抗凝血藥物Heparin
肝素(Heparin) (unfractionated heparin, UFH):
傳統使用的抗凝劑,Heparin 是酸性帶負電粘多醣類,分子量大。
作用機轉為 Heparin 加強抗凝血酶去活性,可與凝血因子Ⅱa、Ⅹa、XⅡa結合,使其失去活性,特別是對凝血酶子。
臨床用途: Heparin 是最主要的抗血栓藥,治療靜脈栓塞、預防手術後血管栓塞。在體內體外均有抗凝血作用,作為體外抗凝血劑。需監測病人的aPTT(活化部分凝血活素時間, activated Partial Thromboplastin Time)
使用劑量:60 U/kg IV bolus, (最大劑量:4000 U), 12-14 U/kg/hr
深部靜脈栓塞(DVT):
預防性:
5000 units SC q8-12hr, OR
7500 units SC q12hr
*DVT treatment Guideline: European Heart Journal (2020) 41, 543-603
急性冠心症(ACS)
1、最初推注劑量:每公斤60單位。(最大劑量4000單位)
2、每小時每公斤滴注12單位,共48小時。
3、維持APTT於控制值之1.5~2倍。
4、於6, 12, 18, 24小時,檢查其APTT值。
5、體重小於70公斤者,滴注劑量為每小時1000單位。
6、合併使用GP IIb/IIIa 抑制劑,劑量:50- 70 U/kg IV bolus
7、未合併使用GP IIb/IIIa 抑制劑,劑量: 70-100 U/kg bolus
*2013 ACCF/AHA STEMI Guideline (J Am Coll Cardiol 2013;61:e78 –1)
*2020 ACS ESC Guideline European Heart Journal (2020) 00, 1-79
Heparin副作用:
1、最大的副作用是出血。因此須監測病人的aPTT,若監測值大於正常範圍的 1.5~2.0倍須減量或停用。
2、使用36小時後,Heparin 與血小板形成複合體,使血小板濃度減少,長期使用(6個月)會使骨鈣流失出現骨骼疏鬆現象。
3、出血,過敏反應(冷顫、蕁麻疹、發燒、鼻炎、氣喘樣的反應),急性可逆性血小板過少症,禿頭,骨稀鬆病、腎功能受損,SC和IM注射部位局部刺激。
Heparin注射過量時的解毒劑:
Protamine 1 mg IV 可中和Heparin 100 U, 最大劑量50mg。靜脈緩慢注射:<20 mg/min,且<50mg in 10 min
如果Heparin是用 IV dripping,就以開始注射時間的長度來換算Protamine的劑量:
Heparin已經滴注30-60分鐘,則使用Protamine 0.5-0.75 mg 可中和Heparin 100 U。
Heparin已經滴注超過2小時,則使用Protamine 0.25-0.375 mg。
Heparin交互作用
1.協同作用:Acetyl Salicylic acid, Dipyridamole, Phenylbutazone,
Indomethacin、Sulfinpyrazone、Probenecid、Dextran、Ethacrynic acid、Dicumarol、Cytostatic drugs。
2.拮抗作用:Antihistamines、Digitalis、Tetracycline、Nicotine abuse、Ascorbic acid。
3. 若同時併用丹參、當歸、川紅花、藏紅花併用,可能會增強抗凝血作用。
4. 若同時併用吉林參、吉林參鬚、高麗參、西洋參併用,可能會降低抗凝血作用。
Heparin禁忌
1.禁用於下列情況之患者:血友病、急性胃腸道出血性潰瘍、代償失調引起的嚴重高血壓症、中樞神經系統外科手術上、疑似腦出血症、漸近性心內膜炎、甲狀腺手術、疑似惡性腫瘤而有出血危險者、
2.對Heparin Sodium過敏者。
Heparin注意事項
Heparin要換成Warfarin時,需要5天同時使用,檢測INR 維持於2.0-3.0,連續2天,然後停掉Heparin 或LMWH改用Warfarin。
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acs am 在 Crisp of Life Facebook 的最佳貼文
Hard Rock Cafe Penang+Kelab Motosikal Helang Malaysia(HTC Motocycle Club) host Rock 2 Rock Malaysia Day Charity Ride 2019
This charity ride has helped in raising funds for these 3 charitable homes:
1. Asia Community Service (ACS) Stepping Stone Support Centre For Community Living
2. Pertubuhan Rumah Kebajikan Seri Cahaya Pulau Pinang
3. Crystal Family Home Penang
Each of the 3 appointed charitable homes received RM 2000 by HTC Motorcycle Club to assist in their daily expenses and operational costs. Hard Rock Cafe Penang too hosted the underprivileged children representing the 3 charitable homes a luncheon buffet and an opportunity to meet and greet their donours during the mock cheque presentation assembly.
40 members of HTC Motorcycle Club from various parts of Malaysia flagged off their journey from Hard Rock Cafe Penang yesterday(Sept 12th, 2019) at 11.30 am to Johor Bahru. During the journey, they will stop by Hard Rock Cafe Kuala Lumpur and Hard Rock Cafe Melaka to deliver more funds to other appointed charitable homes from Kuala Lumpur and Melaka. The ride is expected to cover more than 1500km and takes up 2 days to complete.
Let's wish all the rocking riders a safe journey!
acs am 在 旅行熱炒店Podcast Facebook 的精選貼文
好幾天沒更新了,轉眼間已經走完這趟旅行的前1/3了,也已經跑完烏茲別克和吉爾吉斯準備要入境中國了,但動態更新竟然還停在第四天。為了避免因趕文章進度而一直活在過去,這裡簡單總結一下前幾天的行程。
It's been a while since my last update. I have finished the first 1/3 of the trip, visited Uzbekistan and Kyrgyzstan, and am going to enter China tomorrow. Here I'd like to quickly summarize what I did in the past few days, as I don't have time to make up in details.
