Methylene blue yotsukira m'kamwa pa mucositis: zimene kafukufuku wina wa ululu wa khansa anasonyeza

Mucositis yobwera chifukwa cha chithandizo cha khansa ndi vuto lapadera. Mankhwala a khansa kapena chithandizo chokonzekeretsa kuikidwa maselo atsopano chimavulaza nembanemba ya m'kamwa, zilonda zimapangika, ndipo nsonga za minyewa zomwe zimakhala poyera zimachititsa kudya, kumeza, ndi kulankhula kukhala kopweteka. Pa sikelo ya WHO ya mucositis yofotokozedwa m'malangizo a chithandizo chothandizira wodwala, giredi 2 imalolabe kudya chakudya cholimba pamene pa giredi 3 wodwala amangotha kumwa zakumwa zokha. Kuchepetsa ululu ndi kuchira kwa minofu ndi zotsatira zosiyana. Mankhwala otsukira m'kamwa angathandize kuchepetsa ululu popanda kusintha kuchira kwa minofu.

Kusiyana kumeneku n'kofunika pomvetsetsa kafukufuku wabwino kwambiri wopezeka wa methylene blue yotsukira m'kamwa mwa anthu pa vuto limeneli: kafukufuku wa gawo 2 wa 2022 ku MD Anderson, womwe unagawa odwala m'magulu mwachisawawa, wofalitsidwa mu BMC Medicine monga kafukufuku wa ululu wa mucositis wovuta kuchepetsa. Sunayese methylene blue pa zilonda za m'kamwa zonse, matenda opatsirana a pakhosi, matenda a mafangasi a m'kamwa, kapena kutsuka m'kamwa tsiku lililonse. Unayesa mankhwala amodzi otsukira m'kamwa osakanizidwa m'njira inayake, ogwiritsidwa ntchito m'njira imodzi, pa ululu wosachepa ndi chithandizo chanthawi zonse.

Zimene kafukufukuyu anayesa

Kapangidwe kake n'kosavuta: kuwonjezera mankhwala otsukira m'kamwa okhudza malo opwetekawo pa chithandizo chanthawi zonse, kuwasunga pa minofu yopweteka, kuwalavula, kubwereza pa nthawi zoikidwa, ndi kuyeza ululu ndi ntchito za pakamwa pakatha maola 48.

Akuluakulu omwe anali ndi mucositis yopweteka ngakhale akulandira chithandizo chanthawi zonse anagawidwa mwachisawawa kuti alandire chithandizo chanthawi zonse chokha (n = 16) kapena chithandizo chanthawi zonse kuphatikiza methylene blue ya 0.025% (n = 15), 0.05% (n = 14), kapena 0.1% (n = 15). Mwa anthu 69 omwe anatenga nawo mbali, 60 anamaliza chithandizo. Lipoti lonse la kafukufukuyu limati chimodzi mwa mbali za kafukufukuyu sichinadziwitsidwe mphamvu ya mankhwala, koma gulu loyerekezerera silinalandire mankhwala abuluu otsukira m'kamwa, choncho poyerekeza ndi chithandizo chanthawi zonse, kubisa mtundu wa chithandizo sikunatheke kwenikweni. Panalibe gulu lolandira mankhwala opanda chogwira ntchito, ndipo olemba lipotilo anatchula zimenezi ngati cholepheretsa kafukufukuyu.

Odwalawo anali atakhudzidwa kwambiri. Mwa omwe anamaliza chithandizo, 72% anali atalandira kuikidwa maselo oyambira, ndipo ena onse anali atalandira mankhwala a khansa ogwira ntchito m'thupi lonse kapena chithandizo cha CAR-T. Polowa mu kafukufukuyu, 90% anali ndi mucositis ya WHO giredi 3 ndipo 10% anali ndi giredi 2; nthawi yapakati yomwe anali atakhala ndi ululu inali masiku 6. Lipotilo siligawa mitundu ya khansa yomwe odwalawo anali nayo, choncho silingagwiritsidwe ntchito kunena zotsatira zokhudza mtundu winawake wa khansa.

