Cov Tshuaj Tiv Thaiv Tsis Zoo Hauv Chaw Muag Tshuaj Kho Mob
Pendahuluuan
Cov tshuaj tsis zoo (ADRs) yog ib qho teeb meem tseem ceeb hauv kev kho mob vim tias lawv cuam tshuam ncaj qha rau kev nyab xeeb ntawm tus neeg mob. ADR yog txhais tias yog kev teb tsis xav tau thiab ua rau muaj kev puas tsuaj rau cov tshuaj uas tshwm sim ntawm cov koob tshuaj uas feem ntau siv rau kev tiv thaiv, kuaj mob, lossis kho mob, lossis rau kev hloov pauv ntawm kev ua haujlwm ntawm lub cev. Hauv kev kho mob, ADRs tuaj yeem ncua sijhawm nyob hauv tsev kho mob, nce tus nqi kho mob, txo tus neeg mob lub neej zoo, thiab txawm tias ua rau tuag. Yog li ntawd, kev nkag siab zoo txog ADRs, lawv cov yam ntxwv txaus ntshai, thiab kev tiv thaiv thiab kev tswj hwm cov tswv yim yog qhov tseem ceeb rau cov kws muag tshuaj hauv tsev kho mob.
Lub Tswv Yim thiab Scope ntawm ROM
ROM txawv ntawm cov kev mob tshwm sim Ib qho teeb meem tshwm sim uas feem ntau yuav tshwm sim thiab tsis hnyav heev. ROM tsom mus rau cov teeb meem loj lossis tsis tau xav txog. Nws tseem ceeb heev kom paub qhov txawv ntawm ROM thiab kev siv tshuaj yuam kev. Kev siv tshuaj yuam kev tshwm sim vim yog cov txheej txheem tsis zoo (piv txwv li, siv tshuaj tsis raug, noj tshuaj tsis raug, tus neeg mob tsis raug), thaum ROM tuaj yeem tshwm sim txawm tias siv tshuaj kom raug. Txawm li cas los xij, ob qho no tuaj yeem sib txuas lus, vim tias kev siv tshuaj yuam kev tuaj yeem ua rau muaj teeb meem tshwm sim uas zoo li yog ROM.
Hauv kev kho mob hauv tsev muag tshuaj, lub luag haujlwm ntawm tus kws muag tshuaj tsis yog tsuas yog txheeb xyuas ROM xwb tab sis kuj tseem yuav tsum ntsuam xyuas nws txoj kev sib raug zoo nrog cov tshuaj, qhov hnyav, thiab kev tiv thaiv. Qhov no ua tiav los ntawm kev ntsuam xyuas kev kho mob, kev tshuaj xyuas cov ntaub ntawv kho mob, kev soj ntsuam hauv chaw kuaj mob, thiab kev sib txuas lus nrog pab pawg kho mob thiab tus neeg mob.
Kev faib tawm ntawm Cov Tshuaj Tsis Zoo
Feem ntau, ROM feem ntau raug cais tawm siv hom A thiab hom B, txawm hais tias muaj kev faib tawm dav dua.
1. Hom A (Ntxiv)
Cov tshuaj tiv thaiv kab mob hom A (ROM) muaj feem cuam tshuam nrog cov txheej txheem tshuaj ntawm cov tshuaj, tuaj yeem kwv yees tau, thiab feem ntau nyob ntawm qhov koob tshuaj. Piv txwv li suav nrog insulin- lossis sulfonylurea-ua rau hypoglycemia, anticoagulant-ua rau los ntshav, thiab antihypertensive-ua rau hypotension. Vim tias lawv tuaj yeem kwv yees tau, hom A ROM yooj yim tiv thaiv los ntawm kev hloov kho koob tshuaj, kev saib xyuas kev kho mob, thiab kev qhia cov neeg mob.
