Lissafin allurai insulin da yawan glucose a cikin mafita

Alamu don aiwatarwa:lissafta kashi na insulin tare da gabatarwar maganin glucose.

Manufar horarwa

- lissafta kashi na insulin ta hanyar yawan glucose a cikin maganin.

Kayan aiki:

- ganye don takurawa mai haƙuri a hankali,

- kwalba mai dauke da sinadarin sukari na 20% - 400 ml,

Kulawa ta gaggawa don cutar mahaifa

Alamu don aiwatarwa: kulawar gaggawa.

Kayan aiki:

1. Antishock sa.

2. Sterile syringes don inje, tsarin amfani da guda ɗaya don gudanar da aikin ruwan ciki, bi-x tare da kayan daskarewa da kayan kida.

3. insulin gajeriyar aiki.

4. Maganin Isotonic.

5. Metazone ko norepinephrine.

6. Tray, napkins, mabubban ruwa, mayafar mayaƙa, mayafin mai.

Kulawa ta gaggawa don ƙwayar uremic

Alamu don aiwatarwa: kulawar gaggawa.

Kayan aiki

1. Antishock sa.

2. Sterile syringes don inje, tsarin amfani da guda ɗaya don gudanar da aikin ruwan ciki, bi-x tare da kayan daskarewa da kayan kida.

3. Tray, powerps, gopes, safofin hannu na roba, band roba, matashin kai.

4. Magunguna: glucose 40%, 5%, bitamin C, prednisone, soda soda, isotonic sodium chloride bayani, atropine, droperidol.

5. Kayan aiki don sanya hancin na ciki, saitin enema mai tsarkakewa.

Yawan Carotid zuciya

Alamu don aiwatarwa: gano alamun mutuwar asibiti

Manufar horarwa

Ka sami damar

- tantance kasancewar bugun jini a cikin jijiyar carotid

№	Etapi	Zmist	Tabbatarwa
1.	Farawar Farko don Aiki	1. Wanda aka azabtar ya kwanta akan maɗaukaki 2. Guji taɓawa da jini da sauran abubuwan ɓoye na wanda aka cutar	Kula da amincin mutum.
2.	Babban	3. Sanya yatsunsu guda hudu a gefen gefen wuyan da abin ya shafa, a cikin tsagi tsakanin tsoka da toka da kuma tsoka.	Nemo tsinkayewar carotid artery
3.	Kammalawa ta ƙarshe	4. Lura da rashin bugun jini

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bukata sosai

Glucose, 200 mg / ml da 400 mg / ml jiko bayani

Sunan sunadarai. D - (+) - glucopyranose

Gabaɗaya halaye. A miyagun ƙwayoyi ne mai launi mara launi ko dan kadan mai haske mai haske

Abun da magani.

200 MG / ml

400 MG / ml

0.1 M hydrochloric bayani

Ruwa don allura

Fom ɗin saki. Maganin jiko

Rukunin Magunguna. Magani don gudanarwar cikin jijiya. Magani don rage cin abinci mai narkewa.

Lambar PBX. B05BA03

Kayan magunguna

Pharmacodynamics Plasma maye gurbin, rehydrating, na rayuwa da detoxification wakili. Tsarin aiki shine sakamakon canzawar glucose a cikin ayyukan makamashi (glycolysis) da filastik (transamination, lipogenesis, synthesis nucleotide).

Kasancewa a cikin matakai daban-daban na rayuwa a cikin jiki, yana haɓaka aikin sake fasalin a cikin jiki, yana inganta aikin maganin hanta. Glucose, yana shiga cikin kasusuwa, phosphorylates, juya zuwa glucose-6-phosphate, wanda ke aiki sosai a cikin sassan jikin mutum da yawa. Tare da metabolism na e-glucose a kyallen takarda

an fitarda adadin kuzari mai mahimmanci don rayuwar jikin.

Maganin glucose na 400 MG / ml shine hypertonic dangane da plasma jini, kasancewar yana yin ƙarin aiki na osmotic. Idan ana kulawa dashi cikin jiki, yana kara fitar da kwayar halittar nama zuwa gado na jijiyoyin jiki kuma yana riƙe ta. Diara diureis, ƙara haɓaka abubuwa masu guba a cikin fitsari, inganta aikin maganin hanta.

Lokacin da aka narkar da shi zuwa yanayin isotonic (50-100 mg / ml bayani) yana sake jujjuyawar ƙwayar ruwan batacciyar, yana kula da ƙimar ƙwayar cuta.

don maganin 200 MG / ml - 1278 mOsmol / kg,

don maganin 400 MG / ml - 2989 mOsmol / kg.

Pharmacokinetics Lokacin da aka sarrafa shi cikin hanzari, maganin glucose da sauri ya bar gado na jijiyoyin jiki .. Jirgin ruwa zuwa cikin sel yana sarrafa shi ta hanyar insulin. Jiki yana gudanar da aikin gyaran rayuwa

tare da hanyar hexose phosphate - babban hanyar metabolism na makamashi tare da samuwar mahadi macroergic (ATP) da kuma hanyar pentose foshate hanyar - babbar hanyar metabolism filastik tare da samuwar nucleotides, amino acid, glycerol.

Ana amfani da kwayoyin glucose a yayin samar da makamashi na jiki.

Glucose yana shiga cikin kyallen phosphorylates, yana juya shi zuwa glucose-6-phosphate, wanda daga baya aka haɗa shi a cikin metabolism (ƙarshen samfuran metabolism shine carbon dioxide da ruwa). Yana sauƙaƙe ratsa ta hanyar shinge na tarihi a cikin gabobin kuma

Ya cika jiki baki daya, kodan bai cire shi ba (bayyanar a cikin fitsari alama ce ta cuta).

Alamu don amfani

Sashi da gudanarwa

Kafin gabatarwar, likitan ya zama tilas ya gudanar da gwajin gani na kwayar polymer tare da maganin. Iya warware matsalar ya zama a bayyane, ba ya ƙunshi barbashi ko kwano. Ana ganin miyagun ƙwayoyi sun dace don amfani a gaban alamar da kuma kula da ƙarar kunshin.

Ana magance magudanar jini ta hanyan ciki.

Sashi ya dogara da shekaru, nauyin jikin mutum da yanayin mai haƙuri.

200m / ml maganin ana sarrafa shi ta hanyar juye juye a sikari 30 zuwa digo 30 / min (1.5-

2 ml / min), wanda yayi daidai da kusan 120 ml / awa. Matsakaicin adadin yau da kullun ga manya shine 500 ml.

Maganin 400 MG / ml yana allura a cikin ƙwayoyin cuta a cikin adadin zuwa har zuwa kimanin saukad da 30 / min

(1.5 ml / min), wanda yayi daidai da kimanin 48 ml / awa. Matsakaicin adadin yau da kullun ga manya shine 250 ml.

Lokacin da aka tsinke shi zuwa 100 MG / ml na maganin, matsakaicin matsakaici ya kai 60 saukarwa / min,

girma - 500 ml / rana. Lokacin da aka narkar da shi zuwa 50 mg / ml na bayani, matsakaicin jiko ya kai har zuwa 150 hula / min, ƙarar gudanarwar har zuwa 2 l / rana.

Don cikakkiyar ma'anar insulin glucose da aka gudanar a cikin manyan allurai, ana wajabta insulin lokaci guda tare da shi a cikin adadin 1 na insulin a kowace 4-5 na glucose. Ga marasa lafiya da ke fama da ciwon sukari, ana gudanar da glucose tare da taka tsantsan a karkashin kulawar sukari na jini da fitsari.

M halayen

M halayen da zasu iya faruwa saboda gabatarwar maganin glucose na 200 da 400 mg / ml,

M halayen da za a yi a wurin allura: jin zafi a wurin allurar, tsokar jijiya, phlebitis, thrombosis venous,

Rashin damuwa daga tsarin endocrine da metabolism: hyperglycemia, hypokalemia, hypophosphatemia, hypomagnesemia, acidosis,

Rashin narkewar ƙwayar cuta: polydipsia, tashin zuciya,

Gabaɗayan halayen jiki: hypervolemia, halayen rashin lafiyan (zazzabi, fatar fata, angioedema, shock).

Game da halayen da ba a sani ba, ya kamata a dakatar da gudanar da mafita, a duba yanayin haƙuri kuma a bayar da taimako. Maganin da ya rage ya kamata a riƙe shi don bincike na gaba.

Contraindications

Maganin glucose na 200 da 400 mg / ml an hana shi cikin masu haƙuri da:

- Abun ciki da jijiyoyin jini, in banda yanayin da ake dangantawa da cututtukan jini,

- Rashin ruwa mai saurin lalacewa, gami da matsalar shan barasa,

- Hypersensitivity to dextrose da sauran abubuwan da ke tattare da maganin,

- Ciwon sukari mellitus da sauran yanayi tare da hyperglycemia.

Kada ku sarrafa magani a lokaci guda tare da kwayoyi na jini.

Haihuwa da lactation

Yin amfani da miyagun ƙwayoyi don mata masu juna biyu tare da normoglycemia na iya haifar da hyperglycemia fetal, acidosis metabolic. Latterarshe yana da mahimmanci a yi la’akari, musamman idan wahalar tayin ko hypoxia ta kasance sabili da wasu dalilai na ciki.

Tasiri a kan ƙarfin tuka motoci da kayan haɗari masu haɗari.

