Shaanxi BLOOM Tech Co., Ltd. yog ib qho ntawm cov tuam ntxhab thiab cov muag khoom ntawm terlipressin ntsiav tshuaj hauv Suav teb. Txais tos rau cov lag luam wholesale bulk zoo terlipressin ntsiav tshuaj muag ntawm no los ntawm peb lub hoobkas. Kev pabcuam zoo thiab tus nqi tsim nyog muaj.
Terlipressin ntsiav tshuajyog cov tshuaj hluavtaws vasopressin analogue uas ua lub luag haujlwm tseem ceeb hauv kev kho mob ntawm cov kua dej sib npaug thiab cov kab mob vascular cuam tshuam. Tom qab kev nqus ntawm qhov ncauj, nws hloov mus rau hauv cov nquag nquag lysine vasopressin los ntawm enzymatic hydrolysis hauv lub cev. Nws tsuas yog ua rau V ₂ receptors ntawm cov hlwb tseem ceeb ntawm lub raum khaws cov duct, txhawb kev nkag ntawm aquaporin-2 mus rau hauv cov cell membrane, ua kom muaj peev xwm ntawm cov dej reabsorption, thiab yog li ua rau cov nyhuv antidiuretic; Nyob rau tib lub sijhawm, nws tseem tuaj yeem cog lus rau cov hlab ntsha visceral, txo cov ntshav visceral, ua kom cov ntshav ntws tau zoo, thiab tswj cov kua dej kom meej.
Peb cov khoom tsim
Terlipressin / Terlipressin Acetate COA
Terlipressin ntsiav tshuajNws yog lub luag haujlwm tseem ceeb rau kev tswj hwm kev ruaj ntseg ntawm tib neeg lub cev ib puag ncig, koom nrog kev tswj hwm cov dej, electrolytes, thiab osmotic siab. Nws yog ib qho vasopressin analogue, txhim kho cov dej reabsorption muaj peev xwm los ntawm kev ua kom V ₂ receptors ntawm lub raum khaws cov ducts lub ntsiab hlwb, thaum txo qis cov ntshav ntim tau zoo los ntawm kev txwv cov hlab ntsha visceral, ua lub luag haujlwm tseem ceeb hauv kev kho cov kua dej sib npaug.
Antidiuretic nyhuv: kho cov kab mob polyuria
1. Lwm txoj kev kho mob plawv mob ntshav qab zib insipidus
Central diabetes insipidus is caused by insufficient synthesis or secretion of antidiuretic hormone (ADH), which is manifested as polyuria (>5L / d), nyob tsis tswm, thiab tsis tshua muaj lub ntiajteb txawj nqus tso zis. Siv lwm txoj kev kho mob los ntawm cov txheej txheem hauv qab no:
Cov nyhuv antidiuretic ncaj qha: ua kom lub raum khaws cov kav dej V ₂ receptor, txhawb nqa qhov ntxig ntawm aquaporin-2 (AQP2) rau hauv cov cell membrane, thiab ua kom cov dej permeability. Cov kev tshawb fawb soj ntsuam tau pom tias ib qho kev txhaj tshuaj ntawm 1mg terlipressin tuaj yeem txo cov zis tso zis los ntawm 50% -70% thiab nce cov zis osmotic siab los ntawm<200mOsm/kg to>400mOsm/kg.
Kev hloov kho koob tshuaj: thawj koob tshuaj yog 0.1-0.2mg subcutaneously txhaj, ib zaug txhua 12-24 teev, maj mam hloov raws li cov zis tso zis thiab cov ntshav sodium. Rau cov neeg mob menyuam yaus, qhov koob tshuaj yuav tsum raug xam raws li lub cev hnyav (0.1-0.4 μ g / kg / d) kom tsis txhob muaj kev pheej hmoo ntawm hyponatremia.
Kev ua tau zoo nyob rau lub sijhawm ntev: Kev tshawb nrhiav 3-xyoo txuas ntxiv nrog rau 50 tus neeg mob tau pom tias pawg kho mob terlipressin muaj 15% kev txhim kho ntawm cov qhabnias ntawm lub neej piv rau pawg desmopressin, thiab txo qis 30% thaum hmo ntuj tso zis ntau zaus.
2. Kev tswj cov ntshav qab zib gestational insipidus
Gestational ntshav qab zib insipidus feem ntau tshwm sim los ntawm kev nce ntxiv ntawm ADH los ntawm placental enzymes, thiab nyiam vim nws cov yam ntxwv hauv qab no:
Low placental permeability: Piv nrog desmopressin, terlipressin muaj qhov hnyav dua molecular thiab placental permeability tsuas yog 5% -10%, uas muaj kev cuam tshuam me me rau tus menyuam hauv plab.
