Methylene blue HBOT: kodi oxygen wopanikizidwa amawonjezera phindu?

Tsamba la chipatala limapereka methylene blue HBOT kuti munthu akhale ndi mphamvu, aganize bwino, kapena achire. Nthawi zina amawonjezera chida cha kuwala kofiira ndipo amatcha phukusilo methylene blue, kuwala kofiira ndi oxygen wopanikizidwa. Tsambalo limatchula mitochondria, kufikitsa oxygen m'thupi, ndi kafukufuku wochepa. Mtengo umalipiridwa pa ulendo uliwonse wa chithandizo. Funso limene wowerenga ayenera kufunsa ndi lolunjika kwambiri kuposa lakuti mbali iliyonse ikumveka yotheka kapena ayi. Ndi lakuti kodi pali amene anayesa kuphatikiza zinthu zomwezi n'kuyeza phindu lowonjezera poyerekeza ndi mbali iliyonse payokha.

Funso limenelo ndi limene tikuwunika pano. Phukusilo lili ndi njira zofika zinayi zimene iliyonse ingasinthidwe payokha: kuthamanga kwa mpweya m'chipinda, mlingo wa oxygen, kapangidwe ka mankhwala ndi nthawi yoperekera, komanso kuikidwa pa kuwala. Umboni wa mbali imodzi si umboni wa phukusi lonse, ndipo zotsatira zabwino kwambiri za kuyesa kuphatikizako mwachindunji zikusonyeza kuwonjezeka kwa kupha pogwiritsa ntchito kuwala ndi utoto, osati kuwonjezeka kwa ntchito ya mitochondria mwachisawawa.

Njira zinayi zimaperekedwa pansi pa dzina limodzi

Kuthamanga kwa mpweya ndi mfundo yoyamba. Chithandizo cha kuchipatala cha oxygen wopanikizidwa, chimene nthawi zambiri chimatchedwa HBOT, chimatanthauza kupuma oxygen wochuluka kwambiri pamene kuthamanga kwa mpweya kuli koposa kwa malo ozungulira. Nthawi zambiri kumakhala pafupifupi 1.9 kufika 3.0 atmospheres absolute, ndipo nthawi yopuma oxygen imakhala pafupifupi 90 kufika 120 minutes, kuphatikizapo nthawi yopuma mpweya wamba. M'chipinda cha munthu mmodzi, chipindacho chimapanikizidwa ndi oxygen; m'chipinda cha anthu angapo, chimapanikizidwa ndi mpweya wamba pamene wodwala amapuma oxygen kudzera m'chophimba mutu kapena chigoba. Kuthamanga kwa mpweya ndi gawo la oxygen zimasintha payokhapayokha, choncho kunena kuti ndi hyperbaric yochepa popanda manambala onse awiriwa sikufotokoza chilichonse mwa izo.

Kufikitsa oxygen m'thupi ndi mfundo yachiwiri. Pa 2 atmospheres pamene munthu akupuma oxygen wangwiro, oxygen wosungunuka m'madzi a magazi amakwera kwambiri kuposa mmene amakhalira nthawi zonse, kuwonjezera pa oxygen womangiriridwa ku hemoglobin. Gawo losungunukalo ndi limene limathandiza pa ntchito zovomerezeka monga kutsekeka kwa mitsempha ndi mpweya komanso minofu yoikidwa kuchokera kwina imene ili pachiwopsezo, zomwe zili pa mndandanda wa zifukwa zogwiritsa ntchito chithandizochi wa Undersea and Hyperbaric Medical Society. Limayambitsanso kuvulala: kuvulala kwa makutu ndi njira za m'mphuno chifukwa cha kusiyana kwa kuthamanga kwa mpweya, kuvulala kwa mapapo chifukwa cha oxygen wochuluka, kusaona bwino zinthu zakutali kwakanthawi, komanso kukomoka kogwedezeka pamene kuthamanga kwa oxygen kuli kwakukulu.

