Gentamicin yog ib qho ntawm cov tshuaj tua kab mob tsawg tsawg, yog li nws tau siv dav hauv kev npaj xov xwm. Qhov tshuaj tiv thaiv kab mob dav dav ntawm nws tus kheej tsim los ntawm Tuam Tshoj yog ib qho ntawm kev tshawb fawb thiab thev naus laus zis zoo tshaj plaws txij li nrhiav tau Tuam Tshoj Tshiab. Nws tau tsim thawj zaug hauv xyoo 1967 thiab tau txheeb xyuas tau zoo thaum kawg xyoo 1969. Nws tau lub npe "Gentamicin", uas txhais tau tias ua kev zoo siab rau "Ninth Congress" thiab ua tau zoo ntawm cov neeg ua haujlwm.
Gentamicin tau muab rho tawm los ntawm cov kua txiv fermentation ntawm Monospores ntawm Actinomycetes. Nws yog cov tshuaj alkaline thiab feem ntau siv cov tshuaj tua kab mob aminoglycoside. Nws feem ntau yog siv los kho cov kab mob sib kis, tshwj xeeb yog kev kis mob los ntawm cov kab mob Gram-negative. Gentamicin tuaj yeem khi rau 30s subunit ntawm cov kab mob ribosome thiab thaiv cov kab mob sib txuas ua cov protein.
BALLYA muab a gentamicin kuaj los qhia koj yog tias muaj gentamicin seem hauv cov khoom siv mis uas koj noj txhua hnub.
dab tsi yog gentamicin
2. Keeb kwm
Wang Yue, nws lub npe menyuam yaus yog Zhongwu, tau yug los hauv Nroog Minhou (tam sim no Fuzhou), Fujian. Nws yug hauv Tongming Lane, Shangdu thaum Lub Yim Hli 1915. Nws tsev neeg muaj Wang Dasheng lub khw muag luam yeeb uas muaj keeb kwm ntau dua 200 xyoo. Nws txiv, Ainlu, yog tus kws tshawb fawb nyob rau Qing Dynasty lig. Ainlu, tus paub paub sau ntawv nyob hauv Fuzhou, tau nto moo rau nws kev sau thiab sau ntawv. Nws koom nrog Kev Tawm Tsam Xyoo 1911 hauv nws lub xyoo ntxov thiab tau ua tus tuav ntaub ntawv ntawm Lub Tsev Haujlwm Saib Xyuas Kev Tsim Kho Hauv Nroog thiab Lub Tsev Haujlwm Saib Xyuas Nyiaj Txiag tom qab kho dua tshiab.
Wang Yue ncaj ncees, ncaj ncees, ua haujlwm nyuaj, thiab ua lag luam ib yam li nws nyob deb. Thaum muaj hnub nyoog kaum ob (1927), nws kawm hauv Fuzhou Yinghua Middle School. Xyoo 1929, nws tau pauv mus rau Fuzhou Sany Middle School qhov uas nws kawm nyuaj thiab nyob qib zoo tshaj plaws.
Thaum Lub Yim Hli 1941, nws tau pom zoo los ntawm Asmeskas Tus Thawj Fwm Tsav Tebchaws rau Suav Tebchaws Stuart kom mus rau Tsev Kawm Tiav Kawm tiav ntawm Logus University hauv New Jersey, Asmeskas rau kev kawm ntxiv. Raws li kev taw qhia ntawm tus yeej Nobel nqi zog tus yeej, cov kws tshawb fawb tshuaj tua kab mob pioneer, thiab nrhiav pom ntawm tshuaj streptomycin thiab neomycin, Xibfwb Wagsman, nws ua tiav tag nrho cov ncauj lus tshawb fawb tom qab peb xyoos ntawm kev ua haujlwm hnyav thiab ua tiav cov txiaj ntsig zoo hauv 1943 Ph.D. hauv microbiology, tau txais Golden Key Award los ntawm SIGMX Society, thiab tau ntiav ua tus kws tshawb fawb ntawm Merck Pharmaceuticals Institute of Chemical Therapy.
Thaum nws kawm hauv Tebchaws Meskas, nws tus kws qhia xibfwb Waggsman muaj nuj nqis rau nws thiab qhia nws kom nyob hauv Tebchaws Meskas kom koom nrog kev tshawb fawb txog kab mob microbiology thiab muab nws txoj haujlwm zoo thiab tshawb fawb tshawb fawb. Tab sis nws ntseeg tias nws muaj lub luag haujlwm thiab lub luag haujlwm kom rov qab mus rau lub tebchaws niam thiab mob siab rau nws tus kheej rau kev txhim kho kev tshawb fawb hauv tebchaws. Tsav los ntawm kev tawm tsam Nyij Pooj thiab lub teb chaws txoj kev cawm seej nyob txawv tebchaws hauv Tebchaws Meskas uas tau tawg tawm thaum lub Cuaj Hli 1943, nws tau rov qab los Tuam Tshoj xyoo 1944 nrog kev mob siab rau ua haujlwm rau niam.
