻi hypothalamic-pituitary-adrenal ma ka waiho ʻole ʻana o ka mumū (mo ka laʻana, me ka maʻi Cush) hoʻoulu i ka immunosuppression a hoʻonui i ka naʻau o ka maʻi. Hiki i ka hoʻoulu ʻana o ke koʻi hypothalamic-pituitary-adrenal, hōʻeha i ke kiʻekiʻe cortisol a alakaʻi i ka immunosuppression, hiki ke hōʻeha ʻia e nā ʻano kumu kaumaha, e pili ana i ka ʻeha, ka hōʻeha ʻuhane, ke anuanu, ka hoʻāhewa kino nui, nā maʻa maʻi, nā hōʻihoʻi ʻana i ka haukapila. Endogenous glucocorticoids, me ka hana homeostatic, hoʻololi i nā pane anti-inflammatory. Hōʻike ʻia nā hōʻike loea i ka hopena o ka hoʻonāukiuki o ka glucocorticoids o ka endogenous i hana nui i ka pathogenesis o kekahi mau ʻōnaehana o ka maʻi o ka hoʻopili a i ʻole ka hoʻomau ʻana o ka hana hoʻonaninani. I nā maʻi o ka rheumatic e like me ka rheumatoid arthritis, SLE, dermatomyositis a me nā mea ʻē aʻe, ua loli ka nui o nā loli nui i loko o ke koʻi hypothalamic-pituitary-adrenal, i hiʻohiʻona ʻia e ka hemahema o ka hana ʻana o ACTH i ka hoʻopuni ʻana i nā cytokines, i ʻole haʻahaʻa haʻahaʻa a hoʻōla ʻia i ka huna ʻana o ka cortisol androgen.

Ke hoʻohana nei ka hoʻohana ʻana o ka glucocorticoids synthetic me ka pale ʻana o ka synthesis a me ka hoʻokuʻu i nā lua corticotropin-hoʻokuʻu i ka hormone a me ACTH, a no laila, ke hoʻololi ʻana i ka hana cortisol. Hoʻomoe ka lōʻihi o ka hopena glucocorticoid therapy i ka adrenal atrophy a me nā hoʻokakeuki o ke koʻi hypothalamic-pituitary-adrenal, e hōʻemi ana i ka hiki ke hana hou i ka glucocorticoids endogenous i pane aku ai i nā ACTH a me nā kumu koʻikoʻi.

I kēia manawa, hana maʻamau ka hoʻokaʻawale ma waena o nā mea ʻelua o ka hana o ka glucocorticoids - genomic a me ka non-genomic.

Ka nānā ʻana o ka genomic ma o ka hoʻopili ʻana i nā mea nānā cytoplasmic kikoʻī ma kekahi mau kaha a ʻike ʻole ʻia ma mua o 30 mau minuke ma hope o ka hoʻokumu ʻana o ka paʻakikī-hormone receptor.

ʻO ka hana pilikino o ka hana genomic o nā glucocorticoids ka hoʻoponopono ʻana i ka lawe ʻana i nā ʻano o nā gen i ke kāohi i ka synt synt o nā protein. ʻO ka hopena o ka glucocorticoids ma glucocorticoid receptors (nona nā lālā o ka ʻohana receptor membrane) alakaʻi i ka hoʻolālā ʻana o kahi hanana o nā hanana e pili ana i ka RNA kikoʻī, nā mea RNA nukela, a me nā mea hoʻolaha hoʻolaha. ʻO ka hopena o kēia kāpili ke hoʻonāukiuki a hōʻemi paha i ka hoʻololi ʻana i ka gen. Hoʻopilikia ka Glucocorticoids i kahi helu nui o nā huaʻehā, me nā huaʻōlelo i mālama i ka hoʻokumu ʻana o nā cytokine e like me IL-la, IL-4, IL-6, IL-9 a me gamma interferon. I kēia hihia, hiki i nā glucocorticoids ke hoʻoikaika i nā ʻōnaehana o nā aila a hoʻopaʻa aku iā ia.

Mālama ʻo Glucocorticoids i ke kāpili ʻana o ka protein cellular. Hiki i nā penetrating maʻalahi a wikiwiki me nā membrane, e hana lākou i nā paʻakikī i ka ʻenehana komo i loko o ka cytoplasm e hele ana i ka ʻākuhi o ka puʻukū, e hoʻokau ana i ke kākau inoa ma ka ʻatikala genetic

kikoʻī kikoʻī RNA no ka hōʻailona o nā peptides regulat a me nā protein, pili nui me kahi ʻōnaehana o nā enzyme, a, ʻo ia hoʻi, e hoʻopaʻa i ka hana o ka cellular.Hiki i kēia mau enzyme ke hana i nā hana e hoʻoulu ai a me ka inhibitory. No ka laʻana, hiki iā lākou ke hoʻoulu i ka hana o nā mea pale o ka protein i loko o kekahi mau cell, ka mea e hoʻōki i ka lawe ʻana i nā hua i nā pūpili lymphoid, ma laila e hoʻohuli ai i nā pane a me nā maʻi.

