I-hypnosis yisimo sokuqaphela esishintshile lapho umuntu ezwa khona izinga eliphezulu lokugxila nokunaka, amukele iziphakamiso, kanye nokuncipha kokuqaphela okubucayi. Ama-hypnotics yizinto ezingadala lesi simo sokuluthwa ingqondo futhi zisetshenziswa ezimweni zokwelapha, njengokwelapha ukuphazamiseka kokulala, ukukhathazeka, nobuhlungu obungapheli. Kunezinhlobo ezahlukene ze-hypnotics, njenge-benzodiazepines, barbiturates, ne-non-benzodiazepine hypnotics, ngayinye enezici zayo kanye nemiphumela ethile. Kulesi sihloko, sizohlola izici, izinhlobo, kanye nemiphumela ye-hypnotics ngokujula okwengeziwe.
Imiphumela eyinhloko ye-hypnotics: thola imithelela evamile yale mithi.
I-hypnotics imithi esetshenziselwa ukuyenga ukulala nokwelapha ukuphazamiseka kokulala njengokuqwasha. Nokho, kubalulekile ukuqaphela imiphumela engemihle eyinhloko le mithi engayibangela.
Omunye wemiphumela eyinhloko ye-hypnotics ukozela kwasemini, okungaphazamisa ukugxila nokusebenza emisebenzini yansuku zonke. Ukwengeza, le mithi ingabangela isiyezi, i-vertigo, nokudideka. em abanye abantu.
Omunye umphumela ovamile we-hypnotics ukuncika, ikakhulukazi uma kusetshenziswa isikhathi eside. Lokhu kungaholela ku à ubunzima bokulala ngaphandle kosizo lwemithi kanye nezimpawu zokuhoxiswa lapho imithi iyekwa.
Ukwengeza, i-hypnotics ingabangela imiphumela emibi yesisu njengesicanucanu, ukuhlanza, nesifo sohudo. Ezinye iziguli nazo zibika umlomo owomile kanye nezinguquko ekunambithekeni ngemva kokuthatha le mithi.
Kubalulekile ukuthi uhlale ulandela izincomo zikadokotela wakho futhi ungeqi umthamo onqunyiwe ukuze ugweme imiphumela emibi kakhulu. Uma uhlangabezana nanoma yiziphi izimpawu ezimbi, kubalulekile ukufuna usizo lwezokwelapha ngokushesha.
Qonda ukuthi uyini umphumela we-hypnotic nokuthi usebenza kanjani ngamafuphi.
Umthelela we-hypnotic yisimo sokwazi esishintshile lapho umuntu eba osikisela kakhulu futhi eyamukele kakhudlwana imiyalo neziphakamiso. Phakathi ne-hypnosis, umuntu ungena esimweni sokuphumula okujulile, lapho ingqondo enengqondo ihlehlela ngemuva futhi ingqondo engaphansi kwengqondo ifinyeleleka kalula. Lokhu kuvumela i-hypnotist ukuthi ibe nomthelela emicabangweni yomuntu, indlela yokuziphatha nemizwa yakhe.
Kunezinhlobo ezahlukene ze-hypnosis, njenge-hypnosis yakudala, i-Ericksonian hypnosis, kanye nokuluthwa esiteji. Uhlobo ngalunye lunamasu athile, kodwa wonke ahlose ukunxenxa isimo se-hypnotic trance kumuntu.
Imiphumela ye-hypnosis ingahluka kumuntu nomuntu, kodwa ngokuvamile ihlanganisa ukuphumula okujulile, ukugxila okukhulayo, ubuhlungu obuncishisiwe, nezinguquko zokuziphatha. I-hypnosis ingase isetshenziselwe ukwelapha izimo ezihlukahlukene, njengokukhathazeka, ama-phobias, ukulutheka, nokuphazamiseka kokulala.
Izinhlobo zama-sedatives: funda ngezinketho ezahlukene zokuphumula nokulala kahle.
Ama-sedative yimithi ekhuthaza ukuphumula futhi ebangela ukulala. Kunezinhlobo ezimbalwa zamaphilisi okulalisa umzimba atholakalayo emakethe, ngalinye linezici ezithile nezindlela ezihlukene zokwenza emzimbeni.