Yawan abin sama da ya kamata

Tare da yawan ƙwayar maganin ƙwayar cuta, hyperglycemia, glucosuria, haɓakar hawan jini na osmotic (har zuwa haɓakar ƙwaƙwalwar hyperglycemic hyperosmolar), hauhawar iska, rashin daidaituwa na lantarki. A wannan yanayin, an soke maganin kuma ana yin insulin aiki da sauri a ƙimar kashi 1 ga kowane 0.45 - 0.9 mmol na glucose na jini har sai an sami matakin glucose na jini na 9 mmol / l.

Ya kamata a rage matakan glucose a hankali. Lokaci guda tare da alƙawarin insulin, jiko na daidaitattun kayan kwalliyar saline ana yin su.

Idan ya cancanta, ana wajabta magani na gwaji.

Umarni na musamman

Lokacin amfani da miyagun ƙwayoyi, ya zama dole don saka idanu akan daidaitawar ruwa-electrolyte da matakin glucose a cikin ƙwayar jini.

Tare da tsawanta amfani da maganin tazara, ya zama dole don sarrafa matakan sukari na jini.

Ba'a ba da shawarar yin maganin glucose ba a cikin lokacin mummunan rauni mai rauni na kwakwalwa, idan akwai haɗari mai haɗari na cerebrovascular, tun da miyagun ƙwayoyi na iya ƙara lalata lalacewar ginin kwakwalwa kuma ya cutar da cutar (sai dai a lokuta na gyaran hypoglycemia).

Tare da hypokalemia, gabatarwar maganin glucose dole ne a haɗe tare da gyaran rashi na potassium (don haɗarin haɓakar hypokalemia).

Don mafi kyawun maganin glucose a cikin yanayin normoglycemic, yana da kyau a haɗu da gudanar da magani tare da gudanar da (insulinaneous) mai aiki da insulin a cikin ƙananan sashi na 1 a kowace 4-5 g na glucose (batun bushe).

Kada kayi amfani da mafita ƙarƙashin ƙasa da intramuscularly.

Kada a kula da maganin glucose da sauri ko na dogon lokaci. Idan jin sanyi ya faru a lokacin gudanarwa, ya kamata a dakatar da gudanarwar nan da nan. Don hana thrombophlebitis, ya kamata ku shiga a hankali ta cikin manyan jijiyoyin.

Tare da gazawar koda, gazawar zuciya, zubar da jini, ana buƙatar kulawa ta musamman lokacin da ake rubuta glucose, saka idanu na tsakiyar hemodynamics.

Za'a iya amfani da abubuwan da ke cikin kwandon don mai haƙuri ɗaya kawai, bayan cin zarafin ɗaukar akwatin, za a jefar da sashin da ba a amfani da shi ba.

Yin hulɗa tare da wasu kwayoyi

Maganin glucose na 200 da 400 mg / ml bai kamata a gudanar da su a cikin sirinji iri ɗaya tare da hexamethylenetetramine ba, tunda glucose shine wakili na oxidizing mai ƙarfi. Ba'a ba da shawarar haɗa magungunan alkaline a cikin sirinji iri ɗaya ba: tare da maganin kwantar da hankali gaba ɗaya da magungunan bacci, yayin da ayyukansu ke raguwa, mafita na alkaloids, inactivates streptomycin, yana rage tasirin nystatin.

A ƙarƙashin tasirin thiazide diuretics da furosemide, haƙuri haƙuri yana raguwa. Insulin yana haɓaka ci gaban glucose a cikin kyallen na yanki, yana ƙarfafa samuwar glycogen, ƙirar sunadarai da mai mai. Maganin glucose yana rage illa mai guba da pyrazinamide akan hanta. Gabatarwar babban adadin maganin glucose yana ba da gudummawa ga haɓakar hypokalemia, wanda ke ƙara yawan guba a cikin magungunan digitalis a lokaci guda.

Sharuɗɗan da yanayin ajiya. Adana a yanayin zafi daga 5 ºС zuwa 30 ºС. Ayi nesa da isar yara.

Ranar karewa. Shekaru 2 Kada kayi amfani bayan ranar karewa.

Sharuɗɗan hutu. Da takardar sayan magani.

Kamawa. 100 ml, 250 ml da 500 ml a cikin kwantena na polymer don maganin jiko.

Kowace akwati na polymer, tare da umarnin don amfani da lafiya, an sanya shi cikin jakar filastik amintacce.

Don asibitoci: kowane akwati na polymer an sanya shi a cikin jaka na filastik amintacce kuma an sanya shi tare da umarnin aikace-aikacen likita a cikin adadin wanda ya dace da adadin kwantena na polymer, a cikin akwatunan kwali na 100 ml a cikin fakitoci 80 ko 100, 250 ml a cikin fakitoci 40 ko 55, 500 ml 25 ko 30 fakitoci.

Kamfanin Mai - masana'anta, kasar

Kamfanin Belarusian-Dutch tare da Kamfanin haɗin gwiwar Farmland Limited Liability Company, Republic of Belarus
222603, yankin Minsk, Nesvizh, st. Leninsky, 124-3
Tel./fax. 8 (017) 2624994, tel. 8 (01770) 63939

Poan sanda a cikin lura da ciwon sukari

Ana amfani da cakudawar polarizing sosai don bi da matakan glucose na ƙanƙantar da ƙananan jini - hypoglycemia. Wannan yanayin mafi yawan lokuta yana tasowa ne a cikin marasa lafiya da masu ciwon sukari na 1 waɗanda suke amfani da allurar insulin don magance cutar.

Sharparin raguwar sukari a cikin ciwon sukari na iya zama sakamakon babban adadin insulin, da gangan shigar dashi cikin jijiya ko ƙwayar tsoka (kuma ba cikin tsokar subcutaneous) ba, har ma da katsewar abinci a cikin abinci ko mummunan aiki na jiki.

Yana da tasiri musamman don amfani da wannan abun don hypoglycemia, lokacin da mai haƙuri bai san komai ba. A wannan yanayin, an gabatar da cakuda glucose-insulin-potassium a cikin jinin mai haƙuri ta amfani da dropper. Powallon yana ba ku damar sauri ƙara yawan sukarin jini zuwa matakin al'ada kuma yana hana mutuwar kwakwalwa.

Duk da abubuwan da ke cikin glucose, sinadarin shima yana cikin magungunan da ake amfani da su wajen maganin cutar sikari da cutar ketoacidosis. Cakuda glucose-insulin yana taimakawa hana ci gaba da wasu matsaloli wadanda mutane masu dauke da cutar hawan jini ke iya kamuwa da su.

Wannan ya faru ne saboda gaskiyar cewa haɓakar ƙwayar glucose a cikin jini yana da alaƙa da isasshen adadin insulin, wanda ke taka muhimmiyar rawa a cikin shan glucose. A cikin wannan halin, ƙwayoyin carbohydrates suna ƙare kasancewa tare da jiki kuma sel jikin sun fara jin rauni mai ƙarfi.

Don rama wannan, an ƙaddamar da aikin glyconeogenesis, ƙirar glucose daga sunadarai da mai, a cikin jikin mai haƙuri da ciwon sukari. Amma tare da furotin da ƙwayar lipid, babban adadin ketone jikin yana shiga cikin jinin mai haƙuri, wanda ke da sakamako mai guba a jiki.

Mafi hatsarin samfurin glyconeogenesis shine acetone, haɓakar abun ciki wanda acikin jini da fitsari suna ba da gudummawa ga haɓakar ketoacidosis. Don dakatar da ƙirƙirar wannan rikitaccen rikicewar ciwon sukari, yana da mahimmanci don tabbatar da wadatar da sukari ga sel, wanda ake amfani da maganin a cikin magani wanda ya ƙunshi duka glucose da insulin.

Cutar sankarar mellitus shima yana da matukar amfani saboda wasu abubuwanda aka cakuda, wato potassium da magnesium. Potassium yana da mahimmanci don aiki na al'ada na tsarin zuciya da rigakafin bugun jini. Yana taimaka wajan fadada jijiyoyin jini, saboda haka rashin wadataccen potassium yakan haifar da hauhawar jini.

Ofaya daga cikin manyan alamun cututtukan sukari shine samar da fitsari mai yawa, saboda wanda mai ciwon sukari ya rasa mahimmancin potassium. Sabili da haka, jiyya tare da cakuda-insulin-potassium yana taimakawa rashi don rashi wannan mahimmancin kuma yana rage hawan jini.

Magnesium shima yana taka rawa sosai wajen kiyaye hawan jini. Kuma a hade tare da potassium, yana da tasiri mafi amfani ga zuciya da jijiyoyin jini, wanda yawanci ke fama da cututtukan hyperglycemia.

Bugu da ƙari, magnesium yana haɓaka aiki da tsarin mai juyayi kuma yana taimakawa hana ci gaban neuropathy.