Hoʻopilikia ka Glucocorticoids i nā hana selular a me ka hana humoral. ʻO ka hoʻomohala ʻana o ka lymphocytopenia ma lalo o ko lākou mana no ka pale ʻana i ka hana a me ka hoʻokuʻu i nā sela lymphoid mai ka ʻōpū o ka iwi, ke hōʻoki ʻia o kā lākou neʻe ʻana a me ka hāʻawi hou ʻana i nā lymphocytes i nā ʻāpana lymphoid. Hoʻopilikia ka Glucocorticoids i ka hoʻopili ʻana i ka lau o nā pū me T a me B i ka pane ʻana i ka pale. Ka hana like lākou i nā subpopulepule i nā ʻano T-lymphocytes e hōʻalo ana i ka pae o nā T-cell e loaʻa ana i ka ʻohi o ka IgM Fc hāpana, a me ke ʻano ʻole o ka hoʻololi ʻana i ke kaila o ka T-lymphocytes e lawe nei i nā receptors no ka popo IgG Fc. Ma lalo o ka hopena o nā glucocorticoids, ke hoʻomakeke ʻia nā pono proliferative o nā pūmela T a ʻelua i vivo a me ka vitro. Hōʻike ʻia ka hopena o nā glucocorticoids ma nā pane ʻana o ka B-cell i ka liʻiliʻi ma mua o nā T-cell. No laila, i nā mea maʻi e loaʻa nā pona maʻa o nā glucocorticoids, e nānā ʻia ka pane ʻana o ka antibody maʻamau. I ka manawa like, ʻo ka manawa o ka hoʻokele pōkole o nā koina nui o ka glucocorticoids e waiho ai i ka emi ʻana o nā pae Serum IgG a me IgA a ʻaʻole i hoʻopilikia i nā pae IgM. Hiki ke hoʻopili ʻia ka hopena o ka glucocorticoids ma ka hana B-cell ma muli o ko lākou hopena ma ka macrophages.

ʻAʻole i kū like i ka hopena genomic, ʻaʻohe hopena o genomic o glucocorticoids ka hopena o ka launa pūpū physicochemical pololei me nā membranes biola a / a i ʻole he mea koho a i ʻole nā ​​steroid-selective membrane. Loaʻa nā hopena non-genomic o nā glucocorticoids ma lalo o ke kumu o nā kiʻekiʻe kiʻekiʻe a loaʻa i hope ma hope o kekahi mau kekona a mau minuke paha.

ʻO ka hopena anti-inflammatory o ka anti-inflammatory o nā glucocorticoids e pili ana i ka hoʻomau ʻana o nā membrane lysosomal, kahi hōʻemi i nā ʻāpana o nā membranes, he hōʻemi i ka pae o ka capillary a me ke kahe koko o nā wahi i loko o nā wahi o ka ʻaihue, ka hōʻemi ʻana i ka nui o nā ʻāpana o ka endothelial, he hōʻemi i ka hiki ke kūleʻa o nā membula, a me ke kūleʻa i ka likule. nā ipu i ka hoʻomaka o ka mumū a me ka hoʻohaʻahaʻa i kā lākou permeability (mahele ʻokoʻa ma muli o

ka pale ʻana o ka syntaglandin synthesis), he hōʻemi i ka nui o nā monocytes a me nā seloliona mononuclear i ka neʻe ʻana o ka mumū, a me ka hopena i ka leukocytes polymorphonuclear. ʻOke aku, ʻo ke alakaʻi koʻikoʻi i ka hopena anti-inflammatory o ka glucocorticoids e pili ana i ka pale ʻana o ka neʻe ʻana a me ka hōʻuluʻulu ʻana o nā leukocytes i loko o ka foci o ka mumū. Ma lalo o ka mana o nā glucocorticoids, ka hana bactericidal, hoʻopiʻi ka mea hoʻopihapiha Fc a me nā hana ʻē aʻe o nā monocytes a me nā mācrophages, a me nā pae o nā eosinophils, monocytes a me nā lymphocytes i ka hoʻōki ʻana. Eia kekahi, pane nā pane kelepona i nā kinins, histamine, prostaglandins, a me nā loli chemotactic, a me ke hoʻokuʻu ʻana o ka prostaglandins mai nā wahi e hoʻoulu ʻia ai. A hoʻopaʻa ʻia non-genomic hoʻokūkū pili i ka hana o ka endothelial synthase o nitric oxide.

ʻO ka hopena o ka glucocorticoids e hoʻoholo i ko lākou hopena, a me ke alapine a me ka paʻakikī o nā hopena ʻaoʻao. Hoʻokomo ka hopena o nā genomic o nā glucocorticoids ma ka liʻiliʻi liʻiliʻi loa a hoʻonui i ka like me ka 100 mg o ka prednisolone kūlike i kēlā me kēia lā, ke kū nei ia, a noho mau i ka wā e hiki mai ana. Inā ka hoʻohana ʻana i ka glucocorticoids ma loko o kahi make o 30 mg o ka like me ka prednisolone, ʻo ka hopena therapeutic kokoke loa i hoʻoholo ʻia e nā hana genomic, a laila ma kahi kikoʻī o 30 mg o prednisolone kūlike i ka hopena non-genomic e lilo i mea nui, ka nui o ka hana o ka wikiwiki me ke hoʻonui ʻana i ka nui.

