Peb suav nrog kev txhaj tshuaj tiv thaiv. Ntu 25. Vitamin K

2024 Tus sau: Seth Attwood | [email protected]. Kawg hloov kho: 2023-12-16 16:06

1. Ib qho ntawm cov txheej txheem uas yuav luag txhua tus me nyuam tau txais tam sim tom qab yug me nyuam hauv ntau lub teb chaws tsim yog kev txhaj tshuaj vitamin K. Vitamin K ua lub luag haujlwm tseem ceeb hauv cov txheej txheem ntshav txhaws, thiab qhov tsis muaj nws ntseeg tias yuav ua rau muaj kab mob hemorrhagic neonatal. (VKDB).

2. Vitamin K nyob rau hauv neonates: qhov tseeb thiab myths xwb. (Lippi, 2011, Ntshav Transfus)

Vitamin K tau tshawb pom thaum ntxov xyoo 1930 thaum tus kws tshawb fawb Danish biochemist pom tias qaib tau noj cov zaub mov tsis muaj rog, tsis muaj roj cholesterol tsim subcutaneous thiab intramuscular los ntshav. Cov vitamin tau muaj npe nrog tsab ntawv K rau coagulation.

Vitamin K1 muaj nyob rau hauv cov nplooj ntsuab ntsuab xws li spinach, Swiss chard, turnips, zaub qhwv (kuj cauliflower, Brussels sprouts, kale), qee cov txiv hmab txiv ntoo (avocado, txiv tsawb, kiwi), thiab qee cov roj zaub. Vitamin K2 yog tsim los ntawm ntau hom kab mob plab, tab sis qhov no tej zaum tsis yog qhov tseem ceeb tshwj xeeb.

IOM pom zoo kom noj cov vitamin txhua hnub yog 120 mcg rau cov txiv neej thiab 90 mcg rau cov poj niam. Hauv Tebchaws Europe, cov koob tshuaj pom zoo yog qis dua.

Cov koob tshuaj pom zoo rau cov menyuam mos yog 2 mcg / hnub. Cov mis nyuj muaj 1-4 mcg / liter.

Muaj 3 hom kab mob hemorrhagic ntawm cov menyuam yug tshiab (uas txij li xyoo 1999 tau hu ua VKDB - Vitamin K deficiency los ntshav).

1) Thaum ntxov (thawj 24 teev tom qab yug me nyuam). Nws tau pom yuav luag tshwj xeeb hauv cov menyuam mos uas nws niam tau siv tshuaj uas inhibit vitamin K (anticonvulsants thiab anti-tuberculosis tshuaj, qee cov tshuaj tua kab mob, coumarin, thiab lwm yam). Nws tau pom nyob rau hauv 6-12% (ntawm cov tshuaj noj) thiab feem ntau dhau mus nyuaj.

2) Classic (24 teev - 7 hnub tom qab yug me nyuam). Koom nrog kev noj zaub mov tsis txaus. Nws tau pom nyob rau hauv 0.25-1.5% (raws li cov ntaub ntawv qub) thiab 0-0.44% (raws li cov ntaub ntawv tshiab), thiab feem ntau kis tau yooj yim. Xws li los ntshav los ntawm txoj hlab ntaws thiab los ntshav tom qab kev txiav los yog txhaj tshuaj.

3) lig (2-12 lub lis piam tom qab yug me nyuam). Koom nrog kev pub niam mis tshwj xeeb (HS) (raws li vitamin K ntxiv rau cov mis mos) thiab cuam tshuam nrog vitamin K malabsorption vim kab mob siab thiab tsis txaus vitamin. Qhov mob hnyav hauv cov menyuam yaus uas tsis tau txais cov vitamin K tshwj xeeb rau tus kab mob siab B yog 1 ntawm 15-20,000. Nws yog ib qho nyuaj (kev tuag 20% thiab qhov tshwm sim tsis tu ncua).

Ib qho kev tsis sib haum xeeb hauv neonatal homeostasis yog qhov kev ntsuam xyuas coagulation tsis qhia tias los ntshav. Niaj hnub no nws yog tseeb rau peb hais tias lub physiology ntawm hemostasis nyob rau hauv thaum yau txawv heev ntawm lub physiology nyob rau hauv cov neeg laus. Kev tshawb fawb ntawm tib neeg thiab tsiaj txhu qhia tau hais tias cov ntshav qog ntshav hauv cov menyuam yug tshiab txawv ntawm cov neeg laus ntau tab sis tsis zoo. [12]

Cov kab mob hemostatic yog tag nrho tsim thaum muaj hnub nyoog 3-6 lub hlis. Yog li ntawd, nws yog ib qho tseem ceeb kom paub meej tias qhov sib txawv ntawm cov neeg laus thiab cov me nyuam mos yog feem ntau physiological thiab tsis yog ib txwm qhia ntawm pathology.

Ob qhov ncauj thiab intramuscular vitamin K supplementation tiv thaiv daim ntawv classic ntawm VKDB. Txawm li cas los xij, ib koob tshuaj ntawm qhov ncauj tsis tiv thaiv txhua tus menyuam mos los ntawm VKDB lig.