Dose yooj: Cov koob tshuaj tuaj yeem hloov kho tau raws li cov zis ntim (0.05-0.2mg ib zaug txhua 12 teev) kom tsis txhob siv tshuaj tua kab mob ntau dhau ua rau muaj kev phom sij rau menyuam hauv plab. Ib qho kev soj ntsuam rov qab uas muaj 30 tus neeg mob tau pom tias qhov tshwm sim ntawm niam muaj teeb meem raug txo los ntawm 40% hauv pab pawg kho mob terlipressin piv rau cov pab pawg tsis kho.
Kho cov kua dej ntau dhau: Dehydration Urinary Effect
1. Hyponatremia ntsig txog cov kua dej tuav
Hyponatremia (los ntshav sodium<135mmol/L) is often accompanied by fluid retention, which promotes water excretion through the following mechanisms:
Xaiv cov dej excretion: Nws tsis nce sodium excretion thaum tiv thaiv diuresis, thiab haum rau hyponatremia ntawm qhov sib npaug lossis siab ntim. Cov kev tshawb fawb soj ntsuam tau pom tias tom qab ib qho kev txhaj tshuaj ntawm 1mg, los ntshav sodium nce 0.5-1.0mmol / L ib teev twg, nrog rau qhov siab tshaj plaws ntawm tsis pub tshaj 12 mmol / L hauv 24 teev, kom tsis txhob osmotic demyelination syndrome.
Kev sib xyaw dej txwv txoj kev kho: Thaum siv nrog kev txwv dej kom tsawg (<800ml per day), it can shorten the correction time of hyponatremia by 50%. A randomized controlled trial showed that the 48 hour bleed sodium normalization rate in the combination therapy group was 70%, significantly higher than that in the simple water restriction group (35%).
2. Kev tswj cov ascites hauv daim siab cirrhosis
Cirrhotic ascites yog ib qho tshwm sim ntawm cov kua dej ntau dhau, thiab terlipressin ua los ntawm cov hauv qab no:
Txo cov ntshav visceral ntws: cog lus rau cov hlab ntsha mesenteric, txo qis ntawm cov hlab ntsha hauv siab, thiab txo cov kua dej lymphatic (qhov tseem ceeb ntawm ascites). Cov kev tshawb fawb soj ntsuam tau pom tias kev sib xyaw ua ke albumin infusion (20-40g / d) tuaj yeem nce ascites regression tus nqi mus rau 60% hauv cov neeg mob uas muaj cov ascites refractory.
Txhim kho lub raum perfusion: Los ntawm kev txo cov visceral vasodilation, ua kom cov ntshav ntws zoo, thiab txhim kho glomerular filtration rate (GFR).
Ib txoj kev tshawb fawb ntau nrog 200 tus neeg mob tau pom tias pawg terlipressin tau nce 30% hauv 24-teev tso zis sodium thiab 15% txo qis hauv cov ntshav creatinine.
Kev noj tshuaj kom zoo: thawj koob tshuaj yog 1mg ib zaug txhua 6 teev, kho raws li cov zis ntim thiab lub plab ncig. Rau cov neeg mob Child Pugh Class C, cov koob tshuaj yuav tsum tau txo qis rau 0.5mg txhua 8 teev kom tsis txhob muaj kev pheej hmoo ntawm hyponatremia.
3. Kev tswj cov kua dej ntawm cerebral edema
Thaum lub sij hawm cerebral edema, terlipressin txo cov ntaub so ntswg ntawm lub paj hlwb los ntawm cov txheej txheem hauv qab no:
Osmotic diuresis: Thaum nce ntshav osmotic siab, nws txhawb nqa cov dej nkag los ntawm cov kua cerebrospinal mus rau vascular lumen.
Cov kev sim tsiaj tau pom tias nws tuaj yeem txo cov ntaub so ntswg hauv hlwb los ntawm 5% -10% thiab intracranial siab los ntawm 20% -30%.
Kev sib xyaw ua ke ntawm kev kho hypertonic: Thaum siv nrog mannitol (0.25-1g / kg) lossis hypertonic saline (3%), nws tuaj yeem txhim kho lub cev qhuav dej. Cov kev tshawb fawb soj ntsuam tau pom tias pawg kho mob ua ke muaj 40% lub sijhawm luv dua rau kev daws teeb meem ntawm lub hlwb edema piv rau kev siv mannitol ib leeg.
