Te puru metilīni i te pokanga me ngā tukanga tātari: te mahere, ngā whakamātautau turuturu, me te whai ara mā te waikano

E whakarite ana tētahi tūroro mō te pokanga ū, ā, ka pānui ia ka whakamahia he "waikano puru" hei mahere i ōna kōpuku waitinana. E tirotirohia ana te whēru o tētahi whanaunga, ā, ka rongo ia mō te "whakaahua whēru" me tana whakaaro ka whakamahia he waikano. Ka tukuna ki tētahi tangata kua pokaia tōna pūkorokoro he "whakamātautau waikano puru" hei tirotiro i te haumaru o te horomi. Ka rongo ēnei tāngata tokotoru i te kupu puru, ka whakaaro he ōrite te tukanga me te waikano. Kāore e ōrite.

Ko te huarahi pai ki te mārama ki te puru metilīni i te rūma pokanga, ko te whakaaro kotahi e whakamahia ana ki ngā wāhi kāore e hono ana: he waikano e whakakite ana i ngā mea kāore e kitea. Ka whai i te rere o te waitinana, ka whakapuru i tētahi repe kua tohua, ka tae i te wai whakamātautau e turuturu ana, ka tohu i te pakaru o tētahi pūkoro hiri arahau, ka whakaatu rānei i tētahi hononga huna i waenga i ngā kōhao e rua o te tinana. He tino rerekē ngā taunakitanga, te rahinga ka whakamahia, me te mōrea i waenga i ēnei whakamahinga. Waihoki, ka whakamahia e ētahi tukanga e kīia ana he "whakamātautau waikano puru" ētahi atu waikano, ā, kāore rawa te puru metilīni e whakamahia i te whakaahua whēru mā te iraruke. Ka whakamārama tēnei tuhinga i ia whakamahinga motuhake. Mō te pātai whānui ake e pā ana ki ngā whakamahinga hauora kua whakapūmautia me ērā e rangahautia tonutia ana, tirohia ngā whakamahinga hauora kua whakamanatia me ērā e rangahautia ana.

He mahere tukanga: he whakakite, ehara hei maimoatanga

Kāore tētahi o ēnei he maimoatanga mā te puru metilīni. Ko te whakamahinga whakaora mā te ia toto kua whakamanatia i runga i te tapanga i te United States, ko te methemoglobinemia kua puta i muri i te whānautanga, ko te tikanga 1 mg/kg IV, e ai ki ngā mōhiohio tuku rongoā o DailyMed. Ko te nuinga o ngā whakamahinga whai ara i te pokanga he whakamahinga kei waho i ngā tohutohu tapanga, he whakamahinga rānei e hāngai ana ki tētahi taputapu motuhake, mā taua āhuatanga tae tonu.

Te tango tauira kōpuku waitinana kaitiaki: te whai i te rere

Whai muri i te weronga ā-rohe ki te taha o tētahi puku, ka uru te puru metilīni ki ngā ia waitinana, ka whakapuru i ngā ara rerenga me ngā kōpuku tuatahi, arā, ngā kōpuku kaitiaki, kia taea ai e te rata pokanga te tautuhi mā te titiro. I te mate pukupuku ū, he tohu whai ara kua whakapūmautia tonu te waikano puru, ā, i ngā tikanga o mua ka whakamahia ngātahitia me tētahi radiocolloid technetium-99m. E taunaki ana hoki ngā aratohu NICE o nāianei i te tikanga takirua, arā, te kanoirite me te waikano puru. Kia mōhio, kāore te kupu "waikano puru" i ngā aratohu e tohu pū ana i te puru metilīni i ngā wā katoa; ka whakamahia hoki te patent blue V me te isosulfan blue.

