{"id":9660,"date":"2011-12-04T20:00:00","date_gmt":"2011-12-04T20:00:00","guid":{"rendered":""},"modified":"2011-12-04T20:00:00","modified_gmt":"2011-12-04T20:00:00","slug":"uzsiteses-kosulys","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/uzsiteses-kosulys\/9660\/","title":{"rendered":"U\u017esit\u0119s\u0119s kosulys"},"content":{"rendered":"<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa15\"><span class=\"A19\"><span style=\"font-family: Arial; font-size: 10pt\">Gyd. <b>Oksana Valentij<\/b><\/span><\/span><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span class=\"A19\"><span style=\"font-family: Arial; font-size: 10pt\" lang=\"EN-GB\">LSMU MA<\/p>\n<p><\/span><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span class=\"A19\"><span style=\"font-family: Arial; font-size: 10pt\" lang=\"EN-GB\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa11\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt\">\u012evadas<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\"><a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">Kosulys<\/a> yra viena i\u0161 pagrindini\u0173 prie\u017eas\u010di\u0173, d\u0117l kuri\u0173 pacientai kreipiasi \u012f gydytoj\u0105, ypa\u010d kai jis u\u017esit\u0119sia. <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">Kosulys<\/a>, varginantis pacient\u0105 ilgiau nei 8 savaites, vadinamas l\u0117tiniu. Remiantis ty\u00adrim\u0173 duomenimis, l\u0117tinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">kosulys<\/a> pasirei\u0161kia iki 40 proc. gyventoj\u0173 (1).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\"><a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">Kosulys<\/a> \u2013 forsuotas i\u0161kv\u0117pimas pro burn\u0105, kur\u012f lemia kv\u0117puojam\u0173j\u0173 raumen\u0173 susitrauki\u00admas d\u0117l receptori\u0173 dirginimo rykl\u0117je, gerklose, trach\u0117joje ar bronchuose. <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">Kosulys<\/a> yra nes\u0105lygi\u00adnis refleksas, kurio metu i\u0161 kv\u0117pavimo tak\u0173 pa\u00adsi\u0161alina svetimk\u016bniai ir dirginan\u010dios med\u017eiagos.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa11\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa11\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt\">Kosulio mechanizmas<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">Impulsas i\u0161 kosulio receptori\u0173 keliauja tri\u0161a\u00adkio, lie\u017euvinio rykl\u0117s ir klajoklinio (rykl\u0117s, vir\u00ad\u0161utinio gerkl\u0173 ir plautinio rezginio skaidulomis) nerv\u0173 aferentin\u0117mis ir sensorin\u0117mis skaidulo\u00admis iki kosulio centro. I\u0161 kosulio centro eferen\u00adtiniais laidais plinta i\u0161 pailg\u0173j\u0173 smegen\u0173 \u012f ger\u00adklas ir trachiobronchin\u012f med\u012f klajoklio nervu, o diafragmos ir nugaros smegen\u0173 motorin\u0117s skai\u00addulos (nuo C3 iki S2) impuls\u0105 perduoda tarp\u0161on\u00adkauliniams ir pilvo sienos raumenims bei diafra\u00adgmai (2). Susitraukdami raumenys sukelia stai\u00adg\u0173 ir labai greit\u0105 i\u0161kv\u0117pim\u0105; tod\u0117l i\u0161stumiami skrepliai ir \u012fvair\u016bs svetimk\u016bniai i\u0161 gerkl\u0173, tra\u00adch\u0117jos, bronch\u0173.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">Kosulio receptoriai i\u0161sid\u0117st\u0119 kv\u0117pavimo ta\u00adkuose, nuo rykl\u0117s iki alveoli\u0173. Did\u017eiausia j\u0173 kon\u00adcentracija gerklose, trach\u0117jos karinoje ir stam\u00adbi\u0173j\u0173 bronch\u0173 bifurkacijoje (2).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">Dominuoja trij\u0173 tip\u0173 receptoriai (3\u20135):<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa25\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">1. Greitai besiadaptuojantys receptoriai \u2013 adap\u00adtuojasi per 1\u20132 sekundes; nervinis impulsas skaidulomis plinta 4\u201318 m\/s grei\u010diu (6). Reaguoja \u012f mechaninius dirgiklius (cigare\u010di\u0173 d\u016bmai, amoniakas, r\u016bg\u0161tin\u0117s ir \u0161armin\u0117s me\u00add\u017eiagos, hipotoninis ir hipertoninis fiziologi\u00adnis tirpalas; plau\u010di\u0173 perkrovos (pvz., edema), plau\u010di\u0173 atelektaz\u0117s ir bronch\u0173 susiaur\u0117jimas).