??t??pe?tas??? Te?ape?a st?? ??????? ????? - PowerPoint PPT Presentation

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Title:

??t??pe?tas??? Te?ape?a st?? ??????? ?????

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Title: Author: h Last modified by: Doc Created Date: 10/30/2009 9:11:28 AM – PowerPoint PPT presentation

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Title: ??t??pe?tas??? Te?ape?a st?? ??????? ?????


1
??t??pe?tas??? Te?ape?a st?? ??????? ?????
  • ???sta?t???? ?. ?apad?p?????
  • ?µ?t?µ?? ?a????t?? ?a?d??????a? ?.?.T.
  • p. ??e????t?? ?? ?a?d????????? ???????? ?.?.T.

2
???? ??????S
????? f?s??pa??????a? ????? ?e?ape?t????
3
????????????S ?????????? ??s? ?? ? Pd 1/3
?? ? CO ? R SV ? HR ? R
4
(No Transcript)
5
(No Transcript)
6
??T??S? ?????????S ???S?OS
????????T?S???a????x??t?st?se??
S????t?ta x????? ?a?µ??
???f??t?s?x???sµa ?????se??
?.?.
??es??e??? d?????s?
????????T?S??
S?sta?t???t?ta??t?st?se??
??????s? ?at??????s?
???e?a??? ?????

????t???t?ta ???e???
????? ??µat??
7
S????S ?????S??S??S ??
  • ? a?µ????sa ??de?s?? ??????? ?a? ?st??

8
?????S??S?? ?? ?????? ??O????S ?G???
  1. ?µ???stas?a a?de?se?? e??e??? ???????
  2. ?µ???stas?a spe??aµat???? d????se??
  3. ?µ???stas?a ?????

9
?????S??????? ??????S???
  • S????S
  • ?µ???stas?a a?de?se?? e??e??? ???????
  • ?µ???stas?a spe??aµat???? d????se??
  • ??????S??S
  • ??a??es?? ap? s?spas? µ????? e?ast???? a?t?????
    (e??efa?????-stefa??a???)
  • ????? p??sa????? a?t???d??? ltapa?????
  • (d??s?? ????)

?µ???stas?a ?ef????????a?s??
10
?????S??????? ??????S???
S????S 3. ?µ???stas?a ?????
??????S??S ??t?d?????s?? (? epa?a???f?se??)
?????S?OS ??µ????? ?a? pa?a??????
???GOG?S??µ?d??aµ???
? t???? pe??s????a??a??? a?t???d??? ?? ??, S?T-a1
??d?ste????, ?? ??, S?T-a1 ADH, ??p
??d??e?? ????????e?d? ??ast??? ???, DOPA, PGs ??p
11
(No Transcript)
12
(No Transcript)
13
?????? ???????T??S????? ??????S??? RBF, GFR,
??????S?OS
?e???? S????a???spe??aµat??? a??d?as?? ????e???
a?t?????µ?s?? a?t???d???
14
????S?????S?S ?????????S ???S?OS-??????S?OS
???????µat??
??es??e??? ??????s??
??
?pa?a???f?s??
???s?????
?p??e?e?
15
(No Transcript)
16
(No Transcript)
17
??t???a?? ?p??tas??
?ata???st??? ?e?t?????a a?t??p?tas????
???a??sµ?? (???es??e???? ??????se??)
18
  • ????F????S?S ?? Na
  • ???s?????
  • ?d??pa??? ? Na/H, ? Na/K
  • ??at????t???e?d?
  • ??ep???e?a PG?s, Dopamine, ANF, ????? a?ta??e?d??
  • ?etaß????? S??d??µ? (??s??????, ?ept???)
  • ? ???e??tas??? ??

19
  • S????T??????
  • ?pe?????t???
  • ???e??s?spast???

???f??
??t?a
???t??e??? ??. ????? ?p?d??e?? ??t?s?µata
?etaß????? S??d??µ? ??s?? a?ast???? (???sa?µ???
tase??p?d?????)
20
  • ??????S (ap???t? s?et???)
  • ???????
  • ???µ??????e?a a?de?se?? ?ef?????
  • S?T
  • ???????S???OS F?S????G???
  • 2? ?pe?t??f?a p??sa????? a?t.

