Ob tus kws kho mob, Yi Fan thiab Hu Weifeng hauv Wuhan Central Tsev Kho Mob, hmoov tsis zoo cog lus Covid-19 hauv chav kho mob ua ntej thaum Lub Ib Hlis xyoo no, thiab thaum kawg tau rov ua lawv lub neej tom qab sib ntaus nrog kev tuag ntau dua ob lub hlis. Tab sis daim tawv nqaij ntawm ob tus kws kho mob tau dhau los ua tsaus heev. Dab tsi yog qhov laj thawj nyob tom qab lub ntsej muag tsaus?
Nws muab tawm tias lub tsev kho mob siv polymyxin IB thiab lwm yam tshuaj los kho ob tus kws kho mob thiab ua raws li lawv tus mob. Polymyxin IB ua rau lub raum, daim siab thiab lwm yam kabmob. Ib qho ntxiv, cov neeg mob feem ntau yuav muaj xim daj ntawm lub taub hau, ntsej muag, caj dab, thiab nqua muag tom qab siv tshuaj tas li, yog li daim tawv nqaij yuav tsaus dua.
Yog li cia peb paub qhov polymyxin b no!
Polymyxin B yog a polypeptide tshuaj tua kab mob, uas yog sib xyaw ntawm tsib yam ntawm Polymyxin A, B, C, D, thiab E.
Polymyxin tau siv los kho kab mob Gram-negative kab mob xyoo 1960, tab sis xyoo 1980, nws yuav luag raug tso tseg vim nws muaj tshuaj lom thiab tshwm sim ntawm qee yam tshuaj tua kab mob tshiab. Txawm li cas los xij, qhov nce ntawm cov tshuaj tiv thaiv kab mob Gram-tsis zoo ntau ntxiv nyob rau xyoo tas los no tau ua rau rov thov dua polymyxin hauv kev kho mob.
Polymyxin muaj cov txiaj ntsig zoo ntawm cov kab mob ntau-resistant Gram-negative cov kab mob, tshwj xeeb tshaj yog cov kab mob tshwm sim los ntawm multidrug-resistant Acinetobacter baumannii thiab Pseudomonas aeruginosa (xws li mob ntsws, kab mob bacteremia, mob qog noj ntshav, kis kab mob, thiab lwm yam).
Polypeptide tshuaj tua kab mob, chav kawm tshuaj tua kab mob nrog cov yam ntxwv ntawm polypeptides, suav nrog polymyxins (polymyxin B, polymyxin E), bacitracin (bacitracin, gramicidin) thiab glycopeptide tshuaj tua kab mob (vancomycin tshuaj, norvancomycin thiab teicoplanin).
Cov lwg me me ntawm vancomycin, norvancomycin thiab teicoplanin txhua tus muaj cov piam thaj thiab peptide saw qauv, uas yog cov tshuaj tua kab mob glycopeptide; qee yam ntau yam ntawm polymyxins thiab bacitracin lwg me me kuj tseem muaj peptide qauv, koom nrog polypeptide tshuaj tua kab mob; ob leeg tau sau ua ke hu ua tshuaj tua kab mob polypeptide.
Cov tshuaj tua kab mob Polypeptide muaj qhov zoo sib xws hauv qab no: nqaim cov kab mob tua kab mob, muaj zog tiv thaiv kab mob, thiab sib txawv ntawm qib nephrotoxicity. Lawv feem ntau haum rau kev kis mob hnyav los ntawm cov kab mob uas muaj tshuaj tiv taus ntau yam.
Polymyxin B thiab E tau siv rau lub hom phiaj kho mob. Polymyxin B tsuas yog ua tau zoo tiv thaiv kab mob Gram-negative xws li Aerobacter, Influenzae, Escherichia coli, Shigella thiab Pseudomonas aeruginosa. Cov tshuaj tua kab mob muaj zog dua li polymyxin E.
Polymyxin IB tau nqus tau zoo los ntawm kev txhaj tshuaj intramuscular, tab sis cov ntshav cov ntshav qis, thiab 60% ntawm cov tshuaj raug tso tawm hauv cov zis. Clinically, nws tsuas yog siv rau kev kis mob ntawm qhov txhab, tso zis, qhov muag, pob ntseg, lub ntsws thiab lwm yam tshwm sim los ntawm Pseudomonas aeruginosa thiab lwm yam pseudomonas, ntxiv rau sepsis thiab peritonitis.
Polymyxin tau thov los ntawm kab lis kev cai nruab nrab ntawm polymyxin, uas yog rau cov tshuaj peptide yooj yim tshuaj tua kab mob. Nws suav nrog A, B, C, D, E, K, M, P, thiab lwm yam.
