I-diuretics iyinhlanganisela yezakhi ezahlukahlukene zamakhemikhali okuthi, uma zifakwa, zibe nomthelela ekuqedeni uketshezi. Ngokuya ngeqembu lezemithi, umphumela wokuchama ubangelwa izindlela eziningana zokwenza.
Izidakamizwa zivame kakhulu ekwelapheni izifo zesistimu yenhliziyo, izinso nezinye izitho. Ngaphezu kwalokho, zisetshenziswa ngabasubathi ukususa ngokushesha uketshezi nokunikeza ukukhululeka komzimba.
Yini i-diuretics ye?
Izidakamizwa zisetshenziswa ngabasubathi ukukhipha uketshezi emzimbeni. Umphumela ukuvumela ukuthi unciphise inani eliphelele legazi ezitsheni. Lo mphumela usetshenziselwa ukwehlisa umfutho wegazi kubantu abane-hypertension. Ekuhlulekeni kwenhliziyo okungapheli, kukhona ukuncipha komsebenzi wokumpompa kwenhliziyo nokuma esiyingini esincane nesikhulu sokujikeleza kwegazi. Isithombe somtholampilo sivezwa yi-edema yemikhawulo engezansi nobuso, ukubonakala kokuphefumula nokuphefumula okumanzi, okunqunywa ukukhushulwa kwamaphaphu. Ukuthatha isisu kukuvumela ukuthi ususe uketshezi oluningi futhi ukhulule izimpawu ze-CHF.
I-Osmotic ne-loop diuretics isetshenziselwa ukuvuselela ukwelapha nokuvimbela i-edema yamaphaphu kanye ne-cerebral.
Futhi, i-diuretics inikezwa njengokwelashwa kokukhipha ubuthi ngobuthi ngosawoti bensimbi esindayo, izidakamizwa, izinto ezidakisayo kanye nobunye ubuthi. Zibekiwe esimweni sokuthuthukiswa kwesifo sokuqina kwesibindi, esaziwa nge-portal hypertension. Izidakamizwa ziqeda noma zinciphisa ukuqina kwe-edema, zisuse uketshezi oluvela esiswini sesisu nge-ascites elinganiselayo.
Kubalulekile ukuthatha i-diuretics ye-eclampsia, isimo sokugula esivela kubantu besifazane ngesikhathi sokukhulelwa noma sokubeletha. Lesi sifo sizibonakalisa njengokwenyuka okubucayi kwengcindezi yegazi, okuholela ekuqhumeni kwesifo nokuphazamiseka kobuchopho ngemuva kwesizinda se-edema. Ukwelashwa okuyinkimbinkimbi, ngaphezu kokuchazwa kwama-diuretics, ikakhulukazi i-osmotic, kufaka phakathi umoya wokufakelwa, ukuqapha umfutho wegazi, ukukhululeka komfutho wegazi ophezulu usebenzisa i-magnesium sulfate infusion therapy, kanye nezinyathelo zokuvuselela.
Ukwanda kwengcindezi ye-intraocular (glaucoma) kuyinkomba yokusetshenziswa kwe-carbonic anhydrase inhibitors. I-enzyme ikhiqizwa kwizicubu eziningi, kufaka phakathi umzimba we-ciliary. Ukusetshenziswa kwezihloko kwesichaso ngesimo samaconsi kunciphisa ukubonakala kwe-glaucoma.
Imithambo ye-Varicose ihambisana nokuthuthuka kwe-edema, ngakho-ke, ukwanda kokukhishwa komchamo ngokusebenzisa izidakamizwa kukhulula izimpawu zesifo futhi kuvimbele izinkinga.
Kungani abagijimi bedinga isisu?
Izidakamizwa zisetshenziswa kabanzi kubasubathi nakubakhi bomzimba. Ukusetshenziswa komchamo kuholela ekukhipheni uketshezi, oluqukethe hhayi kuphela egazini nasezicutshini, kepha nasezicutshini ezinamafutha ezingaphansi. Ngenxa yalomphumela, umzimba uthola ukukhululeka ngaphandle.
Ukwelashwa kokudla, okubandakanya ukuphuza usawoti namanzi okulinganiselwe, kukhombisa imiphumela isikhathi eside, kanti izidakamizwa cishe zikuvumela ngokushesha ukuthi uzuze umphumela owufunayo. Lokhu kuyiqiniso ikakhulukazi ngosuku olwandulela umncintiswano.