Nyob rau hnub ntxov ntawm kev dim, cov neeg tsis muaj tebchaws tau yuam kom ua tiav Suav teb, thiab yuam kev txwv tsis pub siv tshuaj tua kab mob rau Suav. Lub sijhawm ntawd, nws yog lub hnub nyoog kub ntawm kev tshawb fawb tshuaj tua kab mob thiab tsim khoom hauv ntau lub tebchaws hauv ntiaj teb, thaum tseem muaj cov tshuaj tua kab mob hauv Suav teb tsis txaus. Lub sijhawm tseem ceeb no, Wang Yue xav tias nws muaj lub luag haujlwm los qhia qhov kev txhawj xeeb rau lub tebchaws thiab tib neeg, thiab tau txiav txim siab los ua qhov sib txawv ntawm cov tshuaj hauv niam txiv.
Xyoo 1965, nws thawj zaug tau thov kev tshawb fawb txog kev nrhiav tshuaj tua kab mob tshiab los ntawm Micromonospora hauv Suav teb. Xyoo 1966, nws thiab nws cov neeg pabcuam tau cais cov neeg paub gentamicin-tsim cov kab mob los ntawm Micromonospora, thiab tau tso cai muab tso rau hauv kev tsim khoom nyob rau xyoo thib 20 ntawm kev nrhiav tau ntawm Cov Neeg Sawv Cev ntawm Tuam Tshoj xyoo 1969. Raws li kev txheeb cais, txij thaum pib tsim khoom txog xyoo 1985, muaj 40 lub tsev tsim khoom thoob plaws lub tebchaws tsim 868 tons nrog cov txiaj ntsig tsim tawm ntau dua 1 billion yuan. Kev tshawb pom ntawm gentamicin tau thawb kev tshawb fawb thiab tsim khoom ntawm tshuaj tua kab mob nyob rau hauv Suav teb mus rau theem tshiab, thiab tau koom tes tseem ceeb rau kev lag luam kho mob Suav.
3. Cov teebmeem tshuaj
Gentamicin yog tshuaj aminoglycoside. Gentamicin mechanism ntawm kev nqis tes ua yog ua los ntawm ribosomes hauv cov kab mob, tiv thaiv kab mob protein synthesis, thiab rhuav tshem kev ncaj ncees ntawm cov kab mob ntawm cov kab mob ntawm tes. Gentamicin tuaj yeem nthuav tawm thawj zaug los ntawm cov leeg ntawm cov txheej sab hauv ntawm lub cev los ntawm kev sib kis tsis sib xws, tom qab ntawd nkag mus rau hauv lub cell los ntawm cov xovtooj ntawm tes los ntawm cov kab ke thauj mus los, thiab tsis hloov pauv mus rau qhov sib cais ribosomal 30S subunit, ua rau kev puas tsuaj ntawm A site, thiab tom qab ntawd :
Tiv thaiv kom raug qhov tseeb ntawm ammonia tRNA ntawm txoj haujlwm A, tshwj xeeb tshaj yog cuam tshuam qhov kev khi ntawm methionyl tRNA, yog li cuam tshuam nrog kev sib dhos ntawm kev ua haujlwm ribosomes thiab tiv thaiv kev tsim ntawm 70S pib nyuaj.
Induce qhov tsis sib xws ntawm tRNA thiab mRNA code triplet, ua rau 30S subunit ntawm cov kab mob tsis tu ncua kom nkag siab tsis raug cov lej caj ces, ua rau cov amino acid tsis raug tso rau hauv cov qauv protein, ua rau txawv txav thiab tsis ua haujlwm cov protein ua ke.
Nws tiv thaiv qhov txiav tawm los ntawm kev khi rau A site, yog li cov saw peptide sib txuas tsis tuaj yeem tso tawm, thiab tiv thaiv kev sib cais ntawm 70S tsis muaj ribosome.
Kev txhaj tshuaj intramuscular ua ke nrog clindamycin lossis tshuaj metronidazole tuaj yeem siv los txo qhov tshwm sim ntawm kev kis mob tom qab phais hnyuv.
Kev txhaj tshuaj Intrathecal tuaj yeem siv los ua kev kho mob hnyav rau lub hauv nruab nrab lub paj hlwb mob (mob purulent meningitis, ventriculitis) tshwm sim los ntawm Pseudomonas aeruginosa lossis Staphylococcus.