Polymyxin B thiab polymyxin E (tseem hu ua tshuaj tua kab mob, colistin, thiab colistin) tau siv hauv tsev kho mob vim tias lawv muaj tshuaj lom tsawg.
Polymyxin B sulfate hmoov yog cov tshuaj dawb los yog mis nyuj dawb amorphous, yooj yim yaj hauv dej thiab ntsev. Polymyxin E sulfate yog hmoov dawb crystalline, yooj yim soluble hauv dej. Kuj tseem muaj polymyxin E sodium methane sulfonate, uas muaj qhov siab hauv dej thiab tsim nyog rau kev txhaj tshuaj intramuscular.
Tsuas yog rau Proteus, nws muaj cov tshuaj tua kab mob rau yuav luag txhua gram-negative bacilli, suav nrog Escherichia coli, Enterobacter, Klebsiella, Pseudomonas aeruginosa, Salmonella, Haemophilus influenzae, Shigella, Pertussis Bacillus, Cholera, thiab tshuaj tua kab mob tiv thaiv Clostridium thiab qee yam Bacteroides.
Tsis muaj kev nqus tom qab kev tswj hwm qhov ncauj, tab sis nqus sai tom qab txhaj tshuaj. Rau ib koob tshuaj 50 mg intramuscularly, 2 teev kom mus txog qhov siab, thiab qhov siab tshaj plaws ntshav plasma yog 1-8 mg/L, tab sis qhov sib txawv ntawm tus kheej yog qhov loj. Nws tsis tau nthuav dav hauv lub cev, tab sis nws tuaj yeem faib rau daim siab, raum, mob ntsws, plawv, lub hlwb lossis nqaij nqaij.
Vim nws qhov hnyav hnyav hnyav, nws nyuaj rau nkag mus rau cov ntshav-cerebrospinal kua teeb meem rau cov kua dej hauv lub cev lossis lub cev. Cov ntshav ib nrab ntawm lub neej yog 6 teev. Tom qab txhaj tshuaj, nws tsuas yog tso tawm los ntawm cov zis, tab sis tsuas yog qee qhov me me tau tso tawm hauv 12 teev, thiab qhov siab tshaj plaws ntawm cov zis tuaj yeem mus txog 20-200μg/ml tom qab. Kev tshem tawm cov tshuaj txuas ntxiv tsis pub dhau 1 txog 3 hnub tom qab siv tshuaj.
Clinically, nws tsuas yog siv rau kev kis mob ntawm qhov txhab, tso zis, qhov muag, pob ntseg, lub ntsws thiab lwm qhov tshwm sim los ntawm Pseudomonas aeruginosa thiab lwm yam pseudomonas. Nws kuj tseem tuaj yeem siv rau sepsis thiab peritonitis.
Cov tshuaj tua kab mob ntawm cov tshuaj polymyxins yog ib yam nkaus. Nws muaj cov tshuaj tua kab mob zoo rau yuav luag txhua gram-negative bacilli. Nws yog qhov tshwj xeeb tshaj yog tiv thaiv Pseudomonas aeruginosa, tshwj tsis yog rau Proteus, uas tsis nkag siab. Lwm yam xws li cocci tsis zoo, cov kab mob zoo, fungi, rickettsiae thiab cov kab mob tsis nkag siab rau nws.
Cov tshuaj tua kab mob no muaj qhov ua haujlwm saum npoo av thiab muaj qhov zoo them dawb cov pab pawg amino, uas tuaj yeem khi rau qhov tsis zoo them phosphates hauv phospholipids ntawm gram-negative cov kab mob ntawm cov kab mob ntawm tes, uas nthuav dav thaj tsam ntawm cov kab mob ntawm cov kab mob cell thiab nce permeability. Kev xau ntawm nucleotides thiab lwm yam khoom ua rau cov kab mob tuag.
Polymyxin muaj txiaj ntsig zoo tiv thaiv kab mob hauv ob theem kev tsim tawm thiab theem nyob ruaj ruaj. Cov kab mob feem ntau tsis yooj yim los tsim kev tawm tsam rau cov tshuaj no. Thaum nws tshwm sim, yuav muaj kev tiv thaiv kab mob sib txawv ntawm cov tshuaj no.
Cov tshuaj tua kab mob no feem ntau yog siv rau ntau yam kev kis mob los ntawm Gram-negative bacilli, tshwj xeeb yog Pseudomonas aeruginosa thiab Escherichia coli.
Rau cov dev thiab miv, polymyxin B tuaj yeem siv kho mob hauv kev kho kab mob ua pa, cov nqaij mos, cov kab mob biliary thiab sepsis los ntawm cov kab mob nkag siab. Polymyxin E tuaj yeem siv rau kev kis mob ntawm qhov txhab, tso zis, qhov muag, pob ntseg, thiab lub ntsws ua los ntawm Pseudomonas aeruginosa thiab lwm yam pseudomonas, ntxiv rau sepsis thiab peritonitis.
