Ib qho mob hnyav rau raum raug mob vim yog lub cev qhuav dej hnyav vim tus neeg taug kev raws plab thaum noj qhov ncauj Angiotensin II Receptor Antagonist.

[Keeb kwm] Renin-angiotensin(RA) system inhibitors xws liangiotensinII receptorantagonists(ARBs) feem ntau tau sau los ntawm qhov pom ntawmcardio- thiab lub raum-tiv thaiv cov teebmeem. Lub Koom Haum Nyij Pooj ntawm Nephrology pom zoo kom cov neeg mob yuav tsum tsis txhob siv cov tshuaj renin-angiotensin (RA) system inhibitors thaum muaj hnub nyoog xws li kub taub hau, raws plab, ntuav, thiab txo qis qhov ncauj, vim tias muaj kev pheej hmoo ntawmmob raum raug mob(AKI). Txawm li cas los xij, nws tsis paub zoo. [Cas] Ib tug txiv neej hauv nws 70s. Nws muajmob raum mob(CKD) G3A vimnephrosclerosisthiab tau sau tsegolmesartanthiabamlodipine. Txawm hais tias tus neeg mob tau mus ncig ua si rau Cambodia thiab txhim kho dejraws plabkwv yees li 8 zaug hauv ib hnub, nws txuas ntxiv noj cov tshuaj noj hauv qhov ncauj, suav nrog ARBs. Tom qab rov qab mus rau Nyiv, nws poob 7 kg hauv qhov hnyav thiab xeev siab, yog li nws tau mus ntsib kws kho mob hauv zos, qhov twg nws qib Cr tau pom tias yog 9.8 mg / dL, thiab nws raug xa mus rau peb lub tsev kho mob. Nws yog oliguric thiab nws Cr tau nce mus rau 13.4 mg / dL, tab sis kev tso zis tshwm sim tuaj yeem txhim kho nrog kev hloov dej thiab ARB tshem tawm. Nws lub raum ua haujlwm kuj tau txhim kho mus rau Cr2.9 mg / dL, thiab nws tau tawm hauv tsev nyob rau hnub 9 hauv tsev kho mob. Nws tau xav tias yuav mob rau mob raum mob vim lub cev qhuav dej los ntawm tus neeg taug kev raws plab thiab nws ARB.

[Xaiv]Nws yog ib qho tseem ceeb kom txiav nws cov RA system inhibitors rau hnub mob.

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Taw qhia

Renin-angiotensin (RA) system inhibitors, xws li angiotensin II receptor blockers (ARBs), feem ntau yog muab rau cov kab mob raum, kub siab, kab mob plawv, thiab lwm yam. Nws yog ntshaw kom tsis txhob noj RA system inhibitors thaum koj tsis xis nyob, tab sis qhov no tsis yog dav paub. Peb tshaj tawm cov xwm txheej ntawm lub raum tsis ua haujlwm vim lub cev qhuav dej hnyav vim yog tus neeg taug kev raws plab thaum tau txais ARB.

Cov tsos mob piv txwv

Piv txwv li: Ib tug txiv neej hauv nws 70s.

Cov kev tsis txaus siab tseem ceeb: raws plab, poob phaus, xeev siab.

[Tam sim no keeb kwm]

Olmesartan 20 mg / hnub thiab amlodipine 5 mg / hnub tau raug tshuaj los ntawm nws tus kws kho mob hauv zos rau kab mob raum ntev (CKD) G3 a vim yog nephrosclerosis (nws Cr 1.1 mg / dL ntawm lub hauv paus). Nws muaj kev ywj pheej kiag li hauv kev ua ub ua no ntawm kev ua neej nyob txhua hnub.

Nws tau mus rau 6-hnub mus ncig xyuas tebchaws Cambodia, thiab txij hnub thib ob ntawm kev mus ncig, nws pib mob raws plab li 8 zaug hauv ib hnub. Tus neeg mob tsis kub taub hau thiab muaj peev xwm tswj tau nws qhov mob plab thiab muaj peev xwm noj tshuaj ntawm qhov ncauj, yog li nws txuas ntxiv noj tag nrho cov tshuaj noj ntawm qhov ncauj. Ntshav siab tsis tau ntsuas vim tus neeg mob tau mus ncig, tab sis tsis muaj cov tsos mob tshwm sim qhia tias hypotension lossis intravascular dehydration tau pom, xws li lub teeb taub hau lossis kev xav ntawm qhov tsaus ntuj ntawm lub qhov muag thaum sawv ntsug.