Abvantbuwan amfãni daga hanya hanyar gudanarwa

Renarfafawa da magunguna yana da damar da za a iya amfani da su ta hanyar sarrafa kai na kwayoyi.Wadannan sun hada da dalilai masu zuwa:

Abubuwan da ke da alaƙa daParenteral Nutrition Lactic Acidosis Cholinolytics kwayoyi

Zai yuwu a kula da marassa lafiya cikin wani yanayi.
Thearfin taimaka wa marasa lafiya da matsanancin amai da sauran rikice-rikice na tsarin narkewa, lokacin da akwai haɗarin kin amincewa da miyagun ƙwayoyi da aka sha a baki.
Inganta bioavailability na abubuwa masu aiki na kwayoyi (kara yawan ƙwaƙwalwar su).
Yawan farawar tasirin warkewa tare da gudanarwar aikin parenteral yana ƙaruwa, wanda yake mahimmanci mahimmanci a cikin mawuyacin yanayi.
Arfin sauƙi a sami sauƙin maida hankali ne na ƙwayoyi a cikin jini.
Yana yiwuwa a yi amfani da magungunan da ke fama da rauni lokacin wucewa ta cikin jijiyoyin ciki ko kuma suna da tasirin jijiya a kai, mahaɗan da aka lalata ta acid da enzymes na ruwan 'ya'yan itace na ciki (alal misali, adrenaline ko insulin).
Saboda manyan pores a cikin membrane na ƙwayoyin endothelial, ragin da aka rarraba don wasu nau'ikan gudanarwar parenteral baya dogaro da Solution na miyagun ƙwayoyi a cikin mai.
Abubuwan da ke cikin abubuwan narkewar ƙwayar ba ya dogara da tsarin abinci, sakamakon ruwan 'ya'yan itace na ciki, bile, enzymes na narkewa.
Abincin Parenteral shine yanki mai mahimmanci na jiyya don mummunan hanta da cututtukan koda.

Prozerin - umarnin don amfani, abun da ke ciki, nau'i na saki, alamu, sakamako masu illa, analogs da Diuretics - menene, rarraba magunguna, amfani da hauhawar jini, edema da cututtukan zuciya Cereton - umarnin don amfani, alamomi, abun da ke ciki, nau'i na saki, gefe tasirin, analogs da farashi

Yadda za'a dauki polar

A bisa ga al'ada, ana gudanar da polo ga mara lafiya ta hanyar magudanar ruwa, amma wani lokacin ana ba da maganin ga mai haƙuri ta hanyar yin allura ta ciki. An yi imani da cewa faɗuwa kai tsaye cikin jinin mai haƙuri, iyakacin duniya yana da tasirin warkewa mafi inganci akan sa.

A cikin lokuta masu wuya, an yarda mai haƙuri ya dauki glucose da potassium salts a baki (ta bakin), kuma allura yana cikin jini tare da zikirin. Wannan hanya ana daukar shi amintacce ne, tunda matakin shaye-shaye na glucose da potassium a cikin hanjin mutum ya dogara da dalilai da yawa kuma yana iya bambanta sosai a cikin mutane daban-daban.

Matsayi na kwayoyi an ƙaddara ta mai halartar likita dangane da tsananin yanayin haƙuri da kuma halayen hanyar rashin lafiyar sa. Sabili da haka, ana bada shawarar yin wannan hanyar kawai a asibiti kuma ƙarƙashin kulawar kwararru. Lationididdigar ƙwayar cuta ba daidai ba zai iya cutar da mara lafiyar kuma ya haifar da mummunan sakamako.

Abin da kuma za a iya amfani da shi don magance ciwon sukari za a bayyana shi ta hanyar masana a cikin bidiyon a cikin wannan labarin.

Iri insulin

Tare da nau'in ciwon sukari na 1, jimlar insulin ya ragu. Tare da nau'in cuta ta 2, ƙwaƙwalwar nama zuwa hormone yana raguwa. A yanayin farko, magani na injection shine kawai hanyar da za a taimaka. A cikin na biyu, an wajabta maganin insulin don ci gaba da cutar.

Kowane mai haƙuri yana da nau'ikan da adadin maganin da aka zaɓa.

Ta hanyar samun insulin ya kasu kashi 4:

ɗan adam - da aka samu daga jikin mutum ta amfani da cocin Escherichia,
alade - an samo shi daga cututtukan aladu,
daga dabbobi - hada daga dabbobin manyan dabbobi,
Whale - an samo shi daga ƙwayoyin whales,
injin halittar jini - wanda aka kirkira daga ƙwayar alade, maye gurbin amino acid wanda ba daidai yake da mutumin da ya dace ba.

Rashin insulin da aka samar da shi a jiki yana daidai da mutum. Mafi sau da yawa, ana amfani dashi don maganin ciwon sukari. Magani daga shanu yana da amino acid daban-daban, an wajabta shi a lokuta mafi ƙaranci saboda halayen halayen na ƙwayoyi. Harkar ciki ta Whale ta fi banbanci da mutum kuma ana wajabta ta da wuya.

Rashin daidaito

Babban rikice-rikice na ilimin halittar jiki bayan hanyoyin sune necrosis, rashin bacci, halayen halayen mutum. Harshen parenteral na gudanar da magunguna yana gudana ne daga ma'aikatan kiwon lafiya. Ingancin lafiya da amincin inje ɗin ya dogara da bin ka'idodi na hana kayan maye da na keɓaɓɓen hannu, ƙwarewar ƙwararrun likitoci, bin ka'idodi da dabaru na gudanar da magunguna. Idan ka keta waɗannan buƙatun a cikin kwana ɗaya bayan tsarin gudanarwar, ana iya lura da ƙirƙirar ɓarna tare da kumburi mai gamsarwa.

Koyi yadda ake zama masanin lafiyar abinci a cikin kwanaki 30 kuma sami ƙarin 50,000 rubles. a wata!

Wani rikitacciyar rikice-rikice na yau da kullun a cikin saɓanin dabarar allura shine iska ko shigarwar mai - ƙaramin iska ko mai shiga cikin jirgin jini. Wannan yanayin na iya haifar da cutar necrosis, tsokana jijiyoyin jini. Injections na yau da kullun na insulin a cikin ciwon sukari mellitus suna ba da gudummawa ga haɓakar insulin lipodystrophy - atrophy ko hauhawar fata na fata a wuraren da ake ci gaba da gudanar da maganin.

Kayan aiki mara amfani ko kayan aiki mara kyau wanda aka yi amfani dashi a lokacin hanyoyin na iya haifar da mai haƙuri ya kamu da mummunar cuta ta kwayar cuta (hepatitis, HIV (ƙwayar cuta na mutum), da sauransu. Sakamakon sakamako na jinkirin ƙwayar cuta shine endoflebitis, wani nau'in kumburi da bangon venous wanda ke tasowa sakamakon lalacewar rufin ciki ko rauni a cikin jirgin bayan catheterization ko tsawaita tsawon lokacin allura zuwa rami.

A cewar ƙididdiga, halayen rashin lafiyan ƙwayoyi masu mahimmanci ga magani, alal misali, firgitar tashin hankali anaphylactic, haɓaka mafi yawan lokuta tare da allurar parenteral fiye da bayan sarrafa bakin. Saboda haka, tsayayyar contraindication ga wannan hanyar sarrafa magani shine haƙuri mai haƙuri ga kowane ɓangaren sashinta.

Hanyar da ke ɗaukar madaidaiciyar hanyar gudanar da magunguna ta bambanta bisa ga wuraren da miyagun ƙwayoyi ke shiga cikin wurare dabam dabam na tsarin. An gudanar da allura a cikin kyallen takarda ta intracutaneously (bincike), subcutaneously (mafita yana shiga cikin tasoshin jini na subcutaneous), intramuscularly (miyagun ƙwayoyi ya shiga cikin jijiyoyin jini da jijiyoyin jini a cikin tsoka), kuma ana yin allura (allura idan allura ko allurar ciki ba zai yiwu ba).

Wata hanyar gudanar da aikin parenteral shine kai tsaye a cikin tasoshin (a cikin ciki, cikin ciki da cikin tasoshin lymphatic). An nuna nau'in allurar ta ƙarshe a cikin yanayi inda ya zama dole don guje wa hanyar da miyagun ƙwayoyi ta hanta da kodan. A wasu halaye na asibiti, gudanar da kai tsaye na miyagun ƙwayoyi cikin rami (ciki, pleural, articular) ya zama dole. Wasu nau'ikan tsarin gudanarwa na zamani sune:

Rumalon - umarnin don amfani da tsari na saki, alamu, abun da ke ciki da farashin Platifillin - umarnin don amfani, tsari saki, alamomi, abun da ke ciki, sakamako masu illa, analogues da farashin Analgin - umarnin don amfani ga yara da manya.

Halin ciki (subarachnoid ko epidural) hanya: ta cikin ruwa na cerebrospinal.
Hanya ta subconjunctival: tare da maganin gida na cututtukan ido, ta hanyar ido.
Hanya na ciki: ta hanyar hanci.
Ratwaƙwalwar ciki (inhalation): ta hanyar inhalation na vapors cike da kayan aikin magani ta hanyar inhaler.
Transdermal: shigarwar sassan jikin magani yana faruwa ta hanyar fata.

Yaushe yakamata in canza wurin yin insulin?

Hukuncin canzawa zuwa ga famfo shi ne tare da iyayen, yara da kuma likitan halartar. Babu ƙuntatawa na shekaru yayin canja wuri zuwa famfo, gami da jarirai.

A mafi yawancin lokuta, ana yin canza wuri zuwa famfo ne sama da watanni 3-6 daga farkon cutar, lokacin da mutanen da ke fama da ciwon sukari da iyayensu ba wai kawai suna da ilimin sanin asalin cutar sankara ba, har ma suna samun isasshen gogewa mai amfani. Tabbas, mutanen da ke da ciwon sukari na iya canzawa zuwa famfo, ba tare da la'akari da tsawon lokacin ciwon sukari ba, har ma nan da nan bayan an gano su.