Enye yezinhlobo ezivame kakhulu zokulalisa i-hypnotics. Ama-hypnotics yizinto ezisebenza ngokuqondile ohlelweni lwezinzwa olumaphakathi, ezikhuthaza ukungeniswa kokulala nokwandisa isikhathi sazo. Ngokuyinhloko zisetshenziselwa ukwelapha ukuphazamiseka kokulala njengokuqwasha.
Kunezinhlobo ezahlukene ze-hypnotics ezitholakalayo, ezivame kakhulu ama-benzodiazepines, ama-barbiturates, ne-zolpidem. Ngayinye yalezi zinhlobo ze-hypnotics inezici ezithile futhi ingaba nemiphumela ehlukene emzimbeni.
I-Benzodiazepines, isibonelo, iyaziwa ngemiphumela yayo yokudambisa, i-anxiolytic, ne-muscle-relaxing. Basebenza ngokuthuthukisa ukusebenza kwe-neurotransmitter GABA, okuholela kumphumela wokuzola nokuphumula.
Ngakolunye uhlangothi, ama-barbiturates angamaphilisi anemiphumela egqama kakhulu futhi angasetshenziswa ukwelapha ukuphazamiseka kokulala okunzima. Kodwa-ke, banamandla amakhulu okuba umlutha kanye nemiphumela engemihle, futhi ngokuvamile banqunywe ngokuqapha.
I-Zolpidem, ngakolunye uhlangothi, iyi-hypnotic esebenza ngokushesha, esebenza kafushane, ekhonjiswe ukwelashwa kwesikhashana kokuqwasha. Isebenza ngokukhetha kakhulu kuma-receptors e-GABA, ikhuthaza ukungeniswa kokulala okusebenzayo.
Kodwa-ke, kubalulekile ukuthi uhlale uthintana nodokotela ngaphambi kokuqala noma yiluphi uhlobo lwe-sedative ukuze uqinisekise ukuphepha nokusebenza kokwelashwa.
Iyiphi into enamandla kakhulu yokulutha etholakala manje emakethe yezemithi?
I-hypnotics imithi esetshenziselwa ukuyenga ukulala nokwelapha ukuphazamiseka kokulala njengokuqwasha. Kukhona izinto ezimbalwa zokulutha ezitholakala emakethe yezemithi, ngayinye inezici zayo kanye nemiphumela.
Phakathi kwama-hypnotics atholakalayo, enye yezinto ezinamandla kakhulu i-zolpidem, okuvame ukunqunywa ukuqwasha okukhulu. I-Zolpidem isebenza ngokushesha emzimbeni, isiza ukukhuthaza ukulala. Nokho, kubalulekile ukugcizelela ukuthi lo muthi kufanele usetshenziswe kuphela ngaphansi kokuqondisa kwezokwelapha, njengoba ungabangela ukuncika kanye nemiphumela engemihle.
Ngaphezu kwe-zolpidem, kunezinye i-hypnotics emakethe, njenge i-lorazepam, noma diazepam futhi i zopiclona, ngayinye inezici zayo namandla ayo. Kubalulekile ukubonana nodokotela ngaphambi kokuqala noma iyiphi i-hypnotic treatment ukuze uqinisekise ukuthi into oyikhethile ifaneleka kakhulu esimweni sakho esithile.
Nokho, kubalulekile ukulandela iseluleko sezokwelapha futhi usebenzise lolu hlobo lwemithi ngokuqapha, ngenxa yemiphumela engemihle engase ibe khona kanye nengozi yokuncika.
I-Hypnotic: izici, izinhlobo nemiphumela yazo
Os i-hypnotics Lena imithi esetshenziselwa ukukhiqiza imiphumela yokozela kubantu, ebavumela ukuba belaphe ukuphazamiseka kokukhathazeka nokuphazamiseka kokulala. Iqembu lezidakamizwa ze-hypnotic lihlobene eduze neqembu lezidakamizwa ezilalisayo.