Polymyxin B ointment yog peptide tshuaj tua kab mob, tshuaj tua kab mob dav, thiab muaj cov tshuaj tua kab mob zoo rau feem ntau cov kab mob. Nws yog xim dawb rau lub teeb daj, uas feem ntau yog siv los tiv thaiv kab mob kis ntawm daim tawv nqaij xws li tawv nqaij txiav, puas, hlawv, thiab tom qab phais mob, thiab tuaj yeem daws qhov mob hauv zos, tab sis nws tsis haum rau qhov muag.
Nws yog rau kev siv sab nraud, siv rau thaj tsam raug mob 2-4 zaug hauv ib hnub, thiab chav kawm ntawm kev kho mob yog 5 hnub. Tom qab siv, muaj kev phiv tshuaj xws li ua xua, hnov mob, liab thiab o tuaj yeem tshwm sim. Vim tias cov tshuaj tsis tshua muaj nqus tom qab siv rau ntawm daim tawv nqaij hauv zos, nws feem ntau tsis cuam tshuam nrog lwm cov tshuaj.
A. Lub raum lom
Qhov tshwm sim siab tshaj plaws. Thaum nephrotoxicity tshwm sim, tsis tas yuav kho qhov koob tshuaj polymyxin B, vim tias cov neeg mob feem ntau tuaj yeem rov ua haujlwm tau zoo hauv lub raum tom qab siv tshuaj.
B. Neurotoxicity
Tsawg dua li nephrotoxicity. Nws yog qhov tshwm sim feem ntau ua rau kiv taub hau thiab ataxia, lub ntsej muag yaug, tsaug zog, peripheral paresthesia, mob hauv siab; intrathecal kev tswj hwm tuaj yeem qhia kev ua rau lub cev tsis txaus, xws li ua npaws, mob taub hau, txhav caj dab, suav cov cell thiab cov protein hauv cov kua dej hauv lub paj hlwb nce; siv ib txhij nrog cov tshuaj neurotoxic tuaj yeem yooj yim ua rau ua tsis taus pa, hypoxemia, thiab apnea.
C. Pigmentation
Qhov tshwm sim ntawm cov xim xim tshwm sim los ntawm kev siv tshuaj polymyxin B yog 8% txog 15%. Ib txoj kev tshawb nrhiav pom tias kwv yees li 15% ntawm cov neeg mob tau pib hloov xim tawv nqaij nyob rau hnub thib peb tom qab siv polymyxin B, uas tau tshwm sim ntawm lub ntsej muag thiab caj dab.
Cov tawv nqaij pigmentation tshwm sim los ntawm polymyxin B yog thim rov qab, thiab cov neeg mob feem ntau tuaj yeem rov zoo tom qab siv tshuaj. Cov xim ntawm cov menyuam mos thiab menyuam mos tuaj yeem ploj tag tom qab siv tshuaj. Cov xim ntawm qee cov neeg laus tuaj yeem maj mam txo qis. Yog tias tus kab mob tau tswj hwm, tso tseg cov tshuaj hauv lub sijhawm lossis nrhiav tshuaj ntxiv yuav pab kho cov tawv nqaij rov qab. Rau ob peb tus neeg mob uas tsis tuaj yeem hloov pauv ntawm cov tawv nqaij pigmentation, tawv nqaij dawb thiab kho laser tuaj yeem ua tau.
D. lwm yam
Lwm yam kev phom sij uas tau tshaj tawm suav nrog nce ntshav eosinophilia, txhaj tshuaj txhaj rau lub cev (mob hnyav), tshuaj ua npaws, tso zis tawm hws, phlebitis, raws plab, thiab ua pa tawm ntawm qhov nqus pa.
Cov neeg mob uas muaj keeb kwm ua xua rau polymyxins yuav tsum tsis txhob siv polymyxin B.
Thaum Lub Kaum Ib Hlis 19, cov kws tshawb fawb los ntawm ntau lub tsev kawm qib siab hauv Suav teb, Tebchaws Askiv thiab Tebchaws Meskas tshaj tawm hauv phau ntawv xov xwm "The Lancet · Cov Kab Mob Sib Kis" uas lawv tau tshawb pom ib daim ntawv tshiab ntawm kev tiv thaiv tshuaj ntsib ib ntawm kab kawg ntawm kev tiv thaiv: Polymyxin- thiab qhov tshuaj tiv thaiv no tseem muaj nyob hauv ob qho tib si nqaij tsiaj thiab tib neeg, tej zaum vim yog kev ua liaj ua teb siv cov tshuaj. Qhov kev tiv thaiv no tuaj yeem hloov pauv tau yooj yim ntawm cov kab mob thiab tej zaum yuav kis mus rau ntau lub tebchaws.
