Fentanyl: ntuziaka maka ojiji

Ogwu ahu di na usoro onodu ure di nma nke nwere ihe ndi na aru oru ike, nke ana akpo usoro ọgwụgwọ transdermalyana n'ụdị ngwọta ntụtụ.

Ofdị ntọhapụ nke Fentanyl:

• Ngwọta maka ntụtụ - 50 ml, 50 mcg / ml.
• Usoro ọgwụgwọ Transdermal, mpaghara kọntaktị dị 4,2 cm 2 / 8.4 cm 2 / 16.8 cm 2 / 25.2 cm 2 / 33.6 cm 2. A na-ahapụ ihe dị ike n'ọrụ na ọnụego 12.5 / 25/50/75/100 μg / h. N ’ihu mpekere nke akara ahụ, akara agba aja aja bụ Fentanyl 12.5 μg / awa / Fentanyl 25 μg / awa / Fentanyl 50 μg / awa / Fentanyl 75 μg / awa / Fentanyl 100 μg / awa. 1 TTC nwere 1.38 mg / 2.75 mg / 5.5 mg / 8.25 mg / 11 mg nke ihe arụ ọrụ. Otu mkpọ katọn nwere akpa ise na-eme ka okpomoku kuo ya.

Omume ọgwụ

Fentanyl bụ narcotic analgesic. Dose 100 mcg (0.1 mg) (2 ml), ihe ruru 10 mg analgesic ọrụ morphine ma obu 75 mg meperidine.

Ihe omume ọgwụgwọ ndị bụ isi bụ analgesia na ogwugwo. Mgbe ị na-a theụ ọgwụ ahụ, ekwesịrị iburu n'uche na mgbanwe na oke iku ume na iku ume nke ngụgụ nwere ike ịdị ogologo karịa na mmetụta analgesic. Site na ịbawanye ụba, a na-ebelata metabolic metabolism. Nnukwu doses nwere ike ibute nsogbu ahu. Fentanyl mgbe ewere ya bụ vomiting dị ala karịa morphine na meperidine.

Pharmacodynamics na Pharmacokinetics

Enwere ike ịkọwa ọgwụ ọgwụ dịka ihe atụ nwere usoro atọ:

• oge nkesa 1.7 nkeji
• oge e jiri meegharị 13 nkeji,
• iwepu ọkara ndu nke nkeji 219.

Olu nke ikesa fentanyl bụ 4 l / kg. Ike nke protein plasma na-ebelata na ionization nke ọgwụ na-abawanye. Mgbanwe nke pH nwere ike imetụta nkesa ya n'etiti plasma nasistemu akwara. Akụrụngwa na-arụ ọrụ na-agbakọta akwara ọkpụkpụ na akwara adipose, emesịa ọ na-ewere nwayọ nwayọ banye n'ọbara. Fentanyl na-agbanwekarị na imeju, na-egosipụta oke ugboro. Ihe dị ka pacenti iri asaa na ise n'ime mmamịrị na-apụ apụ na mmamịrị ọkachasị n'ụdị metabolites. Ihe na-erughị 10% dị sachagharị na mmamịrị. Ihe dị ka 9% nke ọgwụ a na-ahụkarị na feces dị ka metabolites.

Ọgwụ na-amalite ime ihe fọrọ nke nta ka ọ bụrụ ọgwụ nchịkwa ọbara. Ka osiladi, enwere ike mata ihe kachasị emetụta n'ime obere oge. Oge ọ na - ejikarị ọgwụ analgesic sitere na minit 30 ruo otu elekere mgbe ọgwụ ọgbụgba ọbara ruru 100 mcg (0.1 mg) (2 ml). Mgbe nchịkwa intramuscular gasịrị, a na-ahụ mmalite nke ihe dị n'ọrụ si na nkeji asaa ruo asatọ, ma ogologo oge nke ihe ahụ dị ihe dịka awa abụọ.

Ihe ngosi Fentanyl

• maka mmetụta nyocha nke obere oge na ogo ahu izizi na premedntinye na mmezi n’ime oge nkaa,
• maka iji dị ike ọgwụ mgbumgbakwunye na ọgwụ izugbe ma ọ bụ mpaghara
• maka ijikọ ya na ọgwụ mgbochidika Droperidol ya na nbido ụzọ, yana enyemaka na izugbe ọgwụ mgbochi,
• n'ihi na dị ka izizi maka ndị ọrịa nwere nnukwu ihe ize ndụ, mgbe ha na-arụ ọrụ dị mgbagwoju anya, dịka ọmụmaatụ, na obi.

Ọzọkwa, ihe ngosi maka iji fentanyl bụ akwara ozi na usoro orthopedicebe eji ogwu a dika ogwu anakpo.

Ihe ngbanwe

• ndị ọrịa nwere hypersensitivity to nkwadebe opioid,
• ndị ọrịa nwere ụkwara ume ọkụ,
• ndị ọrịa nwereọgwụ riri ahụ,
• ndị ọrịa na-arịa ọrịa tinyere nkụda mmụọ nke akụkụ okuku ume,
• n'oge arụmọrụ ụmụ afọ,
• ndị ọrịa nwere okuku ume iku ume,
• ndị ọrịa na-enyo enyo mgbochi ime eriri afọ.

Nsonaazụ

Ọgwụ a n'ọnọdụ ụfọdụ nwere ike ịkpalite ngosipụta nke mmeghachi omume ọjọọ dị iche iche:

• mmepe nke ị drugụ ọgwụ ọjọọ na ị excessiveụbiga ọgwụ ókè ókè.
• njọ nsogbu iku ume,
• antihypertensive utịp,
• bradycardia,
• mkpụmkpụ mkpụkpu,
• agafeghị oke bronchoconstriction.

Ntụziaka maka iji fentanyl

N'ikwekọ na ntuziaka maka Fentanyl, ekwesịrị ịde ọgwụ ahụ naanị site n'aka ndị ọrụ ahụike maara nke ọma na iwu maka iji opioids dị ike maka ọgwụgwọ nke mgbu na-adịghị ala ala.