Isenzo esiyinhloko sezidakamizwa eziluthayo ukubangela ukozela. Ngakolunye uhlangothi, izidakamizwa ezilalisa umzimba zinenjongo yokwelapha eyinhloko yokunciphisa ukukhathazeka, ukukhiqiza ukuzwa okudambisa ubuhlungu, nokukhuthaza ukuzola.
Njengamanje, ama-hypnotics yizinto ezisetshenziswa ngokuyinhloko ukuze ziyenge ubuthongo, yingakho zaziwa ngokuthi amaphilisi okulala.
Izici ze-hypnotics
Ama-hypnotics yizinto ezithinta ingqondo ezidala ukozela nokulala kumuntu ozidlayo.
Imiphumela yale mithi ivela ngokunciphisa umsebenzi we-cerebral cortex. Ngamanye amazwi, ama-hypnotics asebenza njenge-central nervous system depressants.
Nakuba umsebenzi oyinhloko walezi zinto uwukwelapha, i-hypnotics ingasetshenziswa njengezidakamizwa zokuhlukumeza, njengoba eziningi zazo ziyalutha uma zisetshenziswa njalo.
Njengamanje, ama-hypnotics ahlanganisa izinhlobonhlobo zezinto. Eqinisweni, yonke imithi ebangela ukozela ingahlukaniswa njenge-hypnotics.
Izinhlobo ze-hypnotics
Ama-hypnotics angahlukaniswa ngobubanzi abe izigaba ezimbili ezibanzi: i-oral hypnotics kanye ne-intravenous hypnotics.
I-Oral hypnotics ibonakala ngokuphathwa ngomlomo. Ngokuvamile zisetshenziselwa ukwelapha ukuqwasha okukhulu futhi kufanele zihlale zithathwe ngaphansi kwencwadi kadokotela. Kutuswa ukuthi ungasebenzisi kabi izinto ezingase zibe umlutha, ngakho-ke ngokuvamile kunconywa ukusebenzisa ama-hypnotics ngokuqapha.
Ngakolunye uhlangothi, i-intravenous hypnotics kanye ne-inhaled hypnotics yizinto ezisetshenziselwa i-anesthesia kanye ne-sedation ezindaweni zasesibhedlela. Ziyimithi ebalulekile yokunciphisa nokugcina i-anesthesia futhi ivame ukusetshenziswa ngokuhambisana nemithi ye-morphine noma i-opioid, kanye neziphumlisi zemisipha.
Izinto eziyinhloko ze-hypnotic zibuyekezwa ngezansi:
- Ama-Barbiturates
Ama-barbiturates awumndeni wemithi etholakala ku-barbituric acid. Basebenza njengezidakamizwa ezicindezelayo zesistimu yezinzwa, futhi ukungeniswa kwabo kudala imiphumela eminingi ekusebenzeni kobuchopho.
Imithelela ye-barbiturates ingasukela ekuthobeni okuthambile kuya kokubulala izinzwa ngokuphelele. Baphinde basebenze njenge-anxiolytics kanye ne-anticonvulsants.
Ama-barbiturates nawo abonakala ngomphumela onamandla wokulutha ebuchosheni. Ukusetshenziswa kuveza imizwa yokozela futhi kunciphisa isikhathi sokunaka komuntu.
Ziyizinto ezincibilikayo ngamafutha, ngakho zincibilika kalula emafutheni omzimba. Ama-barbiturates anqamula kalula umgoqo wegazi nobuchopho futhi angene ebuchosheni.
Ebuchosheni, ama-barbiturates enza ngokuvimbela ukugeleza kwe-sodium ion phakathi kwama-neurons nokukhuthaza ukugeleza kwama-ion e-chloride. Zibophezela kuma-GABA receptors ebuchosheni futhi andise isenzo se-neurotransmitter.
Ngakho-ke, ama-barbiturates akhulisa umsebenzi wama-neurotransmitters we-GABA futhi andise umphumela wokucindezeleka owukhiqizayo ezingeni lobuchopho.
Ukusetshenziswa njalo kwama-barbiturates kuvame ukuholela ekwethembekeni nasekuluthekeni. Ngokufanayo, ubuthi obukhiqizwa yile mithi bungabangela ukufa uma imithamo ephezulu kakhulu iphuzwa noma ixutshwe notshwala.
