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LMD (右旋糖酐注射剂)

2014-03-23 20:04:59 作者：新特药房来源：互联网浏览次数：59 文字大小：【大】【中】【小】

简介： 【药理与应用】能提高血浆胶体渗透压，吸收血管外的水份而补充血容量，维持血压；使已经聚集的红细胞和血小板解聚，降低血液粘滞性，从而改善微循环，防止休克后期的血管内凝血；抑制凝血因子Ⅱ的激活， ...

【药理与应用】能提高血浆胶体渗透压，吸收血管外的水份而补充血容量，维持血压；使已经聚集的红细胞和血小板解聚，降低血液粘滞性，从而改善微循环，防止休克后期的血管内凝血；抑制凝血因子Ⅱ的激活，使凝血因子Ⅰ和Ⅷ活性降低以及其抗血小板作用均可防止血栓形成。尚具渗透性利尿作用。
静滴后，立即开始从血流中消除，t1/2约3小时。
用于：
①各种休克：抗失血性休克的疗效优于右旋糖苷70。因其除扩充血容量之外，尚能改善微循环和组织灌流。可用于失血、创伤、烧伤及中毒性休克，还可早期预防因休克引起的弥散性血管内凝血。体外循环时，还可代替部分血液予充心肺机。
②血栓性疾病如脑血栓形成、心绞痛和心肌梗死、血栓闭塞性脉管炎、视网膜动静脉血栓、皮肤缺血性溃疡等。
③肢体再植和血管外科手术，可预防术后血栓形成，并可改善血液循环，提高再植成功率。
【用法】静滴，每次250～500ml，成人和儿童每日不超过20ml／kg。抗休克时滴注速度为20～40ml／分，在15～30分钟注入500ml。对冠心病和脑血栓患者应缓慢静滴。疗程视病情而定，通常每日或隔日1次，7～14次为1疗程。
【注意】
（1）少数病人用药后可出现皮肤瘙痒、荨麻疹、红色丘疹等皮肤过敏反应，也有弓愧哮喘发作。极少发生过敏性休克，多在首次输入本品数滴至数ml时，立即出现胸闷、面色苍白，以至血压下降，发生休克，及时抢救一般可恢复。故初次滴注时，应严密观察5～10分钟，发现症状，立即停注。
（2）偶见发热反应。一类为热原反应，多在用药1～2次，见寒战高烧；另一类在多次用药或长期用药停药后，出现周期性高热或持续性低热，少数尚可见淋巴结肿大，关节痛。
（3）用量过大可致出血，如鼻衄、齿龈出血、皮肤粘膜出血、创面渗血、血尿、经血增多等。因此，每日用量不应超过1500ml。
（4）充血性心力衰竭和有出血性疾患者禁用。肝肾疾病者慎用。
【药物相互作用】与双嘧达莫和维生素B12混合可发生变化，与卡那霉素、庆大霉素和巴龙霉素合用可增加其肾毒性。
【制剂】右旋糖酐40葡萄糖注射液（低分子右旋糖酐葡萄糖注射液）：每瓶10g（100ml）；25g（250ml）；50g（500ml）；6g（100ml）；15g（250ml）；30g（500ml）；均含葡萄糖5％。
右旋糖酐40氯化钠注射液（低分子右旋糖酐氯化钠注射液）：每瓶10g（100ml）；25g（250ml）；50g（500ml）；6g（100ml）；15g（250ml）；30g（500ml）；均含氯化钠0.9％。
【贮法】在25℃以下保存。
Indications and Usage for LMD Injection
LMD Injection - Clinical Pharmacology
The fundamental action of LMD (dextran 40) is the enhancement of blood flow, particularly in the microcirculation. This enhancement is due to:
Its primary effect of volume expansion with resultant hemodilution;
Maintenance of the electronegativity of red blood cells;
Coating of red blood cells and platelets;
Increase in the suspension stability of blood;
Decrease in the viscosity of blood.
It should be emphasized that the above effects are not exerted separately, but conjointly they result in the enhancement of blood flow.
LMD, used in the treatment of shock, produces significant increases in blood volume, central venous pressure, cardiac output, stroke volume, blood pressure and urinary output.
It reduces blood viscosity, peripheral resistance and improves peripheral blood flow with the release of sequestered blood cells, thereby increasing venous return to the heart.
When used as part of the pump prime for extracorporeal procedures, LMD, as compared to whole blood, albumin 5%, or whole blood plus 5% dextrose and water, leads to less destruction of red blood cells and platelets, reduces intravascular hemagglutination and maintains erythrocyte electronegativity.
The infusion of LMD (dextran 40) during and after surgical trauma reduces the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients subject to surgical procedures with a high incidence of thromboembolic complication. Unlike antithrombogenic agents of the anticoagulant type, LMD does not achieve its effect so much by blocking fibrinogen-fibrin conversion but acts by simultaneously inhibiting other mechanisms essential to thrombus formation such as vascular stasis and platelet adhesiveness and by altering the structureandtherebythelysabilityoffibrinclots.
Histopathological studies have shown that the development of a mural platelet thrombus is the first stage of thrombus formation not only in the arterial, but also in the venous system.
A number of studies have further shown that many patients who develop thromboembolic complications show an abnormally high platelet adhesiveness.
Infusion of LMD has been shown to reduce platelet adhesiveness as measured by various in vitro tests on blood samples obtained from humans and to inhibit the growth of a mural platelet thrombus at the site of experimental (laser beam) injury in the rabbit’s ear chamber.