Gentamicin kuj tseem siv tau los kho tus mob listeriosis.
Kev tso dej tawm hauv dej: Cov koob tshuaj yog tib yam li kev txhaj tshuaj intramuscular; txhua koob tshuaj ntxiv rau 50 ～ 200ml ntawm 0.9% saline lossis 5% cov kua qab zib kom cov tshuaj concentration tsis ntau tshaj 1g/L (hauv paus) (sib npaug 0.1% kev daws), maj mam ntws hauv 30-60 feeb.
Intrathecal lossis intracerebroventricular txhaj: 4-8mg txhua lub sijhawm, ib zaug txhua 2-3 hnub. Kos txhua koob tshuaj (concentration ntawm 2g/L) rau hauv 5ml lossis 10ml lub raj mis uas tsis muaj menyuam. Tom qab lumbar puncture, nqa ib qho piv txwv ntawm cov kua dej hauv lub paj hlwb thiab xa mus rau lub chaw kuaj mob, thiab tom qab ntawd muab lub koob txhaj tshuaj uas muaj gentamicin Txuas rau lub lumbar puncture koob, ua kom muaj txiaj ntsig ntau ntawm cerebrospinal kua ntws mus rau hauv rab koob, thawb thaum tso dej, thiab tom qab ntawd maj mam hno tag nrho cov kua hauv rab koob tsis pub dhau 3 txog 5 feeb. Thaum txhaj tshuaj, lub lumbar puncture koob yuav tsum tau nce me ntsis nce siab, yog tias cov kua dej hauv lub cev tsis huv thiab tsis yooj yim ntws tawm, gentamicin kuj tseem tuaj yeem diluted nrog kev txhaj tshuaj ntsev.
Dos thaum lub sij hawm lim ntshav: Tom qab hemodialysis, raws li qhov hnyav ntawm kev kis tus kab mob, koob tshuaj 1 txog 1.7 mg/kg tuaj yeem muab tau raws li lub cev hnyav.
Ceev faj
Cov tshuaj ntshav ntshav yuav tsum tau saib xyuas, tshwj xeeb hauv cov menyuam mos, cov neeg laus thiab cov neeg mob uas lub raum tsis txaus. Kev kho kom zoo zoo ntawm gentamicin yog li ntawm 4 txog 10μg/ml. Nws yuav tsum raug zam tias qhov siab tshaj plaws ntawm cov ntshav ntshav txuas ntxiv mus siab dua 12μg/ml thiab lub qhov dej siab tshaj 2μg/ml. Txawm li cas los xij, vim yog qhov sib txawv ntawm cov neeg mob hauv kev phais mob, kev kho mob poj niam, cev xeeb tub, lossis kub nyhiab, qhov kev suav tshuaj yuav qis dua qhov qis tshaj plaws uas tau siv ntau dua lossis siab dua li qhov siv ntau tshaj plaws. Cov neeg mob tau txais intrathecal kev txhaj tshuaj gentamicin yuav tsum tau saib xyuas cov tshuaj ntau hauv cov kua dej hauv lub paj hlwb.
Tom qab thawj zaug koob tshuaj (1 ～ 2 mg/kg) tau muab, cov tshuaj kho rau cov neeg mob uas lub raum tsis txaus, lub cev ua haujlwm lossis lub ntsej muag tsis hnov lus yuav tsum tau txo qis: koob tshuaj yuav zoo ib yam, tab sis yuav tsum ncua sijhawm ntxiv lossis lub sijhawm siv tshuaj tsis hloov pauv, thiab txo lossis nres gentamicin txhua lub sijhawm. Txij li thaum gentamicin tsis tau hloov pauv hauv lub cev, tab sis raug tso tawm los ntawm cov zis, yog li cov neeg mob uas lub raum tsis ua haujlwm tuaj yeem ua rau cov tshuaj txuam rau hauv cov tshuaj lom.
Cov neeg mob yuav tsum tau muab dej txaus kom txo tau lub raum puas.
Daim ntawv thov mus sij hawm ntev tuaj yeem ua rau muaj cov kab mob tiv taus.
Nws muaj cov txiaj ntsig ntawm kev tiv thaiv kev ua pa, yog li tsis txhaj tshuaj txhaj tshuaj. Nws tsis muaj txiaj ntsig zoo rau kev kis tus kab mob streptococcal. Cov kab mob ua pa ntawm lub ntsws ua rau mob streptococci yuav tsum tsis txhob siv.
