Kev Tswj Tshuaj nyob rau hauv cov neeg mob nrog txo lub raum ua haujlwm
Mar 17, 2022
Yog xav paub ntxiv:Ali.ma@wecistanche.com
ADEEM AZHAR, et al
Nyem rau Cistanche cov teebmeem rau mob raum
Lub raum puastuaj yeem txo cov tshuaj excretion thiab ua rau muaj kev pheej hmoo ntawm kev phiv tshuaj. Kab lus no tham txog yam yuav tsum tau xav txog thaum muab tshuaj rau cov neeg mob uas txo qislub raum ua haujlwmlos yog mob raum raug mob.
Lub raum ua lub luag haujlwm tseem ceeb hauv tib neeg txoj kev noj qab haus huv, nrog rau kev ua haujlwm xws li tswj cov ntshav siab thiab ntsuas cov electrolytes kom ua rau cov vitamin D thiab tsim cov zis.
Ntau yam tuaj yeem txo tus neeg moblub raum ua haujlwm, nrog rau kev kho mob xws li ntshav qab zib, ntshav siab, thiab mob raum mob, nrog rau cov hnub nyoog siab heev. Feem ntau cov kws kho mob tau sau tseg thiab tom khw muag khoom (OTC) cov tshuaj xws li NSAIDs, ACE inhibitors, proton-pump inhibitors (PPIs), diuretics, thiab tshuaj tua kab mob tuaj yeem txo tau.lub raum ua haujlwm.
Txolub raum ua haujlwmua rau qeeb qeeb ntawm kev tshem tawm cov tshuaj rau lub raum, ua rau cov ntshav nce ntxiv thiab muaj kev pheej hmoo ntawm cov tshuaj tsis zoo (uas tej zaum yuav tsis pom), mob raum raug mob, lossis mus pw hauv tsev kho mob.
Cov tshuaj nephrotoxic
Cov tshuaj nephrotoxic yog cov tshuaj uas tsim kev puas tsuaj rau lub raum thiab tuaj yeem ua rau ua ntej, intra-, lossis tom qab lub raum puas.1,2 Kev puas tsuaj rau lub raum yog txhais tau tias yog kev puas tsuaj rau lub raum lossis glomerulus feem ntau thaum cov ntshav ntws mus rau lub raum. txwv tsis pub, kev puas tsuaj hauv lub raum txhais tau tias yog kev puas tsuaj los ntawm cov txheej txheem hauv lub raum thiab tom qab lub raum kev puas tsuaj yog kev puas tsuaj rau lub raum los ntawm kev cuam tshuam ntawm cov urinary tract.1,2 Qee cov piv txwv ntawm cov tshuaj nephrotoxic thiab cov neeg ua haujlwm muaj nyob rau hauv Table 1.