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa25\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">2. L\u0117tai besiadaptuojantys receptoriai \u2013 labai jautr\u016bs mechanini\u0173 j\u0117g\u0173 poky\u010diams kv\u0117pa\u00advimo metu. Nervinis impulsas skaidulomis plinta 15\u201332 m\/s grei\u010diu (6).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa25\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">3. Nociceptoriai (C skaidul\u0173 receptoriai) \u2013 ner\u00advinis impulsas plinta &lt;2 m\/s grei\u010diu (7, 8). Reaguoja \u012f cheminius dirgiklius ir \u012f u\u017edegimo bei imunologinius mediatorius (histaminas, bradikininas, prostaglandinai, kapsaicinas ir r\u016bg\u0161tys) (6).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa11\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa11\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt\">Prie\u017eastys<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">Daugyb\u0119 met\u0173 mokslininkai band\u0117 nustaty\u00adti pagrindin\u0119 kosulio prie\u017east\u012f. Atlikt\u0173 prospektyvini\u0173 klinikini\u0173 tyrim\u0173 re\u00adzultatai parod\u0117, kad 92\u2013100 proc. vis\u0173 l\u0117tinio kosulio atvej\u0173 pagrindin\u0117s prie\u017eastys yra trys. \u0160ios trys b\u016bkl\u0117s vadinamos l\u0117tinio kosulio pa\u00adtogenine triada:<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa25\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">1. Vir\u0161utini\u0173 kv\u0117pavimo tak\u0173 lig\u0173 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">kosulys<\/a>.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa25\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">2. Astma.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa25\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">3. <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/gastroezofaginio-refliukso-liga\/4363\">Gastroezofaginio refliukso liga<\/a> (GERL).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa11\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa11\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt\">Diagnostika<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">Diagnozuojant kosulio prie\u017east\u012f labai svar\u00adbu i\u0161samiai surinkti anamnez\u0119. <i>3 lentel\u0117je <\/i>pa\u00adteikiami simptomai ir prie\u017eastys, kurie lydi ko\u00adsul\u012f. Remiantis \u0161iais duomenimis, galima \u012ftarti kosul\u012f suk\u0117lusi\u0105 lig\u0105. <\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt\" lang=\"EN-GB\">Kiekvienas pacientas, kuris skund\u017eiasi u\u017esi\u00adt\u0119susiu kosuliu, turi b\u016bti i\u0161samiai apklaustas ir i\u0161tirtas. Rinkdami anamnez\u0119, nepamir\u0161kite pa\u00adklausti apie vartojamus vaistus, \u017ealingus \u012fpro\u00ad\u010dius, gyvenam\u0105j\u0105 ir darbo aplink\u0105, ar netur\u0117\u00adjo kontakto su sergan\u010diu tuberkulioze; ar anks\u00ad\u010diau nesirgo arba neserga v\u0117\u017eiu, tuberkulioze ar AIDS; ar anks\u010diau darytosekr\u016btin\u0117s l\u0105stos rent\u00adgenogramose neaptikta plau\u010di\u0173 audinio poky\u010di\u0173.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt\" lang=\"EN-GB\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt\" lang=\"EN-GB\"><img loading=\"lazy\" decoding=\"async\" alt=\"U\u017esit\u0119s\u0119s kosulys\" width=\"494\" height=\"258\" src=\"\"><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\">\u00a0<\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\">\u00a0<\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Tinkamai surinkta anamnez\u0117 padeda nustatyti di\u00adagnoz\u0119 70\u201380 proc. atvej\u0173 be papildom\u0173 tyrim\u0173.