N'ihi ihe egwu nke iku ume iku ume, a na-enye fentanyl naanị maka iji ya na ndị ọrịa na-anabata ọgwụ ndị dị mma. Mgbe ị na-eji ọgwụ a, ọ dị mkpa iji belata ojiji nke ọgwụ ndị ọzọ na - agbatị ọgwụ ọ bụla.

Mara: A na-ahụta ndị ọrịa opioid na-eguzogide ọgwụ ma ọ bụrụ na ha buru ụzọ opekata mpe 60 mg. Morphine kwa ụbọchị, 30 mg Oxycodone kwa ụbọchị, 8 mg Hydromorphone ubochi ma obu ozo opioids otu izu ma ọ bụ karịa.

Ọ dị mkpa ịdere usoro ị theụ ọgwụ ahụ maka onye ọrịa ọ bụla n'otu n'otu, na-eburu n'uche akụkọ ihe mere eme gara aga nke nchịkwa nyocha n'oge ọgwụgwọ na ihe ndị dị ize ndụ maka ndị ọrịa ịzụlite ị dependụ ọgwụ.

Mgbe ị na-edepụta ọgwụ ọ bụla, ọgwụ ọkachamara kwesịrị iji nlezianya nyochaa mmeghachi omume onye ọrịa, ọkachasị ume iku ume, ọkachasị mgbe awa 24-72 mbụ bidoro ọgwụgwọ, mgbe oge ndọpụ uche site na patch izizi rute kachasị.

Usoro onunu ogwu

Na nkwadebe maka oru nke onye ori okenye: iv - 0.05-0.1 mg (yana ijiri 2.5-5 mg nke droperidol) ihe dika nkeji iri na ise tupu iwebata anesthesia. Maka ọgwụ mgbochi: iv - 0.05-0.2 mg maka ọkara elekere ọ bụla.

Na nkwadebe maka ịwa ahụ, ụmụaka: 0.002 mg / kg body body. Maka ọgwụ ịwa ahụ: i / v - 0.01-0.15 mg / kg ma ọ bụ m / m 0.15-0.25 mg / n'arọ. Iji nọgide na-ahụ ọgwụ ịwa ahụ: m / m - na 0.001-0.002 mg / kg.

A na-etinye ịmachi ahụ ruo awa 72 n'elu akpịrị anụ ahụ. N'otu oge, ọ dị ezigbo mkpa na elu anụ ahụ ebe a na-etinye patị ahụ na ntutu dị ntakịrị ma ghara inwe ngosipụta pụtara ìhè nke mgbakasị ahụ.

Ntụziaka pụrụ iche

Fentanyl n'ụdị TTS ga-etinyere n’akụkụ anụ ahụ na-emebibeghị, iwe na-enweghị mgbakasị ahụ, nwere oghere dị larịị, dịka ọmụmaatụ, n’elu obi, azụ ma ọ bụ n’egedege ihu. Obere ụmụaka na ndị mmadụ ọgụgụ isiỌ ka mma itinye patch a na azụ aka iji wee belata ohere a na-ewepụ ihe iwu akwadoro. A ga-ewepụ ntutu dị na ntinye akwụkwọ ahụ tupu ijiri sistemụ ahụ, ọ gaghị atụ aro iji aguba maka nke a. A ga-asacharịrị akpụkpọ ahụ ebe ịmachi ahụ ga-adị tupu eji mmiri ọkụ na-enweghị mgbakwunye.

Ekwesịrị iji Fentanyl n'ụdị TTS ozugbo wepụsicchie oghere ahụ na akpa emechiri emechi. Nweghị ike iji ọgwụ ahụ ma ọ bụrụ na nkwakọ ngwaahịa ya nwere akara nke imebi na nkụda mmụọ.

Ekwesịrị ịgbanwe patch ọ bụla site na ngwugwu ahụ n'ime awa 72. Iji tinye patch ọzọ, ị ga-ejikwa akpụkpọ ahụ ọhụrụ. Ọ bụrụ na nsogbu dị na nkwụchi onu ahụ na mkpọchi ahụ, ịnwere ike itinye enyemaka maka mmachi maka idozi ya.

Amachibidoro ya nke ọma: iji mmiri dị ọkụ, dịka ọmụmaatụ, paịlị na-ekpo ọkụ ma ọ bụ blanket eletrik, yana iduzi ngwaọrụ ndị na-ekpo ọkụ na oriọna a na-edebe ebe a na-edozi ya, iji mee ka anwụ wee saa ya, saa ebe ịsa ahụ na-ekpo ọkụ, ebe a na-asa mmiri na akwa mmiri.

Dodoụbiga ya ókè

Nnukwu ịdoụ ọgwụ ọjọọ nwere ike gosipụta onwe ya n'ụdị:

• ume iku ume
• iro ụra
• adaba onye nzuzuma obu onye ka
• spasm muscle
• bradycardia
• hypotension.

N'ọnọdụ ndị na-adịghị ahụkebe, njupụta nke Fentanyl nwere ike ịnwụ.

Ntụziaka pụrụ iche

Fentanyl na Wikipedia. Jiri ọgwụ eji eme ihe

Na mgbakwunye n'ụdị ntọhapụ ndị a, enwere ikpe mgbe ọrụ pụrụ iche jiri Fentanyl mee ihe iji kpochapụ ndị na-eyi ọha egwu. Mgbe ịtọhapụ ndị njide nke ndị na-eyi ọha egwu jidere n'oge egwu Nord-Ost, ọrụ ndị pụrụ iche jiri ihe mejupụtara sitere na njirisi. fentanyl. N'ihi ikpughe ogige a, ndị nọ n'ime ụlọ ahụ nwere ihe mgbaàmà ndị dịka nchekasị, ọgbụgbọ, akpịrị na-agbọ agbọ, na ahụ mkpọnwụ akpa ume. Dị ka ndị ọkachamara si kwuo, ihe na-akpata ọnwụ dị otú ahụ nwere ike ghara ịkpasu iwe.