Cov tshuaj xws li NSAIDs tuaj yeem ua rau lub raum puas ua ntej thiab yuav tsum zam rau cov neeg mob uas txo qislub raum ua haujlwmtxawm tias cov kev kawm luv luv tuaj yeem ua rau mob raum raug mob (AKI) vimlub raumnyob rau hauv perfusion.2 Cov tshuaj lom rau lub raum tubules los ntawm cov tshuaj xws li aminoglycosides los yog ciclosporin yog cov piv txwv ntawm kev puas tsuaj rau lub raum, xws li cov tshuaj tiv thaiv hypersensitivity.2 Anticholinergic tshuaj, xws li amitriptyline, tuaj yeem ua rau lub raum puas vim yog khaws cov zis hauv lub zais zis. .2 Feem ntau lees txais tias cov tshuaj nephrotoxic yuav tsum zam rau cov neeg mob uas tsis muaj zoglub raummuaj nuj nqiraws li qhov tshwm sim ntawmlub raumtoxicity tuaj yeem ua pov thawj tias tuag taus.3
Txhaum tshuaj
Kev puas tsuajlub raumkev ua haujlwm tuaj yeem cuam tshuam rau kev tshem tawm cov tshuaj nrog rau kev nqus tshuaj, kev faib tawm, thiab kev tshem tawm.4 Thaum txo qislub raum ua haujlwmyog xav tias, lub hauv paus rau lub raum kev ua haujlwm yuav tsum raug soj ntsuam ua ntej yuav muab tshuaj kho uas yuav tsum tau hloov kho, vim tias kev siv tshuaj tsis raug yog tshwm sim hauv cov neeg mob uas tsis zoo.lub raum ua haujlwm.3,4 Cov teeb meem cuam tshuam nrog cov neeg mob raug txo qislub raum ua haujlwmtuaj yeem muaj peev xwm tiv thaiv tau los ntawm kev siv lwm cov tshuaj lossis los ntawm kev kho cov tshuaj raws li qib ntawmlub raum ua haujlwm.3,4
Muaj ntau txoj hauv kev tuaj yeem raug coj los hloov kho koob tshuaj ntawm lub raum tshem tawm cov tshuaj, suav nrog txo cov koob tshuaj lossis ncua sijhawm ntev ntawm cov tshuaj noj tshuaj.3,4 Piv txwv li, hauv cov ntsiab lus ntawm cov yam ntxwv ntawm cov khoom (SmPC) rau pregabalin, uas tuaj yeem pom nyob rau hauv electronic Medicines Compendium (www.medicines.org. UK), nws hais tias "raws li pregabalin clearance yog ncaj qha proportional rau creatinine clearance, koob tshuaj txo nyob rau hauv cov neeg mob uas lub raum tsis ua hauj lwm yuav tsum yog tus kheej raws li creatinine clearance", thiab ib lub rooj yog muab rau cov kws kho mob.
Xwb, es tsis txhob txo cov koob tshuaj rau cov neeg mob uas txo qislub raum ua haujlwm,lwm txoj kev kho yuav raug sau tseg. Piv txwv li, tshuaj linagliptin, uas nws koob tshuaj tsis cuam tshuam los ntawmlub raum tsis zoo, ntau dua li lwm cov gliptin, uas muaj cov lus pom zoo hloov tshuaj rau qislub raum ua haujlwm.
Cistanche yog qhov zoo raulub raum ua haujlwm
Cov tshuaj uas tsis muaj txiaj ntsig hauv lub raum tsis ua haujlwm
Qee cov tshuaj tau txo qis kev ua haujlwm thaumlub raum ua haujlwmtxo qis, suav nrog cov tshuaj uas tau sau tseg xws li thiazide diuretics. Piv txwv li, SmPC rau indapamide qhia tau hais tias hauv cov neeg mob uas mob hnyavlub raum tsis zoo(creatinine clearance [CrCl] qis dua 30ml / min), kev kho mob yog contraindicated. Thiazide thiab cov tshuaj diuretics muaj feem cuam tshuam tsuas yog thaumlub raumkev ua haujlwm yog qhov qub lossis tsis zoo. Nitrofurantoin tsis muaj txiaj ntsig ntawm CrCl<45ml in,="" but="" the="" risk="" of="" adverse="" reactions="" is="">
Yuav xam lub raum ua haujlwm li cas?
Feem ntau siv thiab nquag xam qhov kwv yees ntawm glomerular filtration rate (GFR) rau kev siv tshuaj yog los ntawm Cockcroft-Gault equation. Muaj ntau qhov sib npaug zoo li Kev Hloov Kho Kev Noj Qab Haus Huv hauvLub raumKab mob (MDRD) los xam kwv yees li GFR (eGFR), uas tsis tas yuav ntsuas qhov hnyav. MDRD muaj txiaj ntsig zoo hauv kev kwv yees GFR hauv cov kab mob raum tsis zoo (CKD) tab sis tsis raug lees paub hauv lub raum raug mob (AKI), hnub nyoog laus dua lossis hluas dua, hnyav hnyav, lossis rau kev siv tshuaj. CKD tau muab faib ua tsib theem nrog kev faib tawm ntawm theem 3 thiab muab faib raws li GFR thiab albumin: creatinine ratio (ACR).7-8 Cov cuab yeej no tuaj yeem siv los pab txheeb xyuas thiab tswj kev kis tus kab mob.