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Pacientams, kurie r\u016bko, patariama mesti; o tiems, kurie vartoja AKFi preparatus, jie pakei\u00ad\u010diami kitais, neveikian\u010diais kosulio centro. Me\u00adtus r\u016bkyti, <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">kosulys<\/a> praeina per 4 savaites (16). Pakeitus AKFi kitais antihipertenziniais vais\u00adtais, kosulio epizodai praeina per 2 savaites, ta\u00ad\u010diau vidutini\u0161kai gali praeiti po 26 dien\u0173 (16).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Ta\u010diau ne visada pavyksta tiksliai nustatyti diagnoz\u0119 remiantis tik paciento nusiskundimais ir anamneze. <\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Norint diagnozuoti lig\u0105, gal\u0117jusi\u0105 i\u0161provo\u00adkuoti kosul\u012f, gali tekti atlikti papildomus tyri\u00admus: plau\u010di\u0173 funkcijos \u012fvertinimo tyrimus bei inhaliuojam\u0105j\u012f provokacin\u012f m\u0117gin\u012f su meta\u00adcholinu; ezofagografij\u0105 su bariu ir 24 val. <i>pH <\/i>gram\u0105. Jeigukr\u016btin\u0117s l\u0105stos rentgenogramoje pastebimi poky\u010diai (plautinio audinio pa\u017eei\u00addimai), indikuotinakr\u016btin\u0117s KT, bronchosko\u00adpija, biopsija, skrepli\u0173 tyrimas, norint tiksliai diagnozuoti lig\u0105.<i><\/p>\n<p><\/i><\/span><\/p>\n<p style=\"text-align: justify; line-height: 14.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 14.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Kosulio, atsiradusio d\u0117l vir\u0161utini\u0173 kv\u0117pavimo tak\u0173 lig\u0173, gydymas<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 12.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 12.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Atkos\u0117jim\u0105 lengvinantys vaistai<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Ambroksolis <\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">pasi\u017eymi sekretolitiniu, muko\u00adlitiniu, sekretomotoriniu poveikiu, atkurian\u010diu kv\u0117pavimo tak\u0173 fiziologinio klirenso mechaniz\u00admus, tod\u0117l stabdo tir\u0161to sekreto kaupim\u0105si kv\u0117\u00adpavimo takuose ir ma\u017eina plau\u010di\u0173 bei bronch\u0173 alveoli\u0173 ventiliacijos kli\u016btis. Taip veikdamas, ambroksolis gali atkurti ir pagerinti organizmo apsaug\u0105 nuo infekcijos (nat\u016bralioji apsauga). Be to, \u012frodyta keletas svarbi\u0173 papildom\u0173 ambrokso\u00adlio savybi\u0173, kurios i\u0161skiria \u0161iuos vaistus i\u0161 kit\u0173 atkos\u0117jim\u0105 lengvinan\u010di\u0173 preparat\u0173. Ambrokso\u00adlis pasi\u017eymi u\u017edegim\u0105 slopinan\u010diu ir antioksida\u00adciniu veikimu, o tai padeda grei\u010diau nuslopinti u\u017edegim\u0105 ir apsaugoti plau\u010di\u0173 audinius nuo pa\u00ad\u017eeidimo. Taip pat \u012frodytas ambroksolio geb\u0117ji\u00admas ma\u017einti virus\u0173 infektyvum\u0105 (plitim\u0105) \u2013 \u0161i savyb\u0117 buvo \u012frodyta atliekant tyrimus b\u016btent su gripo virusu, kaip viena i\u0161 \u016bminio kosulio prie\u00ad\u017eas\u010di\u0173. Paskutiniu metu kalbama ir apie vieti\u00adn\u012f nuskausminam\u0105j\u012f ambroksolio poveik\u012f, kuris svarbus pacientams, be kosulio, dar besiskun\u00add\u017eiantiems gerkl\u0117s skausmu.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Svarbu taip pat, kad skiriant ambroksolio su an\u00adtibiotikais padid\u0117ja pastar\u0173j\u0173 penetracija plau\u010di\u0173 au\u00addinyje (17\u201322).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Neseniai Lietuvoje pasirod\u0117 naujas ambrok\u00adsolio preparatas <i><a href=\"https:\/\/pasveik.lt\/vaistai-paieska\/?srch=Flavamed\">Flavamed<\/a><\/i>, kuris i\u0161leid\u017eiamas trij\u0173 form\u0173: <\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">1. Sirupas. 5 ml yra 30 mg ambroksolio (vyresniems nei 12 met\u0173 vaikams ir suaugusiesiems pirmas 2\u20133 dienas reikia gerti po 5 ml tirpalo 3 kartus per par\u0105, v\u0117liau po 5 ml 2 kartus per par\u0105).