Methylene blue pa opaleshoni ndi njira zodziwira matenda: kufufuza malo, kuyesa kutayikira, ndi kutsatira utoto

Wodwala amene akukonzekera opaleshoni ya bere amawerenga kuti "utoto wabuluu" udzathandiza kupeza mfundo zake za limfa. Wachibale amene akufufuzidwa fistula amamva za "fistulography" ndipo amaganiza kuti padzagwiritsidwa ntchito utoto. Munthu amene ali ndi chubu lolowetsedwa kudzera pa dzenje la pakhosi amapatsidwa mwayi wa "mayeso a utoto wabuluu" kuti aone ngati kumeza kwake kuli kotetezeka. Onse atatu amamva mawu akuti buluu ndipo amaganiza kuti ndi njira yomweyo yogwiritsa ntchito utoto womwewo. Sizili choncho.

Methylene blue m’chipinda cha opaleshoni imamveka bwino ngati lingaliro limodzi logwiritsidwa ntchito m’malo osagwirizana: utoto umene umapangitsa zinthu zosaoneka kuoneka. Umatsatira kuyenda kwa limfa, umapaka utoto kachithokomiro komwe kakufunidwa, umaika mtundu m’madzi oyesera amene akutayikira, umasonyeza kafu yobowoka ya chubu la mpweya, kapena umaonetsa kulumikizana kobisika pakati pa mipata iwiri ya m’thupi. Umboni, kuchuluka komwe kumagwiritsidwa ntchito, ndi chiopsezo zimasiyana kwambiri pakati pa ntchitozi. Ndipo njira zina zotchedwa "mayeso a utoto wabuluu" zimagwiritsa ntchito mitundu ina ya utoto, pamene fistulography yojambula zithunzi siigwiritsa ntchito methylene blue n’komwe. Nkhaniyi ikufotokoza ntchito iliyonse payokha. Kuti mudziwe zambiri za ntchito zamankhwala zomwe zakhazikitsidwa ndi zomwe zikufufuzidwabe, onani ntchito zamankhwala zovomerezeka ndi zomwe zikufufuzidwa.

Chidule cha njira: kuonetsa zinthu, osati kuchiza

Palibe mwa izi chimene chili kuchiza ndi methylene blue. Ku United States, ntchito yochiza yovomerezeka yolembedwa pa mankhwala olowetsedwa m’mtsempha ndi methemoglobinemia yomwe munthu waipeza pambuyo pake, nthawi zambiri pa 1 mg/kg IV, monga zalembedwera mu malangizo a kupereka mankhwala a DailyMed. Ntchito zotsatira zinthu pa opaleshoni nthawi zambiri sizili m’ntchito zovomerezeka zolembedwa pa mankhwalawo, kapena ndi ntchito zokhudzana ndi chipangizo chapadera, pogwiritsa ntchito mphamvu yomweyo yoika mtundu.

Kutenga chitsanzo cha mfundo ya limfa yoyamba: kutsatira kuyenda kwa limfa

Ikabayidwa pamalo pafupi ndi chotupa, methylene blue imalowa m’mitsempha ya limfa n’kupaka buluu njira zimene limfa imadutsamo ndi mfundo zoyamba, kuti dokotala wa opaleshoni athe kuzizindikira ndi maso. Pa khansa ya bere, utoto wabuluu ukadali chotsatira chovomerezeka, chomwe mwachizolowezi chimaphatikizidwa ndi radiocolloid ya technetium-99m, ndipo malangizo aposachedwa a NICE amalimbikitsa njira yogwiritsa ntchito isotope pamodzi ndi utoto wabuluu. Dziwani kuti "utoto wabuluu" m’malangizo sutanthauza methylene blue nthawi zonse; patent blue V ndi isosulfan blue amagwiritsidwanso ntchito.