3. Vitamin K deficiency los ntshav (VKDB) thaum ntxov. (Shearer, 2009, Ntshav Rev)

Txawm tias nyob rau hauv cov teb chaws tsim, muaj cov ntaub ntawv raug me ntsis ntawm kev nthuav dav ntawm classic VKDB. Hauv kev tshawb fawb Askiv hauv 1988-90, qhov tshwm sim yog ~ 1: 20,000, uas yog, nws tsis txawv ntawm qhov tshwm sim ntawm VKDB lig. Hauv xyoo 1930, qhov tshwm sim hauv Oslo yog 0.8%. Hauv kev tshawb fawb hauv Cincinnati hauv xyoo 1960, qhov tshwm sim yog 1.7% ntawm cov menyuam mos ntawm HB. Tab sis cov ntaub ntawv no tsis tuaj yeem sawv cev, txij li lub tsev kho mob feem ntau yog cov neeg pluag dub.

Kev txom nyem predisposes rau classic VKDB, thiab nyob rau hauv cov teb chaws txom nyem qhov tshwm sim yog ho siab tshaj nyob rau hauv lub teb chaws tsim.

Late VKDB feem ntau ua ntej los ntawm kev ceeb toom los ntshav uas yuav tsum tau tshawb xyuas.

4. Vitamin K prophylaxis rau kev tiv thaiv ntawm vitamin K deficiency los ntshav: ib tug systematic tshuaj xyuas.(Sankar, 2016, J Perinatol)

Kev tshuaj xyuas qhov ua tau zoo ntawm kev txhaj tshuaj.

Ntawm cov neeg uas tsis tau txais vitamin K, qhov tshwm sim ntawm lig VKDB nyob rau hauv cov teb chaws txom nyem yog 80 rau 100,000, thiab nyob rau hauv lub teb chaws nplua nuj 8.8 rau 100,000.

Cov tswv yim tiv thaiv niaj hnub tsis yog yam tsis muaj qhov cuam tshuam. Qhov koob tshuaj prophylactic ib txwm (1 mg) yog 1000 npaug ntawm qhov xav tau txhua hnub. Cov kev tshawb fawb tau pom tias muaj ntau zaus ntawm cov viv ncaus chromatid metabolism hauv lymphocytes thiab mutagenic kev ua haujlwm ntawm qhov muaj siab. Tsis tas li ntawd, kev tswj hwm intramuscular tuaj yeem ua rau muaj mob hauv zos, vascular thiab paj hlwb puas, abscesses, thiab nqaij hematoma. Unsurprisingly, qee lub teb chaws tiv thaiv universal prophylaxis thiab es tsis txhob siv prophylaxis xaiv tsuas yog rau cov me nyuam mos uas muaj kev pheej hmoo los ntshav.

Classic VKDB: Ib txoj kev tshawb fawb pom tau tias txo qis 27% ntawm txoj kev pheej hmoo los ntshav vim kev txhaj tshuaj thiab 81% los ntshav loj. Lwm txoj kev tshawb fawb pom tau tias 82% txo cov ntshav tom qab kev txiav.

Tsis muaj qhov kev sim ntsuas ntawm qhov tshwm sim ntawm prophylaxis ntawm VKDB lig. Hauv kev soj ntsuam kev tshawb fawb, qhov kev pheej hmoo ntawm lig VKDB raug txo los ntawm 98% hauv cov neeg mob txhaj tshuaj.

Kev tshuaj xyuas zoo los ntawm Cochrane pom tias tsis muaj qhov sib txawv ntawm cov ntshav txhaws tom qab intramuscular piv rau qhov ncauj.

Qhov ncauj vitamin supplementation yog pheej yig dua thiab tsis muaj kev pheej hmoo ntawm mutagenicity.

Yav dhau los, hluavtaws vitamin K3 (menadione) tau siv, uas tau cuam tshuam nrog kev pheej hmoo ntawm hemolysis thiab kernicterus.

Vitamin K3 (Vikasol) tseem siv los tiv thaiv VKDB hauv Russia thiab Ukraine.

5. Vitamin K1 (phytomenadione / phylloquinone) tau siv nyob rau hauv cov teb chaws tsim txij li thaum ntxov 1960s. (Ntawm no, vitamin K txhais tau tias K1).

Kev txhaj tshuaj los ntawm cov tuam ntxhab hauv qab no tam sim no muaj:

AquaMEPHYTON (Merck)

6. Ib qho tshiab sib xyaw micellar npaj rau qhov ncauj vitamin K prophylaxis: randomized tswj kev sib piv nrog ib qho intramuscular formulation nyob rau hauv cov me nyuam mos noj pests. (Greer, 1998, Arch Dis Child)

Cov neeg uas tau txais 3 koob tshuaj qhov ncauj (Konakion MM) muaj cov vitamin K ntau dua rau 8 lub lis piam piv rau cov uas tau txhaj tshuaj intramuscular.

7. Muaj ntau ntau qhov kev tshawb fawb piv rau kev ua haujlwm ntawm intramuscular thiab qhov ncauj vitamin K.

Feem ntau xaus lus tias kev tswj hwm qhov ncauj tsis muaj txiaj ntsig zoo dua li kev tswj hwm intramuscular: [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] ib.

Tab sis kuj tseem muaj cov kev tshawb fawb qhia tias kev tswj hwm qhov ncauj tsis zoo dua li kev tswj hwm intramuscular los tiv thaiv VKDB lig: [1]

8. Kev tiv thaiv ntawm vitamin K deficiency los ntshav: kev ua tau zoo ntawm ntau qhov sib txawv ntawm qhov ncauj cov sij hawm ntawm vitamin K. (Cornelissen, 1997, Eur J Pediatr)

Txoj kev tshawb no sib piv cov kev tiv thaiv sib txawv hauv 4 lub teb chaws. Cov kws sau ntawv xaus lus tias 3 koob tshuaj qhov ncauj tsis zoo dua li kev txhaj tshuaj. Tab sis nws siv yav dhau los version ntawm Konakion (uas kuj muaj phenol thiab propylene glycol). Hauv tebchaws Netherlands, ib hnub koob tshuaj 25 mcg tau siv, uas zoo li kev txhaj tshuaj.

