Biguanides a lura da ciwon sukari

An sanya rukuni na kwayoyi don ciwon sukari daban-daban ga kowane mai haƙuri. Biguanides sune magungunan da aka tsara don rage matakan glucose na jini na masu ciwon sukari. Ana samar da maganin a cikin allunan. Oftenari mafi yawa, ana sanya magani a matsayin wata hanya don maganin adjuvant ga marasa lafiya da ke fama da nau'in ciwon sukari na 2 na mellitus. Tare da monotherapy, ba da wuya a ƙulla magunguna (5-10% na lokuta). Biguanides yana mai da hankali kan iyakantaccen amfani saboda sakamako masu illa na cutar. ...

Tare da monotherapy, ba da wuya a ƙulla magunguna (5-10% na lokuta). Biguanides yana mai da hankali kan iyakantaccen amfani saboda sakamako masu illa na cutar. Cutar dyspepsia cuta ce ta gama gari wanda ake yin magani.

Hanyar aiwatar da maganin

Tare da nau'in sukari na nau'in 2, mutanen da ke shan biguanides sun zama masu hankali ga insulin, amma babu wani karuwa a cikin abin da yake fitarwa. A game da tushen canje-canje, akwai karuwa a cikin matakan kwalin insulin a cikin jinin mutum. Wani tabbataccen sakamako a cikin jiyya tare da metformin shine raguwa a cikin nauyin jikin mai haƙuri. A cikin jiyya tare da sulfonylureas, haɗe tare da insulin, sakamakon shine akasin rasa nauyi.

Jerin maganin hana daukar ciki

Mutanen da ke cikin mummunan aiki na jiki (masu motsa jiki, magina, ma'aikatan masana'antu) sun fada cikin rukunin haɗarin. Mutanen da ke cikin damuwa suna iya fuskantar sakamakon shan magani. Ana aiwatar da warkewa tare da horo tare da ilimin halin ɗan adam don daidaita yanayin tunanin mutum.

Yaya suke aiki

Anyi amfani da Biguanides don kamuwa da cutar tun daga shekarun 1970. Ba sa haifar da insulin insulin daga ciki. Ayyukan irin waɗannan kwayoyi suna faruwa ne saboda hana aikin gluconeogenesis. Mafi magunguna na yau da kullun wannan nau'in shine Metformin (Siofor).

Ba kamar sulfonylurea da abubuwan da ke samo asali ba, Metformin ba ya rage glucose kuma baya haifar da hypoglycemia. Wannan yana da mahimmanci musamman bayan azumin na dare. Magungunan yana iyakance yawan karuwa a cikin jini bayan cin abinci. Metformin yana ƙaruwa da ƙwaƙwalwar ƙwayoyin sel da ƙirar jikin mutum zuwa insulin. Bugu da kari, yana inganta ciwan glucose a cikin sel da kyallen takarda, yana rage jinkirin sha a cikin hanji.

Tare da yin amfani da tsawan lokaci, biguanides suna da tasirin gaske akan metabolism mai. Suna rage jinkirin aiwatar da canza glucose zuwa kitse mai kitse, kuma a wasu halaye sun rage abubuwan da ke cikin triglycerides, cholesterol a cikin jini. Ba a gano sakamakon biguanides yayin rashin insulin ba.

Ana amfani da Metformin sosai daga narkewa kuma ya shiga cikin jini, inda mafi girmansa ya kai awowi biyu bayan fitowar. Rayuwa ta rabin rabin lokaci har zuwa awa 4 da rabi.

Manuniya da contraindications

Wataƙila amfani da biguanides a hade tare da insulin. Hakanan zaka iya ɗaukar su a hade tare da sauran magunguna masu rage sukari.

Magungunan yana contraindicated a cikin irin waɗannan lokuta:

• ciwon sukari da ke dogaro da insulin (sai dai idan an hada shi da kiba),
• daina matsalar insulin,
• ketoacidosis
• gazawar koda, gajiya hanjin aiki,
• na zuciya da jijiyoyin jini,
• rashin ruwa, girgiza,
• na kullum,
• lactic acidosis,
• ciki, shayarwa,
• karancin kalori (kasa da kilogram 1000 a rana),
• shekarun yara.