Mmekọrịta na ọgwụ ndị ọzọ

Mmekorita ya na Antidepressants

N’otu oge ahụ Fentanyl ya na ndị ọzọ na-emetụta sistemụ akwara, gụnyere ọgwụ mgbochi, hypnotics, tranquilizer, ọgwụ ị na - ahụ maka akwara, na opioids, nwere ike ịbawanye n'ihe ize ndụ nke sistemụ iku ume, ọgbụgbọ miri emi, coma na ọnwụ. Mgbe ijiri ọgwụgwọ na ọgwụ ọ bụla dị n'elu, ejiri otu ma ọ bụ belata.

Ndị na-egbochi CYP3A4

N'ihi eziokwu ahụ bụ na isoenzyme CYP3A4 na-arụ ọrụ dị mkpa na metabolism nke fentanyl, ọgwụ ndị na-egbochi ọrụ CYP3A4 nwere ike ibute mbelata nke fentanyl, nke ga-eme ka mmụba nke ihe dị na plasma ma nwekwuo oge nke mmetụta nke ọgwụ opioid. Enwere ike ikwuputa mmetụta ndị a site na iji concoitant nke 3A4 inhibitors.

Inductors CYP3A4

Inducers nke CYP450 3A4 nwere ike ibute metabolism nke Fentanyl, nke nwere ike ibute ịkawanye ọgwụ ahụ, mbelata nsonaazụ nke ihe ahụ na plasma, enweghị ike ma ọ bụ, ikekwe, mmepe nke ọrịa nkwụghachi na onye ọrịa ahụ na ọgwụ na-esote ọgwụ ahụ.

Ndị na-egbochi Monoamine Oxidase

A ka na-aghọta mmekorita nke Fentanyl na monoamine oxidase inhibitors, yabụ iji ọgwụ ndị ahụ na ogige ahụ machibidoro iwu.

Fentanyl Analogs

• Dolforin - na mgbakwunye na ihe ahụ na-arụ ọrụ, ihe mejupụtara TTC a gụnyere mmanya mmanya na-egbu egbu na acrylic polymer,
• Durogezik Matrix- ihe mejupụtara ọgwụ ahụ bụ copolymer nke polyethylene terephthalate na ethylene vinyl acetate, polyacrylate na ihe na-arụ ọrụ,
• Lunaldin - ọgwụ na - eme nchọpụta ihe nwere fentanyl,
• Fendivia - ọgwụ anestetiiki, ihe mejupụtara nke ihe yiri ọgwụ a kọwara,
• Fentadol - TTS na ọdịnaya nke fentanyl na-arụ ọrụ.

Nyocha Fentanyl

Nyocha banyere ọgwụ Fentanyl dị iche iche. N'ụzọ bụ isi, ndị ọrịa enweghị ike ịchọpụta nyocha nke ọma nke ọgwụ ahụ n'ihi ogo ọrịa ndị akọwapụtara na ya. Na mkpokọta, ndị ọkachamara na-ekwu na Fentanyl dị elu, ebe ọ bụ na akụrụngwa na-enye aka na-enweghị atụ na ọgwụgwọ ọtụtụ ọrịa, na-enyekwa ndị ọrịa ohere iwepụ ihe mgbu n'oge ọgwụgwọ na mgbe ọ gachara.

Fentanyl Ahịa

Pricegwọ ọgwụ a dị elu, mana ihe nyocha ọ nwere na-agbadata site na ọnụ ahịa ya. Somefọdụ ụlọ ahịa ọgwụ, ị nwere ike ịzụta ihe ngwọta maka nchịkwa intraus na intramuscular site na 2,290 rubles.

Mmụta: Ọ gụsịrị akwụkwọ na Rivne State Basic Medical College na nzere ya na ahịa ọgwụ. Ọ guru akwukwo na Vinnitsa State Medical University. M.I. Pirogov na ihe omumu banyere ya.

Ahụmahụ: Site na 2003 ruo 2013, ọ rụrụ ọrụ dị ka onye na-ere ọgwụ na onye njikwa nke ụlọ ahịa ọgwụ. E nyere ya akwụkwọ ozi na ọdịiche maka ọtụtụ afọ nke ọrụ akọ na uche. E bipụtara edemede gbasara isiokwu ahụike na mbipụta mpaghara (akwụkwọ akụkọ) yana na ọnụ ụzọ ntanetị dị iche iche.

N'ehihie ọma, ebe m nwere ike ịzụta Durogezik ma ọ bụ Fentanyl, ọ dị mkpa n'ezie?

Usoro onunu ogwu na nhazi

Naanị ndị dọkịta nwere ihe ọmụma na ahụmịhe na ijikwa ọgwụ opioid nwere ike nwere mmetụta dị ike nwere ike ịkọpụta ọgwụ ahụ mgbe ejiri ha na-agwọ mgbu na-adịghị ala ala.

Ebe ọ bụ na enwere ike ịkwụsị ọrụ iku ume, a na-enye ọgwụ ahụ naanị ndị mmadụ ndị nwere ezigbo ndidi na ọgwụ ndị dị otú ahụ. N'oge a na-eji Fentanyl, achọrọ ka iwelata ojiji ọgwụ ndị ọzọ.

Ndị na-eguzogide nsonaazụ nke opioids bụ ndị mmadụ gbara ọgwụ kwa ụbọchị 60 mg nke morphine, 30 mg nke oxygencodone, yana 8 mg nke hydromorphone, ma ọ bụ ọgwụ opioid ndị ọzọ maka ụbọchị 7 ma ọ bụ karịa.

A na-eme nhọrọ nke akụkụ maka onye ọrịa ọ bụla n'otu n'otu, na-eburu n'uche akụkọ ihe mere eme dị ugbu a nke iji ọgwụ nyocha n'oge ọgwụgwọ, yana ihe ndị dị ize ndụ maka ọdịdị nke ọgwụ riri ahụ na mmadụ.

