Kususela kudala, sisebenzise i-diuretics ukuze siphume ngaphezulu. Ezinye i-diuretics ezifana ne-caffeine inobuninzi (cinga itiye okanye iziphuzo ezithambileyo). Nangona kunjalo, kwakungekho kude kwekhulu lemashumi mabini ukuba abantu baqaphele amandla okwenza i-pharmological of diuretics. Ngo-1937, abaphandi bafumanisa i-carbonic anhydrase diuretics. Ngo-1957, abaphandi bafumene i-chlorothiazide diuretics enamandla kakhulu.
I-Diuretics isebenza ngokunyusa umthamo womchamo owenzayo kwaye uguqula imizimba ye-electrolyte okanye umzimba weetyuwa. Iingcamango ezilula, ewe? Nangona kunjalo, iindlela ezahlukeneyo ze-biochemical esebenza ngayo i-diuretics zisebenza nzima kunzima ukuyiqonda. Ngokomzekelo, ukwakheka komchamo kubandakanya i-concentration gradients, osmosis, abathumeli kunye nokunye.
Ngokomxholo jikelele, i-diuretics isebenza ngokukhupha umzimba wethu womsindo ogqithiseleyo okanye "amanzi." Kukho izifo ezininzi ezikhutshwa ngumkhuhlane wegazi oquka ukuxinzeleleka kwengqondo, ukungaphumeleli kwentliziyo, ukukhupha kwengqondo (i-edema), ukuvuvukala kweso (ukukhupha kweso) nokuvuvukala kwesibini okanye isifo sesifo.
Ngaphambi kokuba sifunde indlela i-diuretics isebenza ngayo, masihambe ngokukhawuleza kwi- nephron kunye ne-anatomy ye-tubal tubes. Emva koko, i-diuretics isebenza ngezenzo kwiindawo ezahlukileyo ze-nephron, iyunithi yesiseko esisisiseko sezintso ezijongene nokucoca umchamo.
Ukujonga kwiNefron
Nantsi ingcambu ye-nephron anatomy:
- Igazi liziswa ukusuka emzimbeni ukuya kwi-corpuscle ye-renal eyakhiwa i-glomerulus, i-tuft yamapillari, kunye ne-capmanle ye-Bowman. I-coral corpuscle iyona nyathelo lokuqala lokucoca umchamo.
- I-glomerulus iyakhwelela kwiibhubhu ze-renal, inkqubo yee-tubros ezincane ezijongene nokuvelisa umchamo. Inxalenye yokuqala yombumba we-renal yi-tubul ehamba phambili.
- I-tubulus ehamba phambili iyondla kwisondlo se-Henle. Inxalenye yokuqala ye-loop yehla isalathiso kwaye yesibini iyinxalenye enyukayo enyukayo.
- Inyuko ephakamayo idla kwi-tubul ephazamisayo.
- I-distal ye-distal ye-tile ekhohlisayo iya kwi-conveyor conduit.
Njengoko kukhankanywe ngaphambili, i-diuretics eyahlukeneyo isebenza kwiindawo ezahlukileyo ze-tubal renal. Ngokubanzi, i-nephron inoxanduva lokufihla inkunkuma kwi-ultrafiltrate ekugqibeleni ibe ngumchamo kunye nokubuyisela kwakhona izondlo kunye nezinye izinto ezilungileyo umzimba wethu udinga njenge-sodium ions (Na + ), i-sodium bicarbonate (NaHCO 3 ), ii-i-potassium ions (K + ), amanzi kwaye phantse yonke i-glucose ehlongoziwe kunye nama-amino acids. (Ngokwenene, uninzi lwalokhu kulungiswa kwezondlo luyenzeka kwi-tubul ehamba phambili.)
I-Carbonic Anhydrase Inhibitors
I-carbonic anhydrase inhibitors njengomsebenzi we-acetazolamide ngokuvimbela i-enzyme-carbonic anhydrase ekhoyo kwi-tubulus ekhungethweyo. Ngokuqhelekileyo, i-anhydrase ye-carbonic inomsebenzi wokutshiza i-sodium (i-NHE3 antiporter), i-potassium, amanzi, i-amino acids kunye noshukela egazini lakho. Ngokuvimbela le enzyme, iziyobisi ezinjenge-acetazolamide zandisa inani lamanzi kwi-system ye-real tubule. I-carbonic anhydrase inhibitors isetyenziselwa ukuphatha i- glaucoma .