Tom qab rov qab mus rau Nyij Pooj, nws tseem muaj xim av daj daj 5 zaug hauv ib hnub, thiab thaum nws hnyav nws tus kheej hauv tsev, nws pom tias nws poob 7 kg (los ntawm 82 kg mus rau 75 kg). Nws kuj tsim xeev siab, yog li hnub tom qab nws rov qab los tsev (tom qab no hu ua Hnub 1), nws mus ntsib nws tus kws kho mob hauv zos. Txij li thaum Cr qib siab li 9.5 mg / dL, tus neeg mob raug xa mus rau peb lub tsev kho mob nrog kev kuaj mob ntawm tus mob raum mob ntev. Hauv kev xam phaj nrog tus neeg nws tus kheej, nws tau qhia tias qhov thib ob ib nrab ntawm kev mus ncig thiab

Nws tau hais tias nws raug mob oliguria rau Hnub 1 thiab 2 tom qab rov qab los rau Nyiv (raws li tus neeg mob, "Kuv mus rau chav dej ntau zaus, tab sis kuv xav tias kuv tsis tso zis.'').

Nws nug txog cov lus qhia ntxiv txog kev mob raws plab los ntawm cov neeg mus rau sab hnub tuaj Asia, tab sis tsis yog qhov tseeb tias nws haus dej hauv pas dej, nws tsis pom cov ntaub ntawv ntxiv ntawm kev ceeb toom.

【keeb kwm kho mob】

Mob raum mob: Nephrosclerosis,Mob raum mob(CKD) G3 a, ntshav kos ntawm tus kws kho mob yav dhau los txog 1 lub hlis dhau los pom Cr1.1 mg/dL.

Ntshav siab: Qhov no tau pom 5 txog 6 xyoo dhau los. Tsis muaj keeb kwm ntawm kev phais nrog rau kev phais plab.

【allergy】

tsis muaj dab tsi tshwj xeeb.

[Qhov ncauj tshuaj]

Amlodipine 5 mg ntsiav tshuaj, 1 ntsiav tshuaj ib hnub ib zaug thaum sawv ntxov.

Olmesartan 20 mg ntsiav tshuaj, 1 ntsiav tshuaj ib hnub ib zaug thaum sawv ntxov.

[Social History]

Tsis muaj cawv. Kuv txiav luam yeeb 10 xyoo dhau los.

[Kev tshawb pom lub cev thaum tuaj txog]

Qhov siab: 165 cm, hnyav: 75 kg (BMI: 30.1 kg / m2). Ntshiab nco ntsoov. Glasgow Coma Scale (GCS) E4V5M6 (15 ntsiab lus), ntshav siab 164/87 mmHg, pulse rate 98/min, lub cev kub 36.4 degree, SpO2 96% (chav cua), ua pa 16/min.

Tsis muaj nuchal txhav, cov menyuam kawm ntawv yog 3 mm / 3 mm, thiab lub teeb reflex yog ceev. Tsis muaj pallor nyob rau hauv palpebral conjunctiva, thiab tsis muaj yellowing los yog hyperemia nyob rau hauv lub bulbar conjunctiva. Tsis muaj palpable lymphadenopathy nyob rau hauv lub caj dab, thiab tsis muaj liab los yog dawb moss nyob rau hauv lub pharynx. Lub qhov ncauj mucosa tau qhuav heev. Nyob rau hauv lub hauv siab, tsis muaj sab laug-txoj cai sib txawv ntawm lub suab ua pa, tsis hnov ​​​​rales lossis stridor, thiab tsis hnov ​​​​lub plawv yws. Hauv plab, plab hnyuv peristalsis suab tau nce me ntsis.