Mgbe emechara akụkụ ọgwụ ọ bụla, dọkịta kwesịrị iji nlezianya nyochaa nzaghachi nke onye ọrịa, dịka ọmụmaatụ, mwepu nke ọrụ iku ume, ọkachasị n'oge awa 24-72 mbụ site na mmalite nke ahụ, mgbe ọgwụ ahụ ruru ogo ya n'ime ọbara.

Ogo nke usoro onunu ogwu.

N'oge nkwadebe nke okenye maka usoro ịwa ahụ, a na-achịkwa 0.05-0.1 mg nke ọgwụ ahụ intravenously (yana mgbakwunye droperidol (2.5-5 mg). Achọrọ ihe dị ihe dị ka nkeji iri na ise tupu nchịkwa ọgwụ mgbochi. Dịka ọgwụ ịwa ahụ: 0.05-0.2 mg nke ihe a na-achịkwa ọbara n'oge nkeji iri atọ ọ bụla.

N'ihe banyere ịkwadebe nwatakịrị ahụ maka usoro ịwa ahụ, 0.002 mg / kg nke ọgwụ kwesịrị ka a ga-enye ya. Maka usoro izizi, a ga-achọ ọgwụ iv nke 0.01-0.15 mg / n'arọ ma ọ bụ ọgwụ i15 nke 0.15-0.25 mg / kg chọrọ. Iji nọgide na-ahụ ọgwụ ịwa ahụ, nchịkwa intramuscular nke 0.001-0.002 mg / kg nke ọgwụ dị mkpa.

Ekwesịrị itinye patch ahụ na epidermis (mpaghara dị larịị) ruo awa 72. Ọnọdụ dị mkpa maka usoro ahụ bụ obere ntutu dị na ebe a na-agwọ ya, yana enweghị ihe ịrịba ama doro anya nke mgbakasị ahụ.

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Mmekọrịta na ọgwụ ndị ọzọ

Njikọ na antidepressants.

Njikọ ya na ọgwụ ndị ọzọ na-emetụta ọrụ nke sistemụ akwara etiti (gụnyere ọgwụ mgbu, hypnotics ma ọ bụ ogwugwo, opioids na ọgwụ na-akụnwụ ahụ) nwere ike ibute mmụba nke sistem okuku ume, mmepe nke mmetụta akwara mmiri na coma, yana ọnwụ. Site n'iji ihe ndị a dị n'elu mee ihe n'otu oge, ogo nke otu n'ime ha ga-ebelata.

Ọgwụ na-akwụsịlata ọrụ nke CYP3A4.

N'ihi eziokwu ahụ bụ na CYP3A4 isoenzyme bụ ihe dị mkpa nke metabolism nke ọgwụ ahụ, ọgwụ ndị na-ebelata ọrụ ya nwere ike belata ụkpụrụ nke nwechapụ Fentanyl, n'ihi nke ụkpụrụ ya n'ime plasma na-abawanye na oge mmetụta opioid na-agbatịkwu. Mmetụta ndị ọzọ nwere ike ịdị oke ọkụ ma ejiri ya na ndị na-egbochi 3A4.

Ihe nwere ike itinye ọrụ nke CYP3A4.

Ihe ndị mere ka CYP450 3A4 nwee ikike ime ka usoro metabolism dị na ya pụta, n'ihi na nke ọ ga-adịwanye mma, na ọkwa dị na plasma, n'ụzọ megidere, na-ebelata.N'ihi nke a, enweghi ọghọ ọrụ dị n'ịgwọ ọgwụ ma ọ bụ enwere ike ịdapụta ọrịa ga - eme ka ndị riri ahụ ictedụ ọgwụ ọjọọ riri ahụ.

Njikọ ya na IMAO.

Agụbeghị ọgwụ ọgwụ a na MAOI zuru ezu, ọ bụ ya mere na amachibidoro ịme ihe ndị a n'otu oge.

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Usoro onunu ogwu na nhazi

A na-ezubere usoro Fentanyl maka nhazi ma ọ bụ nchịkwa intramuscular.

N'ime oke ihe mgbu, a na-enye ọgwụ ahụ na ọgwụ nke 25-100 μg intravenously ma ọ bụ intramuscularly (dịka naanị ụzọ ma ọ bụ n'otu oge na antipsychotics).

Maka ntụgharị, Fentanyl na-achịkwa intramuscularly na dose nke 50-100 μg nkeji iri atọ tupu arụ ọrụ ahụ.

Maka usoro izizi, a na-ahụ ọgwụ ahụ intravenia na 100-200 microgram. Mgbe ahụ, oge nkeji 10-30 ọ bụla, a na-elekọta 50-150 μg ọzọ iji jigide ọkwa analgesia chọrọ (yana yana droperidol).

Mgbe ị na - eme neuroleptanalgesia mgbe ị na - enwe ume iku ume (dịka ọmụmaatụ, n'oge mmeju na arụ ọrụ oge dị mkpirikpi), mgbe a na - ejighị ntụsara ahụ ike, a na - enye Fentanyl ọgwụ mgbe ọ na - eme ọgwụ neuroleptik nke 50 μg kwa 10-20 kilogram nke ahụ ahụ. N'ọnọdụ a, a ga-achịkwa iku ume oge na njikere maka intubation mberede na ikuku nke ikuku. Usoro ọgwụgwọ dị elu nke Fentanyl (50-100 mcg / kg) ka a na-eji maka naanị maka ịwa ahụ obi.

Maka nyocha ndị ọzọ n'oge ana - arụ ọrụ n'okpuru ọgwụ mpaghara, ọgwụ a na - a intụ ọgwụ ma ọ bụ intramuscularly na dose nke 25-50 microgram (oge mgbe ọ na - ejikọ ya na antipsychotics). Ọ bụrụ na ọ dị mkpa, a na-agbanye Fleanyl injections kwa minit 20-30 ọ bụla.