Cov txiaj ntsig ntawm ntau qhov kev tshawb fawb rov qab tau qhia tias kev siv MDRD kab zauv (eGFR) los ntawm txoj kev Cockcroft Gault feem ntau yuav ua rau muaj kev tshuaj xyuas ntau dua 9-10Qhov no feem ntau yog cim rau cov neeg laus thiab cov neeg uas muaj qhov hnyav heev. lub cev hnyav (cov kws tsim lub cev, cov neeg uas muaj cov leeg tsis muaj zog, cov neeg laus tsis muaj zog). Rau cov tshuaj uas muaj kev pheej hmoo siab thiab muaj lub qhov rais kho qhov nqaim lossis rau cov tib neeg uas muaj kev pheej hmoo siab, yuav tsum tau siv daim duab tshwj xeeb tshaj plaws.
BNF cov luslub raumcov lus pom zoo ua haujlwm raws li eGFR thiab rau cov neeg mob feem ntau ntawm cov hnub nyoog yau, qhov nruab nrab tsim, thiab qhov siab, qhov no txaus. Txawm li cas los xij, lub ntsiab lus tseem ceeb uas yuav tsum nco ntsoov thaum muab tshuaj rau cov neeg laus nrog rau cov tshuaj uas tsis tshua muaj / muaj kev pheej hmoo siab, BNF pom zoo siv CrCl, piv txwv li Cockcroft-Gault equation.3
Tus qauv Cockcroft-Gault tau qhia hauv daim duab 1; qhov no yog txoj kev nyiam rau kev kwv yeeslub raumua haujlwm thaum xam cov tshuaj noj hauv cov neeg mob nroglub raum tsis zoouas yog cov neeg laus los yog nyob rau ntawm cov leeg nqaij. Siv dabigatran ua piv txwv, Daim duab 2 qhia tau hais tias cov lus pom zoo siv tshuaj noj txawv li cas nyob ntawm seb eGFR lossis kwv yees siv CrCl siv. Kev ceev faj yog xav tau thaum muab tshuaj rau cov tib neeg uas muaj hnub nyoog laus lossis hnyav lub cev hnyav. Siv cov piv txwv hauv daim duab 2, qhov kev pheej hmoo ntawm cov ntshav yuav siab dua yog tias cov tshuaj noj kom raug raws lilub raumfunction tsis siv.
Qhov teeb meem loj npaum li cas ntawm kev sau ntawv tawm tswv yim sab nraud hauv kev txo lub raum ua haujlwm?
Drug-induced nephrotoxicity yog ib qho teeb meem loj thiab nthuav dav hauv kev kho mob. Cov tshuaj muaj peev xwm ua rau muaj 60 feem pua ntawm cov neeg mob AKI.13 Cov tshuaj raug moblub raumCov kev mob tshwm sim ntau dua hauv cov neeg mob uas txo qislub raum ua haujlwmxws li cov neeg mob tshaj 65 xyoo.13,14 Hauv kev tshawb fawb ntawm 594 cov neeg mob hnub nyoog tshaj 65 xyoo nrog eGFR<60ml in/1.73m2,="" wood="" et="" al.="" found="" that="" 25%="" of="" patients="" were="" prescribed="" medication="" that="" needed="" to="" be="" altered="" due="" to="" the="" level="" of="" each="" patient's="">lub raum ua haujlwm.14 Zuag qhia tag nrho, 70 tshuaj tau pom tias yuav tsum tau tshuaj xyuas, lawv cov tshuaj hloov pauv lossis yuav tsum tau tso tseg. Cov chav kawm tshuaj uas suav tias yog qhov yuam kev feem ntau yog cov tshuaj lipid-txo qis (30 feem pua) thiab ACE inhibitors / angiotensin-receptor blockers (26 feem pua), tom qab los ntawm thiazides (17 feem pua) thiab tshuaj osteoporosis (14 feem pua). Cov kws sau ntawv xaus lus tias cov kws kho mob yuav tsis paub txog qhov tseem ceeb ntawm kev nojlub raumua haujlwm rau hauv tus account thaum sau tshuaj kho mob.