Koyaya, sauya sheka zuwa insulin wutan kwalliya kai tsaye bayan farkon cutar za a iya danganta ta da matsaloli da yawa. Ba wai kawai cikakken isasshen ilimin ka'idojin maganin insulin ba, ana buƙatar masaniya, har ma da kyakkyawan ilimin cututtukan cututtukan cututtukan mellitus gaba ɗaya. Kamar yadda yake tare da kowane gwaninta, fahimtar yawancin fasalulluka na ciwon sukari yana zuwa da kwarewa.

Bugu da kari, a karo na farko bayan cutar, ana iya rage adadin insulin sosai, wanda zai bukaci gyara kai-tsaye akai-akai na yawan insulin. A cikin shekarar farko ta rashin lafiya, ƙananan yara masu fama da insulin kwantar da hankali suna da wasu halaye na kashi basal, wanda shine kawai 10-30% na yawan yau da kullun, kuma kusan rabin ƙananan yara na iya buƙatar basal na insulin.

A wasu halaye, tare da tsananin sha'awar matasa da iyaye da kuma saurin kwarewar dabarun sarrafa kai, canji zuwa wutan far za'a iya aiwatar da shi a baya, tare da wani gajeran lokaci na ciwon suga. Sabili da haka, likita ya yanke shawara akan lokacin canja wuri zuwa farjin insulin, bisa ga yanayin halayen kowane mutum da ke fama da cutar sankara.

Magungunan ƙwaƙwalwar ƙwaƙwalwar ajiyar magunguna

Ana gudanar da allurar kashewa ta nau'ikan nau'ikan daban-daban bisa ga wasu algorithms wadanda ke tabbatar da amincin da kuma ingancin hanyoyin. Waɗannan ƙa'idodi sun haɗa da shirye-shiryen haƙuri, likita da kayan aikin da suka wajaba, hanyar allurar, da yawa matakan karshe bayan ƙarshen allura. Don magunguna daban-daban, saurin da fasaha na gudanarwar su ya bambanta.

Yanayin canzawa

Kodayake maganin ƙwayar famfo yana karuwa sosai tsakanin yara masu fama da ciwon sukari, ba a ba da shawarar kowa ba. Don yin amfani da famfon yin nasara, yaro da iyayen sa dole su so wannan. Yawancin ƙwararrun masu ciwon sukari sunyi imanin cewa saka idanu na kai (adadin da ake buƙata na ma'aunin glycemic a kowace rana, kiyaye bayanan kula da kansa, gyaran insulin, da sauransu) shine mafi mahimmancin yanayi don canzawa zuwa famfo. Yawancin likitocin yara suna buƙatar tsananin kulawa da kame kai daga mutanen da ke da ciwon sukari don fara amfani da famfo, saboda wannan ba tushe ne kawai don cimma sakamako ba, har ma ya zama dole don hana rikice rikice.

Sanya famfon na insulin ba zai cece ka ba. Don ƙimar glucose jini a kan famfo ya zama mai kyau kuma ketoacidosis bai faru ba, zaku buƙaci kulawa ta yau da kullun da hankali: auna glucose, gudanarwar insulin, adana adadi, ƙididdigar carbohydrate.

Dalilin sauya sheka zuwa magudanar insulin:

Matakan HbA1c masu girma ba su da alaƙa da kamun kai
Yara da matasa tare da abin mamaki na "sanyin safiya"
Rage ingancin rayuwa (mummunan ra'ayi game da buƙatar kula da insulin a cikin baƙi, buƙatar lura da tsauraran abinci, sha'awar sarrafa abinci gwargwadon iko)
Akai-akai ko mai tsawan jini
Yara kanana masu karancin bukatun insulin
Yara tare da tsoron inje
Motsa jiki akai-akai
Sha'awar inganta rayuwar rayuwa

Rashin kyawun maganin warkarwa zai iya haifar da watsi da amfani. Koyaya, mutane masu ciwon sukari da ƙungiyar masu ciwon sukari basa ƙin yarda su ci gaba da aikin maganin famfon. Wani bincike na mutane da ke dauke da cutar kanjamau a kan cutar ta famfo a Jamus da Ostiryia ya nuna cewa kusan kashi 4% na mutane ne kawai suka ki yin famfo.

Babban abubuwanda zasu hana karban maganin su ne: Rashin yanayi don magani, raguwa cikin sassaucin salon rayuwa da raguwa a cikin glucose jini. Sabili da haka, wajibi ne ayi la'akari da waɗannan abubuwan yayin yanke shawara game da canjin zuwa farjin famfo.

Lissafin insulin lokacin canzawa zuwa famfo

Lokacin canzawa zuwa famfo, kashi na yau da kullum na insulin (gajeriyar insulin + tsawon insulin kowace rana) yawanci yana raguwa da 10-25%. Rage kashi na insulin ya danganta ne da matsayin biyan bashin metabolism, wato, a kan alamomin glucose na jini, da kuma yadda ake yawan haifar da cututtukan jini. Game da manyan matakan glucose a cikin jini, kashi na insulin na iya zama wanda bai canza shi ba ko ma ya karu.

Tebur 1. Canza a cikin maganin yau da kullun na insulin (SDI) yayin sauyawa zuwa farjin famfo

Bayan yin lissafin kashi na yau da kullun na insulin akan warkarwa, sun ci gaba zuwa lissafin abubuwan basal da bolus allurai.

Lissafin Kashi na Basal

Yawancin mutane da ke amfani da famfo suna da ƙananan ƙwayar insulin basal fiye da kashi na bolus. A wannan yanayin, rabo tsakanin ka'idodin basal da ƙoshin bolus a kan famfo zuwa babban adadin ya dogara da shekarun ɗan. Lokacin yin lissafin kashi na basal, zaku iya amfani da ka'idoji masu zuwa - ƙaramin yaro, ƙaramin yawan insulin basal cikin sharuddan adadi. A cikin ƙananan yara, kashi na insulin basal na iya zama 30% na kashi na yau da kullun, yayin da a cikin samari da matasa yawanci yawanci shine 50%. Koyaya, a cikin manya, ana amfani da kashi na basal da alama ba zai wuce ƙimar bolus ba.

Matsakaicin kashi na basal:

Yara 0-6 shekara - kusan 30-35% na yawan insulin na yau da kullun
Yara 'yan shekaru 6-12 - kusan kashi 35-40% na yawan insulin na yau da kullun
Yara da tsofaffi - kusan 40-50% na yawan insulin na yau da kullun

Bayan yin lissafin kashi na yau da kullun, yana da muhimmanci a tabbatar da nawa insulin basal din da za'a gudanar kowace awa. Yawan adadin insulin da aka gudanar awa daya ana kiransa basal, tunda ana auna shi a cikin raka'a awa daya - raka'a / awa (UI / h). Akwai zaɓuɓɓuka biyu don yin ƙididdigar yawan basal na kowace awa.

A farkon lamari, ana iya rarraba kashi na yau da kullun a ko'ina cikin rana. Don yin wannan, kawai kuna buƙatar rarraba kashi na yau da kullun da aka karɓa ta awowi 24.

Zaɓi na biyu shine yin ƙididdigar basal, la'akari da halaye na mutum. Yawancin lokaci yayin rana akwai buƙatar daban-daban na insulin basal, wanda yafi dogara da shekarun ɗan. Youngaramin yara yawanci suna da buƙatu mafi girma a ƙarshen yamma da a farkon rabin dare da ƙarancin buƙata na rana.

Matsakaicin basal da insalin 'bolus' ya dogara da shekarun yarinyar.

Yayin da yaro ya girma, ya fara yin nasara. sanyin safiya alfijir - babban bukatar insulin a sanyin safiya. Waɗannan fasalulluka na canje-canje a cikin buƙatar insal ɗin basal suna da alaƙa da bambance-bambance masu dangantaka da shekarun tsufa a cikin ɓoyewar ƙwayoyin tsofaffin ƙwayoyin cuta kamar hormone girma, cortisol da kwayoyin jima'i. Misali, a cikin yara kanana, wata babbar bukatar insal ta insulin a maraice na iya hadewa da karuwa a matakan girma na haila nan da nan bayan barci.

Tebur 3. Siffofin shekaru na bayanan basal

Tebur 4. Misalin yin lissafin kashi na basal lokacin juyawa zuwa famfo

Lissafin kashi na Bolus

Lokacin amfani da famfo, ƙirar bolus don cin abinci ko don babban glucose a cikin jini ana iya lissafa shi ta hanyar mutumin da ke da ciwon sukari ko kuma iyayen shi kaɗai, ko kuma amfani da kalkuleta na bolus (ko kuma taimakon bolus). Lissafin ƙungiyar bolus shine shirin da aka gina a cikin famfo wanda yake ƙididdige yawan insulin daidai da saitunan da aka tsara. Mataimakin ƙungiyar bolus baya sarrafa insulin, amma yana ba da shawarar awo kawai. Yin yanke shawara don gabatar da wannan kashi yana yin ku ne bisa ga kwarewarku.

Mataimakin bolus baya daukar insulin, amma kawai yana bada shawarar kwatankwacin insulin ne!

Bukatar insulin, sabili da haka yawan insulin da aka gudanar, yana canzawa akan lokaci. Wannan ya faru ne saboda haɓakar yaro, canje-canjen rayuwa, da sauransu.Sabili da haka, koda kunyi amfani da kwatancen bolus wanda likitan ku ya tsara, yana da mahimmanci ku sami ikon yin lissafin kashi da kanku, saboda yanayin lalata a cikin glucose jini, koyaushe kuna iya daidaita saiti na mataimakan bolus.