Ka whakamahia e ētahi kawa ū hei tauira te puru metilīni 1% (10 mg/mL), he tata ki te 1 mL i te nuinga o te wā. He rerekē te wāhi weronga: kei raro i te kōmata ū, kei te taha o te kōmata ū, kei roto i te kiri, kei te taha rānei o te puku. Ka taea te mahere mā te puru metilīni anake, engari e tautoko ana ngā taunakitanga kua whakakotahitia i te tāpiri i tētahi tohu iraruke: i pūrongo tētahi tātari whakakotahi mō te puru metilīni anake i te auau tautuhi 91% me te auau tōraro hē 13%, engari he pono ake te kite mā ngā tikanga ngātahi. I te melanoma, ka whakawhirinaki matua te mahere ki te whakaahua waitinana mā te technetium i mua i te pokanga, me tētahi pūoko gamma i te wā o te pokanga, ā, he āpiti te waikano puru. E whakamārama ana ngā aratohu hangarau ASCO/SSO i te weronga 1–2 mL o tētahi waikano puru mō te kiko ora ki roto i te kiri, me te tatari tata ki te 5–10 meneti kia rere mā ngā ia waitinana. Ka whakarārangihia te puru metilīni me te isosulfan blue hei kōwhiringa.

Ko te mahere kōrekoreko hōu mā te indocyanine green (ICG) e whakaatu ana i ngā ia waitinana i taua wā tonu, kāore he iraruke katote. Heoi, me whai taputapu pōkākā-tata, ā, he rerekē tonu te whakaurunga o tēnei tikanga ki ngā aratohu. Ko te tikanga ā-mahi: he iti te utu o te puru metilīni, he ngāwari hoki te mārama ki ngā mea ka whakaaturia e ia, engari ko tōna ngoikoretanga, ka kitea ngā kōpuku i muri anake i te huakitanga mā te pokanga.

He huakore motuhake tō te puru metilīni i tēnei horopaki. Ka roa pea te mau o te tae ki te kiri me te kiko, ka puta pea ngā panonitanga mumura, te matenga o te kiko ngako, me te matenga o te kiri i ētahi wā. Ka kitea hoki i ngā whakaahua ū whai muri i te pokanga ētahi rerekētanga kōhikohiko e hono ana ki te waikano, he rite te āhua ki te hokinga mai o te mate. Me whakamōhio ngā rata pokanga ki ngā kaimahi whakaahua iraruke me ngā kaimātai mate i ngā wā katoa kua werohia te waikano ki roto, ki te taha rānei, o tētahi tauira kiko. Ka taea hoki e ngā waikano puru te whakaputa i te urupare pāwera inamata. I kitea e tētahi tātari whakakotahi o ngā tukanga kōpuku kaitiaki neke atu i te 60,000, ko te auau anaphylaxis whānui e pā ana ki te waikano puru he tata ki te 0.061%, ā, he iti ake ngā auau e hono ana ki te puru metilīni i ērā o te isosulfan blue. Kei ngā pānga taha me te haumaru ngā raraunga haumaru whānui ake.

Te kimi i te wāhi o ngā repe paratairoida: he whakamahinga tawhito ki te tinana katoa, kua kōwhiria ināianei

He tikanga tawhito te tuku puru metilīni mā te ia toto hei kimi i ngā repe paratairoida rerekē, ā, kei te whakamahia tonutia hei āpiti mō ētahi āhuatanga kua kōwhiria anake. I mua, ka tukuna he horopeta āhua nui mā te ia toto i mua i te tirotiro pokanga o te kakī, kia puru ai te kiko rerekē. Ko ngā kawa kua whakaputaina kei te whānuitanga tata ki te 3 ki te 7.5 mg/kg IV. I kitea e tētahi arotake nahanaha e 39 ngā rangahau mātakitaki, kāore he whakamātautau matapōkere: e ai ki ngā pūrongo he nui ngā auau whakapuru, engari kāore anō kia whakapūmautia he painga tāpiri ina whakamahia ngātahitia me ngā tikanga kimi wāhi o ēnei rā.

Ka whakawhirinaki kē ngā mahi o nāianei ki te iratangi me ētahi atu whakaahua i mua i te pokanga, ki te āhua o ngā hanganga tinana ka kitea i te pokanga, me te aroturuki i te taiaki paratairoida i te wā o te pokanga. Ka whakarārangihia e te aratohu AAES te puru metilīni hei tētahi o ngā āpiti whakakite ka taea, kāore hei tikanga matua mō te kimi wāhi.