拜訪絲路古城希瓦(Khiva)、布哈拉(Bukhara)
Visited Silk Road ancient cities Khiva and Bukhara
這兩個城市過去都是汗國的都城,因此保留了許多中亞與伊斯蘭風格的建築。「汗國」這名詞聽起來可能很遙遠(成吉思汗時代的產物),其實不然,中亞的汗國政體一直存在到1920年代被蘇共廢除為止,距今還不到一百年,這也是為什麼這些已經存在幾世紀的建築能被完好保存至今。
Khiva and Bukhara were both capitals of khanates until 1920, when Soviet Communist Party abolished them. The age of khans is actually not that far from us. Consequently, many Turkic and Islamic architectures are well preserved in these cities until now.
用三天時間品味鐵木兒帝國首都撒馬爾罕的輝煌
Enjoying Timur empire capital Samarkand for 3 days
我對中亞的第一印象應該是國中時在國家地理雜誌上看到的照片,一座方正的廣場上,三幢華麗的經院建築面向廣場中間三面並立,繁複的拼貼磁磚與渾圓的尖頂是我未曾見過的,中亞的伊斯蘭風味從那時起就吸引了我,這趟總算可以見到本尊。稱撒馬爾罕為15世紀的巴黎一點都不為過,中亞規模最大的伊斯蘭建築都聚集在這個城市;這裡到今天仍然朝氣蓬勃,即使待了三天也不覺無聊。
My first impression of Central Asia was from Samarkand, where around a square stand three madrassases with delicate tiles and rounded domes. Since then, Central Asia has been attractive to me. In 15th century, this city was as important as Paris, and today this is the place to find the biggest and most splendid Islamic architectures in Central Asia. Today it's still a vibrant city, and I didn't feel bored after spending 3 days there.
進入吉爾吉斯,在比什凱克(Bishkek)遇見台北
Entering Kyrgyzstan, and encountering Taipei in Bishkek
塔什干到比什凱克是行程中除往返外的唯一一趟飛行,之所以不走陸路是為了要以電子簽證入境,但電子簽證目前只開放機場入境。這趟飛完,下次再踏上飛機就是在芬蘭赫爾辛基了。
吉爾吉斯在中亞五國裡面經濟算後段班,但首都仍然是個活力十足的地方,隨處可見的行道樹與綠廊是它與眾不同之處。有趣的是這裡高層公寓與傳統矮房並立,而且居民似乎相當熱衷於裝鐵窗和外掛冷氣,乍看之下還以為回到了台北。
The flight from Tashkent to Bishkek is the only non-over-land segment on my trip, and I did so in order to obtain Kyrgyzstan's e-visa, which now only opens to air passengers. After this flight, the next one would be one month later from Helsinki, Finland.
Kyrgyzstan's economy is not great compared to other Central Asian countries, but its capital still flourishes and looks appealing. Greenways and street plants make its appearance especially unique. New high-rise apartments and old low houses both exist here, and interestingly, just like my hometown Taipei, they also like to protect windows with rails and have ACs hung outside buildings. While seeing this scene, sometimes I thought I was back in Taipei.
在頌湖(Son Kul)體驗遊牧民族生活
Nomadic life at Son Kul
頌湖是吉爾吉斯第二大湖,雖然規模遠遠不及第一大湖,3000多公尺高海拔的純淨藍天配上周遭保存至今的游牧傳統讓我將它列為必遊之地。前往此湖的熱門方式是向旅行社買套裝行程,由當地牧人當嚮導用兩天時間騎馬翻山來到湖邊,然後居住在居民的蒙古包裡體驗他們的生活和飲食。五月中旬來此還沒什麼遊客,當天參團的也只有我一個人,以費用來說是貴了點,但當我來到湖邊,一個人奢侈的享受整個湖的時候,我覺得非常值得。
Son Kul is the second largest lake in Kyrgyzstan. While being outsized by the first, its pure sky at high altitude and nomadic lifestyle made me decide to put it on my "must-go" list. People usually go on tours arranged by agents, where a local guide leads you to ride horses for two days and cross over mountains, and then after arriving at the Lake, you can stay in yurts and experience the life and cuisine of the locals. As it was fairly early in season, I was the only tours that day, which means I had to pay a bit more. However, as soon as I got to the lake and felt the solitude, I thought it was totally worth the price.
下一站
Next stop
離開頌湖之後我一直在搭車——先是2小時下山、3小時回到首都,接著馬上是15小時的夜車從北跨到南部大城奧什(Osh),然後再3.5小時到達今晚過夜的Sary-Tash,一個位在帕米爾高原上海拔3170公尺的小鎮,準備明天一早翻過山進入新疆喀什。從山上下來又搭夜車,已經連續四個晚上沒洗澡了,期待明天到達喀什可以好好給他洗洗睡 :)
明天就要進入五聲音階(CDE_GA_)的國度了,祝我的VPN運作順暢。
Since leaving Son Kul, I've been riding vehicles: 2 hours to get out from the lake, 3 hours to go back to Bishkek, which was followed by a 15-hour night ride from Bishkek to Osh, and then a 3.5-hour ride to Sary-Tash, where I will spend my night at. Tomorrow I'll leave in early morning to enter China via Pamir Highway. My destination is Kashgar. It's been 4 days since the last time I got a shower. Looking forward to doing that in Kashgar tomorrow :)
acs am 在 ACL Packager - ACS AEM Projects 的推薦與評價
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