Hauv cov kev tshawb fawb tom qab, txawm li cas los xij, nws tau pom tias ntau qhov xwm txheej ntawm VKDB tseem tau tshaj tawm hauv Netherlands ntawm cov menyuam mos uas muaj kab mob siab uas tau txais qhov ncauj vitamin K.

Denmark pib muab 1 mg rau ib lub lis piam los ntawm qhov ncauj rau 3 lub hlis, thiab qhov no txo qis qhov tshwm sim ntawm VKDB lig rau xoom.

29% ntawm qhov ncauj vitamin yog absorbed nyob rau hauv txoj hnyuv.

Cov neeg yug nyob rau lub caij ntuj sov muaj cov ntshav txhaws ntau dua li cov neeg yug thaum lub caij nplooj ntoo hlav.

9. Vitamin K prophylaxis los tiv thaiv neonatal vitamin K deficiency intracranial haemorrhage nyob rau hauv Shizuoka prefecture. (Nishiguchi, 1996, p J Obstet Gynaecol)

Hauv Nyij Pooj, qhov muaj feem cuam tshuam ntawm intracranial hemorrhage yog 1 ntawm 4,000 tus menyuam yug tshiab ua ntej siv cov vitamin K. Nyob rau hauv lub teb chaws Yelemees thiab lub tebchaws United Kingdom, qhov twg vitamin K yog siv, qhov tshwm sim ntawm hemorrhage yog 1 ntawm 30,000.

Cov menyuam mos cov ntshav txhaws tau nce siab dua thaum cov niam pub niam mis tau txais vitamin K2 (15 mg / hnub txij hnub 14 tom qab yug menyuam rau ob lub lis piam).

10. Puas yog cov menyuam mos noj mis tsis muaj vitamin K? (Greer, 2001, Adv Exp Med Biol)

Cov mis nyuj muaj vitamin K tsawg heev (~ 1 μg / L). Tab sis yog tias leej niam noj ntau dua 1 μg / kg / hnub thaum cev xeeb tub thiab lactation, qhov no nce qib ntawm cov vitamin K hauv cov mis nyuj (txog 80 μg / L) thiab hauv cov menyuam mos cov ntshav plasma. 1 ntau]

11. Vitamin K nyob rau hauv preterm peastmilk nrog niam supplementation. (Bolisetty, 1998, Acta Paediatr)

Rau tus niam laus tau txais 2.5 mg / hnub ntawm vitamin K1 ntawm qhov ncauj rau 2 lub lis piam. Tom qab thawj koob tshuaj, tus nqi ntawm cov vitamin K hauv cov mis nyuj nce los ntawm qhov nruab nrab ntawm 3 μg / L mus rau 23 μg / ml, thiab tom qab 6 hnub nws ruaj khov ntawm 64 μg / L.

12. Vitamin K1 cov ntsiab lus ntawm niam mis: cuam tshuam ntawm theem ntawm lactation, lipid muaj pes tsawg leeg, thiab cov tshuaj vitamin K1 muab rau niam. (Von Kries, 1987, Pediatr Res)

Qhov concentration ntawm vitamin K nyob rau hauv hind mis nyuj yog siab tshaj nyob rau hauv foremilk, uas tsis yog xav tsis thoob li hindmilk yog paub tias muaj roj ntau. Qhov concentration ntawm vitamin K nyob rau hauv colostrum yog siab tshaj nyob rau hauv cov mis nyuj laus thiab correlates nrog cov cholesterol.

Qhov sib ntxiv ntawm cov vitamin K rau cov niam cov khoom noj (0.5-3 mg) ua rau kom cov vitamin K concentration hauv cov mis nyuj.

13. Cov nyhuv ntawm Vitamin-K koob tshuaj rau plasma-Bilirubin qib hauv cov me nyuam mos ntxov ntxov. (Bound, 1956, Lancet)

Nyob rau xyoo 1950, cov menyuam yug tshiab tau muab cov tshuaj vitamin K2 loj (txog 90 mg). Txoj kev tshawb no pom tau hais tias ntawm cov me nyuam yug ntxov ntxov uas tau txais 30 mg ntawm vitamin K rau peb hnub, 38% muaj cov qib bilirubin siab (ntau tshaj 18 mg / 100 ml) nyob rau hnub thib tsib, thiab ntawm cov neeg tau txais 1 mg, tsuas yog 4%. muaj qib bilirubin siab. (Cov qib bilirubin siab yog jaundice neonatal.) Ntxiv: [1] [2] [3] [4]

14. Kev noj zaub mov ntau dhau hauv Prenatal thiab Neonatal Lub Neej: Ib qho teeb meem? (Cochrane, 1965, Can Med Assoc J)

Cov kev tshawb fawb tsis ntev los no tau lees paub qhov cuam tshuam ntawm cov tshuaj lom neeg ntau dhau ntawm cov vitamin K uas tau muab rau cov menyuam yug tshiab thiab cov menyuam mos ntxov ntxov. Nws kuj tseem pom tau hais tias kev nthuav qhia ntau ntawm cov vitamin K rau leej niam sai sai ua ntej yug me nyuam ua rau muaj kev nce qib ntawm bilirubin hauv cov menyuam mos. Cov tshuaj no, uas yav tas los suav hais tias tsis muaj kev phom sij, yog qhov txaus ntshai yog tias muab ntau rau cov niam ua ntej yug menyuam, ntau npaum li cov koob tshuaj me dua niaj hnub no. Ib txwm tshwm sim vitamin K tsis muaj qhov cuam tshuam no.

