Kev Sib Tham Txog Kev Kho Mob ntawm Hyperkalemia hauv Kab Mob Raum Kab Mob Kho Mob Los Ntawm Cov Tshuaj Hauv Suav Teb

Kev siv tshuaj suav tshuaj suav tshuaj hauv cov neeg mob uas mob raum mob

Kab mob raum mob (CKD) yog ib yam kab mob uas muaj thoob plaws ntiaj teb. Raws li kev tshawb fawb xyoo 2012, qhov tshwm sim ntawm CKD hauv kuv lub tebchaws yog 10.8 feem pua. Vim tsis muaj cov tshuaj kho tau zoo, kwv yees li 10 feem pua ​​​​ntawm cov neeg mob tau nce mus rau theem kawg ntawm lub raum kab mob (kab mob raum kawg). theem raum kab mob, ESRD)[1], cuam tshuam rau kev ciaj sia thiab lub neej zoo ntawm cov neeg mob. Cov tshuaj suav tshuaj yog ib qho kev tsim zoo tshaj plaws hauv Suav teb, cov khoom muaj nqis ntawm Suav keeb kwm kev tshawb fawb, thiab tus yuam sij rau kev qhib lub tsev khoom muaj nqis ntawm Suav kev vam meej. Cov tshuaj tsoos hauv kuv lub tebchaws, cov tshuaj suav tshuaj suav tias yog lub luag haujlwm tseem ceeb hauv kev kho CKD. Kev tshawb nrhiav ntau lub chaw RCT pom tau tias, piv nrog ACEI inhibitors (Benazepril), cov tshuaj suav tshuaj tuaj yeem txhim kho lub raum ua haujlwm ntawm cov neeg mob nrog CKD theem 3, thiab muaj kev phiv tsawg dua [2]. Lwm cov kev tshawb fawb tau pom tias cov tshuaj suav tshuaj muaj txiaj ntsig zoo hauv kev txhim kho cov tsos mob ntawm cov neeg mob CKD thiab kho qhov tsis txaus ntawm calcium / phosphorus metabolism [3,4]. Xyoo 2022, kev tshawb fawb cov ntaub ntawv loj hauv Taiwan pom tias cov neeg mob uas siv tshuaj suav tshuaj (Astragalus-Angelica-Rhubarb-Danshen) tau txo qis kev loj hlob mus rau ESRD thiab kev tuag [5]. Kev tshawb nrhiav rov qab los ntawm Hong Kong tau pom tias qhov sib ntxiv ntawm cov tshuaj suav tshuaj kho mob tuaj yeem ua kom lub raum tsis ua haujlwm zoo hauv cov neeg mob CKD dua li cov tshuaj Western ib leeg, tab sis qhov xwm txheej ntawm hyperkalemia nce (8.1 feem pua ​​​​vs. 2.7 feem pua) [6].

Nyem rau cistanche kuaj mob raum mob

Nws tuaj yeem pom tias cov tshuaj suav tshuaj muaj txiaj ntsig zoo rau CKD, thiab tuaj yeem ncua sijhawm rau CKD nkag mus rau ESRD rau kev kho lub raum. Txawm li cas los xij, hyperkalemia yog ib qho teeb meem uas yuav tsum tau them sai sai rau thaum kho CKD nrog cov tshuaj suav tshuaj.

Potassium ions are important electrolytes in the body and play an important role in maintaining the normal functions of nerves, muscles, and cardiomyocytes. The emergence of hyperkalemia has serious harm to the body, and malignant arrhythmia or even cardiac arrest may occur, which is life-threatening. The traditional view is that hyperkalemia refers to serum potassium ion concentration >5.5mmol/L. With the gradual improvement of research on the relationship between blood potassium levels and cardiovascular events, death risk, etc., there are currently relevant guidelines and expert consensus at home and abroad, such as "KDIGO Kidney Disease Symposium Consensus on Abnormal Blood Potassium Management" (2019 edition), "Chinese Chronic Kidney Disease The Expert Consensus on Serum Potassium Management Practice in Patients (2020), "China Peridialytic Chronic Kidney Disease Management Standards" (2021 Edition) [7-9], etc., all suggest that the serum potassium management window be moved forward to 5.0mmol/L, That is, serum potassium >5.

