Yuav ua li cas yog ntshav Potassium nce? Saib 6 Cov Ntsiab Lus Rau Kev Kho Mob!

Kev noj thiab kev tawm ntawm cov poov tshuaj hauv lub cev tuaj yeem suav nrog hauv ib kab lus: noj ntau dua thiab kab ntau dua, noj tsawg thiab kab tsawg, thiab kab tsis noj. Cov neeg laus ib txwm xav tau cov poov tshuaj 0.4 mmol / kg ib hnub, txog 3-4g, thiab lub hauv paus tseem ceeb yog zaub mov, uas tau noj los ntawm qhov ncauj. Cov neeg laus cov ntshav poov tshuaj ntau npaum li cas yog 3.

Lub raum yog lub hauv paus tseem ceeb ntawm cov poov tshuaj tso tawm hauv tib neeg lub cev. Kev tso tawm ntawm cov poov tshuaj hauv cov zis tso nyiaj rau 85 feem pua ​​​​ntawm tag nrho cov khoom tso tawm ntawm cov poov tshuaj hauv tib neeg lub cev, thiab kev tso tawm ntawm cov poov tshuaj hauv cov quav thiab hws suav txog 10 feem pua ​​​​thiab 5 feem pua ​​​​, 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 nyob rau hauv kab tsis raug tso tawm, thiab cov ntshav poov tshuaj yuav ib txwm sawv.

Nyem rau cistanche deserticola extract rau CKD

1 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, if the glomerular filtration rate (GFR) is >10ml/min and the daily urine output is >600ml, hyperkalemia tsis nquag tshwm sim. Txawm li cas los xij, 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 feem ntau siv hauv nephrology, feem ntau siv tshuaj tua kab mob amoxicillin clavulanate potassium, thiab lwm yam, thiab antagonism ntawm aldosterone. los yog lub raum tubular Potassium-secreting tshuaj yog heev nquag rau hyperkalemia. Cov tshuaj no tau piav qhia hauv qab no.

(2) Feem ntau siv tshuaj hauv nephrology ua rau

■ Potassium-sparing diuretics

Spironolactone yog cov tshuaj potassium-sparing diuretic siv dav hauv kev kho mob. Nws cov qauv zoo ib yam li aldosterone, thiab nws yog ib qho kev sib tw inhibitor ntawm aldosterone. Lub excretion ntawm K ntxiv thiab Mg2 ntxiv yog tsawg, thiab nws ua raws li ib tug potassium-sparing diuretic. Diuretics nrog cov txheej txheem zoo sib xws suav nrog triamterene thiab amiloride.

Hauv cov neeg mob CKD, cov tshuaj no feem ntau yog siv ua ke nrog cov tshuaj potassium-sparing diuretics xws li furosemide thiab torasemide kom txo tau edema thiab tsis txhob hypokalemia. Nws kuj tseem tiv thaiv ventricular remodeling los ntawm thaiv aldosterone thiab feem ntau siv rau cov neeg mob CKD thiab lub plawv tsis ua hauj lwm. Vim nws tus kheej cov tshuaj potassium-sparing, yog tias nws siv nrog cov tshuaj uas muaj cov poov tshuaj, zaub mov, lossis kev tso ntshav ntawm cov ntshav, lossis nrog rau lwm cov tshuaj uas cuam tshuam rau kev tso tawm ntawm cov poov tshuaj, nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib xyuas cov tshuaj poov tshuaj, txwv tsis pub. , hyperkalemia yog nquag tshwm sim.

■ Angiotensin-Converting Enzyme Inhibitors (ACEI) thiab Angiotensin Receptor Blockers (ARBs)

Ob hom tshuaj no feem ntau siv tshuaj hauv kev kho mob CKD, uas tuaj yeem txo cov proteinuria los ntawm kev txo GFR. Txawm hais tias nyob rau hauv cov neeg mob CKD nrog cov ntshav siab creatinine, tsuav yog qhov qhia txog kev txiav tawm tsis tau raws li, nws tseem siv tau hauv kev kho mob. Txawm li cas los xij, cov tshuaj no tuaj yeem txo cov qib ntawm aldosterone hauv tib neeg lub cev, tshwj xeeb tshaj yog thaum siv nrog cov tshuaj potassium-sparing diuretics saum toj no, lawv yuav cuam tshuam rau kev tso tawm ntawm cov poov tshuaj ntau dua, thiab kev saib xyuas tshwj xeeb yuav tsum tau them thaum siv lawv.