Hoʻopili maikaʻi ʻia ʻo Glucocorticoids no nā ʻano like ʻole o kā lākou hoʻohana, i.e., no ka waha, intramuscular, intravenous a intraarticular. Ma hope o ka lawelawe waha, e pili ana i ka 50-90% o nā glucocorticoids. ʻO ka paa ʻana o ka glucocorticoids i nā ʻōnaehana koko he 40-90%. Lawe ka metabolism o nā glucocorticoids i ka nui o ka pehu, a me ka excretion - ka mea nui o nā ʻōpū i loko o ke ʻano o nā metabolites. ʻO ka ʻike kiʻekiʻe o ka glucocorticoids i loko o ke koko ma hope o ka hoʻokele waha i ka wā ma hope o 4-6 mau hola. Me ka hoʻokele intravenous e hana i ka glucocorticoids, ʻoi ka wikiwiki o ko lākou ʻike. No laila, me ka hoʻopuka o 1.0 g o Solomedrol® (methylprednisolone sodium succinate), kahi puʻupuʻu i kona neʻe ʻana i ka plasma a nānā ʻia ma hope o 15 mau minuke. Me ka hoʻokele intramuscular o nā glucocorticoids, ka nui o ka piʻiʻana o ko lākou neʻe i ka plasma

hope aʻe. No ka laʻana, me ka intramuscular injection o Depo-medrol® (methylprednisolone acetate), ʻo kona keʻokeʻo nui loa i ke koko a loaʻa ma hope o nā hola 7.

3. Ka hoʻohana ʻana o nā glucocorticoids

ʻO ka hana i hōʻike ʻia ai nā hana multifaceted o ka hana o nā glucocorticoids a me nā kumuhana like ʻole o kā lākou noi ua lawelawe i kumu no kā lākou hoʻohana ākea ʻana i nā maʻi o nā kino o nā kikowaena, a me nā ʻano o nā kūlana o nā papa. Me nā maʻi o ka rheumatic a me ka vasculitis systemic, kahi o nā glucocorticoids e hoʻohana pinepine i nā lāʻau lapaʻau maʻamau, hoʻohana ʻia ka hopena glucocorticoid i ka endocrinology, gastroenterology, resuscitation, cardiology, pulmonology, nephrology, traumatology a me nā mea hou aku.

Ma lalo aʻe nei mākou i nā maʻi a me nā kūlana patological kahi e hoʻohana ʻia ai nā glucocorticoids:

1.Rheumatoid arthritis - i ka haʻalele ʻole o nā hōʻike keu aʻeʻeha nui o ka maʻi (ʻōnika vasculitis, serositis, myocarditis, fibrosing alveolitis, bronchiolitis obliterans), nā haʻahaʻa haʻahaʻa o ka glucocorticoids e hoʻohana kūʻē i nāʻaoʻao o ka maʻi-modifying therapy. Me ka hoʻomohala ʻana o nā hōʻike hou o ka mea nui aʻe o ka lāʻau rheumatoid, medium, a inā pono, e hoʻohana ʻia nā nui kiʻekiʻe o ka glucocorticoids.

2. ʻO ka spondylitis Ankylosing - i ka hana hoʻoheheʻe, ʻike nui a i ʻole ke kiʻekiʻe o nā glucocorticoids e hoʻohana.

3. Systemy lupus erythematosus - i ka hana like o ka maʻi, a i ka wā e komo ai nā kino nui a me nā ʻōnaehana i ka hana pathological (pericarditis nui a / a i ʻole pleurisy me ka hōʻiliʻili nui o ka exudate, a / a me myocarditis, a / a i ʻole e hōʻino ʻia i ka pūnaehana nūnū, a me / a pomaonitis pulmonary paha. , a / a i ʻole he hemorrhages pulmonary, a / a i ʻole anemia hemolytic, a / a i ʻole plombocytopenic purpura, a / a i ʻole ikaikaususus lupus glomerulonephritis III, IV, V morphological papa) e hōʻike ana i ka hoʻohana ʻana i nā pākēkēahi a nui paha a me nā kiʻekiʻe o ka glucocorticoids, a inā pono - nui loa He lāʻau fira.

4. E ke kuni a i ʻole ke koʻikoʻi o ka maʻi rheumatism - nā nui a i ʻole nā ​​helu kiʻekiʻe o ka glucocorticoids (ʻoi aku me ka hoʻomohala ʻana o ka carditis rheumatic).

5. polymyalgia Rheumatic - glucocorticoids nā lāʻau lapaʻau i koho. I ke kinona a wili, ʻelua a ʻeha a kiʻekiʻe paha o nā glucocorticoids e hoʻohana.

6. Polymyositis a me dermatomyositis - glucocorticoids nā lāʻau lapaʻau i koho. Ma ka maʻi hoʻonaninani, ua kuhikuhi ʻia nā kēpē kiʻekiʻe o nā glucocorticoids.

