Desmopressin, ib qho yooj yim tsim ntawm vasopressin, suav tias yog ib feem tseem ceeb hauv kev saib xyuas cov kab mob sib txawv. Nws txoj kev ntawm kev ua si yog unpredictable tab sis nkag mus, cuam tshuam rau ob peb lub physiological cycles nyob rau hauv lub cev. Hauv blog no, peb yuav dhia mus rau hauv cov subtleties ntawm nws ua haujlwm li cas thiab nws qhov tseem ceeb hauv chaw kho mob.
Yuav Ua Li Cas Desmopressin tswj cov dej sib npaug hauv lub cev?
Desmopressin, ib qho yooj yim engineered ntawm cov tshuaj vasopressin, xav tias yog ib feem tseem ceeb ntawm kev tswj cov dej sib npaug hauv lub cev los ntawm kev xyaum cov dej num ntawm vasopressin. Vasopressin, txwv tsis pub hu ua antidiuretic chemical (ADH), yog tsim los ntawm lub paj hlwb thiab xa los ntawm lub cev pituitary. Nws ua raws li vasopressin receptors hauv ob lub raum txhawm rau ua kom dej reabsorption, ua li no txo qis cov zis tawm los thiab ua kom lub cev ua kua.
Nws ua haujlwm zoo ib yam rau vasopressin los ntawm kev txwv rau vasopressin receptors hauv lub raum sib sau ua ke. Cov receptors no, hu ua V2 receptors, yog qhov tseem ceeb nyob rau ntawm zaj duab xis basolateral ntawm lub raum sib npaug. Enactment of V2 receptors prompts a progression of intracellular flagging times, at the last brings about the inclusion of aquaporin-2 (AQP2) water channels into the apical layer of the renal cylindrical cells.
Aquaporin-2 channels ua haujlwm nrog kev txhim kho cov dej tsis sib xws hauv cov yeeb yaj kiab ntawm tes, tso cai rau cov dej rov qab los ntawm cov kua dej ib zaug ntxiv rau hauv cov hlab ntsha. Yog li, pee hloov mus rau kev xav ntau dua, thiab qhov ntim ntawm cov kua xa tawm diminishes. Cov txheej txheem no pab txuag dej thiab ua kom cov kua dej sib npaug hauv lub cev, tshwj xeeb tshaj yog nyob rau hauv cov xwm txheej uas muaj cov dej tsis zoo los yog siv dej tsawg.
Nws yog cov haujlwm tshwj xeeb ntawm V2 receptors cais nws los ntawm vasopressin, uas tseem cuam tshuam rau V1 receptors cuam tshuam nrog vasoconstriction. Los ntawm kev tsom ntsoov rau V2 receptors, nws nce qib dej reabsorption hauv ob lub raum yam tsis muaj kev cuam tshuam rau vascular tone lossis circulatory strain guideline.
Kev siv nws yog qhov tshwj xeeb tshaj yog muaj txiaj ntsig zoo hauv cov xwm txheej uas tau piav qhia los ntawm kev tsis muaj vasopressin tawm lossis lub raum tsis ua haujlwm rau vasopressin, piv txwv li, focal diabetes insipidus thiab nighttime enuresis (bedwetting). Nyob rau hauv cov xwm txheej no, nws supplementation tuaj yeem txhim kho cov dej reabsorption hauv ob lub raum, txo qis kev tsim cov quav, thiab txo cov kev phiv ntawm polyuria (tsis tsim nyog pee) thiab polydipsia ( nqhis dej ntau dhau).
Nyob rau hauv txhua rooj plaub, nws yog ib qho tseem ceeb rau kev siv nws sensibly, vim hais tias cov dej tsis tsim nyog tu yuav ua rau hyponatremia (tsawg sodium ntau ntau) thiab kua dej ntau dhau, tshwj xeeb tshaj yog nyob rau hauv cov neeg tsis muaj zog xws li lub raum impedance los yog congestive cardiovascular puas. Tom qab ntawd, ceev faj xyuas cov kua dej sib npaug thiab cov qib electrolyte yog qhov tseem ceeb thaum pom zoo nws kho.