Ukuthatha izidakamizwa kungaba yi-parenteral, okungukuthi, ngokwethulwa komjovo emthanjeni. Lolu hlelo luhlinzeka ngomphumela osheshayo. Kodwa-ke, le ndlela ingadala ukwehla okukhulu kwengcindezi yegazi, ukungasebenzi kahle kobuchopho nezinye izinkinga. Abasubathi abangochwepheshe bakhetha amaphilisi okwehlisa isisu, ngoba ukuphathwa kwezidakamizwa okunjalo kuqinisekisa ukumuncwa okufanayo kwento esebenzayo nomphumela othambile.
Abasubathi abaningi abangochwepheshe bathinteka ezifweni ze-metabolic ezibangelwa ukuqoqwa kwe-urea, imizimba ye-ketone, i-uric acid, ngakho-ke, ukusetshenziswa kwe-diuretics kuyindlela yokuvimbela izifo ezinjalo.
Ukuhlukaniswa kanye nokusebenza kwesenzo se-diuretics
Ukwahlukaniswa komchamo kususelwa kuzici zemithi.
Ama-diuretics akhuthaza ukukhishwa koketshezi ngemuva kwesizinda sokuphazamiseka kokubuyiselwa kabusha kwe-ion:
Ukubuyela emuva
I-Loure diuretics isebenza kahle kakhulu. Iphuzu lokusetshenziswa kwezidakamizwa yingxenye ejiyile yengxenye ekhuphukayo yeluphu yaseHenle. Banciphisa ukubuyiselwa kabusha kwe-sodium, i-potassium ne-chlorine ngokuvimba izinhlelo zokuhamba. Kanye nama-electrolyte asohlwini, izimali zisusa i-calcium ne-magnesium ekugxileni okungabalulekile, noma kunjalo, ukwelashwa kwezifundo kungaholela ku-hypomagnesemia. Ukusetshenziswa kwesikhathi eside kuholela ekwenzeni ngcono ukujikeleza kwegazi kwezinso, ngakho-ke kusetshenziswa umsebenzi onganele we-glomerular apparatus.
Phakathi kwezidakamizwa ezikuleli qembu: Furosemide, Lasix, Bumex, Ethacrynic acid, Torasemide.
I-Thiazide
Izakhi ze-Thiazide zithinta izinqubo ze-metabolic ze-ions engxenyeni yokuqala yamatubules ahlanganisiwe we-nephron. Izidakamizwa zivimba amaprotheni athile aqinisekisa ukubuyiswa kabusha kwe-sodium ne-chlorine. Lo mphumela uholela ekwandeni kokukhishwa kwamanzi kanye nama-electrolyte avela emzimbeni. Futhi, i-thiazide diuretics ivimba ngokulinganisela i-anhydrase ye-carbonic, ethuthukisa umthelela we-diuretic.
Izidakamizwa kuleli qembu: Naklex, Dichlorothiazide.
Ukuvikela i-potassium
Izidakamizwa zokuvikela i-potassium zisebenza engxenyeni yokugcina yamatubules e-distal, kanye namapayipi okuqoqa. Naphezu komphumela obuthakathaka, isisu saleli qembu lezokwelapha sisetshenziswa kakhulu kwezokwelapha ngenxa yendlela yabo yokusebenza ekhethekile. Izidakamizwa zandisa ukukhishwa kwe-sodium, kodwa ngasikhathi sinye zigcina i-potassium ne-magnesium, evikela ukushoda kwama-electrolyte egazini, futhi, ngenxa yalokho, ukuphazamiseka kwenhliziyo.
Lolu hlu lubandakanya iSpironolactone, Veroshpiron, Triamteren.
Kwangathi noma kungabi ngabaphikisi be-aldosterone. Okokuqala kufaka iSpironolactone, iVeroshpiron. Lokhu kusho ukuthi umsebenzi wayo wokwelapha uphakeme, izinga liphakeme nokukhiqizwa emzimbeni we-aldosterone (i-hormone mineralocorticosteroid ekhiqizwa i-adrenal cortex). Le nto ikhuthaza ukubuyiselwa kabusha kwe-sodium. Izidakamizwa zaleli qembu ngokuncintisana zivimbela i-hormone, ziyisusa ekuxhumaneni nama-protein protein. Abaphikisi be-Aldosterone banciphisa ukubuyiselwa kabusha kwama-ion e-sodium, ngaleyo ndlela bandise ukukhishwa koketshezi emzimbeni.