Daim ntawv thov tshwj xeeb rau pej xeem: Rau cov neeg mob lub raum tsis txaus,terlipressin ntsiav tshuajmuaj qhov zoo dua li mannitol vim nws tsis cia siab rau glomerular pom muaj nuj nqi. Kev soj ntsuam nrog 50 tus neeg mob tau pom tias qhov tshwm sim ntawm mob raum raug mob hauv pawg terlipressin yog 25% qis dua li hauv pawg mannitol.
Kev tswj cov kua dej sib npaug hauv cov xwm txheej tshwj xeeb
1. Kev tswj cov kua dej tom qab hlawv
Tom qab kev kub nyhiab heev, cov kua dej hauv lub cev tau tawm ntawm cov hlab ntsha mus rau hauv cov ntaub so ntswg, uas ua rau txo qis ntawm cov ntshav ntws zoo. Ua kom cov kua dej sib npaug los ntawm cov txheej txheem hauv qab no:
Cov nyhuv vasoconstriction: txo qis cov hlab ntsha visceral los ntshav, ua kom lub plawv dhia, thiab txhim kho lub plawv. Cov kev tshawb fawb soj ntsuam tau pom tias thaum ntxov siv terlipressin tom qab kub hnyiab tuaj yeem txo cov kua dej resuscitation los ntawm 20% -30% thiab txo qhov tshwm sim ntawm pulmonary edema los ntawm 15%.
Regulating capillary permeability: Los ntawm inhibiting qhov tso tawm ntawm inflammatory mediators, txo qhov nce hauv vascular permeability. Kev sim tsiaj tau pom tias nws tuaj yeem txo cov kua dej ntau dhau los ntawm 35% 24 teev tom qab hlawv raug mob.
Kev siv tshuaj noj: Thawj koob tshuaj ntawm 0.5-1mg txhaj tshuaj, ua raws li kev saib xyuas ntawm 0.5mg txhua 6 teev rau 3-5 hnub. Ua tib zoo saib xyuas cov zis tso zis thiab los ntshav cov qib sodium yog qhov tsim nyog kom tsis txhob siv tshuaj tua kab mob ntau dhau.
2. Cov dej tsis haum tom qab mob stroke
Stroke (tshwj xeeb tshaj yog hemorrhagic) feem ntau nrog cerebral edema thiab kua dej metabolism, uas ua los ntawm cov hauv qab no:
Tswj lub hlwb edema: Raws li tau hais ua ntej, txo cov dej hauv hlwb los ntawm osmotic diuresis. Kev sim randomized suav nrog 100 tus neeg mob tau pom tias 7-hnub kev tuag ntawm pawg terlipressin yog 18% qis dua li hauv pawg tswj hwm (25% vs 43%).
Regulating los ntshav ntim: Nyob rau theem mob stroke, nws tuaj yeem tiv thaiv qhov hnyav ntawm lub paj hlwb edema los ntawm cov kua dej ntau dhau.
Cov kev tshawb fawb soj ntsuam tau pom tias nws tuaj yeem txo qhov tshwm sim ntawm cov mob stroke txuam nrog mob ntsws los ntawm 20%, uas tej zaum yuav cuam tshuam rau kev txo qis ntawm pulmonary edema.
Kev tswj lub sij hawm ntev: Rau cov ntshav qab zib hauv nruab nrab sab laug tom qab mob stroke, nws tuaj yeem siv tau ntev - lwm txoj kev kho tshuaj, thiab qhov ntau npaum li cas yuav tsum tau hloov kho raws li cov zis ntim.
3. Kev tswj cov kua dej hauv tus mob pancreatitis hnyav
Hauv kev mob pancreatitis hnyav, cov neeg kho mob inflammatory ua rau muaj qhov nce ntxiv ntawm capillary permeability, ua rau cov kua dej ntau hauv lub cev nkag mus rau hauv lub plab kab noj hniav thiab cov ntaub so ntswg. Txhim kho cov kua dej sib npaug los ntawm cov txheej txheem hauv qab no:
Txo lub plab exudation: txo qis cov hlab ntsha hauv cov hlab ntsha, txo cov ntshav pancreatic, thiab txo qis kev tso tawm ntawm cov kab mob sib kis. Cov kev tshawb fawb soj ntsuam tau pom tias nws tuaj yeem txo cov ascites los ntawm 40% thiab txo lub sij hawm rau kev ua pa ntawm kev ua pa los ntawm 3 hnub.