Kapangidwe ka mankhwala ndi mfundo yachitatu. Popanda kuwala, utotowo umagwira ntchito mwa kusinthana pakati pa kulandira ndi kutulutsa ma elekitironi, njira yotchedwa redox cycling, komanso monga njira ina yonyamulira ma elekitironi. Umalandira ma elekitironi n'kupanga leucomethylene blue, kenako umawapititsa patsogolo uku ukubwerera m'njira yozungulirayo, monga tafotokozera mu mmene methylene blue imagwirira ntchito potumiza ma elekitironi. Mtundu wa mankhwala, njira yoperekera, mlingo wa mg per kg, ndi nthawi yoperekera poyerekeza ndi ulendo wa m'chipinda zonse zili m'gawoli. Zolemba za jakisoni ku US zimakhudza methemoglobinemia yomwe munthu wapeza, pa mlingo wa 1 mg per kg malinga ndi malangizo operekera ProvayBlue. Umenewu si mlingo wotsimikiziridwa wa maulendo a chithandizo chophatikizidwa amene munthu wasankha kulandira.

Kuikidwa pa kuwala ndi mfundo yachinayi, ndipo kumapezeka m'maphukusi ena okha. Kuwala kofiira kwa 630 kufika 680 nm kumagwirizana ndi dera limene utotowo umayamwa kuwala pafupi ndi 664 nm ndipo kungayambitse zochitika za mankhwala amene amatsegulidwa ndi kuwala. Kuwala kwa pafupi ndi infrared kwa 810 nm sikutsegula utotowo bwino mwachindunji, monga tawunikira mu methylene blue ndi chithandizo cha kuwala kofiira. Kutalika kwa mafunde a kuwala, mphamvu ya kuwala yofika pa malo, mphamvu yonse yofika pa malo, ndi nthawi pakati pa kupereka mankhwala ndi kuyatsa kuwala zimatsimikizira njira imene ikugwira ntchito, malinga ndi malangizo a kutalika kwa mafunde, mphamvu ya kuwala, ndi makonzedwe a malo. Kutchula kuwala kofiira popanda manambala amenewo n'kofanana ndi kutchula hyperbaric popanda kunena kuthamanga kwake.

Zimene kafukufuku wa kuphatikizako anayesadi

Palibe mayeso oyendetsedwa mwa anthu amene apezeka pa kuwunika kumeneku osonyeza kuti methylene blue pamodzi ndi HBOT yeniyeni zimawonjezera phindu m'thupi lonse kuposa mbali zonse ziwirizo payokhapayokha. Zomwe zilipo zili m'magulu atatu, ndipo gulu lililonse limayankha funso losiyana.

Kuyesa kolunjika kwambiri pa kuphatikizako kunachitikira kunja kwa thupi. Bisland ndi anzake anaika S. aureus ndi P. aeruginosa, zonse zoyandama paokha ndi zokhala m'magulu okhala ndi chophimba cha biofilm, pa utoto ndi kuwala kosefedwa kofiira kwa 600 kufika 800 nm, ndi popanda oxygen wangwiro pa 2 atmospheres, monga ananenera mu kafukufuku uyu wa oxygen ndi zochitika zoyambitsidwa ndi kuwala. Kuwonjezera oxygen wopanikizidwa kunawonjezera kupha ndi kuposa log imodzi pa 5 J per square cm, komanso kuposa ma log awiri pa 10 J per square cm. Limenelo ndi phindu lenileni lowonjezera la oxygen pa chithandizo chogwiritsa ntchito kuwala ndi utoto m'mbale ya labotale, osati umboni wakuti oxygen wopanikizidwa ndi utoto zimathandiza anthu kuganiza bwino kapena kukhala ndi mphamvu.

Kuyesa kwa nyama koyandikira kwambiri komwe kunaphatikiza kusankha kosiyanasiyana kwa mbali ziwirizo kunagwiritsa ntchito oxygen wochuluka pa kuthamanga kwa mpweya kwanthawi zonse, osati HBOT. Rodriguez ndi anzake anagawa makoswe amene mtsempha wawo unali utatsekedwa kwa 60 minute m'magulu a mpweya wamba kapena oxygen, ndipo lililonse linalandira madzi onyamulira mankhwala opanda utoto kapena utoto wa 1 mg per kg, mu kafukufuku uyu wa kuchira pambuyo pa sitiroko. Kuphatikizako kunathandiza kubwerera kwa ntchito za thupi kuposa mbali iliyonse payokha, ngakhale kuchuluka kwa minofu imene inafa kunali kofanana ndi kwa utoto wokha. Popeza palibe chimene chinapanikizidwa, izi zimathandizira lingaliro lakuti oxygen ndi utoto zimakhudzana, koma sizikunena ngati 2 kufika 3 atmospheres zimawonjezera chilichonse kuposa oxygen yekha.