Aremụaka ka edepụtara ọgwụ ahụ na usoro ndị a:

• nkwadebe maka ogwugwo: 2 mcg / kg,
• Mkpanaka ịwa ahụ dum: 150-250 mcg / kg intramuscularly ma ọ bụ 10-150 mcg / kg intravenously,
• mmezi nke ọgwụ ịwa ahụ: 2 mcg / kg intramuscularly ma ọ bụ 1-2 mcg / kg intravenously.

Neuroleptanalgesia

Fentanyl bụ ọgwụ eji eme ihe na - esite na 4-aminopiperidine. Ihe ahụ mejupụtara kemịkal ya na promedol bụ akụkụ ya. O nwere ike, ma obere oge (ya na otu ochichi) mmetụta analgesic.

Mgbe nchịkwa intraven, mmetụta kachasị na-etolite mgbe oge 1-3 gachara wee rue nkeji 15-30. Mgbe nchịkwa intramuscular, mmetụta kachasị na-apụta na nkeji 3-10.

Maka nkwadebe ọgwụ maka izizi (ọgwụ izizi), a na-eme fentanyl n'ọtụtụ 0.05-0.1 mg (1-2 ml nke 0.005%) intramuscularly ọkara otu awa tupu ịwa ahụ.

N'ime arụmọrụ n'okpuru mgbatị akwara mpaghara, enwere ike iji fentanyl (a na-ejikọkarị ya na ọgwụ ụkwara mmiri) ka ọ bụrụ ọgwụ nyocha ọzọ. A na-edozi 0,5-1 ml nke 0.005% nke fentanyl na ntanetị ma ọ bụ intramuscularly (ọ bụrụ na ọ dị mkpa, enwere ike imeghachi ọgwụ ahụ kwa minit 20-40).

Enwere ike iji Fentanyl belata nnukwu ihe mgbu na myocardial infarction, angina pectoris, pulmonary infarction, akụrụ na hepatic colic. Ewebata intramuscularly ma ọ bụ intravenously 0,5-1-2 ml nke 0.005% ngwọta. A na-ejikarị Fentanyl eme ihe maka nzube a yana yana ọgwụ antipsychotic.

Fentanyl injections bụ ugboro ugboro mgbe nkeji 20-40, yana ịwa ahụ gachara awa 3-6.

Mgbe ị na-eji fentanyl, karịsịa na ntinye ngwa ngwa n'ime akwara, ịda mbà iku ume, enwere ike iwepụ ya site na nchịkwa intravenous nke naloxone.

Maka obere arụmọrụ na - adịkarịghị mkpa, mgbe a chọghị ihe iji mee ka izu ike ghara ịdị na - arụ ọrụ na akwara neuroleptanalgesia ka a na - ejide ume iku ume, a na - edozi fentanyl na ọnụego 1 ml nke 0.005% nke ihe ọ bụla 10 kilogram 20 nke oke ahụ. N'okwu a, ọ dị mkpa inyocha oke iku ume nwa oge. Ọ dị mkpa ịrụ ọrụ ma ọ bụrụ na ọ dị mkpa, intubation nke trachea na ikuku nke ngụgụ. Na enweghị ọnọdụ maka ikuku ikuku, ojiji nke fentanyl maka neuroleptanalgesia bụ ihe anabataghị.

Enwere ike ịhụ mgbali mọzụlụ, mọzụlụ na isi ike nke akwara na aka, ụkwara ume dị iche iche, hypotension, sinus bradycardia. A na-ekpochapụ Bradycardia site na atropine (0.5-1 ml nke 0.1% ngwọta).

A na-enye ndị ọrịa ọgwụ insulin, corticosteroids na ọgwụ antihypertensive na obere usoro.

Ise igbo na ụtaba na ụfụ (mgbatị anụ ahụ) nwere ike ịmalite fentanyl.

Na kọntaktị akpachasị anya, fentanyl na-abanye n'ọbara ọbara n'ime akpụkpọ ahụ, yabụ ekwesịrị ịkpachapụ anya mgbe ị na-arụ ọrụ na ọgwụ ahụ. A na-atụ aro otu ihe ahụ mgbe ị na-enyocha ihe ndị a na-amaghị ama yiri fentanyl.

Neuroleptanalgesia edit |Ime na lactation

N'oge afọ ime, a na-eji Fentanyl mee ihe naanị mgbe uru elele anya na nne ga-aba karịa ihe egwu dị na nwa ebu n’afọ na nwa amụrụ ọhụrụ.

Ọgwụ ahụ na-abanye na mmiri ara ara, yabụ, ka ị na-eji Fentanyl, a ga-akwụsị ịhapụ inye ya ara.

Womenmụ nwanyị nke afọ ọmụmụ n’oge iji ọgwụ ọjọọ ahụ kwesịrị iji nlezianya họrọ ọgwụ mgbochi.

Mkparịta ụka ọgwụ ọjọọ

Site n'iji Fentanyl na-ejikọ ya na antihistamines nwere ọgwụ ọgbụgba yana ethanol, ohere nke mmetụta ndị ọzọ na-abawanye.

Benzodiazepines na-eme ka ọpụpụ nke onye ọrịa pụọ ​​na neuroleptanalgesia, ndị na-egbochi beta nwere ike belata ugboro ole na ịdị nro nke mmeghachi omume ọbara mgbe ị na-eji Fentanyl na ịwa ahụ, mana bulie ohere nke bradycardia.

Iji otu oge eji monoamine oxidase inhibitors, ihe egwu nke nnukwu nsogbu na-abawanye, yana ọgwụ ọgwụ antihypertensive, mmetụta nke ikpeazụ na-abawanye.

