Enalapril Maleate ntsiav tshuaj

Lub ntsiab mechanism ntawmEnalapril Maleate ntsiav tshuajRaws li angiotensin -hloov enzyme inhibitor (ACEI), yog inhibit ACE thiab thaiv kev hloov pauv ntawm angiotensin I mus rau angiotensin II. Angiotensin II yog ib qho ntawm cov vasoconstrictors uas muaj zog tshaj plaws hauv lub cev, thiab nws cov kev txo qis tuaj yeem ua rau cov vasodilation ntawm peripheral, txo qis peripheral vascular tsis kam, thiab yog li txo cov ntshav siab. Tsis tas li ntawd, ACE inhibition tuaj yeem txo qis aldosterone secretion, txhawb dej thiab sodium excretion, thiab ntxiv pab txo cov ntshav siab.
Kev siv dav dav: npog ntau yam xws li kev kub siab, lub raum vascular hypertension, malignant hypertension, thiab lwm yam. Ntawm lawv, lub raum vascular hypertension yog tshwm sim los ntawm lub raum hlab ntsha stenosis ua rau overactivation ntawm renin -angiotensin system (RAS), thiab Enalapril tuaj yeem siv tshwj xeeb antihypertensive los ntawm inhibiting lub RAS.

Dose yooj: Thawj koob tshuaj feem ntau yog 5-10mg ib hnub, muab faib ua 1-2 koob tshuaj qhov ncauj. Rau cov neeg mob uas muaj lub raum tsis zoo (creatinine clearance rate).<30ml/min), the initial dose should be reduced to 2.5mg/day to avoid adverse reactions such as hypotension caused by drug accumulation.
Qhov zoo ntawm kev kho kev sib xyaw ua ke: Thaum siv ua ke nrog cov tshuaj diuretics (xws li hydrochlorothiazide), nws tuaj yeem txhim kho cov nyhuv antihypertensive, tshwj xeeb tshaj yog rau refractory hypertension. Txawm li cas los xij, nws yog ib qho tsim nyog kom tsis txhob muaj kev sib xyaw nrog cov poov tshuaj diuretics (xws li spironolactone) los tiv thaiv hyperkalemia.

Txoj hauj lwm ntawmEnalapril Maleate ntsiav tshuajHauv kev kho mob plawv tsis ua hauj lwm stems los ntawm nws ob txoj kev tswj hwm ntawm cov kab mob neuroendocrine: ntawm ib sab, nws txo qis kev tsim cov angiotensin II thiab aldosterone los ntawm inhibiting RAS system, li no alleviating cardiac afterload; Ntawm qhov tod tes, los ntawm inhibiting degradation ntawm bradykinin thiab txhim kho kev tso tawm ntawm nitric oxide (NO) thiab prostaglandins (PG), nws exerts vasodilation thiab anti myocardial remodeling teebmeem.
Cov tsos mob plawv tsis ua hauj lwm: siv los txhim kho kev ciaj sia, ncua kev mob plawv tsis ua hauj lwm, thiab txo kev mus pw hauv tsev kho mob zaus. Kev tshawb fawb pom tau tias Enalapril tuaj yeem txo qhov kev tuag ntawm cov neeg mob plawv tsis ua haujlwm los ntawm 27% thiab tus nqi pw hauv tsev kho mob los ntawm 31%.

Asymptomatic sab laug ventricular dysfunction: Rau cov neeg mob asymptomatic nrog sab laug ventricular ejection feem (LVEF) Tsawg dua lossis sib npaug li 35%, Enalapril tuaj yeem ncua qhov pib ntawm lub plawv tsis ua haujlwm thiab txo qhov kev pheej hmoo ntawm kev mus pw hauv tsev kho mob.
Kev hloov kho koob tshuaj: thawj koob tshuaj feem ntau yog 2.5mg ob zaug ib hnub, maj mam nce mus rau lub hom phiaj koob tshuaj (feem ntau 10-20mg ob zaug ib hnub) raws li kev ua siab ntev. Qhov siab tshaj plaws koob tshuaj yuav tsum tsis pub tshaj 40mg / hnub.

Cov neeg mob lub raum tsis txaus yuav tsum tau them nyiaj tshwj xeeb rau kev hloov kho tshuaj thaum siv Enalapril, vim tias cov tshuaj feem ntau tawm los ntawm lub raum. Kev txo lub raum ua haujlwm tuaj yeem ua rau cov tshuaj tsub zuj zuj, ua rau muaj kev pheej hmoo ntawm kev phiv xws li hypotension thiab hyperkalemia.
Lub raum tsis txaus (creatinine tshem tawm tus nqi 30-60ml / min): Tsis tas yuav kho cov koob tshuaj thawj zaug, tab sis yuav tsum tau saib xyuas cov ntshav siab thiab lub raum ua haujlwm.

Lub raum tsis txaus (creatinine clearance rate).<30ml/min): The initial dose is reduced to 2.5mg/day, and the maximum dose does not exceed 10mg/day.
Cov neeg mob lim ntshav: Cov tshuaj yuav tsum tau muab tshuaj tom qab lim ntshav kom tsis txhob muaj ntshav siab hloov pauv los ntawm kev tshem tawm cov tshuaj sai thaum lub sijhawm lim ntshav.

Enalapril ua lub luag haujlwm tseem ceeb hauv kev tiv thaiv theem nrab ntawm myocardial infarction los ntawm inhibiting RAS system, txo qis myocardial remodeling, thiab txo cov kev pheej hmoo ntawm rov tshwm sim infarction thiab tuag.
American College of Cardiology (ACC)/American Heart Association (AHA) cov lus qhia pom zoo rau cov neeg mob uas muaj ST ntu nce myocardial infarction (STEMI) yam tsis muaj contraindications, kev kho ACEI yuav tsum pib ua ntej 24 teev ntawm qhov pib.
European Society of Cardiology (ESC) cov lus qhia sau ACEIs raws li Chav Kawm Kuv pom zoo siv tshuaj rau ntev -kev kho mob tom qab myocardial infarction.

Enalapril Maleate ntsiav tshuajtuaj yeem txo glomerular hypertension, hyperperfusion thiab hyperfiltration los ntawm inhibiting RAS system, yog li ncua kev nce qib ntawm ntshav qab zib nephropathy.
Cov lus qhia ntawm American diabetes Association (ADA) pom zoo tias ACEI lossis ARB (angiotensin receptor antagonist) yuav tsum siv rau kev kho mob ntawm hom 1 thiab hom 2 mob ntshav qab zib mellitus nrog microalbuminuria.
Raws li cov lus qhia ntawm KDIGO, ACEI tau teev npe ua thawj - cov tshuaj kho mob rau ntshav qab zib nephropathy.

Enalapril kuj tuaj yeem siv los kho qee yam kab mob plawv, xws li aortic valve stenosis, hypertrophic cardiomyopathy, thiab lwm yam, tab sis nws yuav tsum tau siv raws li kev qhia ntawm tus kws kho mob tshwj xeeb.