Ya kamata a yi taka tsantsan wajen sanya biguanides ga mutanen da suka wuce shekara 60 idan suna cikin aiki na zahiri. A wannan yanayin, akwai haɗarin haɗari na haɓaka lactic acidosis coma.

Side effects da yawan abin sama da ya kamata

A cikin kusan 10 zuwa 25 bisa dari na lokuta, marasa lafiya waɗanda ke shan biguanides suna fuskantar tasirin sakamako kamar dandano mai ƙarfe a cikin bakin, asarar ci, da tashin zuciya. Don rage yiwuwar kamuwa da irin wannan alamomin, yana da mahimmanci a ɗauki waɗannan magunguna tare da ko bayan abinci. Ya kamata a ƙara yawan hankali a hankali.

A wasu halaye, ci gaban megaloblastic anemia, karancin cyanocobalamin yana yiwuwa. Da wuya, rashin lafiyar fitsari ta bayyana akan fatar.

Game da yawan abin sama da ya wuce, alamomin lactic acidosis na faruwa. Bayyanar cututtuka na wannan yanayin sune rauni, damuwa na numfashi, amai, tashin zuciya, da gudawa. Sanyaya daga ƙarshen ƙarshen, bradycardia, hypotension sanannen abu ne. Jiyya na lactic acidosis alama ce ta alama.

Dole a sanya sashi na miyagun ƙwayoyi kowane lokaci daban-daban. Kullum kuna da glucose a hannu. Hakanan yana da mahimmanci la'akari da jin daɗin rayuwa: sau da yawa sakamako masu illa suna haifar ne kawai saboda ƙimar da ba ta dace ba.

Jiyya tare da biguanides ya kamata farawa da ƙarancin kashi - ba fiye da 500-1000 g kowace rana ba (bi da bi, 1 ko 2 Allunan na 0.5 g). Idan ba'a lura da wani sakamako ba, to ana iya ƙara yawan kashi. Matsakaicin adadin maganin a rana shine 3 grams.

Don haka, Metformin babban kayan aiki ne mai inganci don magani da rigakafin cutar sankara. Wajibi ne a bi umarnin don amfani da miyagun ƙwayoyi.

Alamu don amfani

B. don magance ciwon sukari mellitus za'a iya amfani dashi: a) azaman hanyar magani mai zaman kanta, b) a hade tare da shirye-shiryen sulfanylurea, c) a hade tare da insulin.

Nazarin asibiti ya tabbatar da yiwuwar amfani da B. don maganin marasa lafiya da nau'ikan nau'ikan cututtukan mellitus, ban da marasa lafiya tare da ketoacidosis. Koyaya, azaman hanyar magani mai zaman kanta B. za'a iya amfani dashi kawai don nau'ikan sikari na laushi a cikin marasa lafiya masu kiba.

Jiyya na ciwon sukari mellitus B., kamar sauran hanyoyin don magance wannan cutar, ya samo asali ne daga ka'idodin biyan diyya don raunin ƙwayar cuta. Abincin da ake ci a maganin B. bai bambanta da irin abincin da aka saba da maras lafiya da masu ciwon sukari ba. A cikin marasa lafiya tare da nauyin al'ada, ya kamata ya zama cike da adadin kuzari da abun da ke ciki, ban da sukari da wasu samfuran da ke ƙunshe da ƙwayoyin carbohydrates mai sauƙin narkewa (shinkafa, semolina, da dai sauransu), kuma a cikin marasa lafiya tare da kiba mai yawa ya kamata ya zama sub-caloric tare da ƙayyade kitsen da carbohydrates kuma ban da sukari.

Rage tasirin sukari na B. yana da cikakken aiki a cikin 'yan kwanaki kaɗan daga farkon amfani da su.

Don kimanta tasiri na jiyya, dole ne a ɗauki su a kalla kwana bakwai. Idan kulawar B. ba ta haifar da diyya na matsalolin cuta na rayuwa ba, to ya kamata a daina amfani dashi azaman hanyar magani mai zaman kanta.

Rashin hankali na sakandare ga B. yana haɓaka da wuya: bisa ga Asibitin Joslin (E. P. Joslin, 1971), yana faruwa a cikin ƙasa da 6% na marasa lafiya. Yawan ci gaba mai karɓar B. ta marasa lafiya dabam - 10 da ƙari.