Mgbe ejikọtara ya na akwara izu ike, a na-egbochi ma ọ bụ wepu akwara akwara, a na - egbochi akwara muscle ma nwee vagolytic na - ebelata ọghọm hypotension na bradycardia, ma nwekwa ike ibute ọbara mgbali, tachycardia, izu ike nke na - enweghị ọrụ vagolytic, emela ka ihe belata hypotension na bradycardia dịkwuo elu ma nwekwuo ohere nke nnukwu njọ. mmeghachi omume ọjọọ site na sistem.

Ekwesịrị iji Fentanyl kpachara anya megide mmalite nke usoro nke ọgwụ ịrahụ ụra, ọgwụ na-agwọ ọrịa ọgwụ na ọgwụ na-agwọ ọrịa izugbe iji gbochie mmechi nke ọrụ iku ume, yana oke mgbochi nke usoro akwara. Diitrogen oxide na-abawanye isi ike, na ọgwụ mgbochi tricyclic na-abawanye ohere nke mwepu nke mpaghara iku ume.

Ekwesighi iji ọgwụ a jikọta ya na narcotic analgesics sitere na otu nke opioid receptor antagonist agonists (tramadol, nalbuphine na butorphanol) na agonist ele mmadụ anya n'ihu (buprenorphine), ebe ọ bụ na enwere ihe ize ndụ nke analgesia na-eme ka ike gwụ.

Site na ọgwụgwọ concoitant na ọgwụ antihypertensive, glucocorticosteroids na insulin, a ga-eji Fentanyl na belata belata. A na - ejikọ mmetụta analgesic na mmetụta nke ndị agonist opioid ndị ọzọ (promedol, morphine) na usoro ọgwụgwọ ọgwụgwọ yana ọrụ na mmetụta Fentanyl.

Fentanyl analogues bụ: Dolforin, Lunaldin, Fentadol Matrix, Fentadol Reservoir, Fendivia.

Ọnụ ego Fentanyl na ụlọ ahịa ọgwụ

Enweghị ike ịzụta ọgwụ ahụ n'agbụ ụlọ ahịa na-ere ahịa, ebe ọ bụ naanị maka ụlọ ọgwụ. Agbanyeghị, amara na ọnụahịa Fentanyl sitere na 90-100 rubles kwa ngwungwu ọgwụ nwere 5 ampoules injection maka onunu ogwu nke 50 μg / ml.

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Ime na lactation

Enweghi data zuru oke banyere iji fentanyl n'ime ụmụ nwanyị dị ime. Fentanyl na-agafe Plasenta n’oge afọ ime. Ọmụmụ anụmanụ egosila ọnụnọ nsị na ịmụ nwa, mana amabeghị ịdị mkpa nke ozi e nyere ụmụ mmadụ. Iji fentanyl na-eme ogologo oge n'oge afọ ime nwere ike iduga mmepe nke ọrịa ndọrọ ego na ụmụ amụrụ ọhụrụ, nke nwere ike igbu mmadụ ma ọ bụrụ na elezighị ya anya. Ọ bụrụ na ịchọrọ ị toụ opioids ogologo oge n'ime ụmụ nwanyị dị ime, ị kwesịrị ịdọ onye ọrịa aka na ntị banyere ihe ize ndụ nke ịmalite ọrịa ndọrọ ego na ụmụ amụrụ ọhụrụ, ma gbaa mbọ hụ na a ga-enweta ọgwụgwọ kwesịrị ekwesị.

A naghị atụ aro iji fentanyl (iv ma ọ bụ iv) n’oge ịmụ nwa (gụnyere akụkụ cesarean), n’ihi na fentanyl na-agafe Plasenta, na kwa n'ihi na akụkụ okuku ume nke nwa ebu n'afọ na-emetụtakarị opiates. N'ihe banyere mkpebi iji fentanyl, ọgwụ mgbochi iji eme ihe dị mkpa.

Fentanyl na-apụ apụ na mmiri ara ara ma nwee ike butere nkụda mmụọ / iku ume iku ume na ụmụaka, yabụ ị ga-ajụ inye nri n'ime awa 24 ka ị applyingụsịrị ọgwụ ahụ. Ekwesịrị ịtụle nzere / uru nwatakịrị a na-enye nwa mgbe a gbasịrị iji fentanyl.

Nchedo nchekwa

Ekwesịrị iji ndị ọrụ ruru eru ga-eji Fentanyl mee ihe. Fentanyl kwesịrị ịdebere naanị ndị ọkachamara maara maka iwu maka ịme ọgwụgwọ opioid ogologo oge, ịkọwapụta na iwepu hypoventilation, gụnyere ọgwụgwọ na antagonists opioid ma ọ bụrụ na ọ dị mkpa.

Fentanyl, dị ka ọgwụ nyocha ndị ọzọ opioid, nwere ike ịbụ isi okwu mmekpa ahụ ma ejiri ya mee ihe dabere na njiri iji ya, yana mgbe ị na-enweta ọgwụ ọjọọ. Ihe egwu a kwesiri iburu n'uche mgbe ị na-edebanye aha, depụta ma kesaa ọgwụ mgbe enwere nsogbu gbasara iji ya eme ihe n'ụzọ na-adịghị mma.

Ndị ọrịa nwere ihe egwu dị ukwuu nke mmetọ opioid gụnyere ndị ọrịa nwere akụkọ ihe mere eme nke ezinụlọ (gụnyere ọgwụ ma ọ bụ mmanya) ma ọ bụ ụfọdụ nsogbu uche (wdg., Oké ịda mbà). Tupu ịdepụta onye ọrịa ọrịa opioid nyocha, ekwesịrị ịtụle ogo ihe ọghọm dị n’ịkpa ọrịa opioid. Ekwesịrị inyocha ndị ọrịa niile na-anata opioids maka akara nke iji ya eme ihe n'ụzọ na-ekwesịghị ekwesị, mmetọ, na mmepe nke ịdabere. A na-adụ ndị ọrịa nọ n'ihe egwu dị elu nke mmetọ opioid ka ha hapụ na nkwadebe opioid gbanwere; ndị ọrịa a chọrọ nlebara anya na-aga n'ihu nke akara opioid.