Wodwala aliyense analandira botolo la 100 mL la mankhwala osakanizidwa kuchokera ku malo opangira ndi kupereka mankhwala a kafukufuku: kutenga 6 mpaka 10 mL, kuwasunga pa malo opweteka kwa mphindi 5 uku akuwazunguliza m'kamwa ndi kuguguda nawo pakhosi, kuwalavula osawameza, kudikira asanatsuke m'kamwa kapena kudya, ndi kubwereza maola 6 aliwonse kwa pafupifupi masiku 2. Chithandizo china chinapitirira ndipo chikanaphatikizapo ukhondo wa m'kamwa, mankhwala otsukira m'kamwa a lidocaine, mankhwala osakanizidwa otchedwa magic mouthwash okhala ndi nystatin, zosakaniza za diphenhydramine ndi mankhwala ochepetsa asidi, komanso ma opioid ogwira ntchito m'thupi lonse.

Mu lipoti lofalitsidwa, zotsatira zazikulu zoyezedwa zinali kusintha kwa ululu pa sikelo ya mfundo 11 (0 kutanthauza kusamva ululu, 10 kutanthauza ululu woipitsitsa) kuyambira poyambira mpaka tsiku 2. Ntchito za pakamwa zinayesedwa ndi chiwerengero cha vuto cha 0 mpaka 6, pophatikiza kudya, kumeza, ndi kulankhula; iliyonse inayikidwa ngati yotheka, yovuta, kapena yosatheka. Giredi ya WHO inalembedwa pokhapokha odwala atalowa mu kafukufukuyu, osati mobwerezabwereza pambuyo pake.

Chidule cha kapangidwe ka kafukufuku ndi zotsatira zake

Tebulo ili limasiyanitsa zinthu zitatu: ululu, ntchito za pakamwa, ndi mavuto obwera chifukwa cha mankhwala. Kuchira, kuthetsa matenda opatsirana, ndi kuchepetsa kufunika kwa ma opioid sizinatsimikizidwe pano.

Poyerekeza ndi chithandizo chanthawi zonse, kuchepa kwa ululu kunafika pa mulingo wovomerezeka wa umboni wa ziwerengero pa mphamvu za 0.025% ndi 0.1%, koma pa 0.05% kunali pafupi ndi malirewo (P = .0506). Mphamvu zitatu za mankhwala otsukira m'kamwa sizinasiyane wina ndi mnzake, choncho kafukufukuyu sakusonyeza mphamvu yabwino koposa.

Zimene kafukufukuyu sanayese

Wowerenga angaone zotsatira zabwino pa ululu n'kuganiza kuti zikugwiranso ntchito pa vuto lina lofanana. Lililonse mwa malingaliro otsatirawa limafuna kafukufuku wakewake.

Choyamba, kuchiza matenda opatsirana. Kafukufukuyu anayeza ululu ndi ntchito za pakamwa pa mucositis yokhudzana ndi mankhwala a khansa. Sanayese matenda a m'kamwa oyambitsidwa ndi mabakiteriya, mafangasi, kapena mavairasi, dothi lomamatira m'mano, kutupa kwa nkhama, kapena kusunga fungo labwino la m'kamwa nthawi zonse. Kugwiritsa ntchito mankhwala okhala ndi nystatin monga gawo la chithandizo china sikupangitsa mankhwala oyesedwawo kukhala ochiza mafangasi. Nkhani yathu yosiyanitsa zilonda wamba za m'kamwa ndi mucositis ya khansa imasiyanitsa ntchito zimenezi.

