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a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > h2{}.products_52_wrapper li p{}.mobiles_sidebar{}.foot_contact:before{}.index_sub_title a{}.other_184_right{}.HJZF_contact_inquiry{}.hj_navbar_nav > li > a > h2:before{}.nav_li.on>a h2{}.container-fluid{}.other_184_right{}.other_184_right>.index_sub_title{}#news-44_1891 > section > div > div > div > ul > li > div > div.index_text{}.other_184_right>.con{}.other_184_pagination{}.banner_27_zyzfw{}#aboutus-23_1891 > section > div > div > div > ul > li:nth-child(4){}.main_page{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(2) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(3) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(2):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(4).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(4):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(5).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(5):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(6).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(6):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(7).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(7):hover a{}.HJZF_Z__inner_product_categroy5 ul 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img{}.runlin_banner{}.runlin_banner_left{}.runlin_banner_right{}.runliin_top_email{}.runlin_email.first{}.runlin_des + .more{}.runlin_left li{}.runlin_yiji > span h3{}.submit_runlin_search{}.nav_drop{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > div.runlin_des > b{}.hjzf2_z_products_list_left a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{flex:0 0 100%}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > 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section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, 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氨溴索:祛痰,我是认真的
  2024/01/29| 阅读次数:1695

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最近气温起起伏伏,不少人接连中招流感、新冠,进入恢复阶段还一直咳嗽有痰,咳不出又咳不尽。


PART.1

这些痰液是哪来的?




在正常情况下,气道黏膜每天会产生50-100ml分泌物,来保持气道粘膜的湿润,吸附进入气管的空气里的极细小尘埃微粒和一些病菌等异物,防止肺部受到伤害;当呼吸道出现细菌、病毒、真菌等微生物感染时,气道粘液分泌物过多,就形成了痰液。


在通常情况下我们很少咳出痰液,大部分的痰液会在我们无意识的情况下经过咽部,经吞咽进入胃内。


当呼吸系统受到病菌的感染,呼吸道会分泌更多的黏液来包围异物和病菌,此时患者的痰会增多,其黏稠度也会增加,甚至出现脓性痰液。这时候这些痰液会刺激咽喉部引起咳嗽,之后经口咳出。


而咳出来的痰液不仅包括气道分泌的黏液、空气中的颗粒、细菌、病毒,还包括吞噬有害颗粒的巨噬细胞、炎性细胞及衰老的呼吸道上皮细胞等,所以咳痰的过程就是身体主动排出有害物质的过程。


PART.2

咳不出来可能加重病情




咳痰对于人体来说是一种保护机制。如果我们一直不咳出来,让痰停留在肺部,其中的细菌有可能刺激支气管和肺部,导致粘液增多,纤毛柱状上皮负担加重,这时候的环境更容易滋生细菌。


像手术后的病人、长期卧床的人以及儿童,积极帮助他们排痰可是一项非常重要的护理工作,如果痰液排不出去,停留在呼吸道里,可能会引起:


  • 气道阻塞,导致低氧血症和高碳酸血症,严重的会导致呼吸衰竭;

  • 加重肺部病理改变或继发新的感染,与炎症、阻塞形成恶性循环;

  • 持续刺激气道,加重咳嗽。





一般情况下,痰液的排出是通过气管黏膜的纤毛运动和咳嗽来完成的。但是发生炎症时,痰液的黏稠度大为增加,如果自身不能很好地把痰液排出、咳嗽不止,此时就需要药物来帮助稀释痰液、促进排出。


PART.3

氨溴索是怎么祛痰的?



氨溴索(临床上常用其盐酸盐,即盐酸氨溴索)是临床上应用较为广泛的一类祛痰药物。


氨溴索临床可用于急、慢性支气管炎及支气管哮喘、支气管扩张、肺气肿、肺结核、肺尘埃沉着病、手术后的咳嗽困难等。常规给药途径为口服及静脉给药,常见剂型为片剂、口服溶液剂、注射剂等。


上市至今,其有效性和安全性经过大量的循证医学研究及临床实践的验证,获得了临床医生的广泛认可,并使无数患者从中获益。



它的药理机制主要在以下5个方面——


01

黏痰的稀释与排出

痰液黏度主要是由酸性糖蛋白决定,氨溴索能够裂解糖蛋白中的多糖纤维,并作用于呼吸道分泌细胞,抑制酸性蛋白合成,增加浆液分泌,使痰液变稀薄易于排出。大剂量的氨溴索还能够增加呼吸道上皮的恢复,促进呼吸道纤毛上皮运动,降低黏痰对呼吸道壁的黏附,使痰液容易被排出,保持气道通畅。

02

抗炎及抗氧化作用

氨溴索有较显著的抗炎作用,可通过多种机制抑制机体的炎症反应,对多种参与炎症的细胞均有影响,如肺泡巨噬细胞、白细胞、气道上皮细胞。


03

促进肺表面活性物质(PS)的合成和释放

PS是肺泡Ⅱ型细胞产生的磷脂蛋白复合物,其生理功能主要有:维持肺的功能、参与肺的防御功能、维持小气道稳定,还利于修复支气管上皮,改善支气管黏液纤毛系统的运输功能,有助于分泌物的排出。氨溴索能促进内源性PS的生物合成与释放,从而改善肺功能,缩短病程,使损伤的肺组织得到较快恢复。


04

对病原体的抑制作用

氨溴索可以抑制铜绿假单胞菌、大肠埃希菌等的黏附作用,可以减少生物膜下的活菌数,增加抗生素对生物膜的渗透,从而协同抗生素杀灭细菌。还对甲型流感病毒的感染有一定保护作用。它通过增加呼吸道的内源性蛋白酶抑制物水平,可提高气道分泌物中IgA和IgG浓度,抑制病毒的增殖。


05

提高抗菌药物在肺组织中的浓度

有不少文献报道,氨溴索可以直接提高抗菌药物在肺组织中的浓度,起到协同杀菌作用。例如头孢哌酮、红霉素、头孢克肟等。


参考文献:

[1] 中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2021)[J].中华结核和呼吸杂志,2022,45(01):13-46.

[2]Global Burden of Disease Long COVID Collaborators. Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA. 2022;328(16):1604–1615. doi:10.1001/jama.2022.18931

[3] 陈星,罗征秀,沈照波,严永东,张建华,周亚兵.儿童祛痰止咳治疗专家共识[J].中国实用儿科杂志, 2022,37(08):567-574.DOI:10.19538/j.ek2022080602.

[4] 中华医学会儿科学分会临床药理学组,国家儿童健康与疾病临床医学研究中心,中华医学会儿科学分会呼吸学组,中国医师协会儿科医师分会儿童呼吸专业委员会,中华儿科杂志编辑委员会.中国儿童咳嗽诊断与治疗临床实践指南(2021版)[J].中华儿科杂志,2021,59(09):720-729.

[4] 张琼.盐酸氨溴索的药理和临床分析[J].中国实用医药,2009,4 (35):111-112.

[5] 姜素伟,朱茜.浅淡氨溴索在儿科呼吸系统的临床运用[J].临床肺科杂志,2008,13(9):1231.


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