Maƙala
Allurar methylene blue don ciwon baya da ke fitowa daga diski: abin da gwaje-gwajen suka gano
Ciwon ƙasan baya alama ce, ba ganewar cuta ba. Wannan bambanci ne ke ƙayyade ko wata da'awa game da methylene blue don ciwon baya tana da ma'ana.
Yawancin ciwon baya ba shi da wani sashe guda na jiki da za a iya tabbatar da cewa shi ne sanadin ciwon. Ciwon da ke fitowa daga diski, wato discogenic pain, da'awa ce da ta fi ƙayyadadden ma'ana. Tana nufin cewa ciwon yana fitowa daga ƙarshen jijiyoyi a cikin wani takamaiman diski da ke tsakanin ƙasusuwan kashin baya, yawanci inda zoben waje da ake kira annulus ya tsage, ya kuma ba ƙananan jijiyoyi da saƙonnin kumburi damar shiga ciki. Bayyana wannan ra'ayi abu ne mai sauƙi, amma tabbatar da shi yana da wuya, domin diski da yawa da MRI ke nuna sun lalace ba sa haifar da ciwo ko kaɗan. Hoton bincike kaɗai ba zai iya gano wanda ke haifar da ciwon ba.
Shi ya sa duka gwaje-gwajen da ake tattaunawa a nan suka fara da discography mai tayar da ciwo. A ƙarƙashin jagorancin hoton X-ray mai motsi, wato fluoroscopy, ana saka allura cikin nucleus da ke tsakiyar diskin da ake zargi, ana allurar sinadarin bayyana hoto a ƙarƙashin matsin lamba da ake sarrafawa, sannan likita ya yi tambaya mai sauƙi: shin ƙara matsin lamba a wannan diski yana sake haifar da irin ciwon da kuka saba ji? Ana gwada aƙalla diski ɗaya da ke kusa a matsayin abin kwatantawa, kuma bai kamata ya haifar da ciwo ba. Marasa lafiya da aka samu diskin da ya haifar da ciwon da ya dace da nasu, tare da diskin kwatantawa da bai haifar da ciwo ba, su kaɗai ne ke ci gaba. Wannan matakin zaɓe ne da ke buƙatar shigar da allura cikin jiki, kuma yana tsara duk abin da ke biyo baya.
Masu karatu da ba su san mene ne methylene blue a fannin sinadarai ba wani lokaci suna ɗauka cewa allurar da aka yi nazari a waɗannan gwaje-gwaje tana da alaƙa da shan ruwa mai launin shuɗi. Ba haka ba ne. Allurar methylene blue cikin diski tana saka kusan 10 mg na sinadarin launi kai tsaye cikin diski ɗaya da aka riga aka gano yana haifar da ciwo. Hasashen ya shafi wurin allurar ne: sinadarin launi zai iya lalata ko rage aikin ƙananan ƙarshen jijiyoyi a tsagewar annulus, ya kuma rage kumburin wurin. Wannan hanyar aiki, idan tana faruwa, ta dogara ne da taɓa wurin kai tsaye a cikin wannan diskin.
Yadda aka gudanar da aikin a duka gwaje-gwajen
Misali mai taimakawa wajen fahimta shi ne wani ɗaki da aka rufe, mai hanyar shiga guda ɗaya. Ɗakin shi ne diskin. Hanyar shiga ita ce allura da fluoroscopy ke jagoranta, yawanci ta gefen baya. Da zarar an tabbatar da matsayinta, ana allurar ruwan gwajin a hankali cikin nucleus.
Duka gwaje-gwajen sun kuma saka wani abu dabam cikin diskin. Gwajin farko ya bayar da 1 mL na methylene blue mai kashi 1 bisa ɗari, sannan 1 mL na lidocaine mai kashi 2 bisa ɗari. Gwajin daga baya ya bayar da 1 mL na methylene blue mai 10 mg a kowace mL, tare da 0.5 mL na lidocaine mai kashi 2 bisa ɗari da 0.5 mL na sinadarin bayyana hoto. Saboda haka, ba a taɓa kwatanta allura da rashin yin wani aikin ba. Duka rukunonin sun sami saka allura, ƙara matsin lamba a diski, da maganin sa barci na wurin a cikin diskin. Bambanci guda da aka tsara shi ne methylene blue a maimakon ruwan gishiri. Bayanai kan yadda methylene blue ke aiki a ƙwayoyin halitta suna taimakawa wajen bayyana dalilin da ya sa masu bincike suka ga tasiri a wurin allurar a matsayin abu mai yiwuwa, amma yiwuwar abu ba hujja ba ce.
