Hyperkalemia hauv CKD Cov Neeg Mob? Tsis txhob ntshai, Tus yuam sij rau txo cov ntshav Potassium yog ua raws tsib kauj ruam no
Apr 19, 2024
Kev noj haus thiab tso tawm ntawm cov poov tshuaj hauv lub cev tuaj yeem suav nrog hauv ib kab lus: noj ntau dua thiab tawm ntau dua, noj tsawg thiab tso tawm tsawg dua, thiab txawm tias koj tsis noj, koj yuav tso tawm.Cov neeg laus ib txwm xav tau cov poov tshuaj 0.4 mmol / kg ib hnub, txog 3-4g. Lub hauv paus ntsiab lus yog zaub mov, uas yog noj los ntawm lub qhov ncauj.Cov neeg laus cov ntshav poov tshuaj ntau npaum li cas yog 3.5-5.5 mmol / L. Yog tias nws siab tshaj 5.5 mmol / L, nws yog hu ua hyperkalemia.
Nyem rau Cistanche rau mob raum
Lub raum yog cov kabmob tseem ceeb rau kev tso tawm cov poov tshuaj hauv tib neeg lub cev. Potassium excretion nyob rau hauv cov zis tso nyiaj rau 85% ntawm tag nrho cov potassium excretion nyob rau hauv tib neeg lub cev, thaum quav thiab hws account rau 10% thiab 5% feem. Qhov no piav qhia vim li cas cov neeg mob uas muaj kab mob raum ntev (CKD) ua rau muaj hyperkalemia tshwm sim.
Vim hais tias lub ntsiab ntawm cov poov tshuaj excretion lub cev, lub raum, yog dysfunctional, cov poov tshuaj uas yuav tsum tau muab tso tsis tau tawm, thiab cov ntshav poov tshuaj yuav nce.
01 Feem ntau ua rau hyperkalemia hauv cov neeg mob CKD
1 Txo lub raum ua haujlwm thiab txo cov poov tshuaj tso tawm
For CKD patients, hyperkalemia is not likely to occur if the glomerular filtration rate (GFR) is >10ml/min and the daily urine output is >600 ml.
Tab sis yog tias muaj lwm yam kev pheej hmoo tshwm sim nyob rau lub sijhawm no, xws li qhov ncauj thiab tso cov tshuaj potassium ntxiv, lossis noj cov zaub mov uas muaj cov poov tshuaj, xws li losartan potassium ntsiav tshuaj feem ntau siv hauv nephrology, feem ntau siv tshuaj tua kab mob amoxicillin thiab clavulanate potassium, thiab aldosterone antagonists lossis raum yeeb tshuaj. uas secrete poov tshuaj los ntawm tubules yog heev nquag mus rau hyperkalemia. Cov tshuaj no tau tham txog hauv qab no.
2 Ua los ntawm cov tshuaj nquag siv hauv nephrology
Cov tshuaj nquag siv hauv nephrology uas tuaj yeem ua rau cov ntshav poov tshuaj ntau ntxiv suav nrog cov hauv qab no.
Potassium-sparing diuretics
Spironolactone yog cov tshuaj potassium-sparing diuretic siv dav hauv kev kho mob. Nws cov qauv zoo ib yam li aldosterone. Nws yog ib qho kev sib tw inhibitor ntawm aldosterone. Los ntawm kev thaiv kev sib pauv ntawm Na+-K+ thiab Na+-H-, nws ua rau kom cov pa tawm ntawm Na+, Cl-, thiab dej. K+, mg2+, thiab lwm yam yog tso tawm tsawg dua thiab ua raws li cov tshuaj potassium-sparing diuretics. Diuretics nrog cov txheej txheem zoo sib xws suav nrog triamterene thiab amiloride.
Hauv cov neeg mob uas muaj CKD, cov tshuaj no feem ntau ua ke nrog cov tshuaj potassium-depleting diuretics xws li furosemide thiab torsemide kom txo tau edema thiab tsis txhob hypokalemia. Nws kuj tseem tuaj yeem tiv thaiv kev hloov kho ventricular los ntawm kev thaiv aldosterone, thiab feem ntau siv rau cov neeg mob CKD thiab lub plawv tsis ua haujlwm.
Vim nws cov txiaj ntsig zoo ntawm cov poov tshuaj-sparing, yog tias nws siv nrog cov tshuaj uas muaj cov poov tshuaj lossis zaub mov, lossis siv cov ntshav khaws cia, lossis siv ua ke nrog lwm cov tshuaj uas cuam tshuam rau kev tshem tawm cov poov tshuaj, nco ntsoov rov kuaj xyuas cov poov tshuaj, txwv tsis pub hyperkalemia. tuaj yeem tshwm sim tau yooj yim.