I-Osmotic
Benza ekukhanyeni kwe-nephron tubules. Imithi yokwakha idala ingcindezi ephezulu ye-hydrostatic ukuze amanzi angabuyeli emuva egazini futhi akhishwe emzimbeni. Ngaphezu kwalokho, le mishanguzo ineqhaza ekunciphisweni kwamanzi kwezicubu, kufaka phakathi lezo ezivikelwe yisithiyo esinamandla angokwemvelo. Lesi sici sisetshenziselwa ukuqeda i-edema yamaphaphu kanye neye-cerebral.
Phakathi kwezidakamizwa ezikuleli qembu, kufanelekile ukugqamisa iMannitol.
I-Carbonic anhydrase inhibitors
Kuholela ekwephuleni ukumuncwa okuphindayo kwe-bicarbonate, ngenxa yalokho ukukhululwa kwe-ioni ye-sodium namanzi kwanda.
Leli qembu lifaka phakathi iDiakarb, Fonurit.
I-Mercury
I-Diuresis yandiswa ngokungasebenzi kwezinhlelo zokuhamba nge-sodium. Ukwehla kokubuyiselwa kabusha kwe-ion kuholela ekukhuphukeni kokukhishwa kwamanzi ngezinso. Kukhona inkolelo yokuthi izidakamizwa zaleli qembu lezokwelapha nazo zithinta izakhiwo zezinzwa zezinso. Umuthi unqunywe uma kwenzeka ukungasebenzi kwezinye izindlela, ngoba i-mercury diuretics iyingozi kakhulu.
Phakathi kwemithi enjalo kukhona iNovurit, iMerkuzal.
Ukuqokwa kwama-diuretics athile kuya ngesifo esiyimbangela. Kwezinye izimo, inhlanganisela yezindlela eziningana isetshenziselwa ukufeza umphumela ovelele.
Kwezemidlalo, abagijimi bavame ukusebenzisa izidakamizwa ze-loop ne-thiazide, ngoba bakhombisa ngokushesha umphumela we-diuretic. Ama-potassium-sparing agents nawo ajwayelekile - ukusetshenziswa kwawo kaningi kuholela ekuphazanyisweni kwe-electrolyte.
Ama-diuretics aphezulu kakhulu ngo-2018
I-Furosemide iyona ephumelela kakhulu phakathi kwe-loop diuretics. Isidakamizwa sibonakala ngesenzo esisheshayo sesikhashana. Emkhakheni wezokwelapha, lesi sidakamizwa sisetshenziswa njenge-ambulensi ukuqeda i-edema ebucayi, izimpawu ezinzima zokwehluleka kwenhliziyo okungapheli kanye ne-edema yobuchopho namaphaphu.
Umphumela obonakaliswe kakhulu eqenjini lama-diuretics okonga i-potassium liphethwe ngumphikisi we-aldosterone uVeroshpiron. Isidakamizwa sigwema izimo ze-pathological ezibangelwa ukuntuleka kwe-electrolyte, kepha umphumela obonakalayo utholakala kancane kancane kunalapho usebenzisa i-loop diuretics. Endaweni yesibili, ungabeka i-Amiloride.
Umholi phakathi kwe-thiazide diuretics nguHydrochlorothiazide. Ithuluzi lisusa kahle uketshezi emzimbeni ngokuvimbela ukubuyiselwa kwama-electrolyte. Umuthi unomphumela omenyezelwe ngokulingene nomphumela wesikhathi eside.
Izidakamizwa zomuntu
Eminye imishanguzo yesintu inomphumela wokukhishwa isisu.
- Ukuze ususe uketshezi oluningi emzimbeni, kusetshenziswa ama-decoctions amaqabunga e-birch. Ukulungisa umuthi, u-300 ml wamanzi abilayo uthelwa phezu kwethisipuni elilodwa lesitshalo esomile bese ufakwa imizuzu engama-30. Thatha i-100 ml yomkhiqizo ngosuku isonto.
- Umphumela we-diuretic uboniswa yi-tincture elungiselelwe ngesisekelo se-bearberry, kanye namaqabunga e-lingonberry namagilebhisi.
