Tuhinga
Te wai horoi waha puru metilīni mō te mumura kiriuhi hūpē: ngā kitenga o tētahi whakamātautau mamae mate pukupuku
He āhuatanga motuhake te mumura kiriuhi hūpē nā te maimoatanga mate pukupuku. Ka whara te kiriuhi o roto i te waha i te hahau matū, i te maimoatanga whakarite rānei mō te whakawhitinga pūtau; ka puta ngā whewhe, ā, nā ngā pito io kua noho tahanga ka mamae te kai, te horomi, me te kōrero. I runga i te tauine mumura kiriuhi hūpē a WHO e whakaahuatia ana i ngā aratohu tiaki tautoko, ka taea tonu te kai mārō i te taumata 2, engari i te taumata 3 ka taea e te tūroro ngā wai anake. He putanga motuhake te whakahaere mamae me te whakaora kiko. Ka taea e tētahi wai horoi te whakapai ake i te tuatahi, me te kore e whakarerekē i te tuarua.
Ko taua wehewehenga te tūāpapa mō te whakamātautau ki te tangata pai rawa e wātea ana mō te wai horoi waha puru metilīni mō tēnei whakamahinga: he whakamātautau matapōkere wāhanga 2 i MD Anderson i te tau 2022, i whakaputaina ki BMC Medicine hei rangahau mō te mamae mumura kiriuhi hūpē e kore e taea te whakahaere. Kāore i whakamātauria te puru metilīni mō ngā whewhe waha whānui, te whakapokenga korokoro, te mate harore waha, te whakamahinga wai horoi waha ia rā rānei. I whakamātauria tētahi wai horoi kua waihangatia motuhaketia, i whakamahia mā tētahi tikanga kotahi, mō te mamae e mau tonu ana ahakoa te maimoatanga.
He aha i whakamātauria e te rangahau
He māmā te hoahoa: tāpirihia he wai horoi ka pā tika ki te kiko ki te tiaki tikanga, puritia ki runga i te kiko mamae, tuwhaina ki waho, mahia anō i ngā wā kua whakaritea, ā, inea te mamae me te āheinga mahi i te 48 hāora.
I tohaina matapōkeretia ngā pakeke whai mumura kiriuhi hūpē mamae tonu ahakoa te tiaki tikanga ki te maimoatanga tikanga anake (n = 16), ki te maimoatanga tikanga me te puru metilīni i te 0.025% (n = 15), te 0.05% (n = 14), te 0.1% rānei (n = 15). O ngā kaiuru 69, e 60 i whakaoti i te maimoatanga. E ai ki te pūrongo whakamātautau katoa, i hunaia te kukūtanga i tētahi taha anake, engari kāore te rōpū whakataurite i whiwhi wai horoi puru, nō reira kāore i taea te huna tika te whakataurite ki te tiaki tikanga. Kāore he rōpū rongoā horihori, ā, i whakarārangihia tēnei e ngā kaituhi hei herenga.
He taumaha te pānga o te mate ki te rōpū. I roto i te hunga i whakaoti, e 72% kua whiwhi whakawhitinga pūtau taketake, ā, ko te toenga kua whiwhi hahau matū puta noa i te tinana, maimoatanga CAR-T rānei. I te urunga, e 90% he mumura kiriuhi hūpē taumata 3 a WHO, ā, e 10% he taumata 2; ko te tau waenga o ngā rā kua pā kē te mamae he 6 rā. Kāore te pepa e wehewehe i ngā tātaritanga mate pukupuku mā te momo, nō reira kāore e taea te here i ngā kerēme mō tētahi momo mate pukupuku ki tēnei rangahau.
I whiwhi ia tūroro i tētahi pounamu 100 mL i whakaranu motuhaketia e te whare rongoā rangahau: tangohia te 6 ki te 10 mL, puritia ki ngā wāhi mamae mō te 5 meneti me te koropupū haere i te waha me te korokoro, tuwhaina ki waho me te kore e horomi, tatari i mua i te horoi waha, i te kai rānei, ā, mahia anō ia 6 hāora mō te 2 rā pea. I haere tonu te tiaki o mua, ā, tērā pea i uru mai te akuaku waha, te wai horoi lidocaine, te wai horoi waha whakaranu e kīia ana he “magic mouthwash” me te nystatin, ngā whakaranu diphenhydramine me te patu waikawa, me ngā rongoā opioid e mahi ana puta noa i te tinana.