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">2. Tablet\u0117s. Vienoje tablet\u0117je yra 30 mg ambrokso\u00adlio (6\u201312 met\u0173 vaikams skiriama po pus\u0119 tablet\u0117s 2\u20133 kartus per par\u0105, vyresniems nei 12 met\u0173 vaikams ir suaugusiesiems pirmas 2\u20133 dienas \u2013 po tablet\u0119 3 kartus per par\u0105, paskui \u2013 po tablet\u0119 2 kartus per par\u0105). <\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">3. \u0160nyp\u0161\u010diosios tablet\u0117s. Vienoje tablet\u0117je yra 60 mg ambroksolio (vyresniems nei 12 met\u0173 vaikams ir suaugusiesiems pirmas 2\u20133 dienas \u2013 po 1\/2 tablet\u0117s 3 kartus per par\u0105, v\u0117liau \u2013 po 1\/2 tablet\u0117s 2 kartus per par\u0105. Suaugusiesiems gali b\u016bti skiriama po vien\u0105 <i><a href=\"https:\/\/pasveik.lt\/&lt;a%20href=\" https:>flavamed<\/a>\/&#8221;&gt;Flavamed <\/i>\u0161nyp\u0161\u010diaj\u0105 tablet\u0119 2 kartus per par\u0105).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">N-acetilcisteinas (NAC). <\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Skystina gleives ir skatina j\u0173 pasi\u0161alinim\u0105 i\u0161 bronch\u0173, ma\u017eina sekreto klampum\u0105. Be to, pasi\u017eymi antitoksiniu poveikiu. Skiriamas po 300 mg 3 kartus per par\u0105.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 12.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 12.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Kosul\u012f slopinantys preparatai<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">\u0160ios grup\u0117s preparatai tur\u0117t\u0173 b\u016bti skiriami labai atsakingai \u2013 tik esant varginan\u010diam, ilgalaikiam ne infekcin\u0117s kilm\u0117s kosuliui. Kitu atveju kosulio slo\u00adpinimas gali lemti bakterines komplikacijas. Taip pat \u0161ios grup\u0117s vaist\u0173 negalima skirti kartu su ko\u00adsul\u012f lengvinan\u010diais preparatais.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Okseladino citratas. <\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Tai kosul\u012f slopinantis vaistas, centrinio veikimo (ma\u017eina padid\u0117jusio kosulio centro aktyvum\u0105). Skiriamas, kai vargina sausas <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">kosulys<\/a>.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Prenoksdiazinas. <\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Slopina kosul\u012f, ma\u017eindamas periferini\u0173 juntam\u0173j\u0173 kosulio receptori\u0173 dirglum\u0105. O d\u0117l bronchodilatacinio poveikio slopinami pro\u00adprioreceptoriai, kurie svarb\u016bs kosulio refleksui. Pre\u00adnoksidiazinas lengvina kv\u0117pavim\u0105 ir ma\u017eina skre\u00adpli\u0173 kiek\u012f. \u0160iek tiek slopinamas kv\u0117pavimo centras, ta\u010diau kv\u0117pavimo slopinimo neatsiranda.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Butamirato divandenilio citratas \/ gvaifene\u00adzinas. <\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Butamirato citratas yra periferinio poveikio, ne opiatinis kosul\u012f slopinantis preparatas. Butami\u00adrato citrato kosul\u012f slopinant\u012f poveik\u012f papildo gvai\u00adfenezino atkos\u0117jim\u0105 skatinantis poveikis. Gvaife\u00adnezinas skatina bronch\u0173 sekrecij\u0105 ir ma\u017eina glei\u00advi\u0173 klampum\u0105. Sekrecija padid\u0117ja d\u0117l tiesioginio poveikio bronch\u0173 liaukoms. I\u0161 bronch\u0173 i\u0161siskirian\u00ad\u010dios gleiv\u0117s didina virpamojo epitelio aktyvum\u0105 ir lengvina gleivi\u0173 perne\u0161im\u0105 bei atkos\u0117jim\u0105.<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 14.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/b><\/p>\n<p style=\"text-align: justify; line-height: 14.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><a href=\"https:\/\/pasveik.lt\/ligos-ir-sindromai\/gastroezofaginio-refliukso-liga\/4363\">Gastroezofaginio refliukso <\/a>ligos gydymas<\/span><\/b><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Nazofaringoskopijos metu, esant GERL, mato\u00admi balso ply\u0161io poky\u010diai, susij\u0119 su refliuksu; ger\u00adkl\u0173 edema ir eritema, abipus\u0117 balso ply\u0161io edema ir u\u017epakalin\u0117s s\u0105augos hipertrofija ar gerkl\u0173 glei\u00advin\u0117s sustor\u0117jimas. GERL gali b\u016bti diagnozuoja\u00admas ir pagal tipinius simptomus: tai <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/remuo\/4527\">r\u0117muo<\/a>, r\u016bg\u0161\u00adties skonis burnoje, vir\u0161utin\u0117s pilvo dalies skaus\u00admas. <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/kosulys\/56468\">Kosulys<\/a> \u2013 vienas i\u0161 netipini\u0173 GERL simp\u00adtom\u0173 \u2013 da\u017enai kamuoja ryte (d\u0117l padid\u0117jusios skrand\u017eio r\u016bg\u0161ties gamybos nakt\u012f).