Nchegbu banyere mmetọ, ịdabere na iji ihe na-adịghị mma ekwesịghị ịbụ ntọala maka ọdịda nke ọgwụ mgbu mgbu kwesịrị ekwesị.

Agbanyeghị, ndị ọrịa niile na-anata nyocha nke opioid chọrọ nlezianya nlezianya banyere ihe mgbaàmà nke iri mmadụ ahụ na mmetọ, ebe ọ bụ na enwere ihe ize ndụ nke iri mmadụ ahụ, gụnyere iji ojiji nyocha nke opioid nke ọma.

Inggabiga usoro a tụrụ aro maka fentanyl n'ihi nsụkọ na-ezighi ezi mgbe ị na-ebufe onye ọrịa site na nyocha opioid ọzọ nwere ike ibute oke egbu na ọgwụ mbụ.

Ekwesighi iji Fentanyl mee ihe iji belata mgbu nwa oge.

N'otu oge eji ọgwụ ọjọọ eme ihe na-emetụta sistemụ akwara na-achọ nyocha na nlele pụrụ iche.

Ojiji nke fentanyl nwere ike ibute ịba uru nke akụkụ iku ume, nke na-adabere n'ụdị ọdịdị ma nwee ike ịkwụsị ya site na iwebata otu antagonist a kapịrị ọnụ - naloxone. Mmeghe nke usoro onyonyo naịloone ọzọ nwere ike ịdị mkpa, maka ịda mba iku ume nwere ike ịdị ogologo oge karịa oge onye antagonist na-arụ ọrụ. Depressionda mbà n’obi nke iku ume bụ otu n’ime nsogbu ndị kachasị dị ize ndụ gbasara ọgwụgwọ na ndị agonist opioid, gụnyere fentanyl. A na-ahụkarị ihe egwu dị ukwuu nke nkụda mmụọ na ndị agadi na ndị ọrịa na-esighi ike, na-abụkarị mgbe itinye nnukwu ọgwụ mbụ na ndị ọrịa na-anatabeghị ọgwụgwọ opioid ma ọ bụ n'ọnọdụ ebe edepụtara opioids n'otu oge na ọgwụ ndị ọzọ na-ebelata ọrụ iku ume. A na-egosipụta nkụda mmụọ nke iku ume site na opioids site na nkụda mmụọ iku ume yana mbelata nke iku ume, nke a na-ekwukarị na iku ume “adịghị mma” (iku ume miri emi na-akwụsịtụ n'ohere oge ụfọdụ). Ncheta Carbon dioxide n'ihi nsogbu nke iku ume nwere ike ime ka mmetụta opioids kwụsị. N'akụkụ a, ịdoụfe ọgwụ ọgwụ ndị nwere ọgwụ akụrụngwa na opioids dị ize ndụ karịsịa.

Nnukwu ọgbụgba na-esokwa nkụda mmụọ iku ume, nke nwere ike ịnagide ma ọ bụ jighachi n'oge oge ọmụmụ ahụ. Maka nke a, iji nlezianya nyochaa ndị ọrịa dị mkpa, yana nnweta akụrụngwa dị mkpa yana otu mbuso agha maka ịlọ ụwa. Hyperventilation n'oge oge izizi nwere ike ịgbanwe nzaghachi onye ọrịa na itinye uche CO₂ ma na - akpata ịda mbà nke akụkụ iku ume n'oge oge ọmụmụ.

Ekwesịrị iji nlezianya nye ndị ọrịa nwere ọrịa ọria akwara ma ọ bụ ọrịa obi, yana ndị ọrịa nwere mbelata nke ukwuu na ngụgụ umeji, hypoxia, hypercapnia, ma ọ bụ ndị nweela nkụda mmụọ. N'ime ndị ọrịa a, ọbụlagodi usoro ọgwụgwọ fentanyl na-adịkarị nwere ike ịkwụsị ọrụ akụkụ okuku ume ruo apnea. Maka ụdị ndị ọrịa a, ekwesịrị ịtụle usoro ọgwụgwọ ọzọ na-abụghị opioid, a ga-ekwenyekwa opioids naanị na nlekọta ahụike yana na oke kachasị mma.

Ọkpụkpụ isi na mmụba intracranial

Ekwesighi edere Fentanyl nye ndị ọrịa nwere ike ịmatacha mmetụta intracranial nke ọkwa CO dị elu.₂. Ofdị ndị ọrịa a gụnyere ndị nwere ihe mgbaàmà nke nrụgide intracranial dịkwuo elu, mmụọ na-enweghị isi, ma ọ bụ coma. Opioids nwere ike imebi nyocha nke ọnọdụ ụlọ nyocha nke ndị ọrịa nwere mmerụ ahụ ụbụrụ. Ekwesịrị iji nlezianya nye ndị ọrịa nwere akpụ ụbụrụ ede Fentanyl.

Ọkpụkpụ olu, gụnyere akwara pectoral, ga - ekwe omume, ka enwere ike ịhapụ ya site na ịme usoro ndị a: nchịkwa ọgbụgba dị nwayọ, ịgba ọgwụ na benzodiazepines, na iji ihe ndị na - eme ka ahụ ghara iru ala.

Ihe omume nke mmeghari myoclonic nke udiri anabataghi nke mmadu. Bradycardia, nwere ike ijide obi, nwere ike ime ma ọ bụrụ na onye ọrịa ahụ ezughi oke anticholinergics ma ọ bụ mgbe ejiri fentanyl na-ejikọta ya na akwara ntụsara ahụ nke na-enweghị ọrụ vagolytic. Enwere ike ịkwụsị Bradycardia site na ntinye nke atropine.

Site n'iji fentanyl mee ihe ruo ogologo oge, ndidi na ịdabere na ọgwụ nwere ike ịmalite.