Njira zoyimira zomwe zimagwiritsidwa ntchito pa bere zimagwiritsa ntchito methylene blue ya 1% (10 mg/mL), nthawi zambiri pafupifupi 1 mL, ndipo malo obayira amasiyanasiyana: pansi pa dera lozungulira nsonga ya bere, mozungulira deralo, m’khungu, kapena pafupi ndi chotupa. Kupeza mfundo ndi methylene blue yokha kumatheka, koma umboni wophatikizidwa umakondera kuwonjezera chotsatira cha nyukiliya: kuwunika kophatikiza kafukufuku wa methylene blue yokha kunanena kuti mfundo zinapezeka pa 91% ndipo mayeso omwe anasonyeza molakwika kuti palibe vuto anali 13%, pamene njira zophatikizidwa zimapeza mfundo modalirika kwambiri. Pa melanoma, kufufuza malo kumadalira makamaka lymphoscintigraphy ya technetium isanachitike opaleshoni, pamodzi ndi chipangizo chozindikira cheza cha gamma pa opaleshoni, ndipo utoto wabuluu umangothandizira; malangizo aukadaulo a ASCO/SSO amafotokoza kubaya 1–2 mL ya utoto wabuluu wopangira minofu yamoyo m’khungu, n’kudikira pafupifupi 5–10 minutes kuti udutse m’mitsempha ya limfa, ndipo amatchula methylene blue ndi isosulfan blue monga zosankha.

Njira yatsopano yofufuza malo pogwiritsa ntchito kuwala kwa fluorescence kwa indocyanine green (ICG) imaonetsa mitsempha ya limfa nthawi yomweyo popanda cheza cha ionizing, koma imafuna zida za kuwala kwa near-infrared, ndipo kuvomerezedwa kwake m’malangizo kukusiyanabe. Tanthauzo lake pa ntchito: methylene blue ndi chotsatira chotsika mtengo komanso chosavuta kuona ndi maso, ndipo kufooka kwake n’kuti mfundo zimaoneka pokhapokha zatsegulidwa pa opaleshoni.

Methylene blue ili ndi zovuta zake pano. Ingapangitse khungu ndi minofu kukhala ndi utoto kwa nthawi yaitali, kusintha chifukwa cha kutupa, kufa kwa minofu yamafuta, ndipo nthawi zina kufa kwa khungu. Zithunzi za bere pambuyo pa opaleshoni zingasonyeze malo osakhazikika okhudzana ndi utoto omwe amafanana ndi kubwereranso kwa matenda. Madokotala a opaleshoni ayenera kudziwitsa akatswiri ojambula zithunzi ndi ofufuza zitsanzo za minofu nthawi zonse ngati utoto wabayidwa m’chitsanzo kapena pafupi nacho. Mitundu ya utoto wabuluu ingayambitsenso kusagwirizana kwa thupi nthawi yomweyo; kuwunika kophatikiza kafukufuku wa njira zoposa 60,000 za mfundo za limfa zoyamba kunapeza kuti kuchuluka konse kwa anaphylaxis chifukwa cha utoto wabuluu kunali pafupifupi 0.061%, ndipo methylene blue inagwirizanitsidwa ndi kuchuluka kochepa kuposa isosulfan blue. Deta yochuluka ya chitetezo yasonkhanitsidwa mu zotsatira zosafunika ndi chitetezo.

Kupeza parathyroid: ntchito yakale ya m’thupi lonse, yomwe tsopano imasankhidwa

Kupereka methylene blue m’mtsempha kuti apeze tizithokomiro ta parathyroid tachilendo ndi njira yakale yomwe ikugwiritsidwabe ntchito ngati njira yothandizira yosankhidwa yokha. Kale, kuchuluka kwakukulu ndithu kunkaperekedwa m’mtsempha asanafufuze m’khosi kuti minofu yachilendo ikhale yabuluu; njira zofalitsidwa zimakhala pafupifupi 3 mpaka 7.5 mg/kg IV. Kuwunika mwadongosolo kunapeza kafukufuku 39 wongoyang’anira ndipo palibe mayeso ogawa anthu m’magulu mwachisawawa: akuti kupaka utoto kunali kopambana kwambiri, koma phindu lowonjezera pogwiritsa ntchito limodzi ndi njira zamakono zopezera malo silinatsimikizidwe.

M’malo mwake, ntchito zamakono zimadalira ultrasound ndi zithunzi zina zisanachitike opaleshoni, kudziwa mmene ziwalo zilili pa opaleshoni, ndi kuyang’anira mahomoni a parathyroid pa opaleshoni. Malangizo a AAES amatchula methylene blue pakati pa njira zingapo zothandizira kuona zinthu, osati ngati njira yaikulu yopezera malo.