- I-Propofol
I-Propofol iyi-ejenti yokubulala izinzwa emithanjeni. Isikhathi sayo sokusebenza sifushane, futhi njengamanje sinelayisensi yokwethulwa kokubulala izinzwa okuvamile kubantu abadala kanye nezingane ezingaphezu kweminyaka emithathu ubudala.
Ukusetshenziswa okuyinhloko kokwelapha kwalesi sidakamizwa ukugcina i-anesthesia ejwayelekile ezigulini. Ibuye isetshenziswe njengesedative egunjini labagula kakhulu.
I-Propofol ilawulwa ngezindlela ezihlukahlukene zokwandisa ukubekezelelana. Njengamanje, isetshenziselwa ukwakhiwa okusekelwe kumafutha we-soya, i-propofol, i-egg phospholipid, i-glycerol, ne-sodium hydroxide.
Lapho le nto idliwe, i-propofol ibopha amaprotheni e-plasma futhi igaywe esibindini. Imiphumela yayo ingeyesikhashana futhi ibonakala ngokuqala ngokushesha kwesenzo.
Kodwa-ke, ukusetshenziswa kwalo muthi kungabangela imiphumela emibi efana nokucindezeleka kwenhliziyo, i-amnesia, i-myoclonus, ubuhlungu endaweni yomzimba lapho unikezwa khona, kanye nokungezwani komzimba kubantu abazwela izingxenye zayo.
- Etomidate
I-Etomidate iyisidakamizwa sokulutha esithathwe ku-imidazole carboxylate. Kuyinto esebenza isikhathi esifushane ekhiqiza imiphumela ebalulekile yokubulala izinzwa kanye ne-amnesic. Kodwa-ke, i-etomidate ihlukile kwamanye ama-hypnotics amaningi ngoba ayikhiqizi imiphumela ye-analgesic.
Umphumela we-Etomidate uqala ngokushesha ngemva kokuphathwa. Ngokuqondile, kuthiwa umuthi uqala ukusebenza phakathi nemizuzwana yokuqala engama-30 kuye kwengama-60. Umphumela omkhulu ufinyelelwa kumzuzu wokuphatha, futhi ubude besikhathi esiphelele sesenzo somuthi sihlala cishe imizuzu eyi-10.
Kuwumuthi ophephile, osetshenziswa njalo lapho ufakwa izinzwa futhi unikeze ukulalisa esimweni sasesibhedlela.
Imiphumela ye-cardiovascular ye-etomidate mincane futhi, njengemiphumela emibi, iveza ubuhlungu ekuphathweni kwe-intravenous kanye nokucindezelwa kwe-adrenal.
- I-Ketamine
I-Ketamine iyisidakamizwa esihlukanisayo esinamandla amakhulu e-hallucinogenic. Kuyi-phencyclidine derivative esetshenziswa ezilungiselelweni zokwelapha ngenxa yezindawo zayo zokulalisa, zokudambisa izinhlungu, kanye nezindawo ezibulala izinzwa ngokuyinhloko.
Isici esiyinhloko se-ketamine njengesidakamizwa sokulutha ukuthi ukusetshenziswa kwayo kudala i-anesthesia ye-dissociative. Okusho ukuthi, ikhiqiza ukuhlukaniswa okusebenzayo kanye ne-electrophysiological phakathi kwesistimu ye-thalamocortical kanye nesistimu ye-limbic yobuchopho.
Lokhu kusho ukuthi izikhungo eziphakeme azikwazi ukubona izisusa ezizwakalayo, ezibonakalayo, noma ezibuhlungu ngaphandle kokubangela ukucindezeleka kokuphefumula. Ngokusetshenziswa kwe-ketamine, amehlo ahlala evulekile ngokubukeka okulahlekile.
Ngalo mqondo, umphumela womtholampilo we-ketamine uchazwa ngokuthi "ukuvinjelwa kwezinzwa kwe-anesthesia nge-amnesia ne-analgesia".
Eminyakeni yamuva nje, ukusetshenziswa kwe-ketamine emkhakheni wezokwelapha kuye kwancishiswa kakhulu ngenxa yamandla ayo e-hallucinogenic kanye nokwenzeka kwento eyenza izimo zengqondo ze-post-anesthetic psychotic.