Angiotensin-hloov enzyme inhibitors (ACEI) thiab angiotensin receptor blockers (ARB)
Ob hom tshuaj no feem ntau siv los kho CKD thiab tuaj yeem txo cov proteinuria los ntawm kev txo GFR. Txawm hais tias CKD cov neeg mob uas nws cov ntshav creatinine tau nce ntxiv tuaj yeem siv tau hauv kev kho mob ntev li ntev tau tias cov lus qhia rau kev txiav tsis ua tiav.
Txawm li cas los xij, hom tshuaj no tuaj yeem txo lub cev aldosterone qib, tshwj xeeb tshaj yog thaum ua ke nrog cov tshuaj potassium-sparing diuretics saum toj no, nws yuav cuam tshuam ntxiv rau kev tso tawm ntawm cov poov tshuaj, yog li yuav tsum tau them nyiaj tshwj xeeb thaum siv nws.
Cov tshuaj tiv thaiv kab mob
Cyclosporine thiab tacrolimus feem ntau yog siv los kho cov kab mob raum. Ob leeg muaj peev xwm rov faib cov poov tshuaj los ntawm inhibiting sodium-potassium twj tso kua mis ntawm basal membrane. Qhov txawv yog tias cyclosporine tuaj yeem cuam tshuam COX-2 hauv macula densa. Kev qhia ntawm K + ua rau hypotension thiab hypoaldosteronemia, thiab inhibits K + on-off nyob rau hauv lub distal nephron thiab lwm yam mechanisms, thaum kawg ua rau qhov tshwm sim ntawm hyperkalemia.
Tsis tas li ntawd, cov tshuaj heparin thiab nonsteroidal anti-inflammatory tshuaj (NSAIDs) kuj tuaj yeem ua rau cov ntshav poov tshuaj nce los ntawm cov txheej txheem sib txawv, yog li yuav tsum tau saib xyuas thaum siv lawv.
3 Hyporenin thiab hypoaldosterone syndrome
Cov neeg mob thiab cov neeg laus raug mob ntshav qab zib, kab mob lupus erythematosus, ntau yam myeloma, mob glomerulonephritis, mob raum interstitial thiab lwm yam kab mob, vim yog inhibition ntawm plasma renin-angiotensin-aldosterone system (RAAS), cov lus teb ntawm adrenal glomerulosa rau angiotensin. Ⅱ (Ang Ⅱ) yog qhov tsis zoo, uas cuam tshuam rau kev ua haujlwm ntawm cov poov tshuaj tso tawm ntawm lub raum lub raum thiab tseem ua rau hyperkalemia. Xws li cov neeg mob yuav tsum tau xyuam xim rau kev tshuaj xyuas ntawm cov tshuaj poov tshuaj.
Tsis tas li ntawd, hemolysis ntawm cov qauv thiab kev puas tsuaj thaum lub sij hawm venipuncture tuaj yeem ua rau pseudohyperkalemia. Nws raug nquahu kom tshem tawm cov xwm txheej saum toj no uas tuaj yeem ua rau hyperkalemia thiab rov ua ntshav kom rov kuaj xyuas cov ntshav poov tshuaj.
02 Qhia koj ib kauj ruam los kho hyperkalemia
Qhov kev hem thawj loj tshaj plaws ntawm hyperkalemia rau lub cev yog mob plawv, yog li txoj cai kho mob yog kom txo cov ntshav potassium sai sai thiab tiv thaiv lub plawv.
1 Siv cov tshuaj calcium ntxiv
Vim tias cov poov tshuaj siab ntau yog tshuaj lom rau myocardium thiab tuaj yeem ua rau arrhythmia, thiab thaum cov ntshav potassium nce, cov arrhythmia maj mam zuj zus. Thaum cov ntshav potassium nce mus txog 12 mmol / L, ventricular ntes yuav tshwm sim, ua rau tuag sai.
Yog li, nws raug pom zoo kom siv calcium los tiv thaiv myocardium. Koj tuaj yeem siv 10% calcium gluconate lossis 5% calcium chloride los ntxiv 10-20ml rau qhov sib npaug ntawm 25% glucose txhaj. Txhaj nws maj mam intravenously. Nws yuav siv sijhawm li ob peb feeb thiab tuaj yeem rov ua dua. siv.
2 Txo cov poov tshuaj
Tam sim ntawd tso tseg cov zaub mov uas muaj cov poov tshuaj ntau thiab cov tshuaj uas muaj cov poov tshuaj lossis cuam tshuam rau kev tso tawm ntawm cov poov tshuaj; xyuas kom txaus caloric mov rau lub cev, nquag tswj cov kab mob, thiab txo cov poov tshuaj tso tawm los ntawm catabolism; tshem tawm cov ntaub so ntswg necrotic los ntawm lub cev thiab tsis txhob siv cov ntshav khaws cia.