Iyinso ndi ntchito imene chenjezo la kugwirizana ndi mankhwala ena ndi lofunika kwambiri. Methylene blue ndi choletsa champhamvu koma chosakhazikika cha monoamine oxidase, ndipo kuwunika mwadongosolo kunanena za kuwonongeka kwa dongosolo la mitsempha kwa odwala 25, onse omwe ankamwa mankhwala okhudza serotonin. Kuwunika kwina kwa zolemba zokhudza serotonin syndrome yogwirizanitsidwa ndi methylene blue kunapeza zochitika 50, zonse zokhudza mankhwala oletsa kukhumudwa okhudza serotonin, ndipo zambiri zinali zokhudzana ndi opaleshoni ya parathyroid kapena kuchiza vasoplegia. Kuchuluka komwe kunkagwiritsidwa ntchito kale pa parathyroid kungapose kwambiri kuchuluka kwa 1 mg/kg komwe kumagwiritsidwa ntchito pochiza masiku ano, choncho kugwirizana kumeneku kumakhudza kulowa kwa mankhwalawo m’thupi lonse, osati dontho la utoto pa minofu.

Njira ina yosiyana, yomwe imagwiritsa ntchito kuchuluka kochepa kwambiri, yafotokozedwa pa makhosi omwe akuchitidwanso opaleshoni kapena ali ndi zipsera: kubaya mwachindunji pa malo odziwika motsogozedwa ndi ultrasound, ndipo magulu ang’onoang’ono agwiritsa ntchito pafupifupi 0.2 mL ya madzi a 1% osungunulidwa pa 1:5 (pafupifupi 0.2%) opaleshoni itatsala pang’ono kuchitika. Umboni uli m’magulu ang’onoang’ono ongoyang’aniridwa okha.

Mayeso olowetsa madzi amchere: utoto si umene umapangitsa mayesowo kugwira ntchito

Pa mayeso olowetsa madzi amchere ofufuza ngati kuvulala kwatsegula mkati mwa mfundo, madzi amchere amabayidwa m’mfundo ndipo chilondacho chimayang’aniridwa kuti aone ngati madzi akutuluka. Nthawi zina methylene blue imangowonjezeredwa kuti madzi amene akutuluka azioneka mosavuta. Chofunika kwambiri chomwe chapezeka n’chakuti utoto sunasonyezedwe kuti umapangitsa mayesowo kukhala abwino: pa kafukufuku wa bondo wa odwala 58 amene anagawidwa m’magulu mwachisawawa n’kutsatiridwa kupita m’tsogolo, mayeso omwe anasonyeza molakwika kuti palibe vuto anali 69% ndi methylene blue poyerekeza ndi 66% ndi madzi amchere okha, ndipo kuchuluka kwa madzi kofunikira kuti mayeso asonyeze vuto kunali kofanana. Kuwunika mwadongosolo kwa 2025 kunapeza kuti kafukufuku 8 mwa 23 wa mayeso olowetsa madzi amchere anagwiritsa ntchito utoto, ndipo zotsatira zinkadalira mfundo yomwe ikuyesedwa, malo a chilonda, kuchuluka kwa madzi obayidwa, ndi njira yogwiritsidwira ntchito, osati kuwonjezera utoto. Palibe mphamvu ya madzi ya muyezo yomwe yatsimikizidwa pa ntchito imeneyi. Methylene blue pano ndi chinthu choika mtundu chosankha kugwiritsa ntchito m’njira zakale kapena zoyesera, osati chigawo chimene chimapangitsa mayesowo kupeza vutolo bwino.

Machubu a mpweya pa laser: utoto wotsekedwa mkati mwa kafu

Ntchito imeneyi ndi yosiyana ndi zina zonse patsambali: nthawi zambiri utoto umaikidwa mkati mwa kafu ya chubu lolowera m’njira ya mpweya, osati m’thupi la wodwala. Pa opaleshoni ya laser ya njira ya mpweya, malangizo opewera moto pa kugwiritsa ntchito mankhwala oletsa kumva ululu amalimbikitsa chubu choyenera chosawonongeka ndi laser ndipo, ngati n’kotheka, kudzaza kafu ndi madzi amchere m’malo mwa mpweya. Kuika mtundu m’madzi amcherewo ndi methylene blue kumatanthauza kuti laser ikabowola kafu, madzi abuluu otuluka amaoneka nthawi yomweyo. Palibe mphamvu ya madzi imodzi yotchulidwa kuti igwiritsidwe ntchito kulikonse; cholinga ndi kuika mtundu wooneka, monga tafotokozera mu malangizo a ASA opewera moto m’chipinda cha opaleshoni.