Ko te paearu putanga matua i whakaputaina ko te rerekētanga o te mamae i runga i tētahi tauine 11-ira (0 mō te kore mamae, 10 mō te mamae tino kino) mai i te tīmatanga ki te rā 2. Mō te mahi a te waha, i whakamahia he kaute taumahatanga 0 ki te 6, mā te tāpiri i ngā kaute mō te kai, te horomi, me te kōrero; i whakatauria ia mahi hei taea, hei uaua, hei kore e taea rānei. I tuhia te taumata a WHO i te whakaurunga anake, kāore i aroturukitia auautia.
Whakarāpopototanga o te hoahoa whakamātautau me ngā putanga
Ka wehe tēnei ripanga i ngā ariā e toru: te mamae, te mahi a te waha, me ngā pānga kino. Kāore i whakapūmautia i konei te whakaora, te whakakore whakapokenga, te whakaiti rānei i te hiahia ki ngā opioid.
| Pātai | He aha i inea | Hua i te rā 2 |
|---|---|---|
| I heke te mamae? | Te rerekētanga o te kaute mamae, mai i te tīmatanga ki te rā 2 | He hekenga toharite 1.69 ki te tiaki tikanga, ki te whakataurite ki te 5.20, 4.54, me te 5.15 ki ngā wai horoi 0.025%, 0.05%, me te 0.1%. Ngā kaute tau waenga i te rā 2: 5.5 ki te whakataurite ki te 3, 2, me te 2. |
| I pai ake te kai, te horomi, me te kōrero? | Te taumahatanga ki te mahi a te waha, 0 ki te 6 | He hekenga toharite 0.81 ki te tiaki tikanga, ki te whakataurite ki te 2.47, 2.79, me te 2.87 ki ngā kukūtanga wai horoi e toru. Ngā kaute tau waenga i te rā 2: 4 ki te whakataurite ki te 2, 1, me te 2. |
| He pēhea te tere, ā, he pēhea te roa o te pānga? | Ngā wā i pūrongotia e ngā tūroro | I roto i ngā tūroro 44 i whiwhi wai horoi, i whakaoti hoki, e 77% i rongo i te whakamaurutanga nui rawa i roto i ngā meneti i muri i te horoinga tuatahi. I hoki mai te mamae ki te 57%, ko te nuinga i waenga i te 4 me te 8 hāora, he iti ake tōna kaha. Tata ki te 59% i tono wai horoi anō i muri i te rā 2. |
| I tere ake te ora o ngā whewhe? | Te taumata a WHO i roto i te wā | Kāore i inea i muri i te whakaurunga. E kī ana ngā kaituhi me rangahau anō te wā whakaora. |
| I heke te whakamahinga opioid? | Ngā rahinga ōrite ki te morphine ia rā | Kāore i taea te whakamāori i ngā hua. Ko te tau waenga i te tīmatanga he tata ki te 114 mg ia rā, engari kāore i taea te wehe ngā horopeta mō te mumura kiriuhi hūpē i ngā horopeta mō ētahi atu take mamae. |
| He aha ngā kino i puta? | Ngā takahanga kino tae noa ki te 30 rā | He wera poto i te waha i te whakamahinga tuatahi (5 kēhi i ngā hua taipitopito; e kī ana te whakarāpopototanga he 8, he rerekētanga kāore anō kia whakatauria), tae atu ki tētahi tūroro i wehe atu. I ngaro te poke puru rangitahi mā te akuaku, mā ngā kai rānei. Kāore he takahanga kino taumaha, ā, kāore he poke pūmau i te 30 rā. |
Ki te whakataurite ki te tiaki tikanga, i eke te hekenga mamae ki te paepae tikanga mō ngā kukūtanga 0.025% me te 0.1%, engari i te taitapa mō te 0.05% (P = .0506). Kāore ngā kukūtanga wai horoi e toru i rerekē tētahi i tētahi, nō reira kāore te whakamātautau e tautuhi i tētahi kukūtanga tino pai.