2. Hom B (Txawv Txawv)
Hom B ROM yog qhov tsis paub tseeb, tsis nyob ntawm seb koj noj tshuaj ntau npaum li cas, thiab feem ntau cuam tshuam nrog kev ua xua lossis kev tsis haum tshuaj. Piv txwv li, xws li anaphylaxis rau penicillin lossis Stevens-Johnson syndrome rau qee yam tshuaj xws li lamotrigine lossis sulfonamides. Hom ROM no feem ntau yuav txaus ntshai dua thiab nyuaj rau tiv thaiv vim tias nws tuaj yeem tshwm sim ntawm cov tshuaj tsawg thiab rau cov neeg mob uas tsis tau muaj keeb kwm ntawm cov kev tsis haum tshuaj no ua ntej.
Ntxiv rau hom A thiab B, qee cov ntaub ntawv lees paub lwm hom xws li:
– Hom C (Mob Ntev): tshwm sim tom qab siv ntev, piv txwv li adrenal tsis ua haujlwm vim yog siv corticosteroids ntev.
– Hom D (Qeeb): tshwm sim lig, piv txwv li teratogenic lossis carcinogenic teebmeem.
– Hom E (Thaum kawg ntawm kev siv): cuam tshuam nrog kev tsum tsis siv tshuaj, piv txwv li cov tsos mob ntawm kev tsis siv tshuaj benzodiazepine.
– Hom F (Kev Ua Tsis Tau): kev kho mob tsis ua tiav vim muaj kev sib cuam tshuam ntawm cov tshuaj lossis kev tiv thaiv, piv txwv li kev tiv thaiv kev xeeb tub tsis ua tiav vim yog rifampicin ua rau muaj cov enzyme.
Qhov kev faib tawm no pab cov kws muag tshuaj kwv yees cov qauv tshwm sim, tsim cov tswv yim tiv thaiv, thiab txiav txim siab cov kev cuam tshuam tsim nyog.
Cov Yam Yuav Ua Rau Muaj Kev Pheej Hmoo Rau ROM
ROM yog ntau yam. Qee yam uas ua rau muaj kev pheej hmoo ntxiv suav nrog:
1. Cov yam ntxwv ntawm tus neeg mob
Cov neeg laus thiab cov menyuam yaus muaj qhov sib txawv pharmacokinetics thiab pharmacodynamics uas tuaj yeem ua rau muaj kev cuam tshuam rau ROM. Piv txwv li, cov neeg mob laus dua yuav muaj kev ua haujlwm ntawm lub raum thiab daim siab tsis zoo, ua rau kev tshem tawm tshuaj qeeb dua thiab muaj kev pheej hmoo ntawm kev lom. Keeb kwm kev ua xua, kev noj zaub mov zoo, cev xeeb tub, thiab cov yam ntxwv caj ces (xws li kev hloov pauv ntawm cov enzymes metabolic) kuj tseem ua lub luag haujlwm.
2. Cov kab mob sib koom ua ke thiab cov mob hauv tsev kho mob
Kev ua tsis tau haujlwm ntawm lub raum, kev ua tsis tau haujlwm ntawm daim siab, kab mob plawv, thiab kev cuam tshuam ntawm cov electrolyte tuaj yeem ua rau muaj kev pheej hmoo ntawm ROM. Piv txwv li, cov neeg mob uas muaj kev puas tsuaj ntawm lub raum yuav raug kev sib sau ua ke ntawm aminoglycoside, uas tuaj yeem ua rau muaj kev ua xua rau nephrotoxicity lossis ototoxicity.
3. Kev siv tshuaj ntau yam thiab kev sib cuam tshuam ntawm cov tshuaj
Kev siv ntau yam tshuaj tib lub sijhawm ua rau muaj kev pheej hmoo ntawm kev sib cuam tshuam ntawm cov tshuaj thiab cov tshuaj thiab cov kab mob. Kev sib cuam tshuam tuaj yeem ua rau cov tshuaj ntau ntxiv (piv txwv li, warfarin sib cuam tshuam nrog qee yam tshuaj tua kab mob ua rau INR nce ntxiv) lossis txo qhov ua tau zoo ntawm kev kho mob. Kev siv ntau yam tshuaj kuj ua rau muaj kev nyuaj ntawm kev kho mob, ua rau kev ua raws li tus neeg mob txo qis thiab qhov kev pheej hmoo ntawm cov xwm txheej tsis zoo nce ntxiv.