Gentamicin Cov Teeb Meem
Nws tau tshaj tawm tias kev siv cov tshuaj gentamicin ua ke nrog kev txhaj tshuaj rau hauv lub cev ua rau muaj kev sib tw ntawm tes, tawv nqaij ua pob, ua npaws thiab ua rau lub cev nruj. Qhov tshwm sim ntawm lub raum tsis ua haujlwm los ntawm gentamicin siab dua li ntawm tobramycin.
Cov neeg feem coob tau hnov tsis hnov lus, hnov pob ntseg lossis hnov pob ntseg tag nrho (ototoxicity), hematuria, txo qis hauv kev tso zis ntau zaus lossis txo qis hauv cov zis, tsis qab los noj mov, nqhis dej heev (lub raum lom), taug kev tsis khov, thiab kiv taub hau ( Ototoxicity, cuam tshuam rau lub vestibule; nephrotoxicity). Cov uas muaj qhov xwm txheej qis dua muaj qhov ua tsis taus pa, qaug zog, thiab qaug zog heev (neuromuscular block lossis nephrotoxicity).
Yog tias tsis hnov lus, hnov pob ntseg, lossis pob ntseg tag nrho tshwm sim tom qab siv tshuaj, yuav tsum them sai sai. Cov tshuaj tiv thaiv tsis zoo yog zoo ib yam li ntawm kanamycin, thiab cov tshuaj tiv thaiv yog qhov sib dua thaum cov tshuaj me me. Yog tias qhov ntau npaum li cas, txoj kev kho mob ntev, thiab cov hnyuv hauv lub cev tau cuam tshuam qee zaum, thaum koj tso tseg cov tshuaj, koj tuaj yeem rov zoo li qub. Hauv qee tus neeg, loog, kiv taub hau, thiab tinnitus ntawm daim tawv nqaij ntawm lub qhov ncauj, ntsej muag thiab nqua yuav tshwm sim. Qee zaum, cov tsos mob tseem ceeb yog ua pa nyuaj thiab ua rau lub cev tsis sib xws, ntau dua li ib nrab ntawm cov neeg tuag tom qab tsis ua hauj lwm cawm, yog li qee tus neeg xav tias cov khoom lag luam yog qhov ua rau muaj kev phom sij loj tshaj yog qhov ua rau mob anaphylactic sai, uas tuaj yeem ua rau muaj tsos mob ntawm Romberg tus kab mob ( nyuaj rau sawv nrog kaw qhov muag, tsis khov nyob hauv qhov tsaus ntuj).
Kev siv tshuaj loj tuaj yeem ua rau edema tau yooj yim. Kev siv tshuaj ntau tuaj yeem ua rau tso zis tso zis, lub raum tsis ua haujlwm, thiab cov tsos mob ntawm lub paj hlwb. Kev nqus nws tuaj yeem ua rau muaj kev tsis haum thiab mob hawb pob. Gentamicin qhov muag dauv tuaj yeem ua rau mob edema, mob qog noj ntshav. Cov khoom no tuaj yeem ua rau qee zaum ua rau muaj kev nyuaj siab ua pa, cov ntawv ceeb toom tau tshaj tawm hauv tsev thiab txawv teb chaws. Cov khoom lag luam tuaj yeem ua rau qee zaum ua rau mob polyneuropathy thiab mob qog noj ntshav. Kev ua xua tsis tshua muaj tshwm sim, thiab qee zaum khaus tawv nqaij thiab urticaria, thiab lwm yam tuaj yeem tshwm sim ib ntus, uas feem ntau tsis cuam tshuam rau daim ntawv thov txuas ntxiv, thiab yuav ploj mus sai tom qab siv tshuaj lawm.
Cov khoom ua rau muaj kev tsis haum leukopenia thiab neutropenia qee zaum. Nws tuaj yeem ua rau ntshav tsis txaus, leukopenia, neutropenia, thrombocytopenia, thiab hypotension, thiab lub plab tsis xis nyob xws li xeev siab, tsis qab los, ntuav, thiab mob plab. Ob peb tus neeg mob tuaj yeem hloov pauv lub siab ua haujlwm, xws li nce cov ntshav aminotransferase, cov tshuaj tiv thaiv flocculation zoo, thiab lwm yam.
gentamicin-xeem
xaus
Gentamicin muaj kev ruaj ntseg zoo thiab ntau yam kev ua tau zoo. Thiab tseem ceeb dua, nws yog qhov tseem ceeb hauv keeb kwm ntawm kev tshawb pom tshuaj tua kab mob hauv Suav teb. Txawm li cas los xij, gentamicin, zoo li lwm yam tshuaj tua kab mob, muaj qee yam kev phiv, tshwj xeeb tshaj yog ntawm kev hnov thiab lub siab thiab lub raum ua haujlwm.