21
S???????S ?? ??
???e? a?t?e?
R
?? ??
?p?a d????t? f?e?µ??? ?e???µat????a ?
??? ?????s?????s?? T??µß?t???? ep?p?????
22
(No Transcript)
23
(No Transcript)
24
????? ??G??? S?????
??F?????
Spe??aµat??? ?p??tas??
?e???µat??????a
Spe??aµat??? ???ß?
???????pe?t??f?a
??e????s??
???
?G??F???S
?a???a??e??p??e?a
?????a??e??p??e?a
?p?t???a ??t?????µ?se??
?TS
25
???????GG?????S ?????OS??S ?.?.
???????S
??????
??µ??? ???d?s??
???a???? ep?ß????s??
???a???? F????
??µ???? ?a?????te?
F?e?µ???
?pe?t??f?a
??s?e?t?????a ??d???????
?????? a?t???e?
?e???e? a?t???e?
??t???d??p??e?a
?TS
??
??ad?aµ??f?s??
???efa??-p??e?a
Spe??aµa-t?p??e?a
?etaß. S.
?a?d?a?? a?ep???e?a
?ef???? a?ep???e?a
26
????????? ??????S?
??????????S ???G??S ???????? (F?s?µata, sf??e??
??t? ?????) ? (p?? d?????t???? ? ?p?
ße?apaµ???) ?ef???? ?e?t?????a ???S??????gt100 ?ef?
???aµµa ?????????OS ??? ???OS ???
???????????S CAT ep??ef??d??? ?a?
?????a? ?ate???aµ??e? VMA MIBG S?????S
???G??S ?etaß?????? pa??µet??? ?a?d????????? ??e??
?sµa T??a????? ?a? ?????a??? ???t?? ??e????
?a??t?d?? ?a? sp??d?????? a?t?????
27
??????t???
??????S??? ???S?OS F?????O?
??t?d?as????t?d?????s????t?st?se??
???s???????s? (??a??p???esµa, ?a???p???esµa)
ß-ap???e?sµ??
???s???a?d. ?a????? (?) ???t?st?se??
(?a???p???esµa) ???? ??????s??
(?a???p???esµa)
??t?d?as????t?st?se?? (??a??p???esµa)
?p???e?sµ??R-AT-AT1R
??t?d?as???a?d?a??? ?a?????
???s????t?st?se?? (B)??????s??
(?)?ef??p??stas?a (?)
28
??????S??? ???S?OS F?????O?
CCB ??µß??t??p??
???s????t?st?se?? (??a??p???esµa)??????s??
(?a???p???esµa)
??t?d?as?
CCB ???e??t??p??
??t?d?as??S?T
???s????t?st?se?? (B?a??p???esµa)??????s??
(?a???p???esµa)
29
??????S??? ???S?OS F?????O?
a1-ap???e?sµ??
??t?d?as??R-AT-A?ata???t?s? ?????
???s????t?st?se?? ??????s??
??t???a?? d?asta?t??? (?d?a?a????)
???s????t?st?se??
??t?d?as??S?T, R-AT-A?ata???t?s? ?????
??t??d?
??t?d?as??S?T, R-AT-A?????
???s?F?eß?d?ast?????t?s?µf???s??
30
S????? T???????S ??????S ?.?.
? ?.?. ? ??d?spe??aµat???? p??se?? ?a?
?e???µat????a? ? Ge???e?µ???? d??d??µat????
t?se?? ?a? aß????a? f?e?µ???? ? ??e?d?se?? ?
??d?????a??? d?s?e?t?????a? ? ??t?st?se?? st??
??s?????? ? ??a?s??s?a? st? Na ?
?a?d??a??e?a??? ?pe?t??f?a? ? ?????µ???e??se??
? ?p?p????? Stefa??a?a? ??s??
????
S?T
31
??G?? ??????????S?OS ??????????S???S T???????S
?s?d??aµ? ? a?e?at?µ??e?t? ap?te?esµat???t??
a??? ?e?t??µ??? ? e?at?µ??e?µ???
?p??at?stas?? s???d?? a?µ?d??aµ????
d?ata?a??? ?pe?????t??? ?????f???a ???e??s?spa
s?? ??????a ???stas?a ???????
st???? ?e???µat??????a ?????s?????s?? ?a?d?a
??e?a?? ??ad?aµ??f?s?? St?????? ?a?d?a??
??ep???e?a
32
????? ????S?S ?????????S ???S?OS
?pe?????t??? ???e??s?spast??? ??µat?p?????? ?pe????sa
???t? ?p????? ?a?ßed????? ? ?eµp?ß????? ????? ????1 ?e?apaµ???? ???t?a??µ?? ???d??p???d??? ??????t??? ??t??de? (??t??p??ss??? Na)
??a??a?t??? ?????d???
S?µp????µat??? ???d??p???d??? ?a?ßed????? ? ?eµp?ß?????
33