7. Pūnaewele scleroderma - i kuhikuhi ʻia i nā glucocorticoids i nā hopena haʻahaʻa haʻahaʻa a me ke kūkulu ʻia o ka myositis.

8. Ke hoʻomau nei ka maʻi - i ka hana ʻoi, a me nā mea nui a me nā pūnaehana koʻikoʻi (myocarditis, pericarditis, epilepsy) i loko o ke kaʻina pili a ke ala - nui a i ʻole nā ​​helu kiʻekiʻe o nā glucocorticoids.

1.ʻO ke ʻano a me ke koikoi cell arteritis - i ka hana koʻikoʻi, ʻo nā glucocorticoids ke nānā i ke koho a ua kuhikuhi ʻia i nā ʻaina kiʻekiʻe.

2. ʻO ka maʻi Takayasu - ma kahi hana kūlohelohe, hoʻohana ʻia a i ʻole ka nui o ka glucocorticoids.

3. ʻO ka polyarteritis nodular a me ka polyangiitis mikroskopika - i kahi hana koʻikoʻi, ua hoʻohana ʻia nā kaha kiʻekiʻe o nā glucocorticoids.

4. ʻO ka maʻi Wegener - i kahi hana koʻikoʻi - nā wili kiʻekiʻe o nā glucocorticoids.

5. Charge-Strauss Syndrome - kahi hana kūpono e pili ana i ka maʻi koho - nā kauka kiʻekiʻe o nā glucocorticoids.

6. ʻO ke kākā a Behcet - i ka wī aʻeha o nā wīwī, nā pihi nui a he nui paha o nā glucocorticoids e kuhikuhi ana.

7. Cutaneous leukocytoclastic vasculitis - i nā pilikia koʻikoʻi, ua hoʻohana ʻia nā nui kiʻekiʻe o nā glucocorticoids.

8. ʻO ka vasculitis hemorrhagic (Shenlein-Genoch purpura) - i kuhikuhi ʻia i nā glucocorticoids i nā nui a i ʻole nā ​​dosages me ke ʻano o ka hoʻomohala i kahi glomerulonephritis me ka nephrotic syndrome a / a i ka hoʻokumu ʻana o 50-60% o glomeruli a ʻoi aku ma mua o ka hapalua mahina. Wahi a kekahi helu o ka rheumatologists, hiki i nā nui o nā mole o nā glucocorticoids ke hele i ka ʻeha ʻeha.

1.ʻO Glomerulonephritis me nā loli liʻiliʻi (idiopathic nephrotic syndrome) - i nā manawa mua o ka maʻi a i ʻole me kāna mau exacerbations, nā glucocorticoids i kuhikuhi ʻia i nā ʻaole liʻiliʻi a i ʻole nā ​​hopena lapaʻau e koho ai.

2. ʻO ka glomerulosclerosis-hyalose focal-segmental - i nā manawa mua o ka maʻi a i ʻole ke exacerbations, nā nui a i ʻole nā ​​kumu kiʻekiʻe o nā glucocorticoids e hoʻohana ʻia.

3. Mesangioproliferative glomerulonephritis medium a i ʻole ka nui o nā dosage o ka glucocorticoids e hoʻohana ʻia i ka hoʻomohala ʻana o ka nephrotic syndrome a / a i ʻole ka hapalua mahina i ka 50-60% glomeruli.

4. Mesangiocapillary glomerulonephritis - nā kaila kiʻekiʻe o nā glucocorticoids e hoʻohana ʻia no ka hoʻomohala ʻana i ke akeʻano nephrotic a / a i ʻole ka hapalua mahina i ka 50-60% glomeruli.

5. ʻO ka glomerulonephritis membranous - i ke kuʻuna o ka nephrotic syndrome, ka nui a i ʻole nā ​​kaha kiʻekiʻe o nā glucocorticoids e hoʻohana ʻia.

6. ʻO ka glomerulonephritis ka holomua wikiwiki (subacute, lunate) - hoʻohana ʻia nā dosis kiʻekiʻe o ka glucocorticoids.

Hoʻopuka ka glomerulonephritis (i.e., glomerulonephritis i ulu me SLE, rheumatoid arthritis, polymyositis, dermatomyositis, vasculitis) hoʻohana i nā nui a me nā kiʻekiʻe o nā glucocorticoids.

1.ʻO ka nele o ka ACTH i nā maʻi like ʻole o ka gland pituitary - hydrocortisone a i ʻole nā ​​hopena haʻahaʻa o ka glucocorticoids e hoʻohana ʻia no ka huli ʻana.

2. ʻO ka maʻi thyrotoxicosis-induced Amiodarone - nā kaila kiʻekiʻe o nā glucocorticoids.

3. Ka nele o Adrenal - hydrocortisone a i ʻole ka hoʻohaʻahaʻa a i ʻole nā ​​Dona o ka glucocorticoids e hoʻohana ʻia no ka mea hoʻoponopono maʻi.

1.ʻO ka maʻi o Crohn - i ka hana koʻikoʻi, ua hoʻohana ʻia nā dosis kiʻekiʻe o nā glucocorticoids.

2. colitis nonspecific ulitis - i kahi hana koʻikoʻi, e hoʻohana ʻia nā nui nui a i ʻole koina o ka glucocorticoids.