Qhov no tsis yog tshuaj tshiab rau peb, uas tau tshawb pom xyoo 1959; tab sis rau feem ntau txij li thaum ntawd, cov tshuaj no tsuas yog nyob ntawm lub txee hauv qhov tsis meej pem thiab tsis tshua siv vim tias nws yuav ua rau lub raum lom. Nws yog qhov tseeb vim tias nws tsis tau siv dav uas cov kab mob tsis tau tsim tshuaj tiv thaiv txaus. Yog li ntawd, cov tshuaj no tseem ua tau zoo.
Raws li qhov tshwm sim, qhov kev tsis lees paub no tau dhau los ua qhov muaj txiaj ntsig - uas yog thaum ntau yam tshuaj tiv thaiv kab mob (NDM, OXA, KPC) tau pib kis thoob ntiaj teb ob peb xyoos dhau los. Cov xwm txheej no ua rau cov kab mob tsis tuaj yeem ua rau ib pawg tshuaj hu ua carbapenems. Yav dhau los, carbapenems tau suav tias yog kab kawg ntawm kev tiv thaiv kab mob: lawv yog pawg kawg uas ob qho tib si siv thiab muaj peev xwm tiv thaiv kab mob sib kis. Cov kab mob zoo li no feem ntau tshwm sim los ntawm E. coli, Klebsiella, Acinetobacter baumannii thiab lwm yam neeg nyob hauv plab. Thaum cov kab mob no tiv taus cov tshuaj carbapenem (feem ntau lawv hu ua "carbapenem-resistant Enterobacteriaceae" (CRE)), polymyxin yog ib qho ntawm peb cov kev xaiv uas tseem tshuav, thiab qhov no nce kev siv polymyxin.
Muaj lwm yam hais txog polymyxin uas tib neeg tsis zoo li txuas nrog lwm yam teeb meem: vim qhov no yog cov tshuaj qub, nws pheej yig. Vim tias nws pheej yig, nws tau siv los ua tshuaj ntxiv rau tsiaj kom ua tiav cov txiaj ntsig uas kuv tau tham ua ntej: ua kom tsiaj loj hlob sai dua thiab tiv thaiv lawv los ntawm ib puag ncig cuam tshuam ntawm kev ua liaj ua teb hnyav.
Pom tseeb, qhov no yog li cas cov tshuaj tau siv hauv Suav teb-tab sis nws tsis yog nyob hauv Suav teb nkaus xwb. Tuam Tshoj yog ib lub tebchaws uas muaj kev siv ua liaj ua teb loj tshaj plaws ntawm polymyxin hauv ntiaj teb. Txog rau qhov loj, tau tsav los ntawm Tuam Tshoj, txog rau xyoo 2015, lub ntiaj teb kev ua liaj ua teb xav tau rau polymyxin xav tias yuav ncav cuag 11,942 tons hauv ib xyoos (nqa cov nyiaj tau los cuam tshuam txog 229 lab nyiaj daus las).
Txog xyoo 2021, nws cia siab tias yuav nce mus rau 16,500 tons, nrog rau kev nce txhua xyoo txog 4.75%. Ib ntawm kaum tus kws kho tsiaj polymyxin saum toj kawg nkaus hauv ntiaj teb yog hauv Is Nrias teb, ib qho yog hauv Denmark, thiab lwm yim nyob hauv Suav teb. Asia (suav nrog Suav) suav txog 73.1% ntawm polymyxin ntau lawm, uas 28.7% raug xa tawm mus rau lwm thaj chaw suav nrog Europe. Yog li ntawd, polymyxin tsis kam tuaj yeem pib kis los ntawm tsiaj mus rau tib neeg yam tsis tau ceeb toom.
Polymyxin IB belongs rau peptide tshuaj tua kab mob. Nws tau tso tseg ntau xyoo dhau los rau nws cov kab mob nephrotoxicity, tab sis nyob rau xyoo tsis ntev los no, nws tau tshwm sim ntawm lub khw muag tshuaj vim tias kev txhim kho cov kab mob tiv taus cov tshuaj tua kab mob.
Polymyxin muaj qhov cuam tshuam zoo rau qee cov kab mob, tab sis kev nthuav dav ntawm polymyxin hauv kev pub tsiaj thiab tshuaj tsiaj kuj tseem cuam tshuam nws cov txiaj ntsig muaj zog.
BALLYA muab rau ballya-polymyxin-b-xeem qhia rau koj yog tias muaj polymyxin ua seem hauv cov khoom noj thiab pub.
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