Ko tēnei hoki te whakamahinga e tino hāngai ana te whakatūpato mō ngā taunekeneke rongoā. He kaha te puru metilīni ki te aukati i te monoamine oxidase, ā, he aukatinga ka taea te whakahoki. I pūrongo te arotake nahanaha i te paitini ki te pūnaha io i ngā tūroro 25, ā, i te kai rongoā serotonergic katoa rātou. I kitea e tētahi atu arotake tuhinga mō te mate huinga serotonin e hono ana ki te puru metilīni e 50 ngā kēhi. I whai wāhi ngā rongoā whakahē pōuritanga serotonergic ki aua kēhi katoa, ā, ko te nuinga i hono ki te pokanga paratairoida, ki te maimoatanga vasoplegia rānei. Ka nui ake pea ngā horopeta paratairoida o mua i te horopeta whakaora 1 mg/kg o nāianei. Nō reira, e hāngai ana tēnei taunekeneke ki te pānga ki te tinana katoa, kāore ki tētahi pata waikano i runga i te kiko.

Kua whakamāramatia tētahi tikanga motuhake, he tino iti ake te pānga, mō ngā kakī ka pokaia anō, kua whai nawe rānei: he weronga e ārahina ana e te iratangi ki roto tonu i tētahi wāhi e mōhiotia ana. Kua whakamahia e ngā raupapa rangahau iti he tata ki te 0.2 mL o te wairewa 1% kua waimehatia ki te 1:5 (he tata ki te 0.2%), i mua tonu i te pokanga. He iti ngā taunakitanga, nō ngā raupapa rangahau mātakitaki iti anake.

Te whakamātautau whakakī wairewa tote: kāore te waikano e whakarite kia whai hua te whakamātautau

I tētahi whakamātautau whakakī wairewa tote mō te huakitanga o te kōhao hononga nā te wharanga, ka werohia te wairewa tote ki roto i te hononga, ā, ka mātakihia te wharanga mō te wai e turuturu ana. Ka tāpirihia te puru metilīni i ētahi wā kia ngāwari ake ai te kite i te wai e puta ana. Ko te kitenga matua, kāore anō kia whakaaturia ka whakapai ake te waikano i te whakamātautau: i tētahi rangahau turi matapōkere, anga whakamua, o ngā tūroro 58, ko ngā auau tōraro hē he 69% ki te puru metilīni, he 66% ki te wairewa tote noa. He ōrite hoki ngā rahinga i hiahiatia kia puta he hua tōrunga. I kitea e tētahi arotake nahanaha o 2025, e 8 o ngā rangahau whakakī wairewa tote 23 i whakamahi i te waikano. Ko te hononga, te wāhi o te wharanga, te rōrahi i werohia, me te tikanga whakamahi ngā mea i whakatau i te mahinga o te whakamātautau, kāore ko te tāpiritanga o te waikano. Kāore he kukū paerewa kua whakamana mō tēnei kaupapa. I konei, he matū tae kōwhiringa te puru metilīni i ngā kawa o mua, i ngā kawa whakamātau rānei; ehara ko ia te wāhanga e whakapiki ana i te tairongo o te whakamātautau.

Ngā ngongo arahau mō te taiaho: he waikano kua hiritia ki roto i te pūkoro

He rerekē tēnei whakamahinga i ērā atu katoa i tēnei whārangi: ko te tikanga ka whakatakotoria te waikano ki roto i te pūkoro hiri o te ngongo pūkorokoro, kāore ki roto i te tūroro. Mō te pokanga arahau mā te taiaho, ka taunaki ngā aratohu haumaru ahi mō te rehunga i tētahi ngongo e tika ana, e ātete ana ki te taiaho, me te whakakī i te pūkoro ki te wairewa tote hei utu mō te hau, mēnā ka taea. Mā te tae i taua wairewa tote ki te puru metilīni, ka kitea tonutia he turuturu puru ina werohia e te taiaho. Kāore he kukū kotahi kua whakaritea mō ngā whakamahinga katoa; ko te whāinga kia kitea te tae, e whakamāramatia ana i te tohutohu ASA mō ngā tikanga ahi i te rūma pokanga.