3 Tshem cov ntshav potassium thiab noj cov tshuaj txo cov poov tshuaj
Potassium-depleting diuretics: xws li furosemide, hydrochlorothiazide, thiab lwm yam, raug pom zoo rau kev siv cov hlab ntsha. Nws raug nquahu kom xaiv furosemide nrog cov metabolism hauv siab qis tshaj plaws. Cov txiaj ntsig zoo tuaj yeem ua tiav thaum ua ke nrog thiazides.
Hauv cov neeg mob lub raum tsis txaus, cov tshuaj no muaj cov txiaj ntsig tsis zoo ntawm cov tshuaj potassium. Koj yuav tsum tau them sai sai rau qhov siab tshaj plaws ntawm txhua qhov diuretic. Qhov siab tshaj plaws ntawm furosemide rau kev txhaj tshuaj yog 200 mg / d. Kev siv ntau dhau yuav tsis ua rau muaj kev cuam tshuam ntau dua. Cov tshuaj uas txo cov poov tshuaj hauv qhov ncauj tau pom zoo los ntawm cov lus qhia.
4. Txhawb kev hloov cov poov tshuaj rau hauv cov hlwb
Cov tshuaj uas nquag siv muaj xws li cov hauv qab no.
■ Insulin thiab qabzib:
Muab cov tshuaj insulin zoo tib yam rau hauv cov kua qabzib txhaj tshuaj thiab txhaj tshuaj tas li raws li tus qauv ntawm 1 IU insulin rau txhua 3-4g suab thaj. Feem ntau, cov ntshav potassium yuav pib txo qis hauv 10-20 feeb. Kev siv txuas ntxiv rau 4-6 teev tuaj yeem txo cov ntshav poov tshuaj los ntawm 0.6 -1.0mmol/L. Cov neeg muaj ntshav qab zib siab tsuas yog txhaj tshuaj insulin thiab rov txhaj tshuaj yog tias tsim nyog. Txawm hais tias tus neeg mob puas muaj ntshav qab zib lossis tsis yog, nws raug nquahu kom saib xyuas cov ntshav qab zib kom tsis txhob muaj ntshav qab zib.
■ Sodium bicarbonate:
Ntxiv nrog rau kev txhawb nqa cov poov tshuaj nkag mus rau hauv cov hlwb, sodium bicarbonate tuaj yeem ua rau Na+-K + pauv hauv lub raum raum thiab txhawb cov zis tso zis ntau ntxiv. Nws yog tshwj xeeb tshaj yog haum rau cov neeg mob uas lub raum insufficiency thiab metabolic acidosis. Tsis tas li ntawd, nws tuaj yeem tiv thaiv myocardial inhibitory nyhuv ntawm potassium thiab tiv thaiv myocardium. Koj tuaj yeem siv 100-200ml ntawm 5% sodium bicarbonate rau kev txhaj tshuaj, uas yuav siv sijhawm li ob peb feeb. Tsis txhob muab nws nrog calcium gluconate thaum siv, txwv tsis pub nag lossis daus yuav tshwm sim.
■ 2-adrenoceptor agonists:
Salbutamol, piv txwv li, tuaj yeem txhawb kev nkag ntawm cov poov tshuaj rau hauv cov hlwb.
5 Dialysis
Nws yog qhov ntsuas ceev tshaj plaws thiab zoo tshaj plaws kom txo cov poov tshuaj. Nws yog tshwj xeeb tshaj yog haum rau cov neeg mob uas tau mus txog rau theem uremia thiab muaj lub plawv tsis ua hauj lwm thiab metabolic acidosis thiab pom nws nyuaj mus nrhiav kev kho mob. Yog tias cov kev ntsuas saum toj no tsis muaj txiaj ntsig, kev lim ntshav tuaj yeem siv tau.
Cov ntsiab lus
Nws raug pom zoo tias thaum hyperkalemia tshwm sim, cov hau kev saum toj no yuav tsum tau siv ua ke kom txog thaum cov ntshav potassium poob mus rau qhov qub. Yog tias cov tshuaj saum toj no tau siv ua ke, cov ntshav potassium tseem tsis tuaj yeem txo. Nws raug nquahu kom siv cov tshuaj lim ntshav kom txo cov poov tshuaj kom ntau li ntau tau los tiv thaiv tus neeg mob lub neej.
Cistanche kho mob raum li cas?
Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrog kab mob raum. Nws yog muab los ntawm cov stems qhuav ntawm Cistanche deserticola, ib tsob nroj nyob rau hauv cov suab puam ntawm Tuam Tshoj thiab Mongolia. Lub ntsiab active Cheebtsam ntawm cistanche yogphenylethanoidglycosides, echinacoside cov tshuaj, thiabacteoside, uas tau pom tias muaj txiaj ntsig zoo rau lub raum kev noj qab haus huv.