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; line-height: 10.05pt; margin: 0cm 0cm 0pt; mso-layout-grid-align: none\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Gydymas pradedamas nuo gyvenimo b\u016bdo ko\u00adrekcijos: dieta, t. y. riboti suvartojam\u0173 riebal\u0173 kie\u00adk\u012f; riboti kavos su kofeinu, \u0161okolado, m\u0117t\u0173, citrus\u0173 bei alkoholio; patartina mesti r\u016bkyti; riboti intensy\u00advias treniruotes (23).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">Medikamentinis gydymas pradedamas pre\u00adparatais, kurie efektyviai veikia skrand\u017eio r\u016bg\u0161\u00adties gamyb\u0105, tai pirmiausia histamino H2 recep\u00adtori\u0173 antagonistai (pvz., <i><a href=\"https:\/\/pasveik.lt\/&lt;a%20href=\" https:>raniberl<\/a>\/&#8221;&gt;Raniberl<\/i>). D\u0117l i\u0161skir\u00adtin\u0117s savyb\u0117s efektyviai slopinti naktin\u0119 r\u016bg\u0161\u00adties sekrecij\u0105, ranitidinas (pvz., <i><a href=\"https:\/\/pasveik.lt\/&lt;a%20href=\" https:>raniberl<\/a>\/&#8221;&gt;Raniberl<\/i>) rekomenduojamas skirti vakare, siekiant i\u0161veng\u00adti rytini\u0173 kosulio priepuoli\u0173. Atsakas \u012f gydym\u0105 vertinamas po 2 savai\u010di\u0173, gali prireikti 6\u20138 sa\u00advai\u010di\u0173 kurso, ta\u010diau kai kuri\u0173 ligoni\u0173 gydymas gali b\u016bti dar ilgesnis (24, 25). Esant sunkioms GERL formoms galima rinktis kombinuot\u0105j\u012f gydym\u0105: proton\u0173 pompos inhibitorius ir rani\u00adtidin\u0105 (nak\u010diai).<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\"><\/p>\n<p>\u00a0<\/p>\n<p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"MsoNormal\"><span style=\"font-family: Arial; color: black; font-size: 10pt; mso-ansi-language: LT; mso-fareast-language: LT\">\u017durnalas \u201eInternistas\u201c <\/span><span style=\"font-family: Arial; font-size: 10pt\" lang=\"EN-GB\"><\/p>\n<p><\/span><\/p>\n<p>\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">Kosulys yra viena i\u0161 pagrindini\u0173 prie\u017eas\u010di\u0173, d\u0117l kuri\u0173 pacientai kreipiasi \u012f gydytoj\u0105, ypa\u010d kai jis u\u017esit\u0119sia. Kosulys, varginantis pacient\u0105 ilgiau nei 8 savaites, vadinamas l\u0117tiniu. Remiantis ty&shy;rim\u0173 duomenimis, l\u0117tinis kosulys pasirei\u0161kia iki 40 proc. gyventoj\u0173 (1).<o:p><\/o:p><\/span><\/p>\n<p style=\"text-align: justify; margin: 0cm 0cm 0pt\" class=\"Pa8\"><span style=\"font-family: Arial; color: black; font-size: 10pt\">Kosulys &ndash; forsuotas i\u0161kv\u0117pimas pro burn\u0105, kur\u012f lemia kv\u0117puojam\u0173j\u0173 raumen\u0173 susitrauki&shy;mas d\u0117l receptori\u0173 dirginimo rykl\u0117je, gerklose, trach\u0117joje ar bronchuose. Kosulys yra nes\u0105lygi&shy;nis refleksas, kurio metu i\u0161 kv\u0117pavimo tak\u0173 pa&shy;si\u0161alina svetimk\u016bniai ir dirginan\u010dios med\u017eiagos.<o:p><\/o:p><\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[3154,275,39,517,259,873,64,138],"site":[],"post_item_type":[27345],"class_list":["post-9660","post","type-post","status-publish","format-standard","hentry","category-gydymo-naujienos","tag-citratas","tag-diagnoze","tag-dieta","tag-kosulys","tag-preparatai","tag-preparatas","tag-tabletes","tag-vaistai"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/9660","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=9660"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/9660\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=9660"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=9660"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=9660"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=9660"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=9660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}