I-Sodium-Glucose iCotransporter 2 (SGLT2) i-Inhibitors
I-sodium-glucose cotransporter 2 (SGLT2) inhibitors i-ribonucleotide ye-phosphorylated ethatha inyathelo kwi-sodium glucose cotransporter ehlala kwi-tubulus ehamba phambili. Bayivimbela izenzo ze-transporter kunye nokunciphisa ukubuyiswa kwakhona kwe-glucose kunye ne-sodium ions egazini lakho. Iononi ezincinci ziphinde ziphinde ziphinde zilandele amanzi angaphantsi (i-osmosis), kunye nemiphumo e-diuresis. Nangona izidakamizwa ze-SGLT2 ezifana ne-canagliflozin kunye ne-dapagliflozin ziyi-diuretics ezinomzimba, ngenxa yezenzo zabo zeshukela, zisetyenziswa kakhulu ekuphatheni i-diabetes.acetazolimide
Loop Diuretics
I-Loop diuretics efana ne-furosemide inqanda i-Na / K / 2Cl isithutha kwisithintelo esenyukayo seHenle; ngoko, ukunciphisa i-sodium kunye nokubuyiswa kwamanzi kwigazi lakho. Ngenxa yokuba i-loop diuretics iphinda ihlaziye kunye ne-potassium reabsorption, ukutshabalalisa i-potassium kunokwenzeka. Ukuba ukutshabalalisa i-potassium kunzima ngokwaneleyo, i-hypokalemia ingabangela. Okona kuninzi, i-hypokalemia ingayifaka indlela intliziyo yakho isebenza ngayo iFurosemide isetyenziselwa ukuphatha umfutho wegazi ophezulu (uxinzelelo oluphezulu lwegazi), umkhuhlane kumaphaphu (i-pulmonary edema), ukuvuvukala okuqhelekileyo, i-hyperkalemia (amanqanaba e-potassium aphezulu) kunye ne-hypercalcemia okanye amanqanaba aphezulu e-calcium ( ukusebenzisa iileyile).
Thiazides
I-Thiazides isebenze ngokuphosa kunye ne-Na / Cl ehambayo kwi-tubul ephazamisayo. Ukongeza kokukhusela ukubuyiswa kwakhona kweeoni ze-sodium kunye namanzi, i-thiazides nayo ibangela ukuba i-potassium ichithe. I-Thiazides isetyenziswe njengonyango lokuqala loxinzelelo lwegazi; Enyanisweni, uphando oludumileyo lufumene ukuba i-thiazides iphumelele kakhulu njengonyango lokuqala loxinzelelo lwe-hypertension kune-ACE inhibitors.
Xa izinga lokuhlanjululwa kwe-glomerular (umlinganiselo wesenzo sentso) liphantsi kakhulu, i-thiazides ayisebenzi kakuhle. Ingqalelo, i-thiazides idla ngokudibanisa ne-dioptics ye-loop yefuthe le-synergistic.
Ukongeza kwi-hypertension, i-thiazides isetyenziselwa ukuphatha iilsoum ezineengxaki ze-kidney kunye nesifo sikashukela esiyi-insipidus (ezahlukileyo kuhlobo oluqhelekileyo 1 kunye nohlobo lwesibini lwesifo sikashukela).
I-Potassium-Sparing Diuretics
Njengoko amagama abo athetha, i-potassium-sparing diuretics isebenza ngokunyusa umthamo womchamo ngaphandle kokuchitha i-potassium. I-potassium-ukungagcini nje nge-spironolactone okanye i-amiloride zombini yenza izinto kwiibhola eziqokelelwayo kodwa zisebenzisa iindlela ezahlukeneyo zokwenza.