Kab mob raum, tseem hu ua kab mob raum, hais txog ib yam mob uas lub raum ua haujlwm tsis zoo. Qhov no tuaj yeem ua rau muaj cov khoom pov tseg thiab cov co toxins hauv lub cev, ua rau muaj ntau yam tsos mob thiab teeb meem. Cistanche tuaj yeem pab kho mob raum ase los ntawm ntau lub tswv yim.
Ua ntej, cistanche tau pom tias muaj cov nyhuv diuretic, txhais tau tias nws tuaj yeem ua rau cov zis ntau ntxiv thiab pab tshem tawm cov khoom pov tseg ntawm lub cev. Qhov no tuaj yeem pab txo lub nra ntawm lub raum thiab tiv thaiv kev tsim cov co toxins. Los ntawm kev txhawb nqa diuresis, cistanche kuj tseem tuaj yeem pab txo qis ntshav siab, ib qho teeb meem ntawm cov kab mob raum.
Ntxiv mus, cistanche tau pom tias muaj cov teebmeem antioxidant. Kev ntxhov siab oxidative, tshwm sim los ntawm qhov tsis sib xws ntawm kev tsim cov dawb radicals thiab lub cev tiv thaiv antioxidant, ua lub luag haujlwm tseem ceeb hauv kev mob raum. ies pab neutralize dawb radicals thiab txo Oxidative kev nyuaj siab, yog li tiv thaiv lub raum los ntawm kev puas tsuaj. Cov phenylethanoid glycosides pom hauv cistanche tau tshwj xeeb hauv kev tshem tawm cov dawb radicals thiab inhibiting lipid peroxidation.
Tsis tas li ntawd, cistanche tau pom tias muaj cov nyhuv anti-inflammatory. Kev mob yog lwm yam tseem ceeb hauv kev loj hlob thiab kev loj hlob ntawm cov kab mob raum. Cistanche's anti-inflammatory zog pab txo cov zus tau tej cov pro-inflammatory cytokines thiab inhibit qhov ua kom o yuav tsum tau txoj kev, yog li alleviating o nyob rau hauv lub raum.
Tsis tas li ntawd, cistanche tau pom tias muaj cov teebmeem immunomodulatory. Hauv cov kab mob hauv lub raum, lub cev tiv thaiv kab mob tuaj yeem ua rau tsis zoo, ua rau muaj kev mob ntau dhau thiab cov ntaub so ntswg puas. Cistanche pab tswj lub cev tiv thaiv kab mob los ntawm kev hloov kho thiab kev ua haujlwm ntawm lub cev tiv thaiv kab mob, xws li T hlwb thiab macrophages. Txoj cai tiv thaiv kab mob no pab txo qhov mob thiab tiv thaiv kev puas tsuaj ntxiv rau lub raum.
Ntxiv mus, cistanche tau pom los txhim kho lub raum kev ua haujlwm los ntawm kev txhawb nqa kev tsim kho ntawm lub raum hlab nrog cov hlwb. Lub raum tubular epithelial hlwb ua lub luag haujlwm tseem ceeb hauv kev pom thiab rov nqus cov khoom pov tseg thiab electrolytes. Hauv kab mob raum, cov hlwb no tuaj yeem raug puas tsuaj, ua rau lub raum ua haujlwm puas. Cistanche lub peev xwm los txhawb kev tsim kho ntawm cov hlwb no pab kho lub raum kom zoo thiab txhim kho lub raum tag nrho.
Ntxiv nrog rau cov kev cuam tshuam ncaj qha rau lub raum, cistanche tau pom tias muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev hauv lub cev. Txoj hauv kev zoo rau kev noj qab haus huv no tseem ceeb tshwj xeeb hauv cov kab mob raum, vim tias tus mob feem ntau cuam tshuam rau ntau lub cev thiab lub cev. che tau pom tias muaj kev tiv thaiv rau lub siab, lub plawv, thiab cov hlab ntsha, uas feem ntau cuam tshuam los ntawm kab mob raum. Los ntawm kev txhawb nqa kev noj qab haus huv ntawm cov kabmob no, cistanche pab txhim kho lub raum tag nrho thiab tiv thaiv kev mob ntxiv.
Hauv kev xaus, cistanche yog cov tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho mob raum. Nws cov active Cheebtsam muaj diuretic, antioxidant, anti-inflammatory, immunomodulatory, thiab regenerative teebmeem, uas pab txhim kho lub raum ua haujlwm thiab tiv thaiv ob lub raum los ntawm kev puas tsuaj ntxiv. , cistanche muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.