4. Kev noj tshuaj thiab lub sijhawm kho mob
Kev noj tshuaj ntau dhau, kev ntsuas sai dhau, lossis siv ntev dhau yam tsis muaj kev ntsuam xyuas tuaj yeem ua rau ROM. Cov tshuaj uas muaj cov txiaj ntsig kho mob nqaim (piv txwv li, digoxin, lithium, phenytoin) yuav tsum tau saib xyuas ze.
Kev Tshawb Pom thiab Kev Ntsuam Xyuas ntawm ROM hauv Kev Kho Mob
Kev kuaj pom ROM yuav tsum tau ua tib zoo saib xyuas thiab muaj lub kaw lus tshaj tawm zoo. Cov cim qhia ntawm ROM tuaj yeem suav nrog cov tsos mob tshiab, cov tsos mob hnyav zuj zus, kev hloov pauv ntawm cov txiaj ntsig hauv chav kuaj, lossis cov tshuaj tiv thaiv ntawm daim tawv nqaij. Cov kws muag tshuaj feem ntau siv txoj hauv kev los ntsuam xyuas ROM, xws li:
– Kev ntsuam xyuas qhov ua rau muaj kev tsis haum tshuaj: kev ntsuam xyuas seb cov tshuaj yuav ua rau muaj kev tsis haum tshuaj npaum li cas, piv txwv li siv Naranjo algorithm.
- Kev ntsuam xyuas qhov hnyav: seb qhov kev tawm tsam puas yog me me, nruab nrab, hnyav, txaus ntshai rau lub neej, lossis tuag taus.
– Kev ntsuam xyuas kev tiv thaiv: seb puas tuaj yeem tiv thaiv ROM los ntawm kev xaiv tshuaj kom muaj kev nyab xeeb dua, kev hloov kho koob tshuaj, lossis kev saib xyuas ze dua.
Kev saib xyuas hauv chav kuaj mob yog qhov tseem ceeb rau qee yam tshuaj, xws li kev ua haujlwm ntawm lub raum rau aminoglycosides, electrolytes rau cov tshuaj diuretics, cov enzymes siab rau cov tshuaj hepatotoxic, lossis INR rau kev kho mob warfarin.
Kev Tswj Xyuas Cov Tshuaj Tsis Zoo
Kev kho mob ntawm ROM nyob ntawm hom thiab qhov hnyav, tab sis cov ntsiab cai dav dav suav nrog:
1. Kev txheeb xyuas thiab kev tso tseg cov tshuaj uas xav tias muaj teeb meem
Yog tias ROM hnyav lossis muaj kev phom sij rau lub neej, kev tsum tsis txhob noj tshuaj feem ntau yog thawj kauj ruam. Txawm li cas los xij, qee qhov xwm txheej, qhov kev txiav txim siab no yuav tsum ntsuas qhov txiaj ntsig ntawm kev kho mob thiab qhov muaj lwm txoj hauv kev.
2. Kev kho mob txhawb nqa thiab kev kho mob tsos mob
Piv txwv li, cov tshuaj antihistamines muab tau rau cov kev tsis haum tshuaj me me, cov kua dej rau cov hlab ntsha kom txo tau ntshav siab, lossis cov tshuaj bronchodilators rau bronchospasm. Hauv anaphylaxis, kev kho mob thaum muaj xwm txheej ceev xws li epinephrine yog qhov tseem ceeb heev.
3. Siv cov tshuaj tua kab mob lossis kev kho mob tshwj xeeb
Piv txwv li: naloxone rau kev siv tshuaj opioid ntau dhau, vitamin K rau kev los ntshav uas tshwm sim los ntawm warfarin, lossis N-acetylcysteine rau kev lom paracetamol.