A cikin jiyya tare da shirye-shiryen sulfanylurea, ƙari na B. zai iya ramawa don raunin metabolism inda magani tare da magungunan sulfanylurea kadai ba shi da tasiri. Kowane ɗayan waɗannan magunguna suna haɓaka aikin ɗayan: shirye-shiryen sulfonylurea suna haɓaka ƙwayar insulin, kuma B. inganta amfani da glucose na gefe.

Idan an haɗaka magani tare da shirye-shiryen sulfanylurea da B., wanda aka aiwatar a cikin kwanaki 7-10, ba ya ba da diyya don rikicewar metabolism, to ya kamata a dakatar da shi, kuma ya kamata a tsara insulin ga mai haƙuri. Game da fa'idar tasirin magani tare da B. da sulfonamides, yana yiwuwa a kara rage allurai biyu tare da janyewar hankali na B. Tambayar yiwuwar rage allurai na kwayoyi da ake karba a kowane lokaci ana yin hukunci ne bisa tushen alamu na sukari na jini da fitsari.

A marasa lafiyar da suke karɓar insulin, amfanin B. yakan saba rage buƙatar insulin. Lokacin da aka wajabta su a lokacin da aka isa matakin sukari na yau da kullun na jini, yana da mahimmanci don rage kashi na insulin da kusan 15%.

Ana nuna amfani da B. don maganin sikari da zai iya tsayar da cutar sikari. Tare da labile hanya na cutar a wasu marasa lafiya, yana yiwuwa a yi amfani da B. don cimma wani ingantawa na sukari matakan jini, amma a cikin mafi yawan marasa lafiya da ikon ga ciwon sukari ba ya ragu. B. jihohin rashin ƙarfi ba sa haifar.

Shirye-shiryen Biguanide da amfaninsu

Sakamakon kusancin cutar ta B. ga magungunan masu guba, janar na kula da B. shine yin amfani da ƙananan allurai a farkon jiyya tare da karuwa mai zuwa a duk kwanakin 2-4 idan akwai kyakkyawan haƙuri. Duk shirye-shiryen K. ya kamata a ɗauka nan da nan bayan cin abinci don hana sakamako daga gefen rawaya-hanjin. fili.

B. da aka baki. Suna cikin ƙananan hanji kuma an rarraba su cikin sauri a kyallen takarda. Hankalin su a cikin jini bayan shan allurai warkewa ya kai kawai 0.1-0.4 μg / ml. An lura da tarawar B. ana cikin ƙodan, hanta, gyada, hanji. fili, huhu. A adadi kaɗan daga cikinsu an ƙaddara su a cikin ƙwaƙwalwar ƙwayar cuta da tsohuwar nama.

Phenethylbiguanide yana metabolized zuwa N'-p-hydroxy-beta-phenethylbiguanide, dimethylbiguanide da butylbiguanide basu cikin metabolized a cikin mutane. Thirdaya bisa uku na phenethylbiguanide an keɓe shi azaman metabolite, kashi biyu cikin uku ba su canzawa.

B. da aka cire a fitsari da kuma feces. A cewar Beckman (R. Beckman, 1968, 1969), ana samun phenethylbiguanide da metabolite a cikin fitsari a cikin adadin 45-55%, da kuma butylbiguanide - a cikin adadin 90% na kashi 50 na kwayoyin da aka ɗauka sau ɗaya, ana rage dimethylbiguanide a cikin fitsari don 36 awa a cikin adadin 63% na kashi ɗaya da aka ɗauka, ɓangaren da ba a ɗauka ba na B. an keɓance shi da feces, da kuma karamin sashi daga cikinsu, wanda ya shiga cikin hanji tare da bile. Rabin-rabin biol, ayyukan B. ya sanya fargaba. 2.8 hours.

Tasirin rage sukari na B., wanda aka samar a cikin allunan, ya fara bayyana kansa a cikin awanni 0.5-1 bayan cin abincin nasu, an sami sakamako mafi girma bayan sa'o'i 4-6, sannan tasirin ya ragu kuma ya tsaya ta awanni 10.