Studies have shown an increase in the lysability of thrombi formed in the presence of dextran. A consistent and characteristic alteration in fibrin structure has been observed when fibrin is formed in the presence of dextran, and further experiments demonstrated such fibrin to be more susceptible to plasmin digestion. Other studies have shown that dextran infused into patients during surgery increases the lysability of ex vivo thrombi.
Controlled clinical trials have shown that thrombi in patients treated with dextran have a more pronounced tendency to undergo lysis as determined by phlebography.
LMD is evenly distributed in the vascular system. Its distribution according to molecular weight shifts toward higher molecular weights as the smaller molecules are excreted by the kidney. In normovolemic subjects, approximately 50% is excreted within 3 hours, 60% is excreted within 6 hours and about 75% within 24 hours.
Reabsorption of dextran by the renal tubules is negligible. The unexcreted molecules of dextran diffuse into the extravascular compartment and are temporarily taken up by the reticuloendothelial system. Some of these molecules are returned to the intravascular compartment via the lymphatics. Dextran is slowly degraded by the enzyme dextranase to glucose.
Solutions containing carbohydrate in the form of dextrose restore blood glucose levels and provide calories. Carbohydrate in the form of dextrose may aid in minimizing liver glycogen depletion and exerts a protein sparing action.
Dextrose injected parenterally undergoes oxidation to carbon dioxide and water.
Sodium chloride in water dissociates to provide sodium (Na+) and chloride (Clˉ) ions.
Sodium (Na+) is the principal cation of the extracellular fluid and plays a large part in the therapy of fluid and electrolyte disturbances. Chloride (Clˉ) has an integral role in buffering action when oxygen and carbon dioxide exchange occurs in red blood cells. The distribution and excretion of sodium (Na+) and chloride (Clˉ) are largely under the control of the kidney, which maintains a balance between intake and output.
Water is an essential constituent of all body tissues and accounts for approximately 70% of total body weight. Average normal adult daily requirement ranges from two to three liters (1.0 to 1.5 liters each for insensible water loss by perspiration and urine production).
Water balance is maintained by various regulatory mechanisms.
Water distribution depends primarily on the concentration of electrolytes in the body compartments and sodium (Na+) plays a major role in maintaining physiologic equilibrium.
LMD (dextran 40) is indicated for use in the adjunctive treatment of shock or impending shock due to hemorrhage, burns, surgery or other trauma. It is not indicated as a replacement for whole blood or blood components if they are available. It should not replace other forms of therapy known to be of value in the treatment of shock.
LMD is also indicated for use as a priming fluid, either as a sole prime or as an additive, in pump oxygenators during extracorporeal circulation.
LMD is also indicated for use in prophylaxis of venous thrombosis and pulmonary embolism in patients undergoing procedures known to be associated with a high incidence of thromboembolic complications, such as hip surgery./p> Contraindications
LMD (dextran 40) is contraindicated in patients with known hypersensitivity to dextran, in those with marked hemostatic defects of all types (thrombocytopenia, hypofibrinogenemia, etc.) including those caused by drugs (heparin, warfarin, etc.), marked cardiac decompensation and in renal disease with severe oliguria or anuria.
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产地国家: 日本
原产地英文商品名:
LOW MOLECULAR DEXTRAN L INJECTION 250ml 10bags
中文参考商品译名:
LMD 注射剂 250毫升 10包
生产厂家中文参考译名:
日本大冢
生产厂家英文名:
Otsuka