E rua ngā tūpato matua. I whakaurua e ētahi ngongo taiaho o mua ngā tioata waikano ki roto i te pūkoro hiri, ki te pūnaha whakahaere rānei. E whakamārama ana tētahi kēhi kua whakaputaina i te aukatinga o tētahi ngongo whakahaere e ngā tioata kāore i memeha, nā reira kāore i taea te whakaheke i te pūkoro. Koia te take e whai take ai ngā tohutohu mō ia taputapu motuhake. Waihoki, kāore te puru metilīni tonu e whakarite kia ātete tētahi ngongo noa ki te taiaho; ka whakawhirinaki hoki te ārai ahi ki te hanganga o te ngongo, te whakamarutanga o te pūkoro, me te whakaiti i te kukū o ngā matū e tautoko ana i te tahunga.

Ngā whakamātautau horomi: tērā pea ehara te "waikano puru" i te puru metilīni

I tētahi whakamātautau noa i te taha o te moenga mō te tūroro kua pokaia tōna pūkorokoro, ka taengia te kai, te wai rānei, ā, ka tirohia ngā wai huna o te pūkorokoro mō te tae puru. Ka tautoko te hua tōrunga i te whakapae kua uru te kai, te wai rānei, ki te arahau. He ngāwari te hē o te pānui i ngā kupu: kua whakamahia te Evans blue, te puru metilīni, me ngā waikano kai i ngā kawa "whakamātautau waikano puru" me te Whakamātautau Waikano Evans Blue Kua Whakarerekētia kua whakaputaina. Nō reira, kāore te kupu "whakamātautau waikano puru" e tohu aunoa ana i te puru metilīni.

Ko te raruraru matua ko ngā hua tōraro hē. Kei te whānuitanga tata ki te 38% ki te 95% te tairongo i waenga i ngā kawa rerekē. Ka tirohia e ngā aratohu te whakamātautau hei tohu āpiti matua hei tautoko i te tautuhinga ina tōrunga te hua: kāore te hua tōraro e whakakore i te kuhunga ki te arahau. Ina hiahiatia he aromatawai whakatau, ka whakamahia ngā tirotirohanga mā ngā taputapu, pērā i te arotake horomi mā te endoscope muka-whatu, i te whakaahua ataata fluoroscopy rānei. Kāore he rahinga waikano tino pai kua whakamana.

Kaua e whakakotahi i tēnei ki te tikanga tawhito o te tae haere tonu i ngā whāngai ki te whēkau mā te FD&C Blue No. 1. He waikano kē tērā, he tikanga kē hoki. I hono taua tikanga ki te ngongo o te waikano ki te tinana katoa me te paitini taumaha i ngā tūroro tino māuiui, ā, nō muri mai ka tohutohutia kia kaua e whakamahia.

He rerekē te whai ara whēru me te whakaahua whēru

He huarahi tātari rerekē te whai ara ā-rohe mā te puru metilīni me te whakaahua whēru mā te iraruke, engari he maha ngā wā ka pōhēhētia he ōrite. I te whai ara ā-rohe, ka tukuna te waikano ki roto i tētahi puare e whakapaetia ana he whēru, ki roto rānei i te kōhao o tētahi whēkau, ā, ka mātaki te kaimahi haumanu mō te putanga o te puru ki tētahi atu wāhi, ka whai rānei i te kiko kua whakapurutia i te pokanga. Ko ētahi tauira ko te weronga mā tētahi puare o waho hei kimi i te ara o tētahi whēru nono, te tae i te wai horoi tōngāmimi kia kitea ai tōna turuturu ki te tenetene ina whakapaetia he whēru tōngāmimi-tenetene, me ētahi whakamahinga ōrite e hāngai ana ki te wāhi. E hāngai ana ngā kawa ki ia wāhi, ā, kāore he kukū kua whakaritea hei paerewa.