Nyob rau hauv palpation, nws yog mos thiab tsis muaj rhiab heev los yog cov nqaij ntshiv tau pom. Kev ntsuam xyuas qhov quav tsis pom muaj cov quav ntshav los yog rhiab. Neurological kuaj pom tsis muaj cov tsos mob tseem ceeb hauv zos. Cov tawv nqaij thiab pob qij txha ntawm tag nrho lub cev tau pom, thiab tsis pom pom pom liab liab lossis pob liab liab. Tsis pom cov ceg edema. Tus neeg mob tau tso quav tso rau hauv chav kho mob xwm txheej ceev, thiab cov quav yog xim av thiab dej.

[Kev tshawb nrhiav pom thaum mus ntsib]

Kev kuaj ntshav thiab kuaj cov zis tau sau tseg hauv Table 1. Kev mob raum tsis zoo tau pom nrog UN-102.9 mg/dL thiab Cr13.4 mg/dL, tab sis cov ntshav K yog nyob rau hauv ib txwm muaj ntawm 4.5 mEq/ L. Kev soj ntsuam cov zis zoo qhia tau tias 3+ protein nyob rau hauv cov zis, 3+ occult ntshav, thiab ntau cov qe ntshav liab thiab urothelium nyob rau hauv cov zis sediment. Tsis muaj cov kab mob pathological tau pom. Kev tshawb pom cov roj ntsha hauv cov ntshav tsis tau nce qib ntawm lactic acid, tab sis metabolic acidosis vim anion gap expansion raws li uremia thiab ua pa ua pa.

Raws li pom nyob rau hauv Table 2, cov kev ntsuam xyuas sib txawv ntawm kev mob raws plab nyob rau hauv cov neeg taug kev mus rau sab hnub tuaj Asia tau ua, tab sis tag nrho cov kev ntsuam xyuas tsis zoo.

[Duab pom ntawm kev mus saib]

X-ray hauv siab tsis pom muaj qhov txawv txav, thiab cov duab thoracoabdominal CT tsis pom tias tsis muaj lub raum atrophy lossis urinary tract ob leeg, thiab tsis muaj lwm yam txawv txav. Ultrasound kuaj pom tias sab laug ventricular contractility yog pom zoo (hyperdynamic), tab sis intravascular lub cev qhuav dej yog qhov tseem ceeb.

[Kev nce qib tom qab pw hauv tsev kho mob]

Tus neeg mob tau kuaj pom tias muaj kev mob hnyav ntawm lub raum tsis ua haujlwm ntev (AKI ntawm CKD) vim lub cev qhuav dej hnyav vim yog tus neeg taug kev raws plab, thiab nws chav kho mob tau qhia tias nws ARB tej zaum yuav yog qhov ua rau muaj qhov hnyav dua. Tom qab tau mus pw hauv tsev kho mob, ARB raug txiav tawm thiab AKI tau tswj hwm nrog kev hloov cov kua dej ntxiv thiab kev noj zaub mov txwv tsis pub muaj poov tshuaj. Rau cov neeg taug kev raws plab, siv cov khoom noj uas yooj yim digestible, thiab tom qab paub tseeb tias qhov kev ntsuam xyuas kab mob tshwj xeeb (Table 2) yog qhov tsis zoo, cov tshuaj tiv thaiv kab mob thiab cov kab mob lactic acid npaj tau raug tswj hwm.

Qhov kev nce qib tau sau tseg hauv daim duab 1. Muaj ib hnub tom qab nkag mus, nws tsis teb rau cov kua dej ntxiv ntxiv thiab yog oliguric (cov zis tso zis 300 ml / hnub), thiab nws Cr tau nce mus rau qhov siab tshaj ntawm 13.4 mg / dL, tab sis nws zoo dua. sijhawm thiab nws Cr2. Nws txo qis rau 9 mg / dL. Nws tus mob zoo dua thiab nws tau tawm hauv tsev nyob rau hnub 9 lub tsev kho mob. Tam sim no nws tab tom ua raws li tus neeg mob sab nraud, thiab nws qib Cr tau nce mus rau 1.6 mg / dL.