Igihe methylene blue igabanukaho kimwe cya kabiri: imara igihe kingana iki mu mubiri?

Methylene blue nta gihe kimwe cyemejwe iba “yavuye mu mubiri wawe” ifite. Amabwiriza agezweho ya PROVAYBLUE iterwa avuga ko ku bantu igihe igabanukaho kimwe cya kabiri ari hafi amasaha 24. Ubushakashatsi bwa kera ku bakorerabushake bwagereranyije ko icyo gihe ari amasaha 5.25 nyuma yo kuyitanga mu mutsi. Iyi mibare isobanura igabanuka ry’igipimo cyapimwe mu bihe bitandukanye, ntabwo ari igihe ntarengwa nyuma yacyo buri rugingo ruba rutakirimo uwo muti.

Ikibazo cy’ingirakamaro kirushaho kuba gisobanutse: ni ubuhe buryo bwo gutegura umuti n’iyihe nzira unyuzwamo, ku bahe bantu, wapimwe mu ruhe rugero, kandi mu gihe kingana iki? Ikigereranyo cy’igipimo cy’umuti mu maraso ntigishobora, cyonyine, kukubwira igihe ingaruka umuntu yiyumvamo zigomba gutangirira, igihe imikoranire y’imiti iba itagiteje ibyago, cyangwa niba kuwukoresha buri munsi bikwiye.

Icyo igihe cyo kugabanukaho kimwe cya kabiri gipima koko

Igihe cyo kugabanukaho kimwe cya kabiri mu gihe umuti usohoka mu mubiri ni igihe igipimo cyapimwe gifata kugira ngo kigabanukemo kabiri mu cyiciro cyo kuwusohora kirimo gusesengurwa. Igihe cyo kugabanukaho kimwe cya kabiri mu cyiciro cya nyuma gisobanura igice cyo mu mpera z’umurongo ugaragaza uko igipimo gihinduka. Ntabwo byanze bikunze kiba ari igabanuka ryihuta ribanza kubaho nyuma yo gutera umuti.

Mu rugero rworoshye, reka tuvuge ko igipimo kiva ku bipimo 100 byatoranyijwe ku bw’urugero kikagera kuri 50 mu gihe kimwe cyo kugabanukaho kimwe cya kabiri. Mu kindi gihe kingana n’icya mbere, kigabanuka kikagera kuri 25, aho kugera kuri zeru. Iyi ni imibare yo mu cyitegererezo cyoroshywe, ntabwo ari ikigereranyo cyihariye cya methylene blue isigaye mu mubiri w’umuntu runaka.

Andi magambo atatu asubiza ibibazo bitandukanye:

Igihe igipimo kigera ku rwego rwo hejuru, cyangwa Tmax: igihe igipimo cyo hejuru kurusha ibindi mu ngero zafashwe kiboneka.
Urugero umubiri wagezweho n’umuti, cyangwa AUC: ubuso buri munsi y’umurongo ugaragaza igipimo uko igihe kigenda, buhuza igipimo n’igihe kimara.
Igisubizo ku buvuzi: impinduka mu ndwara cyangwa mu musaruro w’ubuvuzi hagamijwe kuvura, nko kugabanuka kwa methemoglobin kwapimwe.

Igipimo cyo hejuru ntikigomba byanze bikunze guhura n’igihe inyungu iba iri ku rwego rwo hejuru. Igipimo kiri hasi ntigihita gisobanura ko ingaruka ku mikorere y’umubiri cyangwa imikoranire y’imiti byarangiye.

Kugereranya ubushakashatsi ku bantu

Iyi mbonerahamwe ni igereranya ry’umwimerere ry’ubushakashatsi bwa Peter, ubushakashatsi bwa Walter-Sack n’uburyo bwabwo bwose, n’isuzuma rya FDA ku migendekere n’imikorere ya PROVAYBLUE mu mubiri. Ingano z’umuti zakoreshejwe mu bushakashatsi zituma hamenyekana igerageza ryakozwe; ntabwo ari amabwiriza yo kuwukoresha. MB isobanura methylene blue.