Cov kev tshawb fawb sib txawv muaj kev xav sib txawv ntawm kev siv cov tshuaj suav tshuaj thiab qhov tshwm sim ntawm hyperkalemia hauv cov neeg mob CKD, yog li kev sib raug zoo ntawm ob xav tau kev tshuaj xyuas thiab kev tshawb fawb ntxiv. Nrog rau kev nce qib ntawm niaj hnub Suav tshuaj tshawb fawb cov tswv yim thiab cov txheej txheem, cov ntsiab lus ntawm cov poov tshuaj thiab cov txheej txheem ntawm kev ua ntawm cov tshuaj suav maj mam nthuav tawm, uas yuav zoo dua rau kev siv cov tshuaj suav hauv cov neeg mob CKD.

Kev tshuaj xyuas qhov ua rau hyperkalemia tshwm sim los ntawm cov tshuaj suav tshuaj

① Kev tshuaj xyuas cov ntsiab lus potassium hauv cov tshuaj suav tshuaj

The detection methods of potassium in traditional Chinese medicine samples include atomic absorption spectrometry and plasma spectrometry. Different detection methods and different shapes, origins, and parts of samples all affect the potassium content of traditional Chinese medicines[10,11]. Wang Yuhui et al. [12] tested the potassium content of 308 traditional Chinese medicine decoctions, showing that Chinese medicines with high potassium content (>{{0}}.5mmol/), suav nrog Daqingye, purslane, dawb cardamom hmoov, capillary, qhuav Lotus nyom, commelina, lobelia, viola, desmodium, dandelion, Asarum, lub teeb xyoob nplooj, safflower (tso los ntawm siab. tsis tshua muaj poov tshuaj cov ntsiab lus); Cov ntsiab lus ntawm cov poov tshuaj feem ntau yog 0.01-0.19 mmol / g Nruab nrab; Cov tshuaj suav nrog cov ntsiab lus potassium<0.01mmol/g include cyanite, stone cassia, mother-of-pearl, tianzhuhuang, amethyst, cicada slough, magnet, amber, ocher, keel, pumice stone, Poria cocos (containing potassium are sorted from low to high). The study also showed that the potassium content of traditional Chinese medicine varies with different parts of the material. The potassium content of traditional Chinese medicine used as whole grass, flowers, and leaves is higher, and the potassium content of roots, stems, animal insects, minerals, etc. is lower. Lowest in potassium.

② Potassium-sparing diuretic nyhuv ntawm cov tshuaj suav tshuaj

Qee cov tshuaj suav tshuaj, xws li Alisma, motherwort, thiab Poria cocos, muaj cov nyhuv diuretic thiab o thiab feem ntau siv rau kev kho mob rau cov neeg mob edema. Raws li kev tshawb fawb pharmacological ntawm cov tshuaj suav tshuaj suav tshuaj tau pom, lawv muaj cov tshuaj spironolactone zoo li potassium-sparing diuretic nyhuv uas ua rau cov ntshav nce siab [13]. Alisma tuaj yeem ua ncaj qha rau ntawm cov hlab ntim ntawm lub raum tubules txhawm rau txhawm rau tshem tawm cov poov tshuaj ions thiab tib lub sijhawm inhibit qhov rov nqus ntawm sodium ions los tsim cov nyhuv diuretic [14]. Cov khoom tseem ceeb ntawm motherwort yog stachydrine thiab lwm cov zis. Ob qho alkaloids no tuaj yeem ua rau kom muaj kev tso tawm ntawm Na ntxiv thiab txo qhov tso tawm ntawm K ntxiv, qhia tias motherwort muaj cov tshuaj potassium-sparing thiab diuretic nyhuv [15]. Cov khoom xyaw tseem ceeb ntawm Poria cocos yog pachygyria, uas tuaj yeem sib tw rau aldosterone receptors hauv vitro, thiab tuaj yeem thim rov qab cov nyhuv aldosterone hauv vivo yam tsis muaj kev cuam tshuam cov synthesis ntawm aldosterone, yog li khaws cov poov tshuaj thiab tso tawm sodium thiab kua dej [16].