15. Merck thiab lwm cov tuam txhab lag luam tau tshaj tawm tias cov kab mob jaundice tuaj yeem yog cov tshuaj muaj feem xyuam. [1] [2] [3]

16. Vitamin K cov xwm txheej ntawm cov me nyuam mos ntxov ntxov: cuam tshuam rau cov lus pom zoo tam sim no. (Kumar, 2001, Pediatrics)

Cov me nyuam ntxov ntxov muaj vitamin K siab heev 2 lub lis piam tom qab txhaj tshuaj. Cov kws sau ntawv hais kom txo cov koob tshuaj rau cov menyuam mos ntxov ntxov.

17. Vitamin K prophylaxis rau cov me nyuam yug ntxov ntxov: 1 mg piv rau 0.5 mg. (Costakos, 2003, Am J Perinatol)

Hauv cov menyuam mos ntxov ntxov, qib ntawm cov vitamin K nyob rau hnub thib ob tom qab txhaj tshuaj (0.5-1 mg) yog 1900-2600 lub sijhawm siab dua li cov neeg laus li ib txwm, thiab hnub thib kaum - 550-600 npaug siab dua. Qib vitamin nyob rau hauv 0.5 mg pawg tsis txawv ntawm 1 mg pawg.

18. Plasma concentrations tom qab qhov ncauj los yog intramuscular vitamin K1 nyob rau hauv neonates. (McNinch, 1985, Arch Dis Child)

Qhov concentration ntawm vitamin K nyob rau hauv cov me nyuam mos 12 teev tom qab txhaj tshuaj yog 9000 lub sij hawm siab dua thiab tom qab 24 teev 2200 lub sij hawm siab dua li ib txwm concentration nyob rau hauv ib tug neeg laus.

Qhov concentration ntawm vitamin K 4 teev tom qab noj qhov ncauj yog 300 lub sij hawm siab dua thiab tom qab 24 teev 100 npaug ntau dua li cov concentration ib txwm nyob rau hauv ib tug neeg laus.

Cov mis nyuj muaj vitamin K ntau heev. Thaum cov menyuam mos tau muab 90 ml ntawm nyuj cov mis nyuj rau thawj 48 teev 40 xyoo dhau los, qhov no txo qhov tshwm sim ntawm 0.8% mus rau zero.

Nws tshaj tawm tias cov ntshav txhaws hauv cov menyuam mos yog nyob ntawm qhov koob tshuaj ntawm cov kua mis hauv thawj hnub ntawm lub neej. Cov neeg uas tau txais ntau tshaj 100 ml ntawm mis nyuj ib hnub nyob rau hnub 3 thiab 4 muaj ntau ntau dua li cov uas tau txais tsawg dua 100 ml / hnub hauv thawj 4 hnub. Ntxiv: [1] Ntawm no tau tshaj tawm tias cov menyuam mos uas tau noj tam sim tom qab yug me nyuam muaj cov ntshav txhaws ntau dua li cov menyuam mos uas tau noj 24 teev tom qab yug menyuam.

19. Menyuam mos mob qog noj ntshav, intramuscular vitamin K, thiab pethidine muab thaum cev xeeb tub. (Golding, 1992, BMJ)

Ntawm cov neeg uas tau txais kev txhaj tshuaj intramuscular ntawm vitamin K, qhov kev pheej hmoo ntawm mob qog noj ntshav yog 2 zaug siab dua. Ib qho txiaj ntsig zoo sib xws tau txais hauv lwm txoj kev tshawb fawb los ntawm tib tus kws sau ntawv.

Ntawd yog, tiv thaiv 30-60 tus neeg mob hemorrhagic yuav ua rau 980 tus neeg mob qog noj ntshav ntxiv.

Nws ib txwm zoo li qhov tsis zoo ntawm lub cev uas hloov pauv tau tso cai rau cov vitamin K tsis muaj peev xwm txhim kho hauv cov menyuam mos noj mis, uas ua rau muaj kev pheej hmoo ntawm cov kab mob hemorrhagic tsawg. Qhov feem ntau yuav piav qhia rau qhov tshwm sim no yog tias muaj qee qhov kev hloov pauv tau zoo uas ntau dua qhov kev pheej hmoo no.

Nws yog qhov ua tau tias tus txheeb ze tsis txaus ntawm cov vitamin K nyob rau theem tseem ceeb ntawm kev loj hlob sai tuaj yeem tiv thaiv cov ntaub so ntswg los ntawm mutagenesis.

20. Kev tswj xyuas cov ntaub ntawv ntawm kev sib raug zoo ntawm kev mob qog noj ntshav me nyuam yaus thiab kev tswj hwm vitamin K. (Passmore, 1998, BMJ)

Cov me nyuam mos uas tsis muaj kev pheej hmoo los ntshav muaj 1 ntawm 10,000 txoj kev los ntshav. Ntawm cov neeg uas tau txhaj tshuaj, txoj kev los ntshav yog 1 ntawm ib lab.

Hauv txoj kev tshawb no, mob qog noj ntshav (feem ntau yog leukemia) yog txuam nrog kev txhaj tshuaj intramuscular ntawm vitamin K (OR = 1.44, CI: 1.00-2.08). Cov menyuam yaus uas raug kuaj pom ua ntej hnub nyoog 12 lub hlis raug cais tawm ntawm txoj kev tshawb no.