Ib txoj kev tshawb fawb hla ntu tsis ntev los no ua los ntawm Wood et al. Lub hom phiaj los tshawb txog qhov kev sau ntawv sab nraud cov lus pom zoo rau cov neeg mob hnub nyoog tshaj 65 xyoo nrog txo qislub raum ua haujlwmhauv kev saib xyuas thawj.15 Cov ntaub ntawv rau pawg neeg mob no tau sau tseg los ntawm 80 qhov kev coj ua dav dav thiab ob hom tshuaj raug txheeb xyuas hauv txhua pawg uas yuav tsum tau zam (metformin, alendronic acid); yuav tsum tau txo koob tshuaj (gabapentin / pregabalin, simvastatin); yuav tsis muaj txiaj ntsig yog tias tus neeg mob tau txo qislub raum ua haujlwm(thiazides, nitrofurantoin); los yog muaj feem xyuam nrog cov tshuaj tsis zoo tshwm sim hauv lub raum tsis ua haujlwm (NSAIDs, ACE inhibitors / angiotensin-receptor blockers). Txoj kev tshawb no tau pom tias txo qis raum tsis ua haujlwm tsis raug txiav txim siab thaum muab tshuaj thiab pom zoo rau kev qhia tshuaj (xws li BNF) tsis tau ua raws li 4-40 feem pua ntawm cov neeg mob hnub nyoog tshaj 65 xyoo, thiab 24-80 feem pua ntawm cov neeg mob hnub nyoog tshaj 85 xyoo, txawm tias Feem ntau ntawm cov neeg mob no tau kuaj lub raum ua haujlwm tsis ntev los no. Thaum kawg, qhov no tuaj yeem ua rau muaj kev cuam tshuam tsis zoo rau tus neeg mob kev nyab xeeb, ua rau muaj kev nkag siab zoo rau cov tshuaj no, nce qib ntawm cov tshuaj ntshav, lossis hloov pauv qhov kev kho mob tsis zoo. Hauv cov xwm txheej no, cov kws kho mob tuaj yeem txo qhov koob tshuaj ntawm cov tshuaj siv BNF lossis SmPC cov lus pom zoo los yog sau lwm txoj kev kho mob kom txo tau qhov tshwm sim tsis zoo uas tuaj yeem ua rau tus neeg mob raug mob.15
Tshuaj thiab mob raum raug mob
AKI txhais tau tias yog poob rau hauvlub raumkev ua haujlwm ua rau muaj kev nce ntxiv hauv cov ntshav creatinine thiab lwm yam khoom pov tseg.16 Nrog rau kev kwv yees tus nqi rau NHS ntawm £ 620 lab, AKI tau pom hauv 13-18 feem pua ntawm tag nrho cov tsev kho mob nkag.17Table 2 teev cov kev pheej hmoo uas tuaj yeem predispose ib tug neeg raug kev txom nyem los ntawm AKI.17 Qee cov tshuaj, piv txwv li, NSAIDs thiab ACE inhibitors, tuaj yeem ua rau AKI thiab muaj peev xwm ua rau muaj kev phom sij yoglub raumkev ua haujlwm tsis zoo. Cov tshuaj uas tshem tawm ntawm lub raum tuaj yeem sib sau mus rau qib plasma siab, uas yuav ua rau muaj tshuaj lom lossis ua rau muaj kev cuam tshuam ntau ntxiv rau lub raum.18,19 Kev ntsuas los tiv thaiv AKI rau cov uas muaj kev phom sij tshaj plaws, tshwj xeeb tshaj yog cov laus laus, muaj npe nyob rau hauv Table 3; cov no yuav pab tau rau cov neeg nyob hauv tsev thiab cov tsev laus.