Phenformin da buformin, ana samunsu a cikin capsules da dragees, suna ba da hankali a hankali da tsawon lokaci. B. Shirye-shiryen yin aiki mai tsawo ba zai yuwu haifar da sakamako masu illa ba.

Phenethylbiguanide: Phenformin, DBI, allunan 25 MG, na yau da kullun na 50-150 mg don allurai 3-4, DBI-TD, Dibein retard, Dibotin capsules, Insoral-TD, DBI retard, Diabis retard, DB retard (capsules ko dragees for 50 MG, na yau da kullun na 50-150 mg, bi da bi, 1-2 sau ɗaya a rana tare da tazara tsakanin sa'o'i 12.).

Butyl Biguanide: Buformin, Adebit, allunan 50 MG, kullun na 100-300 MG don allurai 3-4, Silubin retard, dragee na 100 MG, kashi 100 na 100 a kowace rana, bi da bi, sau 1-2 a rana tare da tazara tsakanin awanni 12 .

Dimethylbiguanide: Metformin, Glucofag, allunan 500 MG, maganin yau da kullun - 1000-3000 MG a cikin allurai 3-4.

Sakamakon sakamako na biguanides za a iya bayyana ta hanyar cin zarafi daban-daban daga gefen rawaya-mai launin rawaya. fili - dandano mai ƙarfe a cikin bakin, asarar ci, tashin zuciya, amai, rauni, zawo. Duk waɗannan ɓarna gaba ɗaya sun ɓace jim kaɗan bayan an cire magunguna. Bayan wani lokaci, ana iya sake farawa tsarin B., amma a ƙananan allurai.

Ba a bayyana lahani mai illa ga hanta da kodan a cikin kulawar B. ba a bayyana su.

Littattafan sun yi mahawara game da yiwuwar haɓakar lactic acidosis a cikin marasa lafiya da ciwon sukari na mellitus a cikin lura da B. Kwamitin don Nazarin Acabolicic metabolism na Non-ketonemic a cikin ciwon sukari Mellitus (1963) ya lura cewa a cikin lura da B. matakin lactic acid a cikin jinin marasa lafiya na iya ɗan ƙara haɓaka.

Lactic acidosis tare da babban matakin lactic acid a cikin jini da raguwa a cikin pH na jini a cikin marasa lafiyar masu ciwon sukari suna karɓar B. da wuya - ba sau da yawa fiye da marasa lafiya da ke karɓar waɗannan kwayoyi.

A hankali, lactic acidosis yana halin mummunan yanayin mai haƙuri: yanayin yin sujada, Kussmaul na numfashi, ƙwayar cuta, baki na iya ƙarewa cikin mutuwa. Hadarin haɓaka lactic acidosis a cikin marasa lafiya da ciwon sukari yayin lura da B. ya taso idan suna da ketoacidosis, ƙwaƙwalwar zuciya ko gazawar koda, da kuma sauran wasu halaye waɗanda ke faruwa tare da rikicewar microcirculatory da hypoxia na nama.

Contraindications

B. ana sabunta yanayin ketoacidosis, rashin lafiyar zuciya, gazawar koda, cututtukan febrile, a cikin lokacin haihuwa da na bayan haihuwa, yayin daukar ciki.

Bibliography: Vasyukova E.A. da Zephyr o v a G.S. Biguanides a lura da ciwon sukari. Klin, zuma., T. 49, Ba. 5, p. 25, 1971, bibliogr., Ciwon sukari mellitus, ed. V.R. Klyachko, p. 142, M., 1974, bibliogr., Tare da z a z a k A. da. game da. Tasirin biguaniaes akan shayewar hanji na glu-kose, Ciwon sukari, v. 17, shafi. 492, 1968, K r ​​a 1 1 L. P. Amfani da asibiti na wakilai na magana da jini, a cikin: Ciwon sukari mellitus, ed. by M. Elienberg a. H. Rifkin, p. 648, N. Y. a. o., 1970, Williams R. H., Tanner D. C. a. Game da d e 1 1 W. D. Ayyukan hypoglycemic na phenethylamyl, -and isoamyl-diguanide, Ciwon sukari, v. 7, shafi. 87, 1958, Williams R. H. a. o. Nazarin da ke da alaƙa da ƙwayar hypoglycemic acid na phenethyldiguanide, metabolism, v. 6, p. 311, 1957.