Ana bayar da insulin na Bolus don abinci (bolus don abinci) ko don gyara gulukos jini (bolus na gyara).

Yin lissafin bolus don abinci, amfani carbohydrate rabo (UK).

Carbohydrate coefficient - UK

CC shine yawan rufewar insulin 1 naúrar abinci - XE (ga waɗanda suke ƙididdigar carbohydrates a cikin XE), ko kuma adadin giram na carbohydrates wanda 1 U insulin ya rufe shi (ga waɗanda suke ƙidaya carbohydrates a cikin gram).

Carbohydrate coefficient, insulin na hankali factor da manufa glycemic matakin yawanci bambanta a cikin yara daban-daban da kuma a lokuta daban-daban na rana.

Coarin aiki sosai - ƙarin insulin kowace abinci.

Lokacin da ana amfani da lissafin gyaran bolus insulin hankalin abu (PSI) da kuma manufa glycemic matakan.

Ingantaccen Mahimmancin Insulin - PSI

PSI nawa ne matakan glucose a cikin jini ya ragu tare da gabatarwar kashi ɗaya na insulin.

Coarin aiki mai ƙarfi - ƙasa da insulin kowace ƙira.

Tebur 5. Misalin lissafi na carbohydrate mai aiki tare da insulin ji na ƙwarai factor

Idan CC da PSI suka samu ta hanyoyi da yawa ba su daidaituwa ba, zamu iya ɗaukar matsakaicin darajar tsakanin su.

Manufar glucose na jini - amfanin mutum guda daya na glucose na jini wanda fam ɗin zai yi niyya da taimakon ƙwanƙwaran gyaɗa. Matsakaicin ƙwayar cutar glycemia an ƙaddara daban-daban ga kowane mutum tare da likitan halartar kuma ya dogara da shekaru, halayyar cutar hypoglycemia, da dai sauransu.

Yin amfani da gurbi na carbohydrate, zaku iya ƙayyade bolus don abinci-insulin don ɗaukar carbohydrates da aka karɓa.

Bolus Abinci (BE) = Lambar XE x UK

Yin amfani da yanayin ƙwaƙwalwar insulin da manufa glycemia, zaku iya ƙayyade ƙwanƙolin bolus - insulin, ya zama dole don cimma burin manufa jini (HA).

Bolus na gyara (KB) = (GK yanzu - GK manufa) / PSI

Bolus mai iya gyara na iya zama na kwarai (don ragewa) - idan matakin glucose na jini ya yi yawa fiye da makasudin, ko kuma mara kyau (don ƙaruwa) - idan matakin glucose na jini ya yi ƙasa da maƙasudin. Don kirga duka bolus, kana buƙatar ƙara bolus na abinci da abinci. Idan bolus na gyara ya zama mara kyau, to za a rage jimlar insulin don ƙara yawan glucose na jini don ƙididdigewa.

Jimlar Bolus (OB) = Bolus Abinci + Bolus na Kayayyaki

Tebur 6. Misalai na ƙididdigar yawan bolus

Bayanin basal, mai amfani da carbohydrate, da sashin kulawar insulin wanda aka lissafta bayan sauya sheka zuwa famfo basu da inganci koyaushe. A nan gaba, mafi kusantarwa, ana buƙatar gyaran mutum daya dangane da alamun glycemic.

Saitunan bayanan basal da mataimakiyar bolus da aka lissafta bayan sauya sheka zuwa famfo sunada kyau kwarai da gaske. Nan gaba, za a buƙaci gyara na mutum.

I.I. Kakanni, V.A. Peterkova, T.L. Kuraeva, D.N. Laptev

Gudanarwa na ciki

Shirye-shiryen allurar cikin ciki ya hada da ayyuka don bi da ka'idodin tsabta - wankewa da goge hannayen likita, sanyaya safofin hannu (idan ya cancanta), nazarin ampoule na miyagun ƙwayoyi, tattara sirinji, sanya maganin ƙura a ciki da sanya kayan aikin da aka shirya a cikin tarkace mai rauni. Bayan haka, ana yin shirye-shiryen allurar da mara lafiya, wanda ya kunshi ayyuka kamar haka:

Hannun mai haƙuri an aza shi a kan tsayayyen, kafaffen ƙasa.
Ta hanyar bincika, likita ya zaɓi hanyar jiyya don allura.
Ana amfani da farji a tsakiyar na uku na kafada, bayan haka mai haƙuri yana buƙatar datse ya kuma buɗe murfin hannunsa sau uku zuwa hudu saboda yadda jijiyar ya zama a bayyane kuma yatsun ya ji sauƙin.

Ana yin allurar ciki ta hanyar algorithm bayyananne, kawai ƙimar gudanar da canje-canje na miyagun ƙwayoyi. Jerin ayyuka na wannan nau'in allurar parenteral kamar haka:

Ana amfani da auduga wanda aka kwantar da ita tare da barasa don kula da yankin da aka kimanta allurar da kuma wuraren fata dake kusa dashi.
An cire hula daga allurar sirinji, ana ɗaukar sirinji a hannun dama, ana iya gyara cannula tare da yatsa ma'anar. Hannunsa na mai haƙuri yana guntu da hannunsa na hagu, fata yana miƙe tare da babban yatsa kuma yana manne da jijiya. Kafin gabatar da allura, mai haƙuri yana buƙatar cire ƙyallen hancinsa.
Fata da jirgin ruwa suna soke a wani kusurwa na 15 °, to, allura ya ci gaba 15 mm gaba. Tare da hagu, an cire piston kadan, yayin da jini ya kamata ya bayyana a cikin sirinji (wannan yana nufin cewa allura yana cikin jijiya).
Bayan haka an cire farjin tare da hagu, mara lafiya ya kwance dabino, kuma bayan wani bincike na allura a cikin jijiya, likitan a hankali ya matse mai bugun har zuwa allurar gaba daya.

A lokacin allurar, ma'aikacin kiwon lafiya dole ne ya lura da canje-canje a cikin yanayin mai haƙuri (pallor na fata, dizziness, da sauransu). Bayan allura, an cire allura da sauri daga jijiya, an matse wurin wasan tare da kwallon auduga. Mai haƙuri yana buƙatar zauna na minti 7-10 tare da hannu ya lanƙwasa a gwiwar hannu. Bayan wannan, babu jini ya kamata ya fito a wurin allurar.

Algorithm don shirya don gudanar da aikin subcutaneous na gudanarwar parenteral bai bambanta da shigarwar ciki ba. Hannun da kayan aiki suna haifuwa (idan ya cancanta), ana nazarin ampoule, an jawo maganin maganin a cikin sirinji. Wurin allura da fata mai kyau ana maganin su da barasa. Ana yin allurar kamar haka:

Tare da hagunsa na hagu, fata ya zama fata.
An saka allura a wani kusurwa na 45 °, a gindi na ninka, a karkashin fata, zuwa zurfin 15 mm.
Yatsun hannun da suka sanya fatar suka shafi fatar jiki a hankali suna matse maginin mai sirinji.
Bayan an kammala sarrafa magunguna, an cire allura, ana amfani da ƙwallan auduga mai ƙanshi a wurin allura.

Tsarin sauri

Ya danganta da yanayin cutar, ana rarrabe nau'ikan magunguna 5 gwargwadon gudu da tsawon lokacin fallasa:

Ultrashort mataki. Ingancin yana faruwa minti 10 bayan allura. Ana sarrafa shi kafin ko kuma nan da nan bayan abinci, subcutaneously. Ingantacce ba fiye da 3 hours.
Short takaice. Ingantacce bayan minti 30. Ana ɗaukar shi kafin abinci. Bayyanar na tsawon awa 6.
Matsakaici mataki. Ana amfani da miyagun ƙwayoyi sau 2 a rana a lokaci guda. Tasirin yana farawa bayan sa'o'i 1.5 kuma bai wuce awanni 20 ba.
Dogon aiki. Tasirin yana faruwa 3 hours bayan gudanarwa. Tsawon lokacin sakamako shine awanni 24. Ana yin shi sau 1-3 a rana.
Hadin magunguna. Hada saurin sa da matsakaicin lokacin sakamakon.

Drugsa'idodi masu gajeran gajere da gajere suna kwaikwayon ƙwayar cuta bayan cin abinci.

Bayan cin abinci, jiki yana samar da anabolic wanda zai iya canza sakamakon sukari zuwa makamashi. Matsakaici da injections na dogon lokaci suna kwaikwayon aikin narkewa a wajen abinci. Tsakanin abinci, jiki yana samar da glucose, wanda ke buƙatar adadin insulin. Tare da cikakkiyar gazawar ƙwayar cutar koda, amfani da kullun gajeriyar magani mai tsayi zai rama aikin jiki.

Yadda ake lissafin yawan insulin

Rashin insulin da ba daidai ba yana haifar da mutuwa. Lokacin da aka wuce ƙimar ƙwayar jijiyoyin jiki, matakin sukari a cikin jiki ya ragu sosai, wanda ke haifar da cutar glycemic. Ana lissafin kashi na anabolic ta likita daban-daban, amma mai ciwon sukari na iya taimakawa tare da ƙaddarar gwargwado:

Innovation a cikin ciwon sukari - kawai sha kowace rana.