Tswj lub raum ua haujlwm: tiv thaiv mob raum raug mob (AKI) los ntawm kev ua kom lub raum perfusion. Kev tshawb fawb soj ntsuam nrog 80 tus neeg mob tau pom tias qhov tshwm sim ntawm AKI hauv pawg terlipressin tau txo qis los ntawm 30% piv rau pawg tswj hwm (20% vs 50%).
Kev hloov kho koob tshuaj: thawj koob tshuaj yog 0.5mg txhua 6 teev, hloov kho raws li lub plab thiab cov zis tso zis. Rau cov neeg mob uas muaj concomitant hyponatremia, kev sib xyaw dej txwv kev kho yog tsim nyog.
Kev saib xyuas ntawm electrolyte tshuav: kev tswj ntawm sodium thiab potassium
1. Kho ntawm hyponatremia
Kev nyab xeeb kho hyponatremia los ntawm cov txheej txheem hauv qab no:
Controllable water excretion: Compared with desmopressin, its antidiuretic effect is weaker, which can prevent rapid increase in bleed sodium. Clinical guidelines recommend that for chronic hyponatremia (lasting>48 teev),terlipressin ntsiav tshuajua ke nrog kev txwv dej yog kev kho mob uas nyiam.
Dose titration: Thawj koob tshuaj yog 0.1mg ib zaug txhua 12 teev, kho raws li tus nqi ntawm cov ntshav sodium nce. Kev nce hauv cov ntshav sodium yuav tsum tswj tsis pub dhau 4-8 mmol / L txhua 24 teev, thiab yuav tsum tsis pub tshaj 10 mmol / L hauv 48 teev.
Hom tshwj xeeb ntawm hyponatremia: Rau cov mob uas muaj qhov txawv txav ntawm cov tshuaj tiv thaiv kab mob antidiuretic (SIADH), nws tuaj yeem cuam tshuam ADH secretion txawv txav thaum txhawb nqa dej tawm. Ib txoj kev tshawb fawb uas muaj 30 tus neeg mob tau pom tias nws tuaj yeem rov qab los ntshav sodium ntau hauv cov neeg mob SIADH hauv 72 teev.
2. Adjuvant kev kho mob rau hyperkalemia
When hyperkalemia (blood potassium>5.5 mmol / L) tshwm sim, potassium excretion yog txhawb los ntawm cov hauv qab no:
Txhim khu lub raum tubular potassium secretion: Los ntawm constricting lub raum los ntshav hlab ntsha, ua rau kom lub renin angiotensin aldosterone system (RAAS), txhawb aldosterone secretion, thiab yog li nce poov tshuaj excretion.
Cov kev sim tsiaj tau pom tias nws tuaj yeem ua rau tso zis ntau ntxiv los ntawm 30% -50%.
Kev sib xyaw ua ke: Thaum siv ua ke nrog cov tshuaj txo cov tshuaj potassium xws li insulin, qabzib, thiab salbutamol, nws tuaj yeem txhim kho cov nyhuv kho. Cov kev tshawb fawb soj ntsuam tau pom tias qhov txo qis hauv cov ntshav poov tshuaj hauv cov pab pawg kho mob ua ke yog 40% sai dua li siv cov tshuaj ib txwm siv.
Kev txwv koob tshuaj: Kev siv ntau dhau yuav tsum tau zam thaum lub sijhawm hyperkalemia los tiv thaiv kev ua kom tsis zoo ntawm hyponatremia. Nws raug pom zoo tias ib koob tshuaj tsis pub tshaj 0.5mg thiab tag nrho cov koob tshuaj txhua hnub tsis pub tshaj 1.5mg.
Terlipressin ntsiav tshuajplays lub luag haujlwm tsis tuaj yeem hloov pauv hauv ntau qhov xwm txheej kho mob los ntawm kev tswj hwm cov kua dej faib thiab sib npaug ntawm electrolyte. Tus nqi kho mob ntawm lwm txoj kev kho mob rau cov ntshav qab zib hauv nruab nrab insipidus, kev tswj cov ascites hauv cirrhosis, kua resuscitation tom qab kub hnyiab, thiab kev tswj ntawm cerebral edema tau dav lees paub. Nyob rau hauv lub neej yav tom ntej, nrog rau kev nkag siab tob txog cov txheej txheem ntawm kev nqis tes ua thiab kev txhim kho hauv cov txheej txheem kev xa tshuaj, daim ntawv thov ntawm cov khoom yuav raug nthuav dav ntxiv, coj kev cia siab rau kev kho mob ntawm cov neeg mob ntau dua nrog cov kua dej sib npaug.
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