③ Suav tshuaj decoction cuam tshuam cov ntsiab lus potassium hauv dej decoction

Cov kev tshawb fawb tau pom tias ntau txoj kev decoction tsis muaj qhov cuam tshuam loj rau cov ntsiab lus ntawm cov poov tshuaj ntawm cov tshuaj suav tshuaj decoctions xws li txiv hmab txiv ntoo thiab zaub mov; Lawv muaj cov txiaj ntsig tseem ceeb ntawm cov ntsiab lus ntawm cov poov tshuaj ntawm cov tshuaj suav tshuaj decoctions xws li paj thiab nroj tsuag [12], ntawm cov decoctions ntawm cov tshuaj suav tshuaj suav tshuaj Potassium qib los ntawm qis mus rau siab yog raws li hauv qab no: 10 feeb tom qab soaking <30 feeb. Thaum tshav kub kub

④ Cov laj thawj ua rau hyperkalemia dua li cov tshuaj suav tshuaj

Ntau qhov kev tshawb fawb tsis ntev los no tau pom tias hyperkalemia tshwm sim hauv qee cov neeg mob noj tshuaj suav tshuaj, uas cuam tshuam nrog kev sib xyaw ntawm cov tshuaj sab hnub poob. Cov yav tas muaj xws li cov tsis xaiv beta-blockers, intravenous amino acids, overdose ntawm digoxin, nonsteroidal anti-inflammatory tshuaj, angiotensin-hloov enzyme inhibitors, angiotensin II receptor antagonists, calcium Neurophosphatase inhibitors, potassium-sparing diuretics, thiab lwm yam. [17-18 }]. Tsis tas li ntawd, kev ua haujlwm aldosterone qis, kev puas tsuaj ntawm tes los ntawm cov tshuaj kho mob qog noj ntshav siab, thiab kev tso ntshav loj hauv txhab nyiaj kuj tseem yog yam ua rau hyperkalemia.

Potassium-txo cov tshuaj escort tsoos suav tshuaj hauv kev kho mob ntawm CKD

Xyoo 2020 "Cov Kws Tshaj Lij Pom Zoo rau Kev Tswj Xyuas Cov Tshuaj Ntshav Potassium hauv Cov Neeg Mob Mob raum Kab Mob Hauv Suav Teb" [8] tau taw qhia tias cov tshuaj tseem ceeb siv los txo cov ntshav poov tshuaj yog:

① Diuretics: Los ntawm kev txhawb nqa lub raum potassium excretion, lawv muaj kev txwv rau cov neeg mob uas muaj CKD hnyav, thiab tuaj yeem ua rau hypovolemia thiab ua rau lub raum ua haujlwm hnyav dua.

②Cation pauv resin: Sodium polystyrene sulfonate (SPS) thiab calcium polystyrene sulfonate (CPS) feem ntau siv kho mob tam sim no. Los ntawm kev sib pauv ntawm sodium los yog calcium ions thiab potassium ions nyob rau hauv txoj hnyuv, poov tshuaj ions tau nce los ntawm cov quav. tso tawm. Cov tshuaj no ua rau cem quav, thiab muaj kev pheej hmoo ntawm plab hnyuv thiab plab hnyuv perforation.

③Ib hom tshiab ntawm potassium ion binder sodium zirconium cyclosilicate: tuaj yeem ntes cov poov tshuaj ions nrog kev xaiv siab los ntawm kev hloov cov sodium / hydrogen ions nyob rau hauv tag nrho cov hnyuv, txo qhov nqus ntawm cov poov tshuaj ions nyob rau hauv txoj hnyuv, yog li sai thiab zoo txo ​​cov ntshav poov tshuaj concentration, thiab tuaj yeem ruaj khov rau lub sijhawm ntev Potassium thiab kev nyab xeeb zoo.

Cov tshuaj suav tshuaj yog ib qho tseem ceeb rau kev kho mob raum kab mob. Txhawm rau zam qhov kev pheej hmoo ntawm hyperkalemia, ntshav potassium yuav tsum tau saib xyuas txhua hli. Yog tias tsim nyog, cov tshuaj potassium ion tshiab tuaj yeem siv rau kev tswj cov ntshav poov tshuaj mus ntev. Nrog rau qhov nrov ntawm lub tswv yim ntawm kev tswj cov ntshav poov tshuaj mus sij hawm ntev thiab kev kho mob ntau dua hauv kev siv cov tshuaj potassium-txo lub qhov ncauj mus ntev, yuav muaj ntau txoj kev daws teeb meem ntawm hyperkalemia tshwm sim los ntawm cov tshuaj suav tshuaj, uas tuaj yeem siv rau hauv suav cov txiaj ntsig ntawm cov tshuaj suav tshuaj rau cov neeg mob CKD thiab tseem tuaj yeem txo qhov kev pheej hmoo los ntawm cov poov tshuaj siab, ntxiv dag zog rau kev siv tshuaj suav tshuaj hauv cov neeg mob CKD, thiab tau txais txiaj ntsig ntau dua rau cov neeg mob.

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