3. ʻO ka hepatitis Autoimmune - ʻelua a i ʻole nā ​​palena kiʻekiʻe o ka glucocorticoids e hoʻohana ʻia.

4. ʻO nā wahi mua o ka cirrhosis - ke kāpili nei i ka palena awelika o nā glucocorticoids.

5. Hepatitis waiʻona hoʻonāukiuki - waika a i ʻole nā ​​palena kiʻekiʻe o ka glucocorticoids e hoʻohana ʻia.

1.Hoʻolālā ʻia i ka post-viral a me ka nonspecific lymphocytic myocarditis - nā pāʻālua a i ʻole nā ​​palena kiʻekiʻe o nā glucocorticoids.

2. Pericarditis ponoʻoki ʻole e hoʻomaʻemaʻe me ka hōʻiliʻili o ka exudate - ʻelua a i ʻole nā ​​kiʻekiʻe kiʻekiʻe o nā glucocorticoids e hoʻohana.

1.Hoʻokomo i ka hakahaka Bronchial - ka glucocorticoids waha (he nui a i ʻole ka nui o nā hewa) i hoʻākāka ʻia no ke aʻeha o ke aʻeha, nā hoʻomaʻamaʻa koʻikoʻi o ka hānō, kahi o nā glucocorticoids inhaled a me nā bronchodilator e like ʻole.

2. Hoʻohana ʻia ka cryptogen fibrosing alveolitis - nā palena kiʻekiʻe o nā glucocorticoids.

3. ʻO ka bronchiolitis Obliterating - hoʻohana nui ʻia nā kaha kiʻekiʻe o nā glucocorticoids.

4. Sarcoidosis o nā māmā - ka nui a i ʻole nā ​​koina kiʻekiʻe o ka glucocorticoids e hoʻohana ʻia.

5. Ua kuhikuhi ʻia ʻo Eosinophilic pneumonia - nā nui a i ʻole nā ​​palena kiʻekiʻe o nā glucocorticoids.

1.ʻO Hemoblastoses - hoʻohana nui ʻia a kiʻekiʻe a kiʻekiʻe nā glucocorticoids.

2. Anemia (hemolytic, autoimmune, aplastic) - hoʻohana ʻia nā wēwā a me nā kiʻekiʻe o ka glucocorticoids.

3. ʻO Thrombocytopenia - ua kuhikuhi ʻia i nā ʻōhua a me nā kiʻekiʻe o nā glucocorticoids.

1. Laka mai nā ʻano o nā ʻano kumu - hoʻohana i nā palena kiʻekiʻe a kiʻekiʻe loa o nā glucocorticoids. Hoʻohana ʻia ka lāʻau pulse.

2. He ʻano alericio - ua kuhikuhi ʻia nā kiʻekiʻe a me nā wai kiʻekiʻe o ka glucocorticoids, inā pono, "lāʻau pulse".

3. Ka maʻi kaumaha i ka ʻeha polū - hoʻohana ʻia nā kēpē kiʻekiʻe o nā glucocorticoids.

1.Wahi a ke kūlana maʻi maʻi, ua hoʻohana ʻia nā glucocorticoids mai ka palena a i ʻole ke kiʻekiʻe nui, a inā pono, "ʻoihana pulse".

4.Pili manā hopena ʻaoʻao o nā glucocorticoids

Me nā papa aʻoaʻo pōkole me nā glucocorticoids, ʻaʻole e kū pinepine nā hopena koʻikoʻi. Hoʻomaopopo kekahi mau maʻi i ka hoʻonui ʻana i ka momona, loaʻa ka paona, ka huhū o ke aʻelima, a me nā moe hiamoe.

Me ka lōʻihi o ka hoʻokele ʻana o nā corticosteroids, ka mea i kapa ʻia ʻo ka maʻi ʻ Itskia Itsenko-Cush, e ulu ana me ka momona koʻikoʻi, kahi maka "ʻano mahina", ulu nui ka lauoho ma ke kino a hoʻonui i ke koko. Me ka hoʻohaʻahaʻa ʻana i ka hopena o nā halihali, ua hoʻohuli ʻia kēia mau ʻōuli. ʻO ka hopena maikaʻi loa o ka glucocorticoids ma luna o ka mucous membrane o ka gastrointestinal tract: hiki iā lākou ke hōʻeha i nā ʻōpū o ka duodenum a me ka'ōpū. No laila, ʻo ka loaʻa ʻana o kahi mea maʻi me ka ulia peptic kekahi o nā contraindications a hoʻohana nui i nā corticoids. Ke lawe nei ka mea maʻi i nā hormone hāmeʻa, inā he mau ʻeha kaumaha a i ʻole ke hōʻeha i ka ʻōpū ma luna o ka ʻōpū, hōʻeha ka naʻau, pono ke kuhikuhi i nā lāʻau lapaʻau e hoʻohaʻahaʻa i ka waʻa o ka wai o ka ʻōpū. Hoʻopili ʻia me ka hoʻōla ʻia o nā glucocorticoids me ka nalowale o ka paʻakai, no laila, ʻo ka lawe ʻana i ka prednisone e hui pū ʻia me ka lawe ʻana i ka hoʻomākaukau pākaukau (panangin, asparkum). Hoʻokomo ka Corticosteroids i ka sodium a me ka noho paʻa o ka wai ma ke kino, no laila ke ʻike ʻia ka edema, hiki ke hoʻohana ʻia ka diuretics pākia-potassium wale nō (me ka laʻana, triampur, trireside K). Me ka lōʻihi o ka hoʻokele ʻana o nā corticosteroids i nā keiki, hiki i ka ulu ʻana o ka ulu a me ka hoʻokuʻu ʻana i ka puberty.