Pali machenjezo awiri ofunika. Machubu ena akale a laser anali ndi makristalo a utoto m’kafu kapena m’dongosolo lake lolamulira, ndipo nkhani ina yofalitsidwa imafotokoza kuti makristalo osasungunuka anatseka chubu chowongolera moti kafu sinathe kutulutsidwa mpweya; n’chifukwa chake malangizo a chipangizo chilichonse ndi ofunika. Ndipo methylene blue payokha sipangitsa chubu wamba kukhala chosawonongeka ndi laser; kupewa moto kumadaliranso kapangidwe ka chubu, kuteteza kafu, ndi kuchepetsa kuchuluka kwa zinthu zothandiza kuyaka.

Mayeso a kumeza: "utoto wabuluu" sungakhale methylene blue

Pa mayeso ochitika pafupi ndi bedi la wodwala amene ali ndi chubu lolowetsedwa kudzera pa dzenje la pakhosi, chakudya kapena chakumwa chimaikidwa mtundu ndipo zinthu zotuluka m’njira ya mpweya zimayang’aniridwa ngati zasanduka zabuluu; zotsatira zosonyeza buluu zimathandizira kutsimikizira kuti chakudya kapena chakumwa chalowa m’njira ya mpweya. Mawu ake angamveke molakwika mosavuta: njira zofalitsidwa za "mayeso a utoto wabuluu" ndi Modified Evans Blue Dye Test zagwiritsa ntchito Evans blue, methylene blue, ndi mitundu ya chakudya, choncho "mayeso a utoto wabuluu" satanthauza methylene blue nthawi zonse.

Vuto lalikulu ndi mayeso osonyeza kuti palibe vuto pamene lilipo. Luso lopeza vutolo m’njira zosiyanasiyana limakhala pafupifupi 38% mpaka 95%, ndipo malangizo amaona mayesowo makamaka ngati chizindikiro chothandizira kutsimikizira vuto akasonyeza kuti lilipo: mayeso osasonyeza vuto satsimikizira kuti palibe kulowa kwa chakudya kapena chakumwa m’njira ya mpweya. Kuwunika kotsimikizika, pakafunika, kumagwiritsa ntchito zida monga fiberoptic endoscopic evaluation of swallowing kapena videofluoroscopy. Palibe kuchuluka kwabwino kwambiri kwa utoto komwe kwatsimikizidwa.

Musasokoneze izi ndi njira yakale yoika mtundu mosalekeza m’chakudya choperekedwa kudzera mu chubu kupita m’mimba kapena m’matumbo pogwiritsa ntchito FD&C Blue No. 1. Umenewo ndi utoto wina komanso njira ina, yomwe inagwirizanitsidwa ndi kuyamwidwa m’thupi lonse ndi poizoni woopsa kwa odwala ovutika kwambiri, ndipo pambuyo pake kugwiritsa ntchito kwake kunaletsedwa ndi malangizo.

Kutsatira fistula si fistulography

Kutsatira fistula ndi methylene blue pamalo enieni ndi fistulography yojambula zithunzi ndi njira zosiyana zodziwira matenda zomwe nthawi zambiri zimasokonezedwa. Potsatira pamalo enieni, utoto umaikidwa pa khomo lomwe likuganiziridwa kuti ndi la fistula kapena m’bowo la chiwalo, ndipo dokotala amaona ngati buluu ikutulukira kwina kapena amatsatira minofu yomwe yapakidwa utoto pa opaleshoni: kubaya kudzera pa khomo lakunja kuti apeze njira ya fistula ya kuthako, kuika mtundu m’madzi otsukira chikhodzodzo kuti aone kutayikira kupita kumaliseche ngati akuganiza kuti pali fistula pakati pa chikhodzodzo ndi maliseche, ndi ntchito zina zofanana zokhudzana ndi malo enieni. Njira zake zimagwirizana ndi malo ake ndipo mphamvu ya madzi a utoto ilibe muyezo umodzi.