Malipoti a anthu ndi a milandu ya munthu payekha. Munthu wa zaka 52 amene anali ndi methemoglobinemia yoopsa yomwe anapeza analandira oxygen ndi utoto wa 1 mg per kg kudzera m'mtsempha, kenako HBOT pa pafupifupi 2.2 atmospheres kwa 90 minutes, monga tafotokozera mu lipoti ili la mlandu wadzidzidzi. Kupereka chithandizo chopulumutsa motsatizana sikungalekanitse kusintha kwachibadwa kwa vutolo ndi zotsatira za utoto, oxygen, ndi kuthamanga kwa mpweya. Mlandu wina wokhudza dapsone umene unasonyeza zosiyana unapeza kuti 2.5 atmospheres kwa 2 hours sizinathandize kwenikweni, utoto wa 1.5 mg per kg usanagwire ntchito mwamsanga, monga ananenera mu mlandu uyu wa chithandizo chotsatizana. Izi zimatsutsa kugwiritsa ntchito HBOT m'malo mwa utoto, koma siziyesa chithandizo choperekedwa nthawi imodzi. Kafukufuku wa mbewa wa 810 nm amene amatchulidwa kawirikawiri amayesa utoto ndi kuwala popanda chipinda chilichonse, ndipo ali pa PMID 35059872 ndi PMID 31372913, choncho sangatsimikizire njira ya chithandizo cha m'chipinda.

Chifukwa chake oxygen wochuluka ndi utoto wa redox sizitanthauza kugwirizana kowonjezera zotsatira

Kuzungulira kwa redox kwa utoto pakokha kumagwiritsa ntchito oxygen: utoto woperekedwa m'mtsempha pa kuchuluka kwa micromolar unawonjezera kugwiritsa ntchito oxygen kwa thupi lonse ndi pafupifupi theka mwa makoswe. Utoto umene unali utalandira ma elekitironi unkawapereka mwachindunji kwa oxygen, mu kafukufuku uyu wa kagwiritsidwe ntchito ka mphamvu m'thupi. Mmene umakhudzira mitundu ya oxygen yochita zochitika za mankhwala zimadalira zinthu zomwe zikugwiritsidwa ntchito: zimakwera ndi zinthu zogwiritsidwa ntchito ndi complex I ndipo zimatsika ndi succinate mu mitochondria zochotsedwa mu mtima (kafukufuku wa zinthu zogwiritsidwa ntchito). Popanda kuwala, pali malingaliro awiri omwe akadali otheka: oxygen wowonjezera amathandiza utoto kubwereranso mu oxidation pamene kayendedwe ka zinthu kasokonekera, kapena amawonjezera zochitika za oxidation zochokera pakuzungulira kwa utoto. Palibe lamulo lonena kuti utotowo umakhala woteteza kwambiri ku oxidation pamene kuthamanga kwa mpweya kukukwera.

Kuwonjezera kuwala kofiira kumasintha njira yogwirira ntchito. Utoto wotsegulidwa ndi kuwala umapereka mphamvu kapena ma elekitironi kwa oxygen ndipo umapanga zinthu zoyambitsa oxidation, kuphatikizapo singlet oxygen. N'chifukwa chake oxygen wowonjezera anawonjezera kupha mabakiteriya mu zotsatira za m'mbale ya labotale. Zochitika zomwezo zimavulaza ngati zalunjika pa chinthu chosayenera: utoto wowunikiridwa mu mitochondria zochotsedwa m'chiwindi cha makoswe unayambitsa kupangidwa kwa zinthu zoyambitsa oxidation, kuchepa kwa glutathione, kulekana kwa kayendedwe ka ma elekitironi ndi kupanga ATP, komanso kuchepa kwa ATP yopangidwa, mu kafukufuku uyu wa kuvulazidwa kwa mitochondria ndi utoto wotsegulidwa ndi kuwala. Kugwirizana kowonjezera zotsatira kumene kwasonyezedwa ndi kupha maselo kudzera mu utoto wotsegulidwa ndi kuwala, koyenera kupha tizilombo m'malo mopatsa mphamvu minofu yathanzi.