Chachiwiri, kugwiritsa ntchito methylene blue kutsuka m'kamwa mwachizolowezi. Anthu omwe anatenga nawo mbali anali ndi mucositis ya giredi 2 mpaka 3 yosachepa ndi chithandizo chanthawi zonse ndipo anali kusamalidwa ndi akatswiri a khansa. Kafukufukuyu sanaphatikizepo anthu athanzi odzipereka, zilonda zazing'ono wamba za m'kamwa, kapena zilonda za pakhosi. Malire amenewo afotokozedwanso mu malangizo athu okhudza zonena za m'kamwa ndi pakhosi.

Chachitatu, kuchira kwa nembanemba. Popanda kuyeza giredi mobwerezabwereza kapena kuyeza zilonda, kuchepa kwa chiwerengero cha ululu sikungatsimikizire kuti minofu inatseka msanga. Olemba lipotilo afotokoza bwino mfundo imeneyi.

Chachinayi, methylene blue yomezedwa. Odwala analavula mankhwala otsukira m'kamwawo. Kulowa kwake m'thupi lonse, kuyanjana kwake ndi mankhwala ena, ndi poizoni wobwera chifukwa cha kumeza utotowo sizinali zimene kafukufukuyu anayesa. Kulavula m'malo momezera ndi gawo la chithandizo choyesedwacho, osati mfundo yaing'ono.

Chifukwa chake chosakaniza chogulitsidwa m'masitolo sichingalowe m'malo mwake

Mankhwala osakanizidwa a kafukufuku ndi botolo logulitsidwa m'sitolo angakhale ndi mtundu wofanana koma kusiyana pa chilichonse chimene chimakhudza zotsatira ndi chiopsezo: mphamvu, kuchuluka, nthawi yokhudza minofu, zosakaniza zina zosathandiza pa chithandizo, ukhondo wokhudza tizilombo, ndi malangizo. Kafukufukuyu anagwiritsa ntchito mankhwala osakanizidwa a mphamvu pafupifupi 0.25 mpaka 1 mg pa mL, kukhudza minofu kwa mphindi 5 zoyezedwa, ndi kugwiritsa ntchito maola 6 aliwonse. Chinthu chogulitsidwa m'sitolo chokhala ndi mphamvu ina, kuzunguliza m'kamwa kwa nthawi yochepa, kapena malangizo oti chimezedwe sichibwereza mikhalidwe imeneyo.

Mabotolo a kafukufukuyu anachokera ku malo opangira ndi kupereka mankhwala a kafukufuku. Methylene blue yogulitsidwa m'masitolo imasiyanasiyana pa giredi ndi mayeso omwe yachitidwa, ndipo zolakwa za mphamvu yake m'kamwa mokhala zilonda si nkhani yaing'ono. Kuyerekezera kumafuna mphamvu yeniyeni, mndandanda wonse wa zosakaniza, ndi satifiketi yokhudza chosakaniza chomalizidwa, osati chinthu choyambirira chokha. Kufotokoza kwathu za kuyesa chosakaniza chomalizidwa kumalongosola chikalata chimenechi.

Ofufuzawo anaganiza kuti mankhwalawo angachepetse ululu pokhudza ulusi wa minyewa yomva ululu yomwe ili poyera, mwina ndi zizindikiro za m'deralo zochepetsa kutupa, ndipo anaona kuti mankhwala otsukira m'kamwawo sanachotse kumva kukoma kapena mchitidwe wodzidzimutsa wofuna kusanza monga mmene mankhwala ochititsa dzanzi anthawi zonse angachitire. Lingaliro limeneli limapangitsa kuchepa kwa zizindikiro kukhala komveka. Silitsimikizira kuti madzi aliwonse abuluu amagwira ntchito pa chilonda chilichonse cha m'kamwa.