He aha kāore i whakamātauria e tēnei rangahau
Ka kite te kaipānui i tētahi hua pai mō te mamae, ā, ka whakawhānui i taua hua ki tētahi ariā e pātata ana. Me whai whakamātautau motuhake ia whakawhānuitanga i raro nei.
Tuatahi, te maimoatanga whakapokenga. I inea e te whakamātautau te mamae me te āheinga mahi i te mumura kiriuhi hūpē e pā ana ki te hahau matū. Kāore i whakamātauria te whakapokenga waha nā te huakita, te harore, te huaketo rānei, te kirikita niho, te mumura pae niho, te whakapai rānei i te kakara hā i ia rā. Ahakoa i whakamahia he whakaranu whai nystatin hei wāhanga o te tiaki o mua, ehara tēnei i te taunakitanga he patu harore te wai horoi whakamātau. Ka wehe ēnei whakamahinga i tā mātou tirohanga whānui e wehe ana i ngā mariao waha noa i te mumura kiriuhi hūpē nā te mate pukupuku.
Tuarua, te whakamahinga whānui o te wai horoi waha puru metilīni. He mumura kiriuhi hūpē taumata 2 ki te 3 tō ngā kaiuru e mau tonu ana ahakoa te maimoatanga, ā, i raro rātou i te tiaki mātanga mate pukupuku. Kāore i rangahaua ngā tūao hauora, ngā whewhe waha noa, te korokoro mamae rānei. Kei tā mātou aratohu mō ngā kerēme waha me te korokoro hoki tēnei rohe.
Tuatoru, te whakaora kiriuhi hūpē. Ki te kore he whakatauranga auau, he inenga whewhe rānei, kāore te kaute mamae iti ake e whakamātau i kati wawe ake te kiko. E mārama ana te kōrero a ngā kaituhi mō tēnei.
Tuawhā, te puru metilīni kua horomia. I tuwha ngā tūroro i te wai horoi ki waho. Kāore te mimiti ki te tinana katoa, ngā pāhekoheko rongoā, me ngā pānga paitini o te waikano kua horomia i whakamātauria. He wāhanga o te maimoatanga te tuwha, te horomi rānei; ehara i te taipitopito iti.
He aha e kore ai te wairewa hokohoko e taea te whakakapi
Ka ōrite pea te tae o tētahi whakaranu rangahau me tētahi pounamu hokohoko, engari ka rerekē pea ngā āhuatanga katoa e whakatau ana i te pānga me te mōrea: te kukūtanga, te rōrahi, te wā whakapā, ngā matū āpiti, te kounga ā-moroiti, me ngā tohutohu. I whakamahia e tēnei whakamātautau ngā kukūtanga i whakaranu motuhaketia, tata ki te 0.25 ki te 1 mg ia mL, he wā whakapā 5-meneti kua whakaritea, me te tuku horopeta ia 6 hāora. Kāore tētahi hua hokohoko he kukūtanga rerekē, he koropupū poto i te waha, he tohutohu horomi rānei e whakaputa anō i aua tikanga.
I ahu mai ngā pounamu whakamātautau i tētahi whare rongoā rangahau. He rerekē te kōeke me ngā whakamātautau o te puru metilīni hokohoko, ā, he take nui ngā hapa kukūtanga i tētahi waha whai whewhe. Hei whakataurite, me whai te kukūtanga tika, te rārangi whakauru katoa, me tētahi tiwhikete mō te wairewa oti, kaua mō te matū whakauru taketake anake. Ka whakamārama tā mātou whakamāramatanga mō te whakamātautau wairewa oti i taua tuhinga.