ʻO nā glucocorticoids āpau he like nā hopena like, e hilinaʻi ana i ka maʻa a me ka lōʻihi o ka mālama ʻana.

1. Ke kaohi nei i nā hana o ka cortex adrenal. Hoʻokomo ka Glucocorticoids i ka hana o ka ʻōnaehana cortex hypothalamus-pituitary-adrenal. Hiki ke hoʻomau ʻia kēia hopena no nā mahina ma hope o ka hiki ʻana o ka mālama ʻana a hilinaʻi ma ke ʻano i hoʻohana ʻia, ʻo ke alapine o ka hoʻokele ʻana a me ka lōʻihi o ka hāpai ʻana. Hiki ke palupalu ka hopena i ke cortex adrenal inā, ma kahi o nā lāʻau lapaʻau lōʻihi (dex-metazone), nā lāʻau lapaʻau pōkole e like me prednisone a i ʻole methylprednisolone i nā poki liʻiliʻi. Hoʻomaopopo ʻia e lawe i ka dosis holoʻokoʻa i kēlā me kēia lā i ke kakahiaka nui, ʻo ia ka mea like loa me ka ritela physiological o ka ʻimi cortisol o endogenous. Ke lawe ʻia ʻoe i kēlā me kēia lā, e hoʻohana ʻia nā glucocorticoid pōkole e hana ʻia a ʻōlelo hoʻokahi ʻia i kekahi manawa i kakahiaka. Ma lalo o ka hopena o nā hana kaumaha (ka hana o ka ʻōpū, ka maʻi maʻamau e pili ana i ka maʻi, a me nā mea ʻē aʻe), hypofunction o ka adrenal cortex i hana pinepine ʻia, i hōʻike ʻia e ka nele o nā mea momona, ke kaumaha, ka hiamoe, ke kika a me ka hypthension orthostatic. Mālama ʻia ka hana mineralocorticoid o ka cortex adrenal, no laila, ʻike ʻia ka hyperkalemia a me ka hyponatremia, ka ʻano o ka hemahema cortical adrenal maʻamau, maʻamau. Pono nā mea maʻi e kau i kahi kūmaʻa kūikawā a i ʻole ke kāleka olakino me lākou a no ka mea i kahi pilikia e ʻike ai ke kauka e pili ana i ka pono no ka hoʻokele koke ʻana o nā glucocorticoids. I nā mea maʻi e lawe ana i nā hebedoma he 10 mau mea e ʻoi ai ka 10 mg o ka prednisone i kēlā me kēia lā.

2. ʻO ka pale ʻana i ke pale ʻana.Hoʻopau ka Glucocorticoids i ke kū'ē o nā maʻi i ka maʻi maʻamau, ʻoi aku ka maʻi bacterial, hōʻeuʻeu ka mea maʻi ma ka hopena o nā glucocorticoids a ke waiho nei i ke kumu nui o nā hoʻopiʻi a me ka make o nā poʻe maʻi me SLE. Ma muli o ka mālamaʻana i ka steroid, hiki i kahi maʻi kūloko ke lilo i systemic, hiki i ka maʻi latent ke lilo i ikaika, a me nā microorganism non-pathogen hiki pū kekahi. E kue i ke kūpaʻa o ka glucocorticoid therapy, hiki i nā maʻi ke holo pololei, akā, e ala pinepine ke ʻano o ke kino. ʻOiai he mea pale, ka pale ʻana me ka maʻi kanalela a me nā pneumococcal, ʻaʻole i hoʻohālikelike ʻia ka SLE. Ma mua o ka hoʻomaka ʻana i ka mālama ʻana me nā glucocorticoids, pono e hoʻomaʻamaʻa i kahi hōʻike pākaukau.

3. ʻO nā loli i ka helehelena ka mea: ka hoʻopuni ʻana i ka maka, ka nui o ka paona, lawe hou ʻana i ka momona o ke kino, hirsutism, ʻaeʻoni, poni striae, ʻūʻū me ka hōʻeha liʻiliʻi. Ke hoʻololi nei a emi paha paha kēia mau loli ma hope o ka emi ʻana o ka hopena.

4. Mahele mai nā maʻi noʻonoʻo ʻole mai ka huhū o ka ʻoluʻolu, eʻeha a me nā hiamoe i ka ʻeha kaumaha a i ʻole ka psychosis (ka hope loa i manaʻo ʻia he lupus lesion o ka pūnaehana puni waena).