Wannan yana da muhimmanci wajen fahimtar yadda rukunin kwatantawa ya amsa. Duk wani sauƙi da aka samu a rukunin kwatantawa a nan ya haɗa da tasirin duk tsarin yin aikin a kashin baya, lidocaine, yadda ciwo ke sauyawa a dabi'ance, da tsammanin samun sauƙi.
Gwajin farko da ya nuna sakamako mai kyau
Gwajin bazuwar rarrabawa na 2010 da Peng da abokan aikinsa suka yi ya shigar da manya 72 masu ciwon ƙasan baya mai ɗorewa da ke tsakiyar baya, ba tare da ciwon jijiyar ƙafa ba. Alamominsu sun ɗauki fiye da watanni 6 duk da jinyar motsa jiki tare da maganin rage kumburi ko maganin opioid. MRI ya nuna lalacewar diski amma tsayin diskin ya kasance, ba su taɓa yin tiyatar ƙasan kashin baya ba, kuma discogram ya nuna ciwo a diskin da ake zargi amma ba a diskin kwatantawa da ke kusa ba. Talatin da shida sun sami methylene blue tare da lidocaine cikin diski. Talatin da shida sun sami ruwan gishiri tare da lidocaine. Marasa lafiya da masu tantance sakamako ba su san wane rukunin magani aka sanya marasa lafiyar ba. Ba zai yiwu a ɓoye wannan ga mai yin allurar ba domin sinadarin launin shuɗi ne.
An daɗe ana bibiyar su: watanni 6, 12, da 24. Ma'aunan sakamako su ne ciwo a sikeli na lambobi daga 0 zuwa 100, nakasar iya gudanar da ayyuka a Oswestry Disability Index daga 0 zuwa 100, tare da gamsuwa, amfani da magungunan rage ciwo, da matsalolin da suka biyo baya. Sakamakon da aka wallafa ya nuna babban sauƙi fiye da yadda aka saba gani. Matsakaicin ciwo ya ragu daga kusan 72 zuwa kusan 20 a rukunin methylene blue a watanni 24, yayin da rukunin kwatantawa ya sauya daga kusan 67 zuwa kusan 60. Nakasar iya gudanar da ayyuka ta ragu daga kusan 48 zuwa kusan 13 da methylene blue, amma kusan babu sauyi a rukunin kwatantawa. A watanni 24, 33 daga cikin marasa lafiya 36 da aka yi wa maganin sun ce sun gamsu ko sun gamsu ƙwarai, idan aka kwatanta da 5 daga cikin 35 a rukunin kwatantawa. Yawancin waɗanda aka yi wa maganin sun ce ba sa amfani da magungunan rage ciwo. Ba a ba da rahoton kamuwar diski da ƙwayoyin cuta ko raunin jijiyoyi ba a lokacin bibiyar. Marubutan sun bayyana maganin a matsayin mai aminci, mai tasiri, kuma wanda ke buƙatar ƙarancin kutsawa cikin jiki a rahotonsu na gwajin da aka kwatanta da placebo.
Sakamako mai girman haka, daga cibiya ɗaya da marasa lafiya 72 da aka zaɓa, shi ne irin sakamakon da ya kamata wasu masu bincike masu zaman kansu su maimaita gwajinsa.