4. Kev soj ntsuam thiab sau ntawv ua ntej
Yuav tsum sau ROM kom meej meej rau hauv cov ntaub ntawv kho mob kom tiv thaiv kev rov kis dua. Kev kawm txog cov neeg mob kuj tseem ceeb heev kom cov neeg mob paub txog cov tshuaj. uas yuav tsum tau zam.
Kev Tiv Thaiv ROM: Lub Luag Haujlwm Tseem Ceeb ntawm Kev Muag Tshuaj Kho Mob
Kev tiv thaiv yog txoj kev zoo tshaj plaws vim tias ROM feem ntau muaj cov teeb meem loj heev. Cov kws muag tshuaj hauv tsev kho mob pab txhawb los ntawm:
- Kev tshuaj xyuas daim ntawv yuav tshuaj thiab kev sib piv cov tshuaj kom txo tau qhov rov ua dua ntawm kev kho mob, kev noj tshuaj tsis raug, thiab kev sib cuam tshuam.
- Kev hloov kho koob tshuaj yog raws li kev ua haujlwm ntawm lub raum/siab thiab tus neeg mob tus mob.
- Kev saib xyuas tshuaj kho mob (TDM) rau cov tshuaj uas muaj cov ntsuas kho mob nqaim.
- Kev qhia rau cov neeg mob txog kev siv tshuaj, cov cim ceeb toom ROM, thiab qhov tseem ceeb ntawm kev ua raws li txoj cai.
- Kev ceev faj txog kev siv tshuaj los ntawm kev tshaj tawm ROM rau lub kaw lus siv tau ntawm lub chaw kho mob lossis lub koom haum cuam tshuam, yog li ntawd cov qauv kev nyab xeeb ntawm cov tshuaj tuaj yeem raug saib xyuas tas li.
Ib txoj kab lis kev cai ntawm kev nyab xeeb ntawm tus neeg mob kuj tseem yuav tsum tau txhawb nqa los ntawm lub tsev kho mob, suav nrog cov lus qhia hauv kev kho mob, kev siv cov txheej txheem txhawb kev txiav txim siab hauv kev kho mob, thiab kev koom tes ntawm cov kws tshaj lij.
Xaus
Cov tshuaj tsis zoo (ADDs) yog ib qho teeb meem loj hauv kev muag tshuaj hauv tsev kho mob, uas cuam tshuam loj heev rau kev nyab xeeb ntawm tus neeg mob thiab cov txiaj ntsig kho mob. Cov tshuaj tsis zoo (ADDs) tuaj yeem tshwm sim vim yog cov teebmeem tshuaj uas kwv yees tau lossis cov tshuaj tsis xav tau, nrog rau cov yam txaus ntshai suav nrog hnub nyoog, cov kab mob sib koom ua ke, ntau lub tshuaj, thiab kev ua haujlwm tsis zoo ntawm lub cev. Cov kws muag tshuaj hauv tsev kho mob ua lub luag haujlwm tseem ceeb hauv kev kuaj pom, ntsuas, tswj hwm, thiab tiv thaiv ADDs los ntawm kev saib xyuas kev kho mob, kev cuam tshuam raws li pov thawj, kev kawm rau tus neeg mob, thiab kev tshaj tawm txog kev ceev faj txog kev muag tshuaj. Nrog rau txoj hauv kev sib koom tes thiab kev sib koom tes, qhov tshwm sim ntawm ADDs tuaj yeem txo qis, ua rau kev kho mob tshuaj muaj kev nyab xeeb dua thiab zoo dua.
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Yog tias koj xav tau, kuv tuaj yeem kho tsab xov xwm no kom muaj kev kawm ntau dua (nrog rau kev hais txog thiab cov ntaub ntawv teev cov ntaub ntawv), lossis ntxiv cov piv txwv ntawm cov rooj plaub ROM uas feem ntau tshwm sim hauv tsev kho mob thiab yuav ua li cas cov kws muag tshuaj kho mob tau ua tiav.