Fistulogram kapena sinogram yeniyeni ndi njira yojambula zithunzi: chinthu chooneka pa X-ray chimabayidwa m’njirayo ndipo fluoroscopy kapena CT imaonetsa kapangidwe kake. Si mayeso a methylene blue. Palibe mwa njira ziwirizi imene ingalowe m’malo mwa MRI, CT, endoscopy, kapena kuunika munthu atapatsidwa mankhwala oletsa kumva ululu pa fistula yovuta.

Msampha umodzi wokhudzana ndi njira yoperekera utoto uyenera kutsindika: methylene blue yoperekedwa kudzera m’thumbo lomaliza ingayamwidwe kenako n’kutulutsidwa mumkodzo. Kafukufuku wa anthu odzipereka anasonyeza zimenezi pambuyo pa enema ya 50-mg ndipo anatsimikiza kuti utoto wolowetsedwa m’thumbo lomaliza suyenera kugwiritsidwa ntchito kutsimikizira fistula yoganiziridwa pakati pa matumbo aakulu ndi chikhodzodzo, chifukwa mkodzo wabuluu ukhoza kuchitika popanda fistula iliyonse. Tchulani malo a m’thupi ndi njira yojambula zithunzi m’malo moona funso lililonse la fistulography ngati likukhudza mayeso omwewo.

Malire okhudza njira zonse omwe ndi oyenera kukumbukira

Kulowa m’thupi lonse kumafuna kuganizira mmene mankhwalawo amagwirira ntchito zomwe sizifanana ndi kutsatira utoto pamalo enieni. Methylene blue ikakhala yokwanira m’magazi, imayamwa kuwala komwe zida zoyang’anira zimagwiritsa ntchito, choncho pulse oximetry ingasonyeze mpweya wa oxygen wochepa kuposa umene ulipodi. Kupereka m’thupi lonse kungayambitse kuwonongeka kwakukulu kwa maselo ofiira a magazi mwa anthu omwe alibe G6PD yokwanira, ndipo malangizo aposachedwa a mankhwala obayidwa amatchula kusowa kwa G6PD ngati chifukwa chosagwiritsira ntchito mankhwalawo. Apanso, chiopsezo cha kubaya pang’ono kwambiri pamalo enieni kapena cha utoto wotsekedwa mkati mwa kafu ya chubu la mpweya sichofanana ndi kupereka mg/kg zingapo m’mtsempha, koma "pamalo enieni" sikutanthauza nthawi zonse kuti palibe kuyamwidwa m’thupi lonse: njira yoperekera, kuchuluka kwake, ndi mmene minofu ilili ndizofunika.

Mfundo yomaliza ikukhudza kudziwa mtundu wa utoto. Kuonetsa zinthu pa opaleshoni kumadalira kudziwa bwino utoto womwe uli m’sirinji: methylene blue, isosulfan blue, patent blue V, Evans blue, ndi mitundu ya chakudya zimagwira ntchito mosiyana ndipo zili ndi zoopsa zosiyana, koma zonse zimapezeka m’njira zomwe zimangotchedwa mayeso a "utoto wabuluu". Kusamala komweku kumafunikanso kunja kwa chipatala. Zinthu zogulitsidwa monga methylene blue zimasiyana kwambiri pa kalasi yake ndi zolemba zake, ndipo zinthu zopangira nsalu sizilowa m’malo mwa zinthu zopangidwa ndi kuyesedwa kuti zigwire ntchito yomwe yatchulidwa. Pamene kuyera kuli kofunika, yang’anani kupanga kotsatira miyezo yamankhwala, kuyesa kwathunthu kwa USP komwe kuli ndi satifiketi ya kusanthula ya gulu lililonse lopangidwa, ndi kutsimikizira kodziyimira pawokha, osati kuyesa zitsulo zolemera kokha. Buku lotsogolera kuwerenga satifiketi ya kusanthula limafotokoza magawo oti mufufuze. Magwero ozama alembedwa mu laibulale ya kafukufuku.