■ Cov tshuaj tiv thaiv kab mob

Cyclosporine thiab tacrolimus feem ntau yog siv tshuaj rau kev kho mob raum. Ob leeg tuaj yeem rov faib cov poov tshuaj los ntawm inhibiting sodium-potassium twj tso kua mis hauv basal membrane. Qhov txawv yog tias cyclosporine tuaj yeem inhibit COX-2 Kev qhia ntawm, ua rau hypotension thiab hypoaldosteronemia, thiab inhibits K ntxiv rau ntawm-tawm ntawm distal nephrons, nws thiaj li ua rau muaj qhov tshwm sim ntawm hyperkalemia.

Tsis tas li ntawd, cov tshuaj heparin thiab non-steroidal anti-inflammatory tshuaj (NSAIDs) kuj tuaj yeem ua rau kom muaj cov poov tshuaj ntau ntxiv los ntawm cov txheej txheem sib txawv thiab yuav tsum tau siv ceev faj.

(3) Tsawg renin thiab qis aldosterone syndrome

Cov neeg mob thiab cov neeg laus uas muaj ntshav qab zib, kab mob lupus erythematosus, ntau yam myeloma, mob glomerulonephritis, raum interstitial, thiab lwm yam kab mob, vim yog inhibition ntawm plasma renin-angiotensin-aldosterone system (RAAS), cov lus teb ntawm adrenal glomerulus rau angiotensin II. (Ang II) yog qhov tsis zoo, uas cuam tshuam rau kev ua haujlwm ntawm lub raum lub raum kom tso cov poov tshuaj, 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 pseudo-hyperkalemia. Nws raug pom zoo kom tshem tawm cov ntsiab lus saum toj no uas tuaj yeem ua rau hyperkalemia, thiab rov kuaj ntshav rau qhov rov kuaj xyuas cov ntshav cov poov tshuaj [1].

2 Yuav ua li cas kho hyperkalemia

Qhov kev hem thawj loj tshaj plaws ntawm hyperkalemia rau lub cev yog kev mob plawv, yog li lub hauv paus ntsiab lus ntawm kev kho mob yog kom txo cov ntshav potassium sai sai los tiv thaiv lub plawv.

(1) Siv cov calcium:

Vim hais tias cov poov tshuaj siab heev yog tshuaj lom rau myocardium, nws tuaj yeem ua rau arrhythmias, thiab nrog kev nce ntawm cov poov tshuaj hauv cov ntshav, cov arrhythmia maj mam nce. Thaum cov ntshav potassium siab li 12 mmol / L, lub ventricular ntes tau tshwm sim, ua rau tuag sai. Yog li, nws raug pom zoo kom siv calcium los tiv thaiv myocardium. 10 feem pua ​​​​calcium gluconate lossis 10-20ml ntawm 5 feem pua ​​​​calcium chloride tuaj yeem muab ntxiv rau tib qhov kev txhaj tshuaj 25 feem pua ​​​​qabzib, thiab nws tuaj yeem txhaj tshuaj maj mam, thiab nws yuav siv sijhawm li ob peb feeb.

(2) Txo cov poov tshuaj:

Tam sim ntawd txiav 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 muaj caloric txaus nyob rau hauv lub cev, nquag tswj kev kis kab mob, thiab txo cov poov tshuaj tso tawm los ntawm catabolism; tshem tawm cov ntaub so ntswg necrotic hauv lub cev, thiab tsis txhob siv cov ntshav khaws cia.

(3) Tshem cov ntshav potassium thiab noj cov tshuaj txo cov poov tshuaj

Potassium-scavenging 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. Kev sib xyaw ua ke ntawm thiazides tuaj yeem ua tiav cov txiaj ntsig zoo dua. Nyob rau hauv cov ntaub ntawv ntawm lub raum insufficiency, cov tshuaj no muaj cov tsis zoo poov tshuaj excretion nyhuv, thiab yuav tsum tau them nyiaj mloog mus rau lub siab tshaj plaws koob tshuaj ntawm txhua diuretic. Qhov siab tshaj plaws ntawm furosemide txhaj tshuaj yog 200 mg / d, thiab kev siv ntau dhau yuav tsis ua kom muaj txiaj ntsig zoo dua. Cov lus qhia pom zoo kom siv cov tshuaj txo cov poov tshuaj hauv qhov ncauj kom ua tiav cov txiaj ntsig ntawm kev txo cov ntshav poov tshuaj.