Cov tshuaj twg yuav tsum tau kho kom txo tau lub raum ua haujlwm?
Ib daim ntawv teev cov tshuaj uas feem ntau tau sau tseg thiab lawv cov kev tswj hwm tau pom zoo hauv cov kab mob raum muaj nyob rau hauv Table 4.18,20,21 Qhov no tsis yog ib daim ntawv teev tag nrho tab sis muab lub tswv yim ntawm hom kev txiav txim siab uas yuav tsum tau ua thiab tej yam uas yuav tsum tau txiav txim siab txog kev kho tshuaj. Yuav tsum tau ceev faj ntxiv yog tias xav tau cov xov xwm sib txawv rau kev yees duab. Lub koom haum European ntawm Urogenital Radiology tau tshaj tawm cov lus qhia txog qhov no, hais tias rau qee tus neeg mob, metformin yuav tsum raug txwv tsis pub dhau 48 teev ua ntej qhov sib piv xov xwm tau siv thiab rov pib dua 48 teev tom qab.22.
Yuav ua li cas cov kws sau ntawv yuav ceeb toom txog kev hloov tshuaj noj thiab kev zam ntawm kab mob raum?
Cov kws kho mob yuav tsum nkag mus rau hauv tus cwj pwm ntawm kev xav txoglub raum ua haujlwm,tshwj xeeb tshaj yog rau txhua tus neeg mob hnub nyoog 65 xyoos lossis tshaj saud thaum pib kho tshiab lossis tshuaj xyuas tshuaj. Nws yog ib qho tseem ceeb uas yuav tau sau CrCl tshiab. Muaj ntau ntau yam cuab yeej uas yuav siv tau los ntawm kev siv cov ntaub ntawv kho mob dav dav (CIS), uas tuaj yeem pab cov kws kho mob hauv kev txiav txim siab kom tsim nyog rau kev txiav txim siab txog kev txo qis.lub raum ua haujlwm.Lub built-inlub raumLub laij lej hauv EMIS thiab TPP SystmOne tuaj yeem siv thiab siv lub cev hnyav. Kuj tseem muaj lub tshuab xam zauv web/app-based uas siv tau hu ua MDCalc.23
Cov neeg mob uas muaj kab mob raum ntev yuav tsum muaj cov cai kho mob ntxiv rau lawv cov ntaub ntawv, ua kom yooj yim dua los txheeb xyuas lawv nrog daim ntawv qhia yooj yim thiab ua kom lawv muaj kev saib xyuas tsis tu ncua raws li ib feem ntawm Cov Txheej Txheem Zoo thiab Cov txiaj ntsig (QOF). Kev rov qab tuaj yeem muab ntxiv rau cov ntaub ntawv tus neeg mob qhov twg yuav tsum tau saib xyuas txuas ntxiv. Ib pab neeg tuaj yeem ua lub luag haujlwm kom ntseeg tau tias cov neeg mob no raug tiv tauj thiab kuaj ntshav kom tswj tau kev nyab xeeb thiab siv tau zoo.