Nws tswj cov dej sib npaug hauv lub cev los ntawm kev luam cov dej num ntawm vasopressin thiab ua kom cov dej reabsorption hauv ob lub raum los ntawm V2 receptor actuation. Cov khoom no pab txuag lub cev ua kua, txo qis cov qoob loo, thiab khaws cov kua homeostasis. Nws txoj kev kho mob yog qhov tseem ceeb hauv kev tswj hwm ntawm cov xwm txheej cuam tshuam nrog lub peev xwm vasopressin tsis muaj zog, tab sis kev soj ntsuam ze yog qhov tseem ceeb rau kev cuam tshuam nrog cov kua thiab electrolyte lopsidedness.
Dab tsi yog lub luag haujlwm ua Desmopressin ua si hauv kev kho mob ntshav qab zib insipidus?
Desmopressin, ib qho kev tsim kho yooj yim ntawm vasopressin, suav tias yog ib feem tseem ceeb hauv kev tswj hwm ntawm ntshav qab zib insipidus (DI), ib qho mob uas piav qhia los ntawm kev tsis tsim nyog tso zis thiab nqhis dej vim tias muaj peev xwm vasopressin debilitated. Kev nkag siab txog nws cov ntsiab lus ntawm kev ua ub no thiab nws daim ntawv thov nyob rau hauv ntau hom DI yog qhov tseem ceeb rau kev txhawb nqa kev kho mob hauv cov neeg cuam tshuam.
Hauv focal diabetes insipidus (CDI), cov kab mob zais cia suav nrog qhov tsis muaj lossis tawg ntawm vasopressin tsim lossis xa tawm los ntawm lub paj hlwb lossis lub cev pituitary. Nws tiag tiag daws qhov tsis txaus no los ntawm kev hloov pauv rau vasopressin endogenous. Thaum tswj hwm, nws txuas rau vasopressin receptors hauv lub raum sib sau ua ke, ua kom cov dej reabsorption thiab txo qis pee tawm los. Qhov no ua rau txo qis hauv polyuria (tshaj sab saum toj) thiab polydipsia ( nqhis dej heev), txo cov kev mob tshwm sim ntawm CDI.
Conversely, nephrogenic diabetes insipidus (NDI) yog portrayed los ntawm lub raum tsis muaj zog cov tshuaj tiv thaiv rau vasopressin, feem ntau vim yog deformities nyob rau hauv lub vasopressin receptors los yog downstream flagging txoj kev nyob rau hauv lub raum. Tej zaum nws yuav tsis muaj kev vam meej hauv kev kho NDI nyob rau hauv lub teeb ntawm qhov tseeb tias qhov zais deformity muaj nyob rau hauv lub raum tubules uas tsis yog nyob rau hauv vasopressin creation. Txawm li cas los xij, nyob rau lub sij hawm ntawm ib nrab NDI, nws yuav nyob rau hauv txhua rooj plaub muab tswv yim txo los ntawm kev txhim kho dej reabsorption nyob rau hauv lub raum tubules uas nyob twj ywm txais mus rau vasopressin.
Thaum siv nws los kho DI, cov chaw muab kev kho mob yuav tsum xav txog ob peb lub ntsiab lus kom kho tau zoo:
01
Kev ntsuas kev xav
Nws tuaj yeem nkag mus rau hauv cov ntsiab lus sib txawv, suav nrog cov ntsiav tshuaj ntawm qhov ncauj, da dej intranasal, ntsiav tshuaj sublingual, thiab infusions intravenous. Qhov kev ntsuas tsim nyog thiab chav kawm ntawm lub koom haum vam khom raws li cov lus qhia txog kev kho mob, kev mob tshwm sim hnyav, thiab lub raum muaj peev xwm. Titration ntawm nws qhov ntsuas yuav yog ib qho tseem ceeb kom ua tiav qhov zoo tshaj plaws tswj ntawm polyuria thiab polydipsia thaum txwv kev twv txiaj ntawm cov txiaj ntsig tom qab.
02
Tshawb xyuas Conventions
Kev soj ntsuam ntawm kev tso zis, tso kua dej, cov tshuaj electrolytes (tshwj xeeb tshaj yog qib sodium), thiab lub raum muaj peev xwm yog qhov tseem ceeb thaum nws kho. Qhov kev soj ntsuam no pab cov neeg muab kev kho mob nrog kev ntsuam xyuas cov tshuaj tiv thaiv rau kev kho mob, hloov kev ntsuas nyob ntawm qhov xwm txheej, thiab txheeb xyuas cov kev cuam tshuam tsis zoo xws li hyponatremia (tsawg sodium) lossis kua dej ntau dhau.