- Itiye eliluhlaza lenyusa ukuphuma komchamo. Ungangeza i-mint, i-birch, i-currant noma amaqabunga amagilebhisi esiphuzweni ukuze uthuthukise umphumela.
- Amanye amakhambi wesintu angathengwa ekhemisi, ngokwesibonelo, iKanefron, equkethe izithako zamakhambi - ikhulu leminyaka, i-rosemary ne-lovage.
Izinkomba
Ukuthatha isisu kukhonjisiwe:
- umfutho wegazi ophakeme;
- i-edema;
- i-glaucoma njengokwelapha noma ukulungiselela ukuhlinzeka ngamehlo;
- i-preeclampsia ne-eclampsia yokusiza umfutho wegazi ophakeme;
- isifo esingapheliyo sezinso.
Izimo
Ukuthatha isisu kuphikisiwe uma kwenzeka:
- ukwehluleka okukhulu kwezinso, kuhambisana ne-anuria;
- ukuvimbela ukuphuma komchamo kwanoma iyiphi i-etiology;
- ukwanda kwengcindezi emthanjeni wejugular ongaphezu kwe-10 mm Hg;
- hypertrophic cardiomyopathy;
- ukuphazamiseka kwe-electrolyte;
- ukoma emzimbeni ngesizinda sokuhlanza, isifo sohudo kanye nezinye izifo.
Akunconywa ukwandisa i-diuresis ku-infarction ye-myocardial acute, i-cerebral artery stenosis, isifo sikashukela ngaphandle kokwelapha, kanye nezifo ezizimele.
Ngesikhathi sokukhulelwa kunikezwa i-diuretics eqenjini le-thiazide, kepha ekuqaleni kusetshenziswa amanye amaqembu ezemithi. Ucwaningo oluningi lomtholampilo lukhombisile ukuthi ngokwehla kwevolumu yokujikeleza kwegazi ngokuya ngemuva kokusebenzisa isisu, ingozi yokwanda kwe-gestosis sekwanda iyanda.
Okuqhamuka uma udla imishanguzo
Umphumela ovame kakhulu ukuthuthukiswa kwe-hypokalemia lapho uthatha i-thiazide ne-loop diuretics. Lokhu kungalingani kwe-electrolyte kuholela kuma-arrhythmias. IFurosemide kanye nama-analogue ayo akhombisa umphumela we-ototoxic, okungukuthi, anciphisa ukuzwa. Lokhu kwenzeka njengomphumela wokungaboni kahle kwesisindo somsindo endlebeni yangaphakathi ngenxa yezinguquko kubhalansi ye-electrolyte. Lapho umuthi ukhanseliwe, umsebenzi wokuzwa uyabuyiselwa. I-Thiazide diuretics yandisa ubungozi be-glaucoma noma i-myopia yesikhashana.
Izidakamizwa ze-Osmotic zingaholela ekuphelelweni amanzi emzimbeni okukhulu, okuvezwa isikhumba esomile, ukoma, ukukhubazeka kwengqondo, kanye nokwehla kwengcindezi yegazi ngokuphelelwa ngamandla. Kungenzeka futhi ukuthuthukisa ukuntuleka kwe-electrolyte, ubuhlungu besifuba ngendlela ye-angina pectoris.
Ekuphenduleni ukuthatha izidakamizwa zomchamo, ukungezwani komzimba kungahle kuvele.
Ukusetshenziswa njalo kwezidakamizwa ezivela eqenjini labaphikisi be-aldosterone kubangela ukwakheka kwe-gynecomastia kanye nokungasebenzi kahle kwe-erectile emadodeni, ukungabi nenzalo nokuphazamiseka komjikelezo wama-ovari kwabesifazane.
Ukugwema izinkinga, kufanele ufunde ngokucophelela imiyalo yokusetshenziswa komuthi. Ukweqisa izidakamizwa kusongela ngemiphumela emibi evela ezithweni zangaphakathi.
Izidakamizwa ezincanyana
Ukusetshenziswa kwama-diuretics okwehlisa isisindo kuyinto eyiphutha ejwayelekile evame ukuholela emiphumeleni emibi. Indlela yokusebenza kwe-diuretics ukuqeda amanzi emzimbeni, ngakho-ke, lapho ethathwa, isisindo somzimba siyancipha ngenxa yokwanda kwe-diuresis.