Ngakolunye uhlangothi, i-ketamine iyinto esetshenziswa kakhulu ekuzijabuliseni. Ngalo mqondo, i-ketamine idayiswa ngaphansi kwegama elithi "K powder."
Ukusetshenziswa kwayo kuvame ukuholela ekuthembeleni, yingakho kunamacala akhulayo okuhlukunyezwa kwe-ketamine. Ngokufanayo, kwezinye izimo, ukusetshenziswa kwe-ketamine kuvame ukuhlanganiswa nama-psychostimulants afana ne-cocaine noma i-methamphetamine.
- Benzodiazepines
I-Benzodiazepines yizidakamizwa ze-psychotropic ezisebenza ohlelweni lwezinzwa oluphakathi. Ukusetshenziswa kwabo kukhiqiza ngokuyinhloko okudambisayo, ukulalisa ingqondo, i-anxiolytic, i-anticonvulsant, i-amnesic, nemiphumela yokuphumuza imisipha.
Ngalo mqondo, i-benzodiazepines ingenye yemithi esetshenziswa kakhulu empilweni yengqondo, ikakhulukazi ekwelapheni ukukhathazeka, ukuqwasha, ukuphazamiseka kwemizwa, isithuthwane, ukuhoxiswa kotshwala kanye nemisipha.
Ngokufanayo, asetshenziswa ezinqubweni ezithile zokuhlasela, njenge-endoscopy, ukuze kwehliswe isimo somuntu sokukhathazeka futhi kubangele ukulaliswa kanye nezinzwa.
Njengamanje, kunezinhlobo eziningi ze-benzodiazepines; wonke (ngaphandle kwe-clorazepate) amuncwa ngokuphelele umzimba. Lapho efika ezifundeni zobuchopho, ama-benzodiazepines asebenza njengezidakamizwa ezicindezela isimiso sezinzwa ngokukhetha kakhulu kunama-barbiturates.
Le mithi ihlanganiswe nama-benzodiazepine receptors athile ohlelweni lwezinzwa olumaphakathi, okuyingxenye ye-gamma-aminobutyric acid (GABA) complex.
Ngalo mqondo, i-benzodiazepines inezenzo ezifanayo kuma-barbiturates, kodwa anemiphumela ecacile kakhulu. Ngenxa yalesi sizathu, okwamanje ziyimithi ephephe kakhulu ekhiqiza imiphumela engemihle embalwa futhi esetshenziswa kakhulu kwezokwelapha.
Ngokuphathelene nendima yabo yokulutha ingqondo, i-benzodiazepines ingaba usizo ekwelashweni kwesikhashana kokuqwasha. Ukuphatha kwabo kunconywa kuphela isikhathi esingamaviki amabili kuya kwamane ngenxa yengozi yokuncika okubangelwa yile mithi.
I-Benzodiazepines ithathwa kangcono ngezikhathi ezithile nangesilinganiso esiphansi kakhulu sokulwa nokuqwasha. Le mithi iboniswe ukuthi iwusizo ekuthuthukiseni izinkinga ezihlobene nokulala, yehlisa isikhathi esisithathayo ukuze ulale futhi yandise isikhathi sokulala osichithayo.
Mayelana ne-anesthesia, i-benzodiazepine evame ukusetshenziswa kakhulu i-midazolam, ngenxa ye-half-life efushane kanye nephrofayili ye-pharmacokinetic.
Benzodiazepine analogues
Ama-analogue e-Benzodiazepine yizidakamizwa ezisebenzisana ne-BZD/GABA/CL receptor. Ukuphatha kwabo kubangela ukungena kwe-chloride ion kusuka ku-gamma-aminobutyric acid (GABA) complex, okukhiqiza imiphumela ecindezelayo ohlelweni lwezinzwa oluphakathi.
Ama-analogue e-benzodiazepine abaluleke kakhulu yi-zolpidem, i-zopiclone, ne-zaleplon. Zisebenza ngokufanayo kuma-benzodiazepines futhi zibonisa ukukhetha okuphezulu kwama-benzodiazepine receptors ebuchosheni.