Kev ceeb toom tuaj yeem teeb tsa ntawm tus neeg mob cov ntaub ntawv. Qhov no yuav tshwm sim ntawm lub vijtsam hauv tsev thaum nkag mus rau cov ntaub ntawv tus neeg mob. Tig nws mus rau qhov kev ceeb toom tseem ceeb yuav tso cai rau nws pom cov kev pabcuam sab nraud GP phais, piv txwv li, lub tsev kho mob sab nraud. Qhov tsis zoo ntawm kev siv cov lus ceeb toom tuaj yeem yog cov ntaub ntawv khaws tseg ntawm lub vijtsam hauv tsev, uas tuaj yeem ua rau pom cov ntaub ntawv tseem ceeb. Nws raug pom zoo tias tsuas yog cov ntaub ntawv tseem ceeb thiab siv tau yuav tsum tau ntxiv rau lub vijtsam hauv tsev thiab txhua yam tsis xav tau yuav tsum raug tshem tawm. Ib qho kev xaiv zoo sib xws yog siv cov phiaj xwm tus neeg mob hauv SystmOne. Cov no yog daj pop-up thawv uas tshwm nyob rau hauv qab sab xis ces kaum ntawm lub vijtsam; Txawm li cas los xij, cov no tsuas yog tshwm sim yog tias tus neeg siv tus kheej tau qhib rau hauv lawv qhov chaw.
Kev siv cov cuab yeej txhawb kev txiav txim siab muaj nws qhov chaw hauv kev coj ua. Piv txwv ntawm cov software tam sim no muaj xws li ScriptSwitch thiab OptimiseRx. Cov no tau koom ua ke rau hauv CIS thiab muaj txiaj ntsig zoo rau kev qhia rau cov kws kho mob txog ntau yam kev ceeb toom ua ntej, suav nrog kev sau tshuaj los ntawm cov qauv thiab cov lus ceeb toom thaum muab tshuaj rau cov neeg mob uas muaj qhov tsis taus.lub raumkev ua haujlwmqhov twg yuav tsum tau hloov koob tshuaj los yog thaum cov tshuaj muaj contraindicated thiab yuav tsum tau nres. Txawm li cas los xij, cov cuab yeej no tso siab rau qhov tseeb thiab niaj hnub coding. Lwm qhov kev pab cuam software yog STOPP/START, uas tuaj yeem muab tso rau hauv SystmOne thiab tuaj yeem pab tshuaj xyuas tshuaj. Ib qho piv txwv ntawm kev ceeb toom yuav yog tus neeg mob nyob rau lub sijhawm ntev digoxin ntawm qhov ntau dua 125µg txhua hnub nrog eGFR tsawg dua 30ml / min / 1.73m2. Cov txheej txheem no tuaj yeem nkag mus tau los ntawm kev koom nrog Frailty Organization Group.24
Cistanche khoom raulub raum ua haujlwm
Cov ntsiab lus
Kev saib xyuas thiab ceev faj yog xav tau thaum muab tshuaj rau cov neeg mob uas txo qislub raum ua haujlwmnrog rau cov neeg laus / cov neeg uas muaj lub cev hnyav heev. Txhawm rau txo qhov kev pheej hmoo ntawm toxicity, kwv yees CrCl yuav tsum tau siv los ntsuas qib ntawmlub raummuaj nuj nqi. Qhov no yuav tsum pab txiav txim siab txog tshuaj / noj tshuaj thiab pab qhov twg yuav tsum tau hloov kho tshuaj nyob rau hauv ib ntus (xws li AKI) lossis txo qis mus tas lilub raum ua haujlwm.
Los ntawm: 'Kev tswj tshuaj nyob rau hauv cov neeg mob txolub raum ua haujlwm'los ntawmADEEM AZHAR, et al
---Tus kws kho mob Lub Ob Hlis 2019, prescriber.co.uk
Cov ntaub ntawv
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8. Kab mob raum: Txhim kho Ntiaj Teb Kev Ua Haujlwm (KDIGO) CKD Pawg Ua Haujlwm. KDIGO 2012 daim ntawv qhia kev kho mob rau kev ntsuam xyuas thiab kev tswj cov kab mob raum ntev. Raum Int 2013; 3(1): 1-150.
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