Kuna buƙatar sayo glucose, yana ƙayyade yawan sukari a ko'ina, ba tare da la'akari da lokaci ba. Ya kamata a auna sukari a cikin mako: da safe akan komai a ciki, kafin abinci, bayan abinci, a abincin rana, da yamma. A matsakaita, aƙalla ma'auni 10 ana yin kowace rana. Dukkanin bayanan an rubuta su ne zuwa littafin rubutu.
Sikeli na musamman zai sarrafa yawan abincin da aka cinye kuma zai taimaka wajen lissafin furotin da aka ƙona, fats da carbohydrates. A cikin ciwon sukari, rage cin abinci shine ɗayan mahimman abubuwan jiyya. Yawan abubuwan gina jiki ya kamata ya zama daidai da kullun.

Matsakaicin darajar insulin lokacin yin lissafin sashi shine yanki 1 a 1 kilogram na nauyin jiki. Maximumara matsakaicin darajar ba ya ba da gudummawa ga haɓakawa kuma yana haifar da hypoglycemia. Kimanin sigogi a matakai daban-daban na cutar:

Lokacin gano nau'in ƙwayar cuta 2 mai rikitarwa, ana amfani da raka'a 0.3 / 1 kg na nauyi.
Idan an gano digirin-insulin-kwayar cutar na cutar, ana tsara kwaya 0,5 / 1 kg na nauyi.
A cikin shekarar, tare da haɓaka mai kyau, sashi yana ƙaruwa zuwa raka'a 0.6 / 1kg.
Idan kuma akwai wani mummunan hali da kuma rashin diyya, to sashi yakai raka'a 0.7-0.8 / 1kg.
Lokacin da rikice-rikice ya faru, ana tsara raka'a 0.9 / 1 kg.
A lokacin daukar ciki, sashi zai tashi zuwa raka'a 1 / 1kg na nauyi.

Kashi 1 na miyagun ƙwayoyi - ba fiye da 40% na al'ada yau da kullun. Hakanan, girman allura ya dogara da tsananin cutar cutar da abubuwan waje (damuwa, aikin jiki, shan wasu kwayoyi, rikitarwa ko cututtukan haɗuwa).

Ga mara lafiya mai nauyin kilo 90, tare da nau'in ciwon sukari na 1, tare da tasiri mai mahimmanci, kashi na insulin shine raka'a 0.6. kowace rana (90 * 0.6 = 54 raka'a - yanayin insulin yau da kullun).
Ana yin maganin da ke aiki tsawon lokaci sau 2 a rana kuma ya ninka rabin kashi na yau da kullun (54/2 = 27 - kashi na kullum na aikin insulin tsawon lokaci). Kashi na farko na miyagun ƙwayoyi shine 2/3 na jimlar girma ((27 * 2) / 3 = 18 - ƙa'idar safiyar da ke cikin miyagun ƙwayoyi tare da dogon wahalar). Adadin yamma shine 1/3 na jimlar girma (27/3 = 9 - kashi na yamma na insulin mai aiki).
Insulin-gajeran aiki shima yakai rabin adadin kwayoyin halittar (54/2 = 27 - na yau da kullun na magunguna na hanzari). Ana shan maganin kafin abinci sau 3 a rana. Abincin safe shine 40% na jimlar insulin ɗan gajeren lokaci, abincin rana da maraice na 30% (27 * 40% = 10.8 - kashi na safe, 27 * 30% = 8.1 rabe - yamma da allurai abincin rana).

Tare da babban abun ciki na glucose kafin cin abinci, lissafin shan insulin mai sauri yana canzawa.

Ana yin awo a cikin raka'a gurasa. 1XE = gram 12 na carbohydrates. An zaɓi kashi na magungunan gajerun abubuwa dangane da ƙimar XE da lokacin rana:

safe 1XE = raka'a 2,
a abincin rana 1XE = 1,5ed,
da yamma 1XE = 1 raka'a.

Ya danganta da tsananin cutar, lissafin da sigogin sun bambanta:

A nau'in ciwon sukari na 1, jikin mutum baya samar da insulin. A cikin lura da hormones ana amfani da shi, mai sauri da aiki mai tsawo. Don ƙididdige, jimlar damar aikin insulin ya kasu kashi biyu. Magungunan suna da sakamako mai dorewa ana gudanar da su sau 2 a rana. Ana yin insulin gajeren lokaci sau 3-5 a rana.
A cikin ciwon sukari mai tsanani na nau'in na biyu, ana gudanar da magani mai amfani da dogon lokaci. Ana yin allurar sau 2 a rana, ba fiye da raka'a 12 a allura.

1 na insulin lowers jini sukari da matsakaita na 2 mmol / L. Don ƙimar daidai, ana yaba ci gaba da auna sukari na jini.

Insulin far da ire-irensa

Aikin insulin therapy shine gabatarwar wani adadin magunguna wanda yake kusa da tsarin ilimin likitanci na mara lafiya. Yayin rana, har zuwa kashi 80% na kwayoyin ana gudanar dasu, sauran ana gudanar dasu da daddare. Wannan yanayin kula da miyagun ƙwayoyi yana da kusanci ga samar da kwayar halittar mutum a cikin mutum mai lafiya.

Kowane mutum yana aiki da glucose ta hanyarsa. Aikin 1 naúrar burodi yana buƙatar daga raka'a 0.5 zuwa 4 na insulin. Don gano madaidaicin sashi na maganin, kuna buƙatar auna matakin sukari bayan cin abinci.

Iri far

Don lura da ciwon sukari, ana amfani da hanyoyin 2 na insulin:

Maganin gargajiya. A lokacin jiyya, ana amfani da daskararru na gajere da na dindindin. Har zuwa 60% saboda amfani da hormone na tsawon lokaci, 40% zuwa insulin azumi. Ana lura da tsarin abinci da lokacin allura sosai. Abubuwan ciye-ciye na musamman, abubuwan tsallake abinci, wasanni a waje da jadawalin, damuwa.
M kulawa A cikin lura da insulin, ana amfani da ɗan gajeren lokaci da tsayi. An ƙididdige yawan ɗanɗano lokacin hormone bisa ga abincin da aka ci. Ba a buƙatar tsayayyen tsarin abinci, wasanni da kayan ciye-ciye an yarda.

Gudanar da Magunguna

Don dacewa da aikin insulin, an ƙirƙiri na'urori na musamman waɗanda ake amfani da su cikin sauri da sauƙi. Akwai hanyoyi guda uku na gudanar da magani:

Sashin insulin.
Alkalami mai sirinji wata karamar na'urar ce wacce ba ta jinyar maganin. Ana amfani dashi galibi a cikin Rasha.
Dispenser-pump - na'urar da ke gabatar da miyagun ƙwayoyi ta atomatik. An daidaita shi ta likita ko mai haƙuri, gwargwadon yanayin gudanarwar hormone. Ana amfani dashi galibi a Turai da Amurka.

Yawan shan magunguna na yau da kullun zai haifar da ciwo na Somogy, hypoglycemia, ko coma mai ciwon sukari. Idan kun sami tashin zuciya, amai, amai, amai, zazzabi, yana da muhimmanci a auna sukarin jini. Tare da ƙara yawan kuɗi, ya kamata ka kira motar asibiti nan da nan. Don kaucewa kwatsam a cikin glucose, ya kamata ku bi duk umarnin likita, ku kula da insulin akan lokaci kuma ku bi abin da ake ci.

Cutar sankarau koyaushe tana haifar da rikice-rikice. Wuce kima sugar yana da matukar hadari.

Aronova S.M. ya ba da bayani game da lura da ciwon sukari. Karanta cikakken

Intramuscular

Shiri don gudanarwa na wucin gadi an gudanar dashi gwargwadon tsari iri daya. Mai haƙuri ya kwanta a kan shimfiɗar shimfiɗa a ƙasa, don allurar, an zaɓi wuri a saman ɓangaren ƙwayar gluteal. Ana magani da giya Ana yin allurar ne bisa ƙa'idodin masu zuwa:

Ana riƙe sirinji ta hannun dama, tare da yatsun hannun hagu kaɗan shimfiɗa fatar fata a wurin da ake yin aikin.
Tare da motsi mai ƙarfi, ana saka allura a cikin ƙwayar gluteus kamar 2/3 na tsawon sa, a wani kusurwa na 90 °.
Yin amfani da hannunka na hagu, suna bincika don bugawa a cikin tsoka - suna jan piston kadan a kanka, yakamata a sami jini.
An allurar da maganin, an sanya sinadarin firinji tare da swab da auduga.

Abun cikin Intra

Don yin allurar ciki-jijiya, an zaɓi jijiyoyin jini waɗanda suke kusa da farfajiyar fata - na mahaifa, gwiwar hannu, axmaƙi, radial, ko femoral. Ana yin shiri don yin allura gwargwadon ƙa’idoji na gaba ɗaya. Matsayin allura shine likita ya keɓance mafi girman jijiyoyin jiki. An soke fatar jiki da jijiya kamar yadda yake a ka’idoji iri daya kamar da allura ta ciki, a cikin motsin motsi na jijiya. Bayan hanyar, ana amfani da bandejin matsin lamba a wurin aikin furen don mintuna da yawa.

Intrathecal

Gudanarwa na Parenteral na magunguna a cikin ƙwayar cerebrospinal wani tsari ne mai rikitarwa da raɗaɗi a ciki wanda mai haƙuri ya kwanta a gefenta tare da ƙafafunsa suna matsewa zuwa ciki da kansa a kirjinsa. Zaɓin wurin allurar ne tsakanin vertebrae na lumbar, ba wai kawai za'a yi maganin ta hanyar maganin antiseptik ba, har ma ana warkar dashi da magungunan analgesic na gida ta hanyar allura ta subcutaneous. An saka allura kai tsaye cikin canjin bututun; bayan aiwatar da aikin, dole ne mai haƙuri ya zama mara-motsi har tsawon mintuna 20-30.