Ibimenyetso	Inzira umuti wanyujijwemo n’abawahawe	Ikintu cyapimwe, urugero n’uburyo bwo gupima	Ifatwa ry’ingero n’igisubizo cyatangajwe
Peter n’abandi, 2000	100 mg mu mutsi (IV) no mu kanwa; abakorerabushake barindwi	MB mu maraso yose; koromatogarafi ikoresha ibisukika ku rwego rwo hejuru	Imigendekere y’igipimo mu maraso kugeza ku masaha 4, nk’uko FDA yabishyize mu mbonerahamwe; igihe cyo kugabanukaho kimwe cya kabiri mu cyiciro cya nyuma nyuma ya IV ni amasaha 5.25
Walter-Sack n’abandi, 2009, itsinda rya IV	50 mg mu mutsi (IV); abantu bakuru 16 bafite ubuzima bwiza biyandikishije, 15 barangije ibyiciro byo guhinduranya uburyo bwo guhabwa umuti	MB muri plasma no mu maraso yose; koromatogarafi ihujwe n’ipimwa ry’uburemere bwa molekile mu byiciro bikurikirana	Ingero zafashwe kenshi kugeza ku masaha 24; impuzandengo y’igihe cyo kugabanukaho kimwe cya kabiri ni amasaha 18.5 muri plasma n’amasaha 13.6 mu maraso yose
Walter-Sack n’abandi, 2009, itsinda ryahawe umuti mu kanwa	500 mg z’umuti uteguye mu mazi unyuzwa mu kanwa; ba bantu bamwe bahinduranyije uburyo bwo guhabwa umuti	Ikintu cyapimwe, ibice by’amaraso n’uburyo bwo gupima bimwe	Ingero zafashwe kugeza ku masaha 24; impuzandengo y’igihe cyo kugabanukaho kimwe cya kabiri ni amasaha 18.3 muri plasma n’amasaha 14.7 mu maraso yose; impuzandengo ya Tmax muri plasma ni amasaha 2.2
Isuzuma rya FDA, 2016, ubushakashatsi bwo gutegura umuti uterwa	Guhabwa umuti rimwe mu mutsi (IV) ku bakorerabushake bafite ubuzima bwiza; isuzuma rivuga mu ncamake itangwa rya 2 mg/kg binyuze mu mutsi mu minota itanu	MB na Azure B byapimwe buri kimwe ukwacyo mu maraso yose no muri plasma hakoreshejwe koromatogarafi y’ibisukika ihujwe n’ipimwa ry’uburemere bwa molekile mu byiciro bikurikirana	Ibipimo byafashwe kugeza ku masaha 72; isuzuma risobanura ko igihe MB igabanukaho kimwe cya kabiri mu cyiciro cya nyuma ari hafi amasaha 24

Kuramo igereranya ry’ubushakashatsi mu mbonerahamwe ya Markdown.

Ibi ntabwo ari ibigereranyo bishobora gusimburana by’agaciro kamwe kadahinduka k’imikorere y’umubiri wa buri muntu. Iyi mbonerahamwe kandi ntishyiraho ihame ryoroshye ry’uko umuti unyujijwe mu kanwa uhora umara igihe kirekire kurusha unyujijwe mu mutsi. Mu bushakashatsi abantu bahinduranyijemo uburyo bwo guhabwa umuti, igice cy’amaraso cyatoranyijwe gupimwa cyahinduye ikigereranyo nubwo inzira yo gutanga umuti yari imwe.

Impamvu imibare itandukanye

Amaraso yose na plasma ni ingero zitandukanye. Amaraso yose arimo uturemangingo turi muri plasma. Plasma ni igice cy’amazi kiboneka nyuma yo gutandukanya uturemangingo n’amaraso. Uburyo bwo gupima bubara umuti uri mu turemangingo no mu mazi busubiza ikibazo gitandukanye n’ubupima umuti uri mu mazi gusa.

Igihe cyo gukurikirana ni ingenzi. Ubushakashatsi burangira hakiri kare bugira amakuru make ku igabanuka ryo mu gihe cya nyuma. Isuzuma rya FDA rigaragaza by’umwihariko ko igihe ingero zafatiwemo no gupima mu maraso yose aho kuba muri plasma biri mu mpamvu zituma ibyatangajwe ku migendekere ya methylene blue mu mubiri bitandukana. Gukurikirana igihe kirekire bishobora kugaragaza icyiciro kigenda buhoro ifatwa ry’ingero hakiri kare ridasobanura neza.

Ikintu cya shimi gipimwa ni ingenzi. Igisubizo cy’umuti w’umwimerere, icy’ikintu gikomoka ku ihindurwa ryawo mu mubiri, n’igiteranyo kirimo n’ubundi bwoko bwawuvuyemo kubera impinduka za shimi ntibigomba byose kwitwa “igipimo cya methylene blue” nta gusobanura ibyapimwe. Igereranya rigaragaza ibintu byatangajwe ko byapimwe aho gufata ibipimo byose bifitanye isano n’ubururu nk’aho ari bimwe.