Imiphumela yabo eyinhloko ibonakala ngokulondolozwa okuphezulu kwezakhiwo zokulala kanye nemiphumela ephansi yokuphumula kwemisipha. Ngokufanayo, lezi zinto zinamandla amakhulu okuncika uma zisetshenziswa isikhathi eside.
Ukuze ekwelapheni ukuqwasha, okwamanje kukhona impikiswano mayelana nokuthi i-benzodiazepine analogues isebenza kakhulu noma ingaphansi kwemithi ye-benzodiazepine.
Ngokuvamile kuthiwa ukusebenza kwayo yomibili imithi kuyafana. I-Benzodiazepines inenzuzo yokuba namandla kakhulu ekwelashweni kwesikhashana, kodwa ama-benzodiazepine analogue anciphisa imiphumela emibi cishe ngesigamu.
- Melatonin
I-Melatonin iyi-hormone ehlanganiswe ne-amino acid tryptophan ebalulekile. Ikhiqizwa ngokuyinhloko ku-pineal gland futhi ibamba iqhaza ezinqubweni ezihlukahlukene zamaselula, neuroendocrine, kanye ne-neurophysiological.
Isenzo esiyinhloko sale hormone ukulawula ukulala nokuvuka. Ilawulwa kancane ukukhanya kwangaphandle futhi inamazinga aphansi okusebenza emini namazinga aphezulu ebusuku.
Umsebenzi owandayo wale hormone ubonisa umzimba isidingo sokulala futhi, ngakho-ke, iyinto enesibopho sokukhiqiza ukuzwa kokulala.
Ekusetshenzisweni kwayo kokwelapha, i-melatonin igunyazwe njengomuthi wokwelashwa kwesikhashana kokuqwasha okuyinhloko kubantu abangaphezu kweminyaka engama-55. Nokho, i-melatonin ayisebenzi kwezinye izinhlobo eziningi zezinkinga zokulala.
- I-Antihistamine
Ama-Antihistamine yizinto ezisebenza ngokuyinhloko ukunciphisa noma ukuqeda imiphumela ye-allergies. Benza ebuchosheni, bavimbe isenzo se-histamine ngokuvimbela ama-receptors ayo.
Kodwa-ke, nakuba ukusetshenziswa okuyinhloko kwale mithi kuwukwelapha i-allergies, i-sedation ingumphumela ohlangothini obonwa cishe kuzo zonke izimo.
Ngalesi sizathu, le mithi isetshenziswa namuhla futhi ngezinjongo zokudambisa futhi amanye ama-antihistamine, njenge-diphenhydramine noma i-doxylamine, asetshenziselwa ukwelapha ukuqwasha.
- Ama-antidepressants nama-antipsychotics
Okokugcina, ama-antidepressants nama-antipsychotics amaqembu emithi angenakho ukozela njengomphumela wawo oyinhloko wokwelapha.
Ama-Antidepressants imithi esetshenziswa ngokuyinhloko ukwelapha iziyaluyalu ezinkulu zokucindezeleka nezinye izinkinga zokudla kanye nokuphazamiseka kokukhathazeka.
Ama-Antipsychotics imithi evame ukusetshenziselwa ukwelapha i-psychosis.
Ukusetshenziswa kokwelapha kwalezi zinhlobo ezimbili zezidakamizwa akuhlukani. Ngalo mqondo, amaphilisi athile okucindezeleka, njenge-amitriptyline, i-doxepin, i-trozadone, noma i-mirtazapine, nama-antipsychotic athile, njenge-clozapine, i-chlorpromazine, i-olanzapine, i-quetiapine, noma i-risperidone, asetshenziselwa ukwelapha ukuqwasha.
Izinkomba
- Brunton, Laurence L.; Thayi, uJohn S.; Lazo Parker, Keith L. (2006). "17: Ama-hypnotics kanye nama-sedative". I-Goodman & Gilman's Isisekelo Semithi Yezokwelapha (11th ed.). I-McGraw-Hill Companies, Inc. ISBN 0-07-146804-8. Ikhasi livakashelwe ngo-2014-02-06.
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