(4) Txhawb kev hloov pauv ntawm cov poov tshuaj mus rau hauv cov hlwb

■ Insulin thiab qabzib:

Tib neeg insulin, raws li tus qauv ntawm 1 IU insulin ib 3-4g suab thaj, yog muab tso rau hauv cov piam thaj rau kev txhaj tshuaj tas mus li. Feem ntau, cov ntshav poov tshuaj pib txo qis hauv 10-20 feeb, thiab siv tas li 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 muaj ntshav qab zib lossis tsis yog, kev soj ntsuam ntshav qab zib tau pom zoo kom tsis txhob muaj ntshav qab zib.

■ Sodium bicarbonate:

Ntxiv nrog rau kev txhawb nqa cov poov tshuaj nkag mus rau hauv lub hlwb, sodium bicarbonate kuj tuaj yeem ua rau muaj kev sib pauv ntawm sodium thiab potassium ions nyob rau hauv lub raum lub raum tubules thiab txhawb kev tso tawm ntawm cov poov tshuaj hauv cov zis. 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 lub plawv cov leeg. 100-200ml ntawm 5 feem pua ​​​​sodium bicarbonate tuaj yeem siv rau kev txhaj tshuaj hauv cov hlab ntsha, thiab nws tuaj yeem siv tau ob peb feeb. Nws tsis tuaj yeem tov nrog calcium gluconate thaum siv, txwv tsis pub, nag lossis daus yuav tshwm sim.

■ 2-adrenoceptor agonists:

Salbutamol tuaj yeem txhawb nqa cov poov tshuaj hauv cov hlwb.

(5) Cation exchange resin thiab sorbitol:

Feem ntau siv yog sodium polystyrene sulfonate resin. Thaum siv, ntxuav lub enema ua ntej, ces muab 40g ntawm no resin nyob rau hauv 200ml ntawm 25 feem pua ​​sorbitol raws li ib tug retention enema, thiab khaws cia rau ntau tshaj 1 teev.

Qhov ncauj resin, 10-20g, qhov ncauj 2-3 zaug ib hnub. Nws tuaj yeem noj ib leeg lossis ua ke nrog 25 feem pua ​​​​ntawm cov tshuaj sorbitol hauv qhov ncauj, 20ml ib zaug, 2-3 zaug hauv ib hnub, thiab nce cov koob tshuaj raws li qhov tsim nyog kom txog thaum cov quav nyias nyias los tiv thaiv kev nqus ntawm sodium ntau dhau thiab ua rau lub plab zom mov.

Cov nyhuv ntawm txoj kev no qeeb, yog li nws tsis tuaj yeem ua tau sai sai rau cov mob hnyav hyperkalemia. Cov kev kho mob uas tau hais los saum toj no yuav tsum tau siv ua ntej txhawm rau tswj cov tshuaj poov tshuaj hauv cov ntshav mus rau qib tsim nyog ua ntej siv los ua kev tiv thaiv txuas ntxiv.

(6) Dialysis:

Nws yog qhov kev ntsuas ceev tshaj plaws thiab zoo tshaj plaws rau kev txo cov poov tshuaj, tshwj xeeb tshaj yog rau cov neeg mob uas tau mus txog theem uremia thiab muaj lub plawv tsis ua hauj lwm thiab metabolic acidosis thiab cov uas nyuaj nrhiav kev kho mob. Yog tias cov kev ntsuas saum toj no tsis zoo, kev lim ntshav tuaj yeem siv [2].

Saum toj no:

Nws raug nquahu tias thaum hyperkalemia tshwm sim, cov hau kev saum toj no yuav tsum tau siv ua ke kom txog thaum cov poov tshuaj hauv cov ntshav poob mus rau qhov qub. Yog tias cov tshuaj saum toj no tau siv ua ke, cov tshuaj poov tshuaj tsis tuaj yeem txo qis. Nws raug nquahu kom sim txo cov poov tshuaj los ntawm kev lim ntshav los tiv thaiv lub neej kev nyab xeeb ntawm tus neeg mob.

Yog xav paub ntxiv:Ali.ma@wecistanche.com