Chitetezo chimadalira chithandizocho, osati utoto mwachisawawa

Mfundo iliyonse ili ndi kuwunika kwake koyenera kuchitika musanapereke chithandizo, ndipo kuphatikizako kumawonjezera malo amene zinthu zingakhudzane amene tsamba la chitetezo cha utoto mwachisawawa silingafotokoze.

Kuwunika munthu asanalowe m'chipinda kumayamba ndi zoopsa za kuthamanga kwa mpweya ndi oxygen: mpweya wosonkhanitsidwa kunja kwa phapo umene sunachiritsidwe, matenda a mapapo otsekereza mpweya kapena okhala ndi matumba aakulu a mpweya, kulephera kufananitsa kuthamanga kwa mpweya m'makutu, mbiri ya kukomoka kogwedezeka, opaleshoni yaposachedwa ya pachifuwa kapena ya diso, ndi zipangizo zoikidwa m'thupi. Kupewa moto ndi mbali yofunika ya makonzedwe onse. Kalata ya FDA yokhudza kugwiritsa ntchito bwino zipangizo za hyperbaric imafuna kutsatira malangizo a wopanga, kulumikiza zipangizo ku nthaka kuti zitulutse magetsi, kuphunzitsa antchito, kuyang'anira mosalekeza, kukonza zipangizo, kuletsa zinthu zamagetsi zoletsedwa, ndi kuvala zovala zoyenera mogwirizana ndi NFPA 99 ndi ASME PVHO-1. Chida cha kuwala sichiyenera kungolowetsedwa m'chipinda chokhala ndi oxygen wochuluka; kuyenera kwake kugwiritsidwa ntchito mmenemo kuyenera kulembedwa m'malangizo a chipindacho ndi mu dongosolo la chitetezo cha moto.

Kuwunika zokhudza mankhwala kumatsatira zolemba za utoto. Kusowa kwa G6PD ndi chifukwa choletsedwa kugwiritsa ntchito utotowo chomwe chalembedwa pa mankhwalawo; utotowo umalepheretsa monoamine oxidase ndipo uli ndi chenjezo lalikulu lokhala m'bokosi lokhudza serotonin syndrome ukagwiritsidwa ntchito ndi mankhwala okhudza serotonin ndi ma opioid ena. Katswiri wa zachipatala amene akupereka mankhwala ayenera kutsogolera kusintha kulikonse kwa mankhwala, ndipo mimba komanso ntchito ya impso ndi chiwindi ziyenera kuwunikidwa. Utotowo umasokonezanso kuyeza oxygen ndi pulse oximetry, choncho kuchuluka kwa oxygen womangiriridwa ku hemoglobin kuyenera kuyezedwa ndi njira ina pamene kulondola n'kofunika. Kusiyana kumeneku n'kofunika kwa owerenga omwe akufuna kudziwa za miyezo yotsika ya oxygen pa matenda a mapapo kapena mikhalidwe ya kutopa monga ME/CFS.

Chipinda chololedwa ndi FDA sichitanthauza kuti bungwelo linawunika methylene blue HBOT kapena njira iliyonse yokhudza mitochondria, kuganiza, kapena kukhala ndi moyo wautali. Zipinda nthawi zambiri ndi zipangizo za Class II zololedwa kudzera m'njira ya 510(k) pa ntchito zotchulidwa m'zolemba zawo. Kalata ya FDA yomwe yatchulidwa pamwambapa ndi uthenga wa chitetezo, osati kuvomereza kuti chithandizochi chimagwira ntchito.

Mndandanda wowunika umboni wa kuphatikiza: chida chapadera cha nkhaniyi

Gwiritsani ntchito mndandandawu powunika kafukufuku kapena tsamba la chipatala. Njira yodalirika ya chithandizo imafotokoza mfundo iliyonse polemba. Ngati mfundo ina ikusowa, zomwe zikunenedwazo sizinafotokozedwe mokwanira, osati kuti zikulonjeza zotsatira zabwino.