5. Hiki paha ʻo Hyperglycemia i ke piʻi a hoʻonui paha i ka wā o ka mālama ʻana me ka glucocorticoids, akā, ma ke ʻano he kānāwai, ʻaʻole ia e lawelawe i ka contraindication no kā lākou koho. Ke koi paha ka hoʻohana ʻana i ka insulin, ʻaʻole pinepine i ulu nā ketoacidosis.

6. ʻO ka palu ʻana o ke kaila o ka wai-electrolyte e pili ana i ka paʻa o ka sodium a me hypokalemia. ʻO nā pilikia paʻakikī i ka mālama ʻana e kū mai me ka puʻuwai naʻau congestive a me ka edema.

7. Hiki i nā Glucocorticoids ke hoʻonui a hoʻonui i ka hypertension arterial. I / O pulse therapy me steroids e hoʻoulu pinepine ana i ka preexisting hypertension arterial inā paʻakikī ʻole ka mālama ʻana.

8. Hoʻokomo pinepine ʻo Osteopenia i nā hana hoʻopiʻi o nā kino vertebral me ka hoʻomehana holomua glucocorticoid. No laila, pono e loaʻa i nā mea maʻi i nā calcium calcium (1-1,5 g / lā ma ka waha). Hiki paha i kā Vitamin D a me ka diuret thiazide. I nā wahine ma postmenopausal, ma ka nui o ka loaʻa ʻana o ka osteopenia, hōʻike pinepine ʻia nā estrogens, akā kue ka hopena o kā lākou hoʻohana ʻana ma SLE. Hiki ke hoʻohana ʻia nā calciumitonites a me nā diphosphonates. Hoʻomaopopo ʻia ka hoʻomaʻamaʻa ʻana i ka osteogenesis.

9. Hōʻike ʻia ka myopathy Steroid e ka hōʻeha kino o ka ʻūhā a me ke kāʻei pelvic. Ua hoʻomaopopo ʻia ka nāwaliwali o ka ʻōpū, akā ʻaʻohe ʻeha, ka hana o nā enzyme koko o ke kumu muscular a me nā kīpiha electromyographic, ʻaʻole e like me ka hōʻeha ʻana o ka naʻau, ʻaʻole e loli. Ke lawe wale ʻia nei kahi biopsy mākala wale nō i nā hihia kaila i ka wā e pono ai ke kaawale aku i ko lākou nāha ʻole. ʻO ka hiki ke hiki i ka myopathy steroid he emi i ka emi ʻana o ka hopena o ka glucocorticoids a ua hana ʻia kahi paʻakikī o nā hana hoʻoikaika kino kūlohelohe, akā naʻe, hiki ke hoʻōla hou ʻia kekahi mau mahina.

10. ʻO ka maʻi o Oththalmic e hoʻopiʻi ai i ke kaomi intraocular nui (i kekahi manawa ma muli o ka holomua o ka glaucoma) a me nā catarocidae posteriorular.

11. Ischemic bone necrosis (aseptic, avascular necrosis, osteonecrosis) hiki nō hoʻi i ka wā hana o ka lāʻau lapaʻau. Hoʻopili pinepine kēia mau hoʻonāukiuki, me ka poino o ke poʻo wahine a me ka humerus, a me ka pākela tibia. ʻIke ʻia nā abnormalities mua me ka isotopic scintigraphy a me MRI. ʻO ka hōʻike o nā hoʻololi hoʻololi radiological e hōʻike i kahi kaʻina lōʻihi. Hiki i ke hoʻonāukiuki decompression iwi i ke wā mua i ka nekrosis ischemic, akā na mea hoʻohālikelike o kēia kaʻina hana.

12. ʻO nā hopena ʻē aʻe o ka glucocorticoids e pili ana i ka hyperlipidemia, ke ʻano o ka haehae, hoʻonui nui ʻia, ʻoi aku hoʻi i ka pō, a me ka benign intracranial hypertension (pseudotumor cerebri). ʻO ke ʻano o ka thrombophlebitis, necrotizing arteritis, pancreatitis, a me ka uluna peptic i kekahi manawa e pili ana i ka hana a nā glucocorticoids, akā ʻike nā mea pili i kēia pili.

5.ʻŌkole lapuwalenā glucocorticoids

1. He hoʻomaʻemaʻe maikaʻi loa no ka hoʻohana ʻana i nā glucocorticoids.

2. ʻO ke koho kumu kūpono o ka lāʻau glucocorticoid, i hiʻohiʻona ʻia e ka lua kiʻekiʻe a me ke ʻano haʻahaʻa haʻahaʻa o nā hopena ʻaoʻao. Ua hoʻokō ʻo Methylprednisolone (Medrol, Solu-medrol a me Depo-medrol i kēia mau koi, nā hoʻopaʻapaʻa i hāʻawi ʻia i luna.