Maimaita gwajin a cibiyoyi da yawa
An tsara binciken IMBI na Kallewaard da abokan aikinsa a matsayin maimaita gwajin a cibiyoyi huɗu a Netherlands. An shigar da marasa lafiya tamanin da huɗu, kuma 81 sun samar da bayanan bazuwar rarrabawa da za a iya nazari: 40 a rukunin methylene blue, 41 a rukunin placebo. Zaɓen ya sake buƙatar ciwo mai ɗorewa a tsakiyar baya da ya dace da ciwon da ke fitowa daga diski. A wannan karon, sai ciwon ya ɗauki aƙalla watanni 6, kulawar da ba ta ƙunshi tiyata ba ta kasa wadatarwa, ciwo yayin zama ya kai aƙalla 5 cikin 10, kuma MRI da aka yi cikin shekarar da ta gabata ya tabbatar da cewa babu raguwar tsayin diski mai tsanani da ta fi kashi 50 bisa ɗari. Da farko an yi wa marasa lafiya allurar toshe jijiyoyin haɗin facet domin tabbatar da cewa ciwon ba daga wannan haɗin yake ba. Sannan aka yi discography bisa daidaitaccen tsari, da sarrafa matsin lamba, tare da diskin kwatantawa da ke kusa da iyakokin matsin lamba da aka fayyace. An yi aikin a ɗakin tiyata, tare da maganin rigakafin kamuwa da ƙwayoyin cuta da kuma allura a hankali bisa saurin da ake sarrafawa. Rukunin kwatantawa ya sake samun ruwan gishiri tare da lidocaine da sinadarin bayyana hoto.
Babban ma'aunin sakamako shi ne nasarar magani a watanni 6, wadda aka ayyana a matsayin raguwar matsakaicin ƙimar ciwo da aƙalla kashi 30 bisa ɗari, daga bayanan da aka tattara cikin kwanaki huɗu, tare da ra'ayin marar lafiya game da sauyin yanayinsa gaba ɗaya. Ma'aunan sakamako na ƙarin bayani sun haɗa da nakasar iya gudanar da ayyuka ta Oswestry, ma'aunan ingancin rayuwa, yanayin ciwo, amfani da magungunan rage ciwo, da abubuwan illa. Marasa lafiya a rukunin placebo da har yanzu suke jin ciwo za su iya samun methylene blue bayan watanni 6. Saboda haka, kwatantawar bazuwar rarrabawa da ba ta gaurayu ba ta ƙare a watanni 6 maimakon ci gaba zuwa watanni 12 ko 24.
A watanni 6, matsakaicin ciwo ya ragu da maki 1.4 a sikeli daga 0 zuwa 10 da methylene blue, da maki 1.2 a rukunin kwatantawa, tare da ƙimar p ta 0.671 wajen kwatanta rukunonin. Yawan waɗanda suka sami sauƙin da ya cika ma'auni ya kasance kashi 35.0 bisa ɗari idan aka kwatanta da kashi 26.8 bisa ɗari, p ya yi daidai da 0.426. Nakasar iya gudanar da ayyuka ta ragu da maki 7.8 idan aka kwatanta da maki 5.5, p ya yi daidai da 0.459. Yawan waɗanda suka sami sauƙi gaba ɗaya ya kasance kusan iri ɗaya. Abubuwan da suka faru na ɗan lokaci, kamar ƙaruwa ta ɗan lokaci a ciwo ko ciwon da ke bazuwa zuwa wani wuri, sun faru a duka rukunonin ba tare da bambanci mai muhimmanci a ƙididdiga ba. Marubutan sun kammala a rahotonsu na gwajin cibiyoyi da yawa cewa bayanan ba su goyi bayan ba da shawarar allurar methylene blue cikin diski don ciwon da ke fitowa daga diski mai ɗorewa ba.