Muaj ob peb lwm txoj kev tshawb fawb uas tsis tau pom muaj kev sib raug zoo ntawm kev txhaj tshuaj thiab muaj kev pheej hmoo ntawm mob qog noj ntshav. Txoj kev tshawb no tsis pom muaj kev sib raug zoo ntawm kev txhaj tshuaj thiab mob qog noj ntshav, tab sis tau pom muaj kev sib raug zoo nrog cov qog ntshav qog ntshav qog ntshav siab txog li 6 xyoo (OR = 1.79).

Tam sim no, nws ntseeg tau tias tsis muaj kev sib txuas ntawm kev txhaj tshuaj vitamin K thiab mob qog noj ntshav. Txawm li cas los xij, tsis muaj qhov kev sim randomized tau ua, thiab qhov nce me me ntawm kev pheej hmoo tsis tuaj yeem txiav tawm.

Cov kws sau ntawv ntseeg tias kev txhaj tshuaj tsuas yog siv rau cov menyuam mos uas muaj kev pheej hmoo.

21. Vitamin K thiab mob qog noj ntshav thaum yau: kev tshuaj xyuas ntawm tus neeg mob cov ntaub ntawv los ntawm rau qhov kev tshawb fawb txog kev tswj xyuas. (Roman, 2002, p J Cancer)

Cov kws sau ntawv tau tshuaj xyuas 6 cov kev tshawb fawb txog kev sib raug zoo ntawm kev txhaj tshuaj vitamin K thiab mob qog noj ntshav, thiab xaus lus tias yog tias koj txheeb xyuas cov ntaub ntawv hauv ib txoj kev, ces tsis muaj kev sib raug zoo ntawm kev pheej hmoo ntawm leukemia thiab txhaj tshuaj, thiab yog tias lwm yam, ces muaj me me. Association (OR = 1.21, CI: 1.02-1.44) … Thaum ib qho kev tshawb fawb raug cais tawm ntawm kev tshuaj ntsuam, qhov tseem ceeb ntawm cov ntaub ntawv tau ploj mus (OR = 1.16, CI: 0.97-1.39)).

Cov kws sau ntawv xaus lus tias txawm tias cov teebmeem me me tsis tuaj yeem txiav txim siab, tsis muaj pov thawj tseeb tias kev txhaj tshuaj vitamin K cuam tshuam nrog leukemia.

22. Kev sim tshuaj vitamin K tsis txaus thiab qhov tshwm sim ntawm metastases. (Hilgard, 1977, p J Cancer)

Cov nas mob qog noj ntshav uas tau txo qis cov vitamin K qib tau txo qis metastases ntau dua li cov nas tswj. Nws yog qib ntawm vitamin K uas cuam tshuam metastases, thiab tsis yog ntshav coagulation, vim hais tias anticoagulants tsis cuam tshuam rau tus naj npawb ntawm metastases.

23. Kev soj ntsuam ntawm qhov tsis muaj vitamin K hauv tus menyuam hauv plab thiab tus menyuam yug tshiab: Dab tsi tau ua yuam kev? (Israel, 1995, Semin Thromb Hemost)

Hauv fetuses ntawm cov tsiaj nyeg thiab hauv avian embryos, vitamin K qib qis dua li cov neeg laus. Nws tsis paub meej tias yog vim li cas tus menyuam mos ib txwm nkag mus rau lub ntiaj teb sab nraud hauv lub xeev uas yuav tsum tau muaj kev cuam tshuam tam sim ntawd. Cov lus nug vim li cas txawm tias cov neeg laus tsis muaj cov khw muag vitamin K ntau dhau los kuj tseem tsis tau teb.

Benzapirene yog nas carcinogen. Hauv cov nas ntawm cov khoom noj uas tsis muaj vitamin K, cov qog tom qab noj cov tshuaj no tau tsim qeeb qeeb dua li cov nas ntawm kev noj zaub mov zoo.

Hauv cov nas uas tau txhaj tshuaj vitamin K ntxiv rau benzopyrene, cov qog tsim sai dua.

Thaum cov nas tau txhaj tshuaj vitamin K ib leeg, tsis muaj benzopyrene, cov qog tsis tsim.

Cov kws sau ntawv qhia tias cov vitamin K tsawg hauv tus me nyuam hauv plab yog ib qho kev tiv thaiv theem nrab tiv thaiv xenobiotics uas hla cov placenta.

24. Vim li cas peb thiaj xav tau kev sim tshuaj rau cov vitamin K. (Slattery, 1994, BMJ)

Kev pheej hmoo ntawm cov kab mob hemorrhagic yog nce los ntawm cov txheej txheem phais, asphyxia thaum lub sij hawm ua hauj lwm, kev ua hauj lwm ntev, muaj protein ntau nyob rau hauv cov zis ntawm leej niam thiab kab mob siab B.

Vitamin K tau muab rau cov menyuam yaus thaum yug los, tab sis peb tseem tsis paub tias nws ua rau muaj kev pheej hmoo loj. Txawm hais tias vitamin K tau siv rau 30 xyoo, thawj txoj kev tshawb fawb ntawm nws cov teebmeem mus ntev tsis tau luam tawm txog xyoo 1992. Txij li thaum cov tshuaj tau muab rau ntau tus neeg, txawm tias muaj kev pheej hmoo me me tuaj yeem ua rau muaj kev phiv ntau. Yog li ntawd, nws yog ib qho tseem ceeb los tsim kom muaj kev puas tsuaj ntawm kev tiv thaiv. Tsuas yog ib qho kev tshawb fawb loj loj ntawm cov menyuam yaus uas muaj feem pheej hmoo ntawm cov kab mob hemorrhagic, ntawm ib pab neeg yuav tau txais vitamin K thiab lwm tus yuav tsis tuaj yeem teb cov lus nug no.