Ko te whakaahua whēru, ko te whakaahua ara kōhao rānei, i tōna tikanga tika, he tukanga whakaahua: ka werohia tētahi matū whakakaha whakaahua tauārai iraruke ki roto i te ara, ā, ka maherehia tōna hanganga mā te fluoroscopy, mā te CT rānei. Ehara tēnei i te whakamātautau puru metilīni. Kāore tētahi o ēnei huarahi e āhei i ngā wā katoa ki te whakakapi i te MRI, te CT, te endoscopy, te tirotiro rānei i raro i te rehunga mō tētahi whēru matatini.

Me tino whakanui tētahi raruraru e hāngai ana ki te ara tuku: ka ngongohia pea te puru metilīni ka tukuna mā te tōu, ā, nō muri mai ka whakaputaina ki roto i te mimi. I whakaatu tētahi rangahau tūao i tēnei whai muri i tētahi weronga wai mā te tōu o te 50-mg, ā, i whakatau kia kaua te waikano ki roto i te tōu e whakamahia hei whakaū i te whēru kōpiro-tōngāmimi e whakapaetia ana, nā te mea ka puru pea te mimi ahakoa kāore he whēru. Me whakahua te wāhi o te tinana me te tikanga whakaahua, kaua e whakaarohia he ōrite te whakamātautau i ia pātai mō te whakaahua whēru.

Ngā herenga e hāngai ana ki ngā whakamahinga katoa

He take ā-rongoā tō te pānga ki te tinana katoa kāore e hāngai ki te whai ara ā-rohe. Ina nui te puru metilīni i te toto, ka ngongo ia i te aho e whakamahia ana e ngā taputapu aroturuki, nō reira ka iti rawa pea te whakatau a te inenga hāora mā te tukinga toto i te kukū hāora o te toto. Ka taea e te tuku ki te tinana katoa te whakaputa i te pakarutanga taumaha o ngā pūtau toto whero i te hunga he ngoikore te G6PD. E whakarārangihia ana hoki te ngoikore G6PD i ngā tapanga rongoā werohanga o nāianei hei take kia kaua e whakamahia. Anō hoki, kāore te mōrea o ngā weronga ā-rohe tino iti, o te waikano rānei kua hiritia ki roto i te pūkoro arahau, e ōrite ki tō ngā mg/kg maha ka tukuna mā te ia toto. Heoi, kāore te kupu "ā-rohe" e tohu aunoa ana kāore rawa he ngongo ki te tinana katoa: he take nui te ara tuku, te rahinga, me te tōtika o te kiko.

Ko te take whakamutunga ko te tuakiri o te waikano. Ka whakawhirinaki te whakakite i te pokanga ki te mōhio pū ko tēhea waikano kei roto i te pūwero: he rerekē te whanonga me ngā mōrea o te puru metilīni, te isosulfan blue, te patent blue V, te Evans blue, me ngā waikano kai. Heoi, ka kitea ēnei katoa i ngā tukanga e kī noa ana he whakamātautau "waikano puru". Me pēnei hoki te tūpato i waho i te hōhipera. He tino rerekē te kōeke me ngā tuhinga whakamārama o ngā hua e hokona ana hei puru metilīni, ā, kāore te matū kōeke papanga e whakakapi i te matū kua hangaia, kua whakamātauria hoki mō tōna kaupapa kua kīia. Ina whai take te parakore, rapua te hanga ki ngā paerewa rongoā, te whakamātautau USP katoa me tētahi tiwhikete tātari mō taua puranga motuhake, me te manatoko motuhake, kaua ko te tirotiro konganuku taumaha anake. Ka whakamārama te aratohu pānui tiwhikete tātari i ngā āpure hei tirotiro. Kei te whare pukapuka rangahau te rārangi o ngā puna kōrero hōhonu ake.