Nkhani ya chitetezo ndi malire ake

Kupirira mankhwala kwa nthawi yochepa m'gulu losankhidwali sikutsimikizira kuti ndi otetezeka kwa anthu onse. Kafukufukuyu sanaphatikizepo anthu omwe anali ndi kusowa kwa glucose-6-phosphate dehydrogenase, oyembekezera, oyamwitsa, kapena omwe anali ndi mucositis yokhudzana ndi chithandizo cha cheza. Methylene blue ikagwira ntchito m'thupi lonse imakhala ndi chiopsezo chachikulu cha serotonin syndrome ikayanjana ndi mankhwala okhudza serotonin, chiopsezo cha kuwonongeka kwa maselo ofiira a magazi mwa anthu omwe alibe G6PD yokwanira, ndiponso njira zopewera mavuto pa nthawi ya mimba. Sitikudziwa bwino kuchuluka kwa chiopsezo cha m'thupi lonse pamene mankhwala otsukira m'kamwa alavulidwa moyenera, choncho kuunikanso mankhwala amene munthu akumwa n'kofunika.

Yembekezerani kusintha kwa mtundu kukhala wabuluu kwakanthawi, nenani za kumva kuyaka komwe kumapitirira pambuyo pa kugwiritsa ntchito koyamba, ndipo musasinthe mankhwala otsukira m'kamwa oti alavulidwe kukhala mlingo womezedwa popanda kuunikidwa ndi akatswiri a zachipatala.

Kutsatira zotsatira za kugwira ntchito kwa mankhwala mu kafukufuku wofalitsidwayo kunali kwa maola 48; kuyang'anira chitetezo kunapitirira mpaka masiku 30. Anthu omwe anatenga nawo mbali anali ochepa, chithandizo china chinasiyanasiyana, ndipo gulu loyerekezerera silinabisidwe mtundu wa chithandizo. Zotsatirazi ndi chizindikiro cha gawo 2 cha kuchepetsa zizindikiro, osati muyezo wa chithandizo. Malangizo athu owerengera kafukufuku wa methylene blue amasonyeza mmene mungayang'anire kugawa mwachisawawa, kubisa mtundu wa chithandizo, zotsatira zoyezedwa, ndi kutsatira odwala musanachite kanthu potengera kafukufuku umodzi.

Mafunso oti mufunse gulu losamalira khansa

Ululu wa mucositis uli kale ndi chithandizo chothandizira wodwala chovomerezeka, ndipo mankhwala aliwonse oyesera otsukira m'kamwa ayenera kukambidwa mkati mwa dongosolo limenelo. Mafunso othandiza ndi monga giredi ya mucositis yomwe ilipo, njira zachithandizo chanthawi zonse zomwe zikugwiritsidwa ntchito kale, mankhwala omwe angayanjane ndi methylene blue, ngati mkhalidwe wa G6PD ukudziwika, ndi zotsatira zomwe zingasonyeze kupambana kapena chifukwa chosiyira chithandizo (chiwerengero cha ululu, kuthekera komeza zakumwa, kapena vuto lobwera chifukwa cha mankhwala). Bweretsani tsatanetsatane wolondola wotchulira kafukufukuyo ndi wa mmene mankhwalawo anasakanizidwira m'malo mwa mawu wamba otsatsa chinthu. Mndandanda wathu wokonzekerera kukambirana ndi katswiri wa zachipatala umasonyeza tsatanetsatane wa chinthu ndi kafukufuku woyenera kusindikiza.

Choncho zimene zinaphunziridwa n'zochepa komanso zenizeni: mankhwala osakanizidwa otsukira m'kamwa, omwe analavulidwa ndi kugwiritsidwa ntchito mobwerezabwereza pafupipafupi, anachepetsa ululu wa mucositis wosachepa ndi chithandizo chanthawi zonse ndipo anathandiza kudya, kumeza, ndi kulankhula pa masiku 2 mu kafukufuku woyerekeza wa anthu ochepa wosabisa mtundu wa chithandizo, popanda kusonyeza kuchira mofulumira, kuchepa kwa kufunika kwa ma opioid, kuchiza matenda opatsirana, kapena phindu la kutsuka m'kamwa kwa anthu onse.