25. CDC tshaj tawm tias txhua tus menyuam mos yug tshiab tsis muaj vitamin K thiab qhov kev txhaj tshuaj tsis zoo tag nrho. Benzyl cawv yog siv los ua cov tshuaj tua kab mob, uas tseem muaj kev nyab xeeb thiab siv ntau yam tshuaj. Muaj tseeb, lawv sau, nyob rau xyoo 80s lawv pom tias cov me nyuam ntxov ntxov tuaj yeem mob los ntawm benzyl cawv, vim muaj ntau yam tshuaj muaj xws li tshuaj tua kab mob. Tab sis txawm tias qhov tseeb tias muaj toxicity tsuas yog pom nyob rau hauv cov me nyuam ntxov ntxov xwb, txij li thaum cov kws kho mob tau sim txo cov benzyl cawv hauv cov tshuaj uas lawv muab rau cov me nyuam mos. Thiab nws yog qhov nkag siab, lawv sau (txawm hais tias lawv tsis hais qhov twg los), tias cov tshuaj benzyl cawv hauv kev txhaj tshuaj tsawg heev uas nws muaj kev nyab xeeb.

26. Cov koob tshuaj ib nrab ntawm benzyl cawv rau cov nas yog 0.48 g / kg. (Cov ethyl cawv tsis tu ncua yog 4 npaug tsawg dua tshuaj lom tshaj li benzyl cawv).

Nyob rau hauv tag nrho, cov tshuaj ampoule (los ntawm Hospira) muaj 9 mg ntawm benzyl cawv ib 2 mg ntawm vitamin K. Ntawd yog, kwv yees li 0.7% ntawm cov koob tshuaj ib nrab rau tus menyuam yug tshiab (3 mg / kg).

Wikipedia tshaj tawm tias:

1) benzyl cawv yog tshuaj lom heev rau qhov muag. Ntshiab benzyl cawv ua rau corneal necrosis.

2) benzyl cawv yog tshuaj lom rau cov menyuam mos, nws ua rau gasping syndrome.

Gasping syndrome yog ib yam kab mob uas tsis muaj lawm. Nws yog tshwm sim los ntawm qhov tseeb tias daim tawv nqaij ntawm cov me nyuam yug los txog rau thaum xyoo 1980s tau rubbed nrog benzyl cawv, los ntawm qee qhov pib choke thiab tuag. Cov koob tshuaj benzyl cawv rau kev txhim kho tus kab mob no yog 99 mg / kg.

Benzyl cawv tau paub tias muaj tshuaj lom tsawg kawg thaum xyoo 1970s. Qhov no tsis tiv thaiv nws los ntawm kev siv yam tsis muaj kev txwv rau cov menyuam yug ntxov ntxov txog thaum ntxov 80s, thaum nws tau raug pov thawj tias muaj tshuaj lom tsis yog rau cov dev xwb, tab sis kuj rau cov menyuam mos. Tab sis txawm tias qhov no tsis txwv nws txoj kev siv tshuaj, uas tau muab rau thawj hnub tom qab yug me nyuam.

27. Amphastar tso tawm vitamin K yam tsis muaj benzyl cawv. Nyob rau ntawd, propylene glycol yog siv los ua ib qho tshuaj tiv thaiv. Propylene glycol kuj tseem siv los ua cov tshuaj tiv thaiv kab mob thiab cov dej nres, tuaj yeem ua rau lub raum tsis ua haujlwm, thiab yog cov tshuaj neurotoxin.

28. Amphastar kuj ntxiv polysorbate 80 rau vitamin K. Ntxiv mus, nws muaj 10 mg ntawm polysorbate 80, uas yog 200 npaug ntau dua hauv Gardasil. (Kanavit kuj muaj polysorbate 80.)

Konakion MM tsis muaj benzyl cawv, propylene glycol lossis polysorbate 80.

29. Hospira qhia tias kev noj cov tshuaj vitamin tuaj yeem ua rau tuag taus. Qhov tshwm sim hnyav thiab tuag tau raug pom los ntawm kev txhaj tshuaj intramuscular. Nws kuj tau tshaj tawm tias cov tshuaj muaj cov khoom siv txhuas, uas tuaj yeem ua rau muaj tshuaj lom.

30. Anaphylactic shock vim vitamin K nyob rau hauv ib tug me nyuam mos thiab tshuaj xyuas cov ntaub ntawv. (Koklu, 2014, J Matern Fetal Neonatal Med)

Cov menyuam mos yug los nrog lub cev tsis muaj zog hauv lub cev. Vim tias lawv lub cev tiv thaiv kab mob tsis muaj zog dua li cov neeg laus, lawv tsis tshua muaj peev xwm tsim cov tshuaj tiv thaiv anaphylactic. Lub peev xwm ntawm kev tsim ntawm anaphylaxis hauv cov menyuam yug tshiab tseem tsis tau paub meej.

Ntawm no yog thawj kis ntawm anaphylactic poob siab vim kev txhaj tshuaj vitamin K Ntxiv: [1]

31. Nicolau Syndrome yog gangrenous dermatitis tshwm sim los ntawm ntau yam tshuaj. Kev txhaj tshuaj vitamin K kuj tuaj yeem ua rau nws qee zaus.