I-Indapamide iyakwazi ukwandisa uketshezi lwama-prostaglandin athile, okuholela ekunciphiseni kokuhlushwa kwama-lipoprotein asezingeni eliphansi egazini, okungukuthi, i-cholesterol, ebangela ukwakheka kwamapulangwe e-atherosclerotic. Kepha umphumela onjalo awuhlangene nokuncipha kwesisindo, ngokungafani nenkolelo evamile.
Lokhu kusho ukuthi ukusetshenziswa kwe-diuretics akuholeli emiphumeleni oyifunayo, ngoba ukwehla kwesisindo kwenzeka kuphela ngenxa yokukhishwa koketshezi. Ukudla njalo okwehlisa isisu ngaphandle kwesizathu esikhulayo kwandisa ubungozi bokuba nemiphumela engadingeki.
Izinhlobo zemithi yokwelapha yabasubathi
I-Loure diuretics inamandla. Ama-pharmacokinetics awo abonakala ngokumunca amathumbu ngokushesha. Umphumela omkhulu utholwa ngesigamu sehora futhi ubonakala ngokwanda kokukhishwa komchamo nokulahleka okusheshayo kwesisindo somzimba. Iqembu le-thiazide diuretics lifakwa isikhashana, umphumela unamandla kakhulu kunaleyo yezidakamizwa ze-loop. Leli qembu lezemithi lithandwa ukusetshenziswa phakathi kwabagijimi ngenxa yemiphumela engemihle yemiphumela engemihle.
- Ekwakheni umzimba, ukusetshenziswa kweFurosemide kunikeza ukukhishwa okusheshayo koketshezi olusuka ezicutshini ezinamafutha ezingaphansi, okuholela ekuguqulweni kwangaphandle - umzimba uyavelela. Kunconywa ukusebenzisa umuthi kwifomu lephilisi ukugwema izinkinga. Umphumela utholakala kungakapheli imizuzu engama-30 ngemuva kokuphathwa ngomlomo komuthi, ubude besenzo buyahluka kusuka kumizuzu engama-90 kuye emahoreni amathathu. IBumetanide inesenzo eside. Njengomthetho, isetshenziswa lapho i-Furosemide ingasebenzi.
- Ikhambi lamakhambi i-Canephron, elihlanganisa i-centaury, i-rosemary ne-lovage, lilungele ukusetshenziswa, ngoba lidala umthelela omubi wokukhipha isisu.
Muva nje, izithasiselo ezikhethekile zabasubathi zithola ukuthandwa, okuqukethe isisu, amavithamini nama-electrolyte. Lokhu kufaka phakathi:
- I-Hydrazide evela kuMuscleTech
- I-Xpel evela ku-MHP;
- Isikhathi sokubonisa ngeSciVation.
I-Hydrazide yi-MuscleTech
Inhlanganisela yokondleka kwezemidlalo ne-diuretics ngesikhathi esifushane inika umsubathi ukukhululeka komzimba.
Indlela yokufihla ukudla kwe-anabolic steroid
Kukholakala ukuthi ukukhishwa koketshezi emzimbeni kuyakwazi ukususa ama-metabolites akhiwe ngesikhathi sokuwohloka kwama-anabolic steroids. Lesi sitatimende siyinganekwane, njengoba iningi le-doping lifakwa ezicutshini futhi alikwazi ukukhishwa emanzini.
Ukusetshenziswa kwama-masking agents kuyathandwa kubasubathi:
- I-Probenecid iyi-ejenti ekhulisa ukukhishwa kwe-uric acid. Isetshenziselwa ukwelapha i-gout.Kodwa-ke, kwezemidlalo kungavunyelwe uhlelo lokulwa nokusebenzisa izidakamizwa, ngoba i-ejenti ikhuthaza ukuqedwa kwama-steroids emzimbeni.
- I-Epitestosterone yinto ephakathi nendawo eyakheka ngesikhathi somzimba we-testosterone. Ukusetshenziswa kwezidakamizwa ezakhiwe ngobumbano kuphazamisa ukutholwa kokudla kwe-anabolic steroid.
Ukufihla iqiniso lokusebenzisa izidakamizwa, abagijimi basebenzisa izinhlanganisela ze-polycyclic - amanye ama-antibiotic, izidakamizwa ze-immunotropic ezisuselwa ku-bromantane.