Abubuwan da ke cikin glucose

Likita na Burtaniya W. Praouth da farko ya ware kuma ya bayyana shi a farkon karni na 19. Abu ne mai dadi (carbohydrate), kwayoyin da suke a ciki sunadaran carbon 6.

An kafa shi a cikin tsire-tsire ta hanyar photosynthesis, a cikin tsarkakakkiyar siffar shine kawai a cikin inabi. A yadda aka saba, yakan shiga jikin mutum ne da kayayyakin abinci waɗanda ke ɗauke da sitaci da abinci mai ɗorewa, kuma ana fitar dashi yayin narkewar abinci.

Jiki ya samar da “kayan ajiyar dabarun” wannan kwayar ta hanyar glycogen, ta amfani da shi azaman karin tushen makamashi don tallafawa rayuwa yayin tashin hankali, zahiri ko tunani mai zurfi, rashin lafiya ko wasu matsanancin yanayi.

Don yin aiki na yau da kullun na jikin mutum, matakin glucose a cikin jini ya zama kusan 3.5-5 mmol kowace lita. Abubuwa da yawa na kwayoyin halitta suna aiki a matsayin masu kula da adadin sinadarin, mafi mahimmanci sune insulin da glucagon.

Ana cinye glucose koyaushe a matsayin tushen samar da ƙarfi ga jijiyoyi, tsoka da ƙwayoyin jini.

Ya zama dole ga:

samar da metabolism a sel,
hanya ta yau da kullun ta sake tsarin tafiyarwa,
normalization na hanta,
cike gurbin makamashi,
mai daidaita ma'aunin ruwa,
inganta kawar da gubobi.

Yin amfani da glucose cikin hanji don dalilai na likita yana taimakawa wajen dawo da jiki bayan guba da cututtuka, ayyukan tiyata.

Tasiri a jiki

Tsarin dextrose na mutum ne kuma an tsara shi ta duka fasali da nau'in aikin ɗan adam.

Babban buƙata na yau da kullun don ita ce ga mutanen da suke yin aiki mai ƙwaƙwalwa ko aiki na jiki (saboda buƙatar ƙarin hanyoyin samar da makamashi).

Jiki yana wahala daidai da rashi kuma daga yawan ƙwayar jini:

wuce haddi tsokani tsokanar da m jiki don samar da insulin da kuma kawo glucose zuwa al'ada, wanda sa sa sashin jiki sa haihuwa, kumburi, degeneration na sel hanta cikin mai, rushe zuciya,
rashi yana haifar da matsanancin ƙwayoyin kwakwalwa, rashi da rauni, tsokanar gaba ɗaya, damuwa, rikicewa, kasala, mutuwar jijiyoyi.

Babban dalilan rashin glucose a cikin jini sune:

rashin abinci mai kyau na ɗan adam, isasshen abincin da ke shiga narkewar abinci,
abinci da guba mai guba,
hargitsi a cikin jiki (cutar ta thyroid, m neoplasms m, gastrointestinal cuta, cututtuka daban-daban).

Dole ne a kula da matakin da yakamata a cikin wannan abu a cikin jini don tabbatar da ayyuka masu mahimmanci - aiki na yau da kullun na zuciya, tsarin juyayi na tsakiya, tsokoki, ƙarancin zafin jiki.

A yadda aka saba, matakan da ake buƙata na kayan sun cika da abinci, idan akwai yanayin cuta (rauni, rashin lafiya, guba), an wajabta glucose don daidaita yanayin.

Yanayi don Dextrose

Don dalilai na likita, ana amfani da dropper tare da dextrose don:

ragewan sukari na jini
jiki da hankali,
tsawon lokaci da yawa daga cututtukan da yawa (cututtukan hepatitis, cututtukan hanji da naƙasa, da jijiyoyin jiki tare da maye gurbin jijiyoyin jiki) azaman ƙarin tushen ƙarfin kuzari ga jiki,
hargitsi a cikin aikin zuciya,
yanayin rawar jiki
raguwa sosai a cikin karfin jini, gami da bayan zubar jini,
m fitsari saboda maye ko kamuwa da cuta, gami da kwayoyi, barasa da kwayoyi (tare da gudawa da amai da gudawa),
ciki don kula da ci gaban tayin.

Babban nau'ikan sashi na magani wanda aka yi amfani dashi a magani shine mafita da allunan.

Siffofin Sashi

Magani sune mafi kyau duka, amfaninsu yana taimakawa haɓakawa da daidaita jikin mai haƙuri da sauri.

A cikin magani, ana amfani da nau'ikan maganin Dextrose biyu, waɗanda suka bambanta a cikin tsarin aikace-aikacen:

isotonic 5%, wanda aka yi amfani da shi don inganta ayyukan gabobin, abincinsu na yau da kullun, daidaita ma'aunin ruwa, ba ku damar ba da ƙarin makamashi don rayuwa,
hauhawar jini, daidaita yanayin aiki da aikin hanta, hawan jini na osmotic, haɓaka tsarkakewa daga gubobi, yana da hankali daban (har zuwa 40%).

Mafi sau da yawa, ana gudanar da glucose a cikin ciki, a matsayin allurar babban taro mai hauhawar jini. Ana amfani da ikon sarrafa motoci idan ana buƙatar yawan zubar da miyagun ƙwayoyi a cikin tasoshin na ɗan lokaci.

Bayan shigowa cikin kwayar halitta mai narkewa, ta rushe zuwa carbon dioxide da ruwa a karkashin tasirin acid, yana fitar da kuzarin da sel suke bukata.

Glucose a cikin maganin isotonic

Dextrose 5% maida hankali ne ga jikin mai haƙuri a duk hanyoyi masu yiwuwa, tunda ya dace da ƙididdigar jini na osmotic.

Mafi yawan lokuta, ana gabatar da drip ta amfani da tsarin 500 ml ko fiye. har zuwa 2000 ml. kowace rana. Don sauƙaƙe amfani, glucose (bayani don dropper) an cakuda shi cikin jakunkuna na polyethylene 400 ml ko kwalaben gilashin iko ɗaya.

Ana amfani da maganin isotonic a matsayin tushen tushen dilution na wasu kwayoyi da suka wajaba don magani, kuma sakamakon irin wannan dropper a jikin mutum zai kasance ne sakamakon haɗuwar aikin glucose da takamaiman ƙwayar magani a cikin abubuwan da ya ƙunsa (cardiac glycosides ko wasu kwayoyi tare da asarar ruwa, ascorbic acid).

A wasu halaye, sakamako masu illa tare da gudanarwar drip suna yiwuwa:

keta ruwa-gishiri metabolism,
canjin nauyi saboda tara ruwa,
wuce gona da iri
zazzabi
ƙwanƙwasa jini da hematomas a wurin allura,
karuwa a cikin jini,
wuce haddi na sukari na jini (a lokuta masu tsauri, nai).

Ana iya haifar da wannan ta hanyar ƙudurin rashin daidaituwa na adadin ruwan da jikinta yayi asara da kuma yawan ɗigon abin da ya wajaba don cike shi. Gua'idar juzu'in ruwa mai gudana mai gudana ta hanyar diuretics.

Maganin Hypertonic Dextrose

Babban hanyar gudanar da maganin shine maganin cutarwa. Don masu digo, ana amfani da miyagun ƙwayoyi a cikin taro wanda likita ya tsara (10-40%) dangane da babu fiye da 300 ml kowace rana tare da raguwa mai yawa a cikin sukari na jini, babbar asarar jini bayan raunin da ya faru da jini.

Ropaddamar da gabatarwar glucose mai yawa yana ba ku damar:

inganta aikin hanta,
inganta aikin zuciya
mayar da daidaitaccen ƙwayar ruwa ta jiki,
Yana haɓaka kawar da ruwa daga jiki,
inganta metabolism nama,
dilates tasoshin jini.

Matsakaicin jiko na abu a cikin awa daya, girman da za'a gudanar dashi a rana guda, ana tantance shi da shekaru da nauyin mai haƙuri.

manya - babu fiye da 400 ml.,
yara - har zuwa miliyan 170. a kowace 1000 na nauyi, jarirai - 60 ml.

Tare da maganin shanyewar jini, an sanya dropper tare da glucose a matsayin hanyar sake farfadowa, wanda, bisa umarnin likita, ana kula da matakin sukari na mai haƙuri a koyaushe (a matsayin martanin ƙungiyar don magani).

Siffofin magani

Insulin na hormone wani magani ne na peptide wanda aka yi amfani dashi don takamaiman maganin cututtukan mellitus. Yana da ikon yin tasiri sosai kan tafiyar matakai na rayuwa a jiki, kuma musamman akan carbohydrate.

Godiya ga insulin, glucose a cikin jini da kuma yawan shan kwayar ta zai iya raguwa sosai. Bugu da kari, kwayar halittar na inganta samarda glycogen kuma yana dakatar da canzawar lipids da amino acid zuwa carbohydrates.

Babban ɓangaren insulin an ɗauka don ɗaukar ayyukan rage sukari na 0.045 MG na insulin ruwan kwalliya.