I whakatakoto ngā kairangahau i te whakapae he pānga whakamauru mamae ā-rohe tō te wai horoi ki ngā muka io mamae kua noho tahanga, tērā pea mā ngā tohu ā-rohe e whakaiti ana i te mumura. I tuhia hoki e rātou kāore te wai horoi i whakakore i te rongo tāwara, i te urupare ruaki rānei, pēnei i te rongoā whakamoe tikanga. Nā taua whakapae ka whai take te tūponotanga o te whakamauru tohumate. Kāore e whakamātau ana ka whai pānga tētahi wai puru ahakoa tōna momo ki tētahi wharanga waha ahakoa tōna momo.
Te horopaki haumaru me ngā herenga
Ahakoa i pai te whakamanawa ki te maimoatanga mō te wā poto i tēnei rōpū kua tīpakohia, kāore tēnei e whakapūmau i te haumaru whānui. I aukatihia i te whakamātautau te hunga whai ngoikoretanga glucose-6-phosphate dehydrogenase, te hunga hapū, te hunga whāngai ū, me te hunga whai mumura kiriuhi hūpē nā te haumanu iraruke. Ka pā te puru metilīni e mahi ana puta noa i te tinana ki tētahi pāhekoheko taumaha e puta ai te mate serotonin ki ngā rongoā e pā ana ki te serotonin, ki te mōrea pakaru pūtau toto whero mō te hunga whai ngoikoretanga G6PD, me ngā whakatūpato mō te hapūtanga. Kāore anō kia pai te ine i te nui o te mōrea ki te tinana katoa mō tētahi wai horoi ka tuwhaina tika ki waho, nō reira he mea nui te arotake rongoā.
Me tūmanako he panoni tae puru rangitahi, me pūrongo te wera e mau tonu ana i tua atu i te whakamahinga tuatahi, ā, kaua e huri i tētahi wai horoi hei tuwha ki waho hei horopeta ka horomia me te kore arotake haumanu.
Ko te aroturuki mō te whai huatanga i te tātaritanga i whakaputaina he 48 hāora; i haere tonu te aroturuki haumaru ki te 30 rā. He iti te tauira, he rerekē ngā maimoatanga o mua, ā, kāore i hunaia te rōpū whakataurite. He tohu wāhanga 2 te hua mō te whakahaere tohumate, ehara i te paerewa maimoatanga. Ka whakaatu tā mātou aratohu mō te pānui rangahau puru metilīni me pēhea te tirotiro i te tohatoha matapōkere, te huna, ngā paearu putanga, me te aroturuki i mua i te mahi i runga i tētahi whakamātautau kotahi.
Ngā pātai hei kawe ki te rōpū mātanga mate pukupuku
Kua whai tiaki tautoko kua whakapūmautia kē te mamae mumura kiriuhi hūpē, ā, me matapaki tētahi wai horoi whakamātau i roto i taua mahere. Ko ētahi pātai whai take: he aha te taumata o te mumura kiriuhi hūpē; he aha ngā tikanga maimoatanga e whakamahia kētia ana; he aha ngā rongoā ka pāhekoheko pea ki te puru metilīni; e mōhiotia ana rānei te āhua G6PD; ā, he aha te putanga ka tautuhi i te angitu, i te whakamutu rānei (te kaute mamae, te āhei ki te horomi wai, tētahi pānga kino rānei). Kawea te tohutoro whakamātautau tika me ngā taipitopito whakaranu, kaua ko tētahi kerēme hua whānui anake. Kei tā mātou rārangi arowhai mō te matapaki ki te mātanga haumanu ngā taipitopito hua me te rangahau e whai take ana kia tāngia.
Nō reira, he whāiti te ariā i rangahaua: he wai horoi i whakaranu motuhaketia, i tuwhaina ki waho, i whakamahia auautia anō, i whakaiti i te mamae mumura kiriuhi hūpē e mau tonu ana ahakoa te maimoatanga, ā, i whakapai ake i te kai, te horomi, me te kōrero i roto i te 2 rā i tētahi whakataurite iti kāore i hunaia, me te kore e whakaatu i te whakaora tere ake, te hiahia iti ake ki ngā opioid, te maimoatanga whakapokenga, tētahi painga whānui rānei o te wai horoi waha.