Kwatanta gwaje-gwajen
| Abu | Peng 2010, cibiya ɗaya | IMBI 2019, cibiyoyi huɗu |
|---|---|---|
| Marasa lafiyar da aka yi nazarinsu | 72 da aka rarraba bazuwar, 71 sun kammala watanni 24 | 84 da aka shigar, 81 da aka yi nazarinsu har watanni 6 |
| Zaɓen marasa lafiya | Ciwo mai ɗorewa a tsakiyar baya fiye da watanni 6, jinyar motsa jiki da magunguna sun kasa, babu matsalar jijiyoyin da ke fitowa daga kashin baya, babu tiyata a baya, tsayin diski ya kasance, discogram ya nuna ciwo amma diskin kwatantawa da ke kusa bai nuna ba | Ciwo mai ɗorewa a tsakiyar baya na watanni 6 ko fiye, kulawar da ba ta ƙunshi tiyata ba ta kasa, ciwo yayin zama 5 cikin 10 ko fiye, raguwar tsayi kashi 50 bisa ɗari ko ƙasa, gwajin toshe jijiyoyin facet bai nuna su ne tushen ciwon ba, discography bisa daidaitaccen tsari da sarrafa matsin lamba tare da diskin kwatantawa |
| Abin da rukunin kwatantawa ya samu | Huda diski tare da 1 mL na ruwan gishiri da 1 mL na lidocaine mai kashi 2 bisa ɗari | Huda diski tare da 1 mL na ruwan gishiri da 0.5 mL na lidocaine mai kashi 2 bisa ɗari da 0.5 mL na sinadarin bayyana hoto |
| Maganin da ake gwadawa | 1 mL na methylene blue mai kashi 1 bisa ɗari, 10 mg, tare da 1 mL na lidocaine mai kashi 2 bisa ɗari | 1 mL na methylene blue mai 10 mg a kowace mL tare da 0.5 mL na lidocaine mai kashi 2 bisa ɗari da 0.5 mL na sinadarin bayyana hoto |
| Ma'aunan sakamako | Sikeli na lambobin ciwo daga 0 zuwa 100, Oswestry daga 0 zuwa 100, gamsuwa, magungunan rage ciwo, matsalolin da suka biyo baya | Nasara a matsayin raguwar ciwo da kashi 30 bisa ɗari ko fiye tare da ra'ayi kan sauyi gaba ɗaya a watanni 6, da Oswestry, ingancin rayuwa, magungunan rage ciwo, abubuwan illa |
| Bibiyar bayan gwaji | Watanni 6, 12, da 24, kwatantawar bazuwar rarrabawa ta kasance yadda aka tsara | Kwatantawar bazuwar rarrabawa har watanni 6, daga baya an ba da damar sauyawa zuwa ɗayan maganin |
| Muhimmin sakamako | Ciwo daga kusan 72 zuwa 20 idan aka kwatanta da 67 zuwa 60 a watanni 24, nakasar iya gudanar da ayyuka daga kusan 48 zuwa 13 idan aka kwatanta da rashin sauyi mai ma'ana, kashi 91.6 bisa ɗari sun gamsu idan aka kwatanta da kashi 14.3 bisa ɗari | Ciwo ya ragu da 1.4 idan aka kwatanta da 1.2 cikin 10 a watanni 6, waɗanda suka sami sauƙin da ya cika ma'auni kashi 35.0 bisa ɗari idan aka kwatanta da kashi 26.8 bisa ɗari, babu bambanci mai muhimmanci a ƙididdiga |
Wani ƙarin bayani yana hana ruɗani. Wasu taƙaitattun bayanai suna danganta iyakar darajar Pfirrmann da waɗannan gwaje-gwaje. Wannan iyakar ta fito ne daga wani ƙaramin binciken gwaji na farko a Netherlands, ba daga ƙa'idojin cancantar shiga ɗayan gwaje-gwajen bazuwar rarrabawa guda biyu da aka taƙaita a sama ba.
Yadda za a fahimci saɓanin
Gwaje-gwaje biyu da aka yi da gaskiya na iya samun sakamako dabam ba tare da ɗayansu ya zama na yaudara ba. Bambance-bambancen da ke da muhimmanci su ne daidaiton zaɓe, daidaita hanyoyin gudanar da aikin, iyakokin ɓoye rukunin magani, girman samfurin bincike, da yadda aka ayyana ma'aunin sakamako.