Opioids nwere ike ibute hypotension, ọkachasị ndị ọrịa nwere hypovolemia. A ga-emerịrị ihe ndị dị mkpa iji mee ka ọbara mgbali elu kwụsie ike.

Zere ịgba ogwu bolus ngwa ngwa nke ọgwụ opioid na ndị ọrịa nwere mgbanwe ụbụrụ: na ndị ọrịa a, mbelata ọnụọgụ nke olu pụtara mgbe ụfọdụ yana mbelata obere oge na mgbali ọka.

Ndị ọrịa nọworo ogologo oge ọgwụgwọ opioid ma ọ bụ ndị nwere opioid nwere ike ịchọ ọgwụ fentanyl dị elu.

A na-atụ aro ka e belata mbelata nke ndị okenye na ndị ọrịa nwere nsogbu.

Ojiji nke fentanyl chọrọ ịkpachara anya na ndị ọrịa nwere ọnọdụ ndị a: hypothyroidism a na-achịkwaghị achịkwa, ọrịa ngụgụ, mbelata olu, mmanya na-egbu egbu, imeju na-arịa ma ọ bụ ọrụ akụrụ. Patientsdị ndị ọrịa a chọkwara nleba anya oge ogologo oge.

Mgbe ị na-eji fentanyl yana ọgwụ ọgwụ (dịka droperidol), ọ dị mkpa iburu n'uche ọdịiche dị na oge nke ọgwụ ndị a. N'iji ha eme ihe n'otu oge, ohere nke hypotension na-abawanye. Antipsychotics nwere ike ibute mgbaàmà extrapyramidal nke enwere ike ịchịkwa site na iji ọgwụ antiparkinsonian.

Dị ka ọ dị n'ụdị opioids ndị ọzọ, n'ihi nsonaazụ anticholinergic ya, ojiji nke fentanyl nwere ike ibute mmụba na bile dupe ma, n'ọnọdụ ndị dịkarịsịrị, enwere ike ịchọpụta spasm nke sphincter nke Oddi.

N'ime ndị ọrịa nwere ọrịa myasthenia gravis, ị kwesịrị ichebara echiche nke iji ọgwụ na-egbochi ọrịa anticholinergics na ọgwụ ndị na-egbochi nnyefe akwara tupu yana n'oge ọrịa izugbe, nke gụnyere nchịkwa intravenous nke fentanyl.

Ojiji nke fentanyl mgbe a na-amụ nwa nwere ike ibute ịda mmụọ nke nwa amụrụ ọhụrụ.

Mmekọrịta na Mmanya na Ọgwụ riri ahụ

Fentanyl nwere ike nwekwuo mmetụta na iwepu ọrụ sistemụ akwara Central mgbe edepụtara ya na mmanya, opioids ndị ọzọ ma ọ bụ ọgwụ iwu na-akwadoghị nwere mmetụta yiri ya na sistemụ akwara Central.

Jiri na umuaka. Ekwuputaghị nchekwa nke fentanyl na ụmụaka na-erubeghị afọ abụọ. Fentanyl ka enwere ike inyefe umuaka kariri iri abuo n’abuo bu onye egosila ihe nnabata opioid.

Analgesia na ụmụaka na - ejigide iku ume oge na - ekwesịghị ka ejiri ya mee ihe dị ka usoro mgbatị ahụ ma ọ bụ dịka ihe metụtara usoro ịgba ahụ (ma ọ bụ dịka akụkụ nke usoro ịgba ume / analgesia), ebe ọ bụ na ndị ọrụ na akụrụngwa ruru eru dị maka intubation tracheal na iku ume mmụọ. Nchịkwa ọghọm nke fentanyl, ọkachasị ụmụaka, nwere ike ibute ịdoụ ọgwụ ahụ ókè.

Jiri na ndị agadi. Ihe omuma a nwetara n’oge omumu ihe banyere ogwu banyere fentanyl na-egosi na ndi oria agadi nwere ike belata ocha ma mee ka ndu ogwu di ogologo karie, na mgbakwunye, ndi oria di otua nwere ike karia ndi fentanyl karia ndi oria na-eto eto. Ọrịa ndị agadi chọrọ nlezianya nyocha iji chọpụta akara nke fentanyl nwere ike ịdoụbiga mmanya ókè, nke ga-achọ ibelata dose nke fentanyl.

Ekwesịrị iji nlezianya mee ihe n'iji fentanyl jikọtara ya na ọgwụ ndị na-emetụta usoro serotonergic neurotransmitter.

Njikọ aka na ọgwụ serotonergic, dịka nhọrọ serotonin reuptake inhibitors, serotonin na norepinephrine reuptake inhibitors, yana ọgwụ ndị na-emetụta metabolism serotonin (gụnyere monoamine oxidase inhibitors), nwere ike ibute ọrịa egwu ndụ serotonin.

Mmepe nke ọrịa serotonin nwere ike ịdaba na iji ọgwụ were ọgwụ ndị a tụrụ aro ya.

Ngosiputa ogwu a banyere oria serotonin nwere ike itinye ihe omuma ndi a:

- mgbanwe na ọnọdụ uche (ụjọ inye aka, ihe ijuanya, enweghị atụ),

- nsogbu nke sistem ụjọ akwara (tachycardia, ọbara mgbali, ọbara mgbali elu),

- nsogbu akwara neuromuscular (hyperreflexia, nhazi mkpụkọ, akwara olu),

mgbaàmà eriri afọ (dịka ọmụmaatụ, ọgbụgbọ, ọgbụgbọ, afọ ọsịsa).

Ọ bụrụ na eche na mmepe nke ọrịa serotonin syndrome, a ga-akwụsị iji fentanyl ozugbo.

Mmetụta ikike ịkwọ ụgbọala na usoro ndị ọzọ nwere ike ibute nsogbu. Drikwọ ụgbọ ala na itinye aka n'ihe ndị ọzọ nwere ike ibute nsogbu ga-ekwe omume ma ọ bụrụ na oge ezuru agafeela kemgbe eji ọgwụ ahụ.