Uburyo umuti uteguwemo ni ingenzi. Igerageza ryo guhinduranya uburyo bwo guhabwa umuti ryasuzumye umuti wo mu kanwa uteguye mu mazi mu buryo bwihariye. Ibyavuye muri iryo gerageza ntibyemeza agaciro k’umuti wo muri kapisule utasobanuwe, umuti w’amazi ugurishwa, cyangwa indi nzira yo kuwutanga. Mu buryo nk’ubwo, igerageza ryo kureba uko umuti ukwirakwira mu ngingo z’imbeba ryashyizwe mu nyandiko ya Peter ritandukanye n’ibipimo byo mu maraso y’abakorerabushake b’abantu byari muri iyo nyandiko. Ntirigaragaza igihe umuti umara kugira ngo ushire mu bwonko bw’umuntu.

Bifata igihe kingana iki kugira ngo ikore?

Biterwa n’icyo “gukora” bisobanura. Mu kuvura methemoglobinemia itavukanwa, abaganga bashobora gukurikirana igipimo cy’amaraso cyagenwe. Amabwiriza y’umuti uterwa avuga ko abantu bakuru 9 muri 12 bari bafite ibipimo bya mbere bikenewe bagize igabanuka rya methemoglobin rya nibura 50% ku isaha imwe nyuma yo guhabwa umuti. Ibyo ni ibyagaragaye ku gisubizo ku buvuzi, ntabwo ari igihe methylene blue igabanukaho kimwe cya kabiri mu gusohoka mu mubiri.

Ku muti unyuzwa mu kanwa, kugera ku gipimo cyo hejuru muri plasma hafi y’amasaha abiri mu igerageza ku bakorerabushake ntibyemeza ko nyuma y’amasaha abiri ari bwo ubushobozi bwo kwibanda ku kintu, imbaraga cyangwa kwibuka bitangira kwiyongera. Ubushakashatsi ku migendekere y’umuti mu mubiri bwapimye ibipimo by’umuti, ntabwo bwapimye izo nyungu. Ibyo umuntu avuga ko yiyumva na byo ntibishobora kugaragaza igipimo cy’umuti muri plasma ye cyangwa kwemeza ko umuti wose washize mu mubiri igihe ibyo yiyumvaga birangiye.

Ibara ry’inkari, gukoresha umuti kenshi n’igihe cyo gufata imiti

Inkari z’ubururu cyangwa icyatsi ntabwo ari ikizamini cy’igipimo gifite ibipimo ngenderwaho. Amabwiriza yemera ko ibara ry’amazi yo mu mubiri rishobora guhinduka, ariko ntagaragaza urugero rw’ibara rwemeza ko umuti washize mu mubiri. Kureba uko ibara rigenda rigabanuka ntibishobora gusimbura isuzuma ry’imikoranire y’imiti.

Imikorere y’impyiko na yo ihindura uko ibisubizo bisobanurwa. Amabwiriza agezweho avuga ko urugero umubiri ugerwaho n’umuti rwiyongera iyo imikorere y’impyiko yangiritse, nubwo igihe cyo kugabanukaho kimwe cya kabiri kitahindutse ku bafite iyangirika ryoroheje cyangwa riringaniye. Iri tandukaniro ryerekana impamvu igihe cyo kugabanukaho kimwe cya kabiri cyonyine kidahagije mu gupima umutekano. Amabwiriza yacu ku mutekano wa methylene blue asobanura ibindi bintu bireba umurwayi bigomba kwitabwaho.

Gukoresha umuti kenshi bizana ikindi kibazo: ni iki kiba gisigaye igihe umubiri wongeye kuwuhabwa? Igihe cyo kugabanukaho kimwe cya kabiri nyuma yo guhabwa umuti rimwe nticyemeza gahunda itekanye yo kuwufata buri munsi, gahunda ifite akamaro yo kuwukoresha ugenda usimburanya ibihe byo kuwufata n’ibyo kuwuhagarika, cyangwa umutekano wo kuwukoresha amezi menshi. Ibyo bisaba ibimenyetso ku buryo nyakuri bwo kuwukoresha kenshi n’ibibuvamo.

Ntukoreshe imibare y’igihe cyo kugabanukaho kimwe cya kabiri kugira ngo uhagarike, wongere utangire cyangwa utandukanye ibihe byo gufata imiti yanditswe na muganga. Ibyemezo bireba imiti ivura ihungabana n’indi miti ishobora gukorana na methylene blue bisaba urutonde nyakuri rw’imiti, uburyo iteguwemo, inzira inyuzwamo, amateka y’igihe n’ingano by’umuti umubiri wahawe, n’imiterere y’ubuzima bw’umurwayi. Amabwiriza ku mikoranire ya methylene blue n’indi miti asobanura iri tandukaniro. Kugira ngo uhe umuganga cyangwa umuhanga mu by’imiti amakuru, andika igicuruzwa, ingano, inzira cyanyujijwemo, igihe cyose cyafatiwe, imiti yafashwe n’ibimenyetso byose byagaragaye. Ayo makuru arusha akamaro itariki igereranyijwe umuti uzaba washiriyeho mu mubiri.