Peng ya zaɓi ƙayyadadden rukuni daga cibiya ɗaya, ya kuma bibiyi su na shekaru biyu ba tare da sauyawa zuwa ɗayan maganin ba. Wannan yana sa babban tasiri ya zama mai sauƙin gani, amma kuma yana sauƙaƙa yin ƙari wajen fassara shi idan zaɓen marasa lafiya, sauran magungunan da aka haɗa, ko tsammani sun bambanta tsakanin rukunonin ta hanyoyin da rahoton bai nuna ba. Mai yin allurar ya san rukunin da aka sanya marar lafiya. Wannan ba abin kaucewa ba ne da sinadarin launi mai shuɗi, amma har yanzu rauni ne. IMBI ya yi amfani da cibiyoyi da yawa, ƙa'idojin matsin lamba masu tsauri, gwajin haɗin facet, daidaitaccen saurin allura, da ma'anar wanda ya sami sauƙin da ya cika ma'auni da aka ƙayyade tun farko a watanni 6. Wannan tsarin ba shi da sauƙin samar da sakamako mai matuƙar girma ta sa'a kawai, amma kuma yana amsa tambayar da ta shafi ɗan gajeren lokaci ne. Ba ya bayar da tabbataccen bayani kan sakamakon bazuwar rarrabawa na watanni 24, domin an ba rukunin kwatantawa damar sauyawa zuwa ɗayan maganin bayan watanni 6.
Ga marar lafiya ko ma'aikacin kiwon lafiya, ya kamata a fassara sakamakon da taka-tsantsan. Wani ƙaramin gwaji na farko ya gano babban amfani mai ɗorewa. Wani gwajin maimaitawa mafi girma da aka daidaita ya gano ƙaramin ƙarin sauƙi kawai, wanda bai kai muhimmanci a ƙididdiga ba, idan aka kwatanta da rukunin da aka yi wa aikin kuma ya riga ya sami lidocaine. Wannan yanayin yana rage amincewa maimakon tabbatar da tasirin maganin. Duk wanda aka ba da shawarar allurar methylene blue cikin diski ya kamata ya tambayi irin ƙa'idojin zaɓe da asibitin ke amfani da su, ko ana buƙatar discography da diskin kwatantawa, abin da ake haɗawa a allurar, yawan nasarar da asibitin ke da'awar samu a watanni 6 bisa ma'anar ciwo da aka ƙayyade tun farko, da yadda ake bin diddigin matsaloli da marasa lafiya bayan aikin. Ya dace a karanta bayanai kan tambayoyin aminci da ke tattare da amfani da methylene blue kafin duk wani shirin aikin da zai kutsa cikin jiki, da kuma ƙarin bayani kan abin da binciken asibiti game da methylene blue ya nuna da abin da bai nuna ba.
Dalilin da ya sa wannan ba ya goyon bayan ɗigon sha ko alewar gummy
Hanyar shigar da magani wani ɓangare ne na abin da ake gwadawa. Waɗannan gwaje-gwajen sun gwada sinadarin launi da aka saka cikin diski da aka zaɓa. Methylene blue da aka haɗiye yana bi ta hanji zuwa jinin da ke zagayawa a jiki, kuma yana isa kyallen jiki da taro mafi ƙanƙanta sosai kuma ba a nufa da shi zuwa takamaiman wuri ba. Babu wani ma'auni a waɗannan gwaje-gwajen da ya nuna cewa adadin da aka sha yana samar da irin taron sinadarin ko tsawon lokacin zamansa a cikin diski ɗaya na ƙasan kashin baya. Ko da an maimaita tasirin allurar cikin diski a fili, hakan ba zai shafi abin sha, ɗigo, ko alewar gummy ba sai an yi wani gwaji dabam ta wannan hanyar, da wannan adadin, a wannan rukunin masu ciwo.
Ba za a ɗauka cewa aminci ma zai kasance iri ɗaya ba. Shigar sinadarin cikin dukkan jiki yana kawo hulɗa da sauran magunguna a dukkan jiki, ciki har da hulɗar da aka rubuta sosai da magungunan da ke shafar serotonin. Aikin allura a wani diski da shan sinadarin kullum hanyoyi ne daban na samun sinadarin, masu nau'o'in haɗari daban. An yi ƙarin bayani kan wannan a hujjojin hulɗar methylene blue da magunguna.
Abin da za a iya kammalawa yana da iyaka. Wani gwajin farko na allurar methylene blue cikin diski ya ba da rahoton babban sauƙi har shekaru biyu. Gwajin maimaitawa na daga baya a cibiyoyi da yawa, wanda aka kwatanta da placebo, bai sake samun wannan sakamakon a watanni shida ba. Babu ɗaya daga cikin sakamakon da yake hujjar cewa methylene blue da ake sha yana taimakawa ciwon baya.