Tus kab mob Texier yog ib qho pseudo-sclerodermal cov tshuaj tiv thaiv uas tshwm sim tsis tshua muaj tom qab txhaj tshuaj vitamin K thiab kav ntev li ob peb xyoos.

32. Qee lub sij hawm nws tshwm sim tias hloov cov vitamin K, tus me nyuam mos raug txhaj tshuaj methylergometrine. Nws yog psychedelic alkaloid uas yog siv los tiv thaiv los ntshav tom qab yug menyuam. Nws tsis meej pem nrog vitamin K vim tias lawv muaj cov ampoules zoo sib xws. Ntawm cov me nyuam yaus uas tau txais los ntawm qhov ncauj, tag nrho cov ciaj sia. Thiab ntawm cov neeg uas tau txais kev txhaj tshuaj, qhov kev tuag yog 7.5%. [1] [2] [3] [4] [5] [6] [7]

33. Txog rau xyoo 1999, nws ntseeg tias cov menyuam yaus pib mob thaum muaj hnub nyoog 12 hli.

34. Puas muaj qhov mob mus sij hawm ntev hauv cov me nyuam mos los yog me nyuam mos heev? (Page, 2004, J Perinat Educ)

Tau ntau xyoo, cov kws kho mob hauv Tebchaws Meskas tsis pom qhov mob ntawm cov menyuam mos yog qhov txaus ntshai lossis qhov tsis zoo ntawm kev txiav txim siab kho mob. Kev soj ntsuam sab saum toj tau pom tias cov tshuaj txo qhov mob muaj qee qhov kev pheej hmoo, thiab cov me nyuam zoo li tsis nco qab txog qhov mob lawm. Tom qab tag nrho, yog tias tus neeg mob tsis rov qab los nrog kev tsis txaus siab ntawm qhov mob, dab tsi tuaj yeem yog qhov tseem ceeb hauv nws?

Txawm li cas los xij, cov kev tshawb fawb hauv xyoo 1990 tau pom tias qhov mob tshwm sim hauv menyuam yaus muaj qhov tshwm sim ntev. Piv txwv li, cov menyuam mos uas tsis muaj lidocaine ointment raug mob ntau dua thaum txhaj tshuaj tiv thaiv ntau dua li cov menyuam mos uas tau txiav nrog lidocaine, uas dhau los raug kev txom nyem ntau dua li cov menyuam mos uas tsis tau txiav.

Cov menyuam yug tshiab nas, uas tau sib cais los ntawm lawv niam rau qee lub sijhawm, tau pom tias muaj kev tiv thaiv kab mob thiab muaj kev cuam tshuam rau metastases.

Hauv cov menyuam nas uas tau txhaj tshuaj endotoxin hauv cov menyuam mos, thaum muaj hnub nyoog laus, muaj qhov ua rau muaj kev ntxhov siab ntau ntxiv, ua rau muaj kev cuam tshuam rau metastases, thiab ncua lub qhov txhab kho, uas qhia tias tsis muaj peev xwm tsim tau cov lus teb.

Pups uas raug mob los ntawm kev sib tsoo hauv lub paw qhia tias mob rhiab heev thaum lub hnub nyoog hluas. Thaum muaj hnub nyoog laus, lawv tau pom muaj kev ntxhov siab loj, kev sib raug zoo hypervigilance, thiab lawv tau pom tias muaj kev xav haus cawv.

Cov menyuam mos uas yug ntxov ntxov (uas tau ua tiav cov txheej txheem kho mob hnyav dua li cov uas yug los ntawm lub sijhawm) tau txo qis qhov mob.

Hauv cov menyuam mos uas muaj ntau qhov kev raug mob thaum yug, qhov kev pheej hmoo ntawm kev tua tus kheej yog 4.9 npaug siab dua rau cov txiv neej thiab 4% siab dua rau cov poj niam. Tab sis yog tias leej niam tau txais tshuaj opioids thaum yug me nyuam, qhov kev pheej hmoo ntawm kev tua tus kheej yog 31% qis dua rau ob leeg poj niam txiv neej, piv rau cov yug tsis muaj kev raug mob.

Cov kws sau ntawv xaus lus tias txawm hais tias tib neeg tsis nco qab cov xwm txheej mob thaum ntxov, lawv raug kaw rau qhov chaw hauv lub cev. Cov txheej txheem kho mob ntau tus menyuam mos dhau los, los ntawm kev txhaj tshuaj pob taws mus rau kev txiav, tuaj yeem hloov pauv tus menyuam txoj kev loj hlob. Kev mob thaum yau yuav tsum zam kom tsis txhob mob thaum twg los tau thiab, yog tias tsim nyog, kho kom zoo zoo ib yam li cov neeg laus mob. Cov kws kho mob thiab cov niam txiv yuav tsum paub tias qhov mob yuav tsum tau muab ntxiv rau hauv daim ntawv teev kev pheej hmoo txhawm rau txiav txim siab txog kev kho mob thiab pom zoo rau cov txheej txheem uas tus menyuam mos raug. Qhov kev txiav txim siab no tsis yog ib feem ntawm cov qauv kev txiav txim siab ib txwm muaj rau cov kws kho mob feem ntau.