Zigawo zake: mtundu wa chipinda ndi mmene chilolezo chake chilili; cha munthu mmodzi kapena anthu angapo; kuthamanga kwake kwenikweni mu atmospheres absolute; gawo la oxygen limene wodwala akupuma; nthawi yopuma oxygen kuphatikizapo nthawi yopuma mpweya wamba; nthawi yonse m'chipinda; chiwerengero cha maulendo ndi kuchuluka kwa maulendo pa nthawi inayake. Mtundu wa mankhwala ndi kapangidwe kake; njira yoperekera; mlingo mu mg per kg; mlingo wonse wapamwamba kwambiri ukaphatikizidwa; nthawi pakati pa kupereka mankhwala ndi kulowa m'chipinda. Ngati pali kuwala: kutalika kwa mafunde; mphamvu ya kuwala yofika pa malo; mphamvu yonse yofika pa malo; nthawi yogwiritsa ntchito; nthawi yake poyerekeza ndi kupereka utoto; komanso ngati gwero la kuwala lili mkati kapena kunja kwa chipinda, ndi zolemba zotsimikizira kuti n'loyenera kugwiritsidwa ntchito pa kuthamanga kwa mpweya kwa hyperbaric.

Magulu oyerekezera: pa kafukufuku, magulu ayenera kuphatikizapo kuphatikizako, mbali iliyonse payokha, ndipo ngati n'kotheka gulu la chithandizo choyerekeza chopanda chinthu chogwira ntchito kapena la chisamaliro chanthawi zonse. Anthu ayenera kugawidwa mwachisawawa ndipo chotsatira chachikulu chiyenera kutchulidwa kafukufuku asanayambe. Miyezo ya anthu asanalandire phukusi lonse ndi atalilandira singasonyeze kuti phindu lachokera ku kuphatikizako. Pa tsamba la chipatala, funsani kuti kafukufuku amene watchulidwa anayesadi magulu ati mwa amenewo. Kutchula mayeso a utoto wokha pamodzi ndi mayeso a HBOT yokha ndi kupanga kuphatikiza pogwiritsa ntchito mndandanda wa mabuku, osati umboni wa kugwirizana kowonjezera zotsatira.

Zotsatira: tchulani chotsatira chimene chikufufuzidwa, njira yoyezera, ndi nthawi yoyezera. Miyezo ya mmene thupi likugwirira ntchito, kuchuluka kwa minofu yowonongeka, chiwerengero cha tizilombo, ndi miyezo ya zizindikiro ndi zonena zosiyanasiyana zokhala ndi zipangizo zoyezera zosiyanasiyana. Kusintha kwa miyezo yogwiritsidwa ntchito m'malo mwa zotsatira zenizeni pa nthawi ya chithandizo, monga nambala yapamwamba pa chipangizo pamene munthu akupuma oxygen, sikutsimikizira phindu lokhalitsa.

Njira za chitetezo: kuwunika kolembedwa kwa matenda a mapapo, kufananitsa kuthamanga kwa mpweya m'makutu, mbiri ya kukomoka kogwedezeka, mmene G6PD ilili, mankhwala okhudza serotonin ndi ma opioid, mimba, komanso ntchito ya impso ndi chiwindi; kuyang'anira mosalekeza ndi antchito ophunzitsidwa za hyperbaric; njira zoyendetsera kuvulala chifukwa cha kusiyana kwa kuthamanga kwa mpweya ndi kuvulala chifukwa cha oxygen; dongosolo lochepetsera kuthamanga kwa mpweya pakachitika mwadzidzidzi; njira zopewera moto ndi mndandanda wa zinthu zoletsedwa; kulemba zochitika zosafunikira; ndi dongosolo lofotokozedwa la kuyang'anira oxygen poganizira kuti utoto umasokoneza pulse oximetry.

Tsamba likalephera kupereka mfundo zimenezi, gwiritsani ntchito njira yomweyo yotsimikizira imene mungagwiritse ntchito powunika njira ya chithandizo yopezeka pa intaneti. Funsani buku lofalitsidwa limene linayesa phukusi lomwelo, werengani kuti linayesa magulu ati, ndipo musatengere njira yogwirira ntchito yomwe ikumveka yotheka ngati chotsatira choyezedwa. Kuphatikiza komwe kukumveka kogwirizana kungakhalebe kosayesedwa, ndipo pa nkhaniyi kukhudzana kumodzi komwe kunayesedwa kumawonjezera zochitika za mankhwala zimene simungafune kuti zilunjikidwe pa minofu yathanzi.