3. ʻO ke koho ʻana o ka hopena mua o ka lāʻau glucocorticoid e hoʻolako i ka hopena klinika pono loa ma nā liʻiliʻi liʻiliʻi e pono ke kau ʻia ma luna o ka loiloi hohonu o ka mea maʻi, me ka nosology o kēia maʻi, kāna hana, ka hōʻino o nā mea ola a me nā ʻōnaehana, a me ka mea i ʻae ʻia i nā ʻōlelo aʻo i loko o nā kao ʻana o ka lapaʻau glucocorticoid no nā ʻano like ʻole. kūlana. I kēia mau lā, ua ʻike ʻia ka hoʻonaninani glucocorticoid e like me ka mālama ʻana o ke koho no nā maʻi rheumatic he nui, ʻo ia hoʻi ʻo SLE, dermatomyositis a me polymyositis, vasculitis, glomerulonephritis a me nā mea hou aku. I ka manawa like, loli ka nui o nā dosage ma mua o nā hiʻohiʻona o ke kiʻi lapaʻau a me nā ʻāpana laboratorium. No laila, no ka laʻana, me nā hana kiʻekiʻe o SLE, dermatomyositis, polymyositis, vasculitis systemic a / a i ʻole komo i nā ʻili kino a me nā ʻōnaehana ma kēia mau maʻi, ka hoʻohana ʻana o nā dosages kiʻekiʻe a i ʻole nā ​​kiʻekiʻe o ka glucocorticoids i hōʻike ʻia. I ka manawa like, me ka hana haʻahaʻa o SLE, vasculitis, he hopena lapaʻau maikaʻi e hiki ke loaʻa e nā hopena haʻahaʻa o nā glucocorticoids, a me ka nele ʻole o ka pōʻino o nā kino kūloko a me nā ʻōnaehana waena, ʻaʻole pono ia e kuhikuhi i ka therapy glucocorticoid e hoʻokō i ka kala ʻana, no ka mea hiki ke loaʻa mai kahi hopena lapaʻau ma ka hoʻohana ʻana i nā NSAIDs , ka mea maʻamau me ka hui pū me ka hoʻomākaukau ʻana o aminoquinoline. I ka manawa like, pono i kahi nui o nā poʻe maʻi e hoʻohana i nā hoʻohana hou o nā papa haʻahaʻa o ka glucocorticoids (Medrol 4-6 mg i ka lā a i ʻole ka prednisolone 5-7.5 mg i kēlā me kēia lā).

ʻO ka nui o ka hoʻohana ʻana i nā lāʻau e hoʻololi nei i nā maʻi i ka hoʻomaka mua o ka lāʻau rheumatoid, ka hemahema o ka ʻikepili i ka hopena maikaʻi o nā pualeka lā a me nā kiʻekiʻe o ka glucocorticoids ma ke kīhāpai lōʻihi i ka poʻe maʻi me ka rheumatoid arthritis, a me ka nui o ka hopena o nā hopena koʻikoʻi i ka wā e hoʻohana ai iā lākou, ua loli nui ke ala i ka hoʻohana ʻana o nā glucocorticoids. I kēia lā i ka lilo

Ka hōʻike hōʻike kino loa-articular o ka lāʻau rheumatoid (no ka laʻana, he vasculitis, pneumonitis) ʻaʻole i ʻōlelo ʻia no ka hoʻohana ʻana o nā glucocorticoids i nā nui he 7.5 mg i kēlā me kēia lā o ka prednisone a i ʻole 6 mg o ka methylprednisolone. Eia kekahi, i nā mea maʻi he nui me ka lāʻau o ka rheumatoid, ʻo ka hoʻohui ʻana o 2-4 mg i kēlā me kēia lā o Medrol i ka hōʻola hou ʻana i ka maʻi e hōʻike ʻia ana e ka hopena kulana maikaʻi.

1. E hoʻokumu i kahi kaʻina no ka lawe ʻana i nā glucocorticoids: hoʻomau (ka maʻamau o kēlā me kēia lā) a i ʻole intermittent (kahi koho a me ka intermittent) mau koho.

2. I ka hapa nui o nā maʻi rheumatic, vasculitis, glomerulonephritis, glucocorticoids ka mea ʻaʻole lawa e hoʻokō a hoʻopau ʻokoʻa āpana a me ka kala ʻana i ka laboratorium, e koi ana i kā lākou hui pū ʻana me nā ʻano lāʻau cytotoxic (azathioprine, cyclophosphamide, methotrexate a me nā mea ʻē aʻe). Eia kekahi, hiki i ka hoʻohana ʻana o ka cytostatics ke hiki nui i ka hōʻemi ʻana i ka dosage o nā glucocorticoids (a i ʻole hoʻokake ʻole paha) i ka wā e mālama ana i ka hopena hopena, kahi e hōʻemi nui ana i ka pinepine a me ka paʻakikī o nā hopena o ka hopena o ka glucocorticoid therapy.

3. Manaʻo nā kauka lapaʻau he mau haʻahaʻa loa o ka hopena o ka glucocorticoids (2-4 mg / lā o Medrol® a me 2.5-5.0 mg mg / lā o prednisolone) e hoʻomau ʻia i loko o nā mea maʻi he nui nā maʻi rheumatic ma hope o ka hoʻokō ʻana i ke kala ʻana a me ka hoʻoiho ʻana i nā lāʻau.

Me kapapa inoa o nā palapala paʻi i hoʻohana ʻia

1 haʻawina MD, prof. Lobanova E.G., Ph.D. Chekalina N.D.