I-spironolactone ixhathisa i-aldosterone ngendlela eqondwa kakuhle. I-Aldosterone iyi-hormone ye-steroid eveliswa yi-correnx ye-adrenal. Ngokuchasene nemiphumo ye-aldosterone, i-potassium, i-sodium kunye nokugcinwa kwamanzi kuncitshiswa. I-Spironolactone isetyenziselwa ukulwa nokutshatyalaliswa kwe-potassium ebangelwa yi-thiazide ne-loop diuretics. Le nkunkuma iphinde ilawulwe emva kokuhlaselwa kwentliziyo okanye isetyenziswe ukuphatha i-aldosteronism kunoma yiphina isizathu.
U-Amiloride uvimba izitishi ze-sodium kwi-tuble yokuqokelela kwaye ngoko uvimba ukubuyiswa kwakhona kwamanzi emzimbeni wakho. Njenga-spironolactone, i-amiloride isetyenziselwa ukulwa nokutshatyalaliswa kwe-potassium ebangelwa ezinye izidlovu.
Osmotic Diuretics
I-osmotic diuretics idlula emzimbeni wakho. Xa i-osmotic diuretic efana ne-mannitol ingena kwiibhola zakho ze-renal, zidweba ngamanzi nge-osmosis. (Khumbula nge-osmosis, amanzi alandela ukuxilongwa kweengxubevange eziphezulu. Ngaphezu koko, i-osmotic diuretics kwi-vasculature ngaphandle kweentso (cinga ingqondo okanye iso) inokukhupha amanzi kunye nokunciphisa ukuvuvukala.
Ukongezelela ukunyanga kokubili ukuvuvukala kwamehlo (glaucoma) kunye nokukhukhumeza kwengqondo (ukunyuka kwengcinezelo engaphezulu), i-osmotic diuretics isetyenziselwa ukuyeka ukungaphumeleli kwintsimi ekunyuseni umthwalo ongenamandla obangelwa yi-chemotherapy okanye i-rhabdomyolysis (ukuphazamiseka kwemisipha). Ngamanye amagama, ngokuhlalutya iziyobisi kunye nezibonda ze-nasphron, uxinzelelo oluncinci lubekwe kwiintso.
Vaptans
Abaphikisi be-Vasoreceptor okanye ama-vaptans (conivaptan kunye ne-tolvaptan) yiklasi elitsha leziyobisi. Basebenza ngokuchasene ne-vasopressin okanye i-hormone ye-antidiuretic kwaye kunceda umzimba wakho usebenzise amanzi angenawo-electrolyte. Ngaloo ndlela, ama-vaptans anceda kwiimeko ze-hyponatremic ezichazwe yinkxalabo ephantsi ye-sodium egazini njenge-SIADH.
Uninzi lwezidlovetics ezixoxwa ngazo kweli nqaku zifumaneka ngomyalelo. Nangona kunjalo, ungathenga ezinye i-diuretics ngaphandle kwemithi. Nangona ukwandisa umthamo wakho womchamo kunye nokuzithoba ngamanqanaba akho e-electrolyte kunokuvakala ukuba kunobungozi, xa kuthathwa ngokungalunganga, i-diuretics ingabangela ukungcola kunye nokungalingani kwe-electrolyte eyingozi. I-Diuretics nayo inokukhuphaza i-cirrhosis, ukungaphumeleli kwintliziyo, okanye ukungaphumeleli kwe-renal. Kucelwa uthathe i-diuretics kuphela emva kokubonisana nodokotela wakho ngokukodwa ukuba unemiba yokulinganisela emzimbeni.
Kwinqaku lokugqibela, ukuba uyamangalisa nge-caffeine, uphando lubonisa ukuba xa umntu onempilo esela iziyobisi ze-caffeinate, ukulahleka kwamanzi kungabi ngaphezu komthamo wesiselo esiphucukileyo kwaye isimo se-hydration asiyikutshatyalaliswa. Ngamanye amagama, ukuba unempilo, i-caffeine iphephile.
Imithombo:
I-Eaton DC, i-Pooler JP. Isahluko 8. Ummiselo we-Potassium Balance. Ku: Eaton DC, Pooler JP. eds. I-Vander's Renal Physiology, 8e . New York, NY: McGraw-Hill; 2013.
Sam R, Pearce D, Ives HE. Agcisa. Ku: Katzung BG, Trevor AJ. eds. I-Basic & Clinical Pharmacology, 13e . New York, NY: McGraw-Hill; 2015.