03
Tej yam tshwm sim tshwm sim
Thaum nws yog los ntawm thiab loj heev tiv taus, muaj peev xwm ua rau muaj kev tiv thaiv dej, hyponatremia, migraine, queasiness, thiab plab torment. Cov neeg mob yuav tsum tau qhia txog cov kev tshwm sim tom qab no thiab kawm kom tshaj tawm cov kev mob tshwm sim tsis zoo rau lawv tus neeg muab kev kho mob sai.
04
Txoj Kev Kho Mob Tus Kheej
Kev tswj hwm ntawm DI nrog nws yuav tsum yog tus kheej los ntawm qhov pom ntawm qhov laj thawj, qhov hnyav ntawm cov kev mob tshwm sim, thiab cov ntsiab lus ntawm tus neeg mob. Qee lub sij hawm, nws yuav raug siv los ua kev kho mob kho mob, thaum lwm tus, nws tuaj yeem raug pom zoo nyob ntawm qhov xwm txheej los saib xyuas cov kev mob tshwm sim los yog thaum lub sij hawm muaj kev mob nkeeg ntxiv (piv txwv li, kab mob, kev kho mob).
Desmopressin suav tias yog ib feem tseem ceeb hauv kev kho mob ntshav qab zib insipidus los ntawm kev tsom mus rau kev ua haujlwm ntawm vasopressin thiab ua kom cov dej reabsorption hauv ob lub raum. Thaum yuam hauv focal ntshav qab zib insipidus, nws qhov txaus ntawm nephrogenic diabetes insipidus yuav raug txwv. Ceev faj ntsuas titration, kuaj xyuas, thiab cov neeg mob hauv tsev kawm ntawv yog qhov tseem ceeb ntawm kev kho mob desmopressin kom lav qhov zoo tshaj plaws kev phiv tshuaj tswj thiab txwv kev twv txiaj ntawm cov kev cuam tshuam tsis zoo.
Yuav Ua Li Cas Desmopressin cuam tshuam cov ntshav txhaws thiab hemostasis?
Lwm intriguing nam ntawmdesmopressinHom kev ua haujlwm yog nws lub luag haujlwm hauv kev txhim kho hemostasis thiab tswj kev los ntshav. Cov txheej txheem dab tsi hauv qab nws lub peev xwm los txhawb kev tso tawm ntawm von Willebrand yam thiab qhov VIII, cov neeg ua si tseem ceeb hauv coagulation cascade? Yuav ua li cas cov kws kho mob leverage nws nyob rau hauv cov xwm txheej xws li von Willebrand kab mob thiab hemophilia? Peb yuav tshawb xyuas cov txheej txheem biochemical muaj feem cuam tshuam, kev ua tau zoo ntawm kev kho mob, thiab kev saib xyuas kev nyab xeeb, xa mus rau cov lus qhia tam sim no thiab cov kws tshaj lij kev xav los muab cov lus qhia dav dav.
Csuav nrog
Txhua yam, nkag siab li casdesmopressinua haujlwm ntawm qib atomic thiab physiological yog qhov tseem ceeb rau kev txhim kho nws cov txiaj ntsig zoo thaum nruab nrab yuav muaj kev phom sij. Los ntawm kev nyiam nws cov txiaj ntsig ntawm cov lus qhia sib npaug dej, nws txoj hauj lwm hauv kev kho mob ntshav qab zib insipidus, thiab nws qhov cuam tshuam rau hemostasis, peb tau txais txiaj ntsig zoo dua rau tus kws kho mob tshwj xeeb no ntau yam xwm txheej. Cov kws kho mob cov kws tshaj lij thiab cov neeg mob tib yam tuaj yeem siv cov ntaub ntawv no los daws cov kev xaiv paub txog kev kho mob, txhim kho cov neeg mob tau txais txiaj ntsig thiab kev txaus siab ntawm tus kheej.
Cov ntaub ntawv
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8. National Hemophilia Foundation. Kev kho mob Hemophilia. Tau txais los ntawm https://www.hemophilia.org/Bleeding-Disorders/Treatment/Treatment-of-Hemophilia
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10. American Society of Hematology (ASH). Von Willebrand Kab Mob: Cov Lus Qhia Txog Kev Kho Mob. Tau txais los ntawm https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines/vwd