35. Iatrogenic mob nyob rau hauv cov me nyuam mos yog ib qho kev pheej hmoo rau cov mob ntev. (Reshetnyak, 2017, Lavxias Journal of Pain)

Kev mob tshwm sim ntau zaus hauv cov menyuam mos, tshwj xeeb tshaj yog cov menyuam mos ntxov ntxov, ua rau lub hauv paus rhiab heev ntawm cov chaw ntawm lub paj hlwb cortex uas ua rau cov thawj coj ntawm cov neuromatrix ntawm qhov mob thiab yog lub luag haujlwm rau kev hnov lus, kev xav thiab kev paub txog qhov mob. Central rhiab heev thiab dysfunction ntawm lub tshuab uas tswj qhov mob rhiab heev yog paub tias yuav ua rau cov tsim ntawm mob mob syndromes.

36. Ncua qaum clamping nyob rau hauv cov me nyuam mos ua ntej heev txo qhov tshwm sim ntawm intraventricular hemorrhage thiab lig-pib sepsis: ib tug randomized, tswj mus sib hais. (Mercer, 2006, Pediatrics)

Yog tias koj tsis txiav txoj hlab ntaws tam sim tom qab yug me nyuam, tab sis tos tsawg kawg 30-40 vib nas this, ces qhov kev pheej hmoo ntawm intraventricular hemorrhage thiab sepsis yuav txo qis.

37.peastmilk, PCBs, dioxins thiab vitamin K deficiency: daim ntawv sib tham. (Koppe, 1989, J R Soc Med)

Daim ntawv lig ntawm cov kab mob hemorrhagic neonatal yog ib yam kab mob tshiab uas tau piav qhia hauv 1985 thiab pom tsuas yog hauv cov menyuam yaus uas muaj kab mob siab B tshwj xeeb. Cov mis nyuj hauv cov teb chaws uas muaj kev lag luam muaj cov kab mob polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs) thiab polychlorinated dibenzofurans (PCDFs).

Xenobiotics tau pom nyob rau hauv cov mis nyuj ntawm cov niam Dutch, tab sis lawv tsis yog nyob rau hauv cov mis nyuj ntawm ib tug poj niam uas nyuam qhuav immigrated los ntawm Suriname. Nyob rau hauv ib tug poj niam uas immigrated los ntawm Suriname 15 xyoo dhau los, xenobiotics kuj tau pom.

PCBs, PCDDs thiab PCDFs paub tias ua rau lub siab loj, lub sijhawm ua kom cov ntshav txhaws, lub siab cirrhosis, thiab lwm yam. Cov tsos mob ntawm cov menyuam mos uas leej niam raug tshuaj lom nrog cov tshuaj no suav nrog kev loj hlob stunted, me me ncig lub taub hau, hirsutism, thiab lwm yam. mis nyuj uas muaj PCBs tau ntsib, ntawm lwm tus, qaug zog, anorekia, mob plab, ntuav thiab eczema. Cov rog rog, pancreatic atrophy, thiab plab hnyuv hemorrhage tau pom nyob rau hauv cov liab tom qab noj ntau heev. Ntau lab tus menyuam qaib uas tuag los ntawm cov zaub mov tsis huv tau los ntshav subepicardial. Hauv cov nas, cleft palate, los ntshav, thiab subcutaneous edema raug pom.

Cov kws sau ntawv tau sim cov tshuaj dioxins hauv cov kua mis ntawm 14 leej niam. Cov niam ntawm 4 tus menyuam mos uas los ntshav tau muaj cov tshuaj dioxin ntau dua li kaum leej niam. Cov kws sau ntawv ntseeg tias tej zaum muaj kev sib raug zoo ntawm PCBs, dioxins thiab furans hauv cov kua mis thiab cov kab mob lig hemorrhagic. Cov xenobiotics no kuj tseem muaj feem cuam tshuam nrog rau lub sijhawm ntev ntawm cov menyuam yug tshiab jaundice. Ntau: [1] [2]

38. Yog vim li cas rau qhov tsis kam ntawm cov me nyuam mos vitamin K prophylaxis: cuam tshuam rau kev tswj thiab kev kawm.(Hamrick, 2016, Hosp Pediatr)

Ntawm cov niam txiv uas tsis kam txais cov tshuaj vitamin K, feem ntau yog dawb (78%), tshaj 30 (57%), thiab nrog kev kawm keeb kwm (65%). Lawv feem ntau kuj tsis kam txhaj tshuaj tiv thaiv kab mob siab B thiab erythromycin tshuaj pleev rau qhov muag. Lawv feem ntau tau txais lawv cov ntaub ntawv los ntawm Is Taws Nem thiab txhawj xeeb txog cov khoom xyaw hluavtaws thiab tshuaj lom, tshuaj ntau dhau, thiab cov kev mob tshwm sim.

67% ntawm lawv tau paub txog qhov txaus ntshai ntawm kev tsis lees paub, tab sis feem ntau tsis nkag siab txog qhov txaus ntshai ntawm kev los ntshav, tshwj xeeb tshaj yog qhov muaj feem cuam tshuam ntawm intracranial hemorrhage thiab tuag.

Hauv tsev kho mob, qhov chaw muaj vitamin K hauv qhov ncauj, qhov kev txhaj tshuaj tsis kam yog siab dua.

Cov kws sau ntawv txiav txim siab tias cov ntaub ntawv online cov niam txiv tso siab rau feem ntau tsis tau txais kev txhawb nqa los ntawm cov phooj ywg txheeb xyuas cov ntaub ntawv tshawb fawb thiab txhawb nqa kev yug me nyuam yam tsis muaj kev kho mob. Qhov tseem ceeb tshaj plaws, cov kws sau ntawv sau, yog tias cov teeb meem tshwj xeeb uas tau hais hauv cov vev xaib hauv Is Taws Nem tsis raug cuam tshuam los ntawm cov kws kho mob hauv lawv cov kev sib tham nrog niam.