??????T?S ??????????? ????????? ??????S?
?????? 60 60 60 60 ?a?????t???
???????? S???????? 80/1? 80-60/1? 60/1?
???t? ?p????? ?a?ßed????? ? ?eµp?ß????? (? ????? ß-ap???e?st??) ????? ????1 Moduretic ? Spe??????a?t??? (a? ? ?)? ep?e?e???? ?e?apaµ??? ? ???t?a??µ? ? ???d??p???d??????? ? ????1 ?a?ßed?????
??a??a?t??? ?e?apaµ??? (? ?ese?p???)
S?µp????µat??? ??????t??? ???? ? ????1 ???d??p???d??? ??????t??? ?e?apaµ??? ? ?a?ßed????? ? ?eµp?ß????? ???d??p???d??? ??????t??? ?a?ßed???????eµp?ß?????? ?ese?p??????????d??? ??t??de?
34
?????? ?????
???te????-?f?p??se?? ?? RX p?? ?ata???se?? a
ap???e?st?? ? d??d??p???d???
? ??t??de? d?ade?µ????
35
??????G????S ?????????S ??????S??S
Stefa??a?a ??s?? ß-ap???e?st?? (? ße?apaµ???) ??t??d? ???? ? ????1
?p?d?. ?? ?a?ßed????? ? ?eµp?ß????? (? ????? ß-ap???e?st??) ???? ? ??t??d?
?e??f. ??t????p??e?a ???e??d?asta?t???? ß-ap???e?st??(?eµp?ß????? ? ?a?ßed????? ? Se??p??????) ? ?e?apaµ??? ???d??p???d??e?
?a?d?a?? ??ep???e?a ???? ? ????1 ??????t??? Spe????a?t??? ??t??d? ?a?ßed????? ? ?eµp?ß?????
36
??????G????S ?????????S ??????S??S
Sa??a??d?? ??aß?t?? ???? ? ????1 ??????t??? ?a?ßed????? (? ????? ß-ap???e?st??) a-ap???e?st??
?a??sa???a (?etaß????? S??d??µ?) ???? ? ????1 ??????d??? ??????t???
???s?? A-methyl-Dopa (Aldomet) ß-ap???e?st??
??? ?e?apaµ??? ? d??t?a??µ? ????1 ??????t???
37
S??S??S ?O? ??????S??G??O? ????G???O?
Na
S?T ? S?T
r
R
38
???G?? ???????S??? Na Cl
Na-a?e???t?t??s???? d?e?e?s?µ?t?ta R-AT-A ep?
ste??se?? NaCl
?etaß??? ?aµp???? se Na e?a?t?µ??? (??s??e??? ?
Fa?µa???e???) ??ep???e?a PGs ??ep???e?a
Dopamine ??ep???e?a ANF ??ata?a?? ?????
Na-????t???? pa?a???t??
39
???F?G? ???????S????S ????OS ?????S
?????
??ep???e?a PGs ? ?ata???st??? d??s??
ADH ???????a ??ast????? d?s?e?t?????a
S?st????? d?s?e?t?????a ? p?e?µ??.
s?µf???s?? ????? se ?p??tas?
?a?d??µ??p??e?e? S? ??????µ?????
Stef. ??s?
40
?????? ????G?S?OS F?????O?
  • ????G????
  • F??µa?a s?st?µat?? R-AT-A
  • ???d??p???d???
  • ?e?t???? S?µpa????t??? (S?T)
  • ?p???e?st?? ß-?p?d??e??
  • ???????S?S
  • ?µ??a
  • ???d?
  • ???d?
  • ?µ??a

41
????S T??????????S
????? ????????? ??????S?
S????T??????????? ???????????? ß?, ßa?
CaCB ?GG???S?S??S???? CaC? ? Capto
ßa? ???S????T??????????? ??????t???
42
????S T??????????S
?????? ????????? ??????S?
???????????? ? NaCl ßa? ? ?ß ????
? AT1 RB ??????t??? CaC?
43
????S T??????????S
?????? ????????? ??????S?
?GG???S?S??S???? ? NaCl ???? ? AT1 RB
CaC? ßa? ? ß?
??????t???
44
????S T??????????S
?????? ????????? ??????S?
???S????T??????????? ? NaCl ??ta?
???st?? ??d?ste????? ??????t???
45
(No Transcript)
46
(No Transcript)
47
F?S??? ?S????? ?????????S ??????S?OS
?a?e?a (accelarated)
?e???t???a?t????t??
?a?e????(??ep?t???? Rx)
?a??????
?????s??????t??? ??s??
?????a ?a?d?a?? ??ep???e?a
?a??? (S?ed?? ep?t???? Rx)
?.?.?
???e?a?? ???efa???? ?pe?s?d?a
?etaß?????? pa?????te?
48
???a??st?!!
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