Tasirin warkewa akan jikin mai ciwon sukari da farko yana hade da kawar da katsewar hanji a cikin abinci na yau da kullun na lipids da carbohydrates. Insulin yana inganta yanayin lafiyar marasa lafiya saboda gaskiyar cewa:

jini yana raguwa
Ana cire glucosuria (glucose a cikin fitsari) da acetonuria (tarin acetone a cikin jini),
bayyanuwar yawancin rikice-rikice na ciwon sukari (polyarthritis, furunlera, polyneuritis) an rage.

Wanene aka nuna don insulin?

Babban nuni ga amfani da miyagun ƙwayoyi shine cutar nau'in 1 mellitus na sukari (insulin-dogara). Idan ka shigar da kwayoyin a cikin karancin magunguna (daga 5 zuwa 10 raka'a), to zai taimaka wajen kawar da:

wasu cututtukan hanta
acidosis
asarar mahimmanci
ci
furunlera,
szarinicharsus.

A cikin isasshe, ana iya amfani da miyagun ƙwayoyi a ilimin likitanci. Insulin zai iya yin tasiri sosai tare da cututtukan cututtukan cututtukan mahaifa, kuraje, eczema, psoriasis, urticaria, pyoderma na kullum da lalacewar fata.

Wani lokaci yana yiwuwa a yi amfani da insulin a cikin tunanin mutum da ayyukan neuropsychiatric. Bugu da ƙari, ana amfani da hormone a cikin lura da dogaro na barasa da matsalolin tsarin juyayi.

A yau, wasu daga cikin nau'ikan schizophrenia ana gudanar da su cikin nasara tare da godiya ga maganin insulinocomatosis. Yana bayar da gabatarwar miyagun ƙwayoyi a cikin irin waɗannan matakan waɗanda zasu iya haifar da girgiza hypoglycemic.

Dokokin aikace-aikace

A mafi yawan lokuta, insulin ya hada da allurar ciki da na ciki yayin aiki da sirinji na musamman. A cikin yanayi na musamman, misali cikin coma, ana iya gudanar da shi ta cikin ciki. Ana sarrafa insulin na dakatarwa ne kawai a karkashin fata.

Ya kamata a saka farashi na yau da kullun sau 2-3 kuma koyaushe kafin abinci (minti 30). Sakamakon allurar farko ta fara ne bayan mintuna 30-60 kuma yana daga awa 4 zuwa 8.

Lokacin da aka gudanar da shi ta hanyar ciki, ƙwayar ta kai ga mafi girma bayan mintuna 20-30 kuma bayan mintuna 60 maida hankali ne na hormone a cikin jinin mai haƙuri ya isa matakin farko.

Aara aikin dakatar da bayyanar wuri a cikin sirinji, abubuwan da ke cikin murfin ya girgiza sosai har sai an kafa fitowar suttura.

Lokacin da ake kawar da ciwon sukari tare da inulin, yana da mahimmanci a kula da abinci na musamman. Da sashi na miyagun ƙwayoyi a wannan yanayin ya kamata a zabi akayi daban-daban. Zai dogara gaba ɗaya akan:

tsananin tsananin cutar
nawa glucose yake a cikin fitsari
janar yanayin haƙuri.

Matsakaicin girman ya bambanta daga raka'a 10 zuwa 40 a kowace rana. A wajen lura da cutar siga da gudawa, ya kamata a kara yawan sashi na hormone sosai:

tare da babban tsarin kulawa na kusan 100
cikin intravenously har zuwa raka'a 50.

Toxidermy na ciwon sukari na samar da kashi na insulin, wanda zai bambanta gwargwadon tsananin cutar rashin lafiyar. Duk sauran lokuta na asibiti ba sa buƙatar ƙara girma na abubuwan da ake sarrafawa.

Wanene bai kamata ya saka allurar ba?

Akwai takamaiman matakan contraindications ga yin amfani da insulin. Waɗannan halaye sun haɗa da cututtuka:

hepatitis
na ciki da duodenal miki,
fitar
maganin ciwon huhu
cutar dutsen koda
decompensated cututtukan zuciya.

Side effects kan jiki

A matsayinka na mai mulkin, mummunan halayen yana faruwa ne kawai saboda yawan yawan insulin. Sakamakon tsarin gudanarwa na ciki ko na ƙarƙashin ƙasa, haɗuwarsa cikin jini yana ƙaruwa sosai. Haka kuma, idan glucose din bai shiga jikin mutum ba, to kuwa yiwuwar haifarwar girgiza jini tayi girma (idan glucose din ta fadi zuwa matakin da ba zai karba ba).

Yawanci, babban insulin yana haifar da:

musamman bugun zuciya
ƙarancin tsoka
karancin numfashi
gumi
salivation.

A cikin mawuyacin yanayi, karuwar insulin ba tare da ramawar carbohydrate ba (idan ba a cinye glucose ba) ya ƙunshi asarar hankali, rashiwar jiki da kuma cutar motsa jiki.

Don kawar da wannan yanayin cikin sauri, ya zama dole don ciyar da mai haƙuri 100 g farin gurasa na farin alkama, shayi mai baƙar fata ko kofuna biyu na sukari mai girma a farkon bayyanar cututtuka na hypoglycemia.

Tare da mummunan alamun girgiza masu ciwon sukari, glucose a cikin jijiya mara nauyi ne. Idan ya cancanta, ana iya sarrafa glucose a cikin subcutaneously ko ana amfani da epinephrine.

Yadda ake yin allura?

An wajabta allura ta ciki a cikin wuraren cike da jijiyoyin kumbura: a hannu, a cikin ulnar fossa kuma a hannu. Alurar rigakafin ta hada da abubuwa masu zuwa:

cikakken gano jijiya
shigar da allura ta hanyar fitsari cikin jijiya,
Yatsa a cikin gwiwar hannu na hannun mutum don dakatar da jinni daga fagen aikin.

Shirya mai haƙuri don yin allura - zauna a kujera ko a kujera.
Sanya gwiwar hannu na hannu kafin allurar ta a cikin jijiya a kan mayalli.
Theara magungunan cikin sirinji.
Sanya wani wurin shakatawa mai zurfi a saman gwiwar hannu don samun kwararar jini zuwa jijiyoyin.
Nemi mai haƙuri ya yi aiki tare da dunƙulensa a lokacin ji don ƙaiƙayi mai cike da jini.
Za a gudanar da magunguna a wurin da aka nufa.
Rarraba tare da barasa sau biyu wurin allura.
An saka allura (ta yanka), ba a saka kayan yawon shakatawa, dunƙulen ba ya buɗe.
Ana gudanar da maganin a hankali, ma'aurata na goma na ml ya rage a cikin sirinji.
An cire allurar daga cikin jijiya, ana shafa swab auduga a wurin allurar, hannu ya lankwashe.
A cikin lanƙwasa matsayi, an bada shawara don riƙe hannunka tsawon minti biyar (bruise ba ya kafa).

Mahimmanci! Zai yuwu a kare mara lafiya daga kamuwa da jini idan an lura da tsabtace tsabtace: inginan da za a iya zubar da shi daga wata ma'aikaciyar, in da masanan masana'antar ke bayarwa, sinadarin allura da kuma allurar. A ƙarshen hanyar, an rufe wurin allura tare da swab auduga tare da barasa.

Samun jini daga jijiya da duk wani allura na kwayoyi a cikin jijiyoyin ne kwararrun likitoci ke yin su.

Hanyar sarrafa kansa, dokoki da bayanai game da allura ta ciki tun daga farko har ƙarshe yana nuna bidiyon

Dabarar aiwatar da allura ta ciki

Tsawon lokacin gabatarwar kwayoyi a cikin jijiya yana da minti goma. Hanyar allurar tana bawa kwararrun gogewa allura cikin jijiya mara nauyi kuma da sauri cewa baka da lokacin tsoro. Yawanci, ana sanya magani a cikin jijiya a gwiwar hannu. Idan ba zai yiwu a nemo tsoffin jini a wannan yankin ba, to sai a ɗauki sauran jijiyoyin da ke bayan hannun daga allura. Ba a allurar da maganin a cikin jijiyoyin kafafu a dalilin dalilin barazanar suturar jini yana ƙaruwa. Ainihin allurar rigakafin ya ƙunshi hanya kamar haka:

Ana ɗaukar sirinji tare da hannun dama, an yi amfani da allura cannula ta hannun yatsa.
An matse sirinji tare da sauran yatsunsu.
An sake bugun murfin, za a kula da shafin allurar nan gaba da sabon swab, hannun hagu yana gyara fata.
Marasa lafiya yana tafin hancin.
Hannun ya riƙe sirinji kusan a layi daya (a wani kwana na digiri 15) zuwa wurin allurar, allura - tare da yanke.
Ana yin huɗa, allura ya wuce kashi ɗaya bisa uku na fata tsakanin fata da jijiya, sannan ya soke bangon jijiya, ana sarrafa wannan matakin ne ta hanyar "lalacewa".
Daɗaɗaɗa mai ɗaukar silsila, jini zai bayyana a cikin silinda, wanda ke tabbatar da kasancewar allura a cikin jijiya.
An cire kayan shakatawa, dunkulallen hutawa
Sake bincika allura a cikin wata jijiya.
Gudanar da magungunan jinkirin, wani ɓangare na miyagun ƙwayoyi ya rage a cikin silinda - ba allurar ba.
An cire sirinji, ana amfani da swab na auduga tare da barasa, tanƙwara hannu.
A cikin lanƙwasa matsayi, riƙe hannunka tsawon mintuna 5, ba za a yi rauni.