Methylene blue iterwa n’itangwa ryayo mu mutsi hakoreshejwe serumu

Uducupa tubiri turimo igisukika cy’ubururu bwijimye dushobora kugaragara kimwe duteretse ku meza. Kamwe karimo umuti utarimo mikorobe wagenewe guterwa mu mitsi. Akandi ni agacupa gafite igikoresho cyo gutonyangiriza umuti unyobwa, irangi rikoreshwa muri laboratwari, cyangwa igicuruzwa kigenewe ikigega cy’amafi kitagomba na rimwe kwinjira mu mutsi. Ibara nta cyo rikubwira. Uko umuti uteguwe ni byo bikubwira byose.

Iki ni cyo gitekerezo cy’ingenzi cy’iyi nyandiko: kuba ikinyabutabire ari cyo nyacyo ntibivuze ko gikwiriye guterwa. Igisukika gishobora kuba kirimo methylene blue nyayo ifite ubuziranenge buhanitse mu rwego rw’ubutabire, ariko kigakomeza kuba kidakwiriye guterwa, kuko imiti iterwa igomba no kuba itarimo mikorobe, irimo uburozi buke buturuka kuri bagiteri, ifite uduce duto tugenzurwa, kandi ipakiye mu kintu gikwiriye. Uzirikanye iryo tandukaniro, ibindi bisobanuro byo muri iyi nyandiko birumvikana.

Umuti wemewe uterwa kandi utarimo mikorobe

Umuti fatizo ugenderwaho ni ProvayBlue, methylene blue iterwa itangwa ku nyandiko ya muganga, yemewe kuvura methemoglobinemia itari iya kavukire mu bantu bakuru n’abana. Ubukana bwayo ni 5 mg/mL (0.5%), bubarwa hashingiwe kuri methylene blue trihydrate, kandi itangwa ari 10 mg muri 2 mL cyangwa 50 mg muri 10 mL, mu twombo cyangwa uducupa tw’ikirahure tugenewe gukoreshwa rimwe. Ikintu cyonyine kiyigize kitari igikora ni amazi yagenewe imiti iterwa, kandi pH y’igisukika iri hagati ya 3.0 na 4.5, nk’uko bisobanurwa mu kirango cya ProvayBlue kiriho ubu kuri DailyMed.

Ubu hari imiti rusange myinshi ihwanye na yo iyifata nk’umuti fatizo, bityo ProvayBlue ni izina ry’ubucuruzi aho kuba wo muti wonyine wemewe guterwa. Icyitonderwa kimwe: kuba umuti ufite urupapuro kuri DailyMed ubwabyo ntibyemeza ko wemewe na FDA. Nibura methylene blue imwe ya 1% iterwa igurishwa ivuga ku kirango cyayo ko FDA itasanze ari umuti utekanye kandi ukora neza. Genzura niba wemewe n’uko hari amagambo agaragaza ko utarimo mikorobe kandi ugenewe gukoreshwa rimwe, aho kwibwira ko buri gacupa k’ubururu kujuje ibisabwa.

Ingano z’umuti zemewe ku kirango zifite imbibi zisobanutse. Abantu bakuru n’abana bahabwa 1 mg/kg mu mutsi mu gihe cy’iminota 5 kugeza kuri 30, bingana na 0.2 mL/kg y’igisukika cya 5 mg/mL. Niba methemoglobin ikomeje kuba hejuru ya 30% cyangwa ibimenyetso bigakomeza, nyuma y’isaha hashobora gutangwa indi ngano imwe ya 1 mg/kg. Niba gutanga umuti inshuro ebyiri bidakemuye ikibazo, ikirango cyerekeza ku bundi buryo bwo kwita ku murwayi aho kongera methylene blue. Abarwayi bafite imikorere y’impyiko yangiritse ku rugero ruciriritse cyangwa rukomeye bahabwa gusa 1 mg/kg rimwe, kuko ingano y’umuti umubiri uhura na yo yiyongera cyane uko imikorere y’impyiko igabanuka.

Gutanga umuti na byo bifite amabwiriza yabyo. Uyu muti ugenewe gutangwa mu mutsi gusa kandi ntugomba guterwa munsi y’uruhu. Igisukika gifite ubukana bwa osimozi buri munsi y’ubw’amaraso, bityo gishobora kuvangwa muri 50 mL za dextrose ya 5% kugira ngo hagabanuke ububabare aho gitangirwa, cyane cyane mu bana, kandi icyo gisukika kimaze kuvangwa kigomba gukoreshwa ako kanya. Ntikigomba kuvangwa mu bisukika bya sodium chloride, kuko chloride igabanya ubushobozi bwa methylene blue bwo gushonga. Genzura buri kintu gipakiwemo umuti, ukoreshe ibiri mu kombo cyangwa agacupa kagenewe gukoreshwa rimwe inshuro imwe gusa, maze ujugunye ibisigaye. Umuti ubikwa ku bushyuhe busanzwe bwo mu cyumba, ukingirwa urumuri, udashyizwe muri firigo cyangwa ngo ukonjeshwe kugeza uhindutse urubura.

Abasomyi bifuza gusobanukirwa icyo iyi molekile ikora imaze kugera mu maraso bashobora gutangirira ku nyandiko ivuga uko methylene blue ikora mu mubiri, itandukanya imikorere y’umuti mu mubiri n’ibibazo by’itegurwa ryawo bisobanurwa hano.

Serumu zitangwa ku mpamvu zitari ku kirango zikoresha molekile imwe ariko zikurikiza amabwiriza atandukanye

Uretse methemoglobinemia, rimwe na rimwe abaganga batanga methylene blue mu mutsi ku bibazo nka vasoplegia nyuma yo kubagwa umutima cyangwa ihungabana rikomeye ry’umubiri ritewe n’ubwandu, aho ingaruka zayo ku bwikanye bw’imitsi y’amaraso zikiri kwigwa. Ubu buryo akenshi bukoresha ingano zitandukanye, gutanga umuti ubudahagarara binyuze muri serumu, cyangwa kuwutanga inshuro nyinshi zidahura n’uburyo bwemewe bwo kuwutanga inshuro ebyiri. Ibyo bituma buba uburyo bwo gukoresha umuti butari ku kirango: umuti ubwawo ushobora kuba wemewe guterwa, ariko uburyo bwo kuwutanga ntibube ari bwo bwemewe na FDA. Ibimenyetso by’ibanze bivuye mu igerageza kuri vasoplegia n’ihungabana rikomeye ritewe n’ubwandu bigaragaza impamvu abashakashatsi babishishikariye, ndetse n’impamvu ingano z’umuti zikiri mu bushakashatsi aho kuba zarashyizweho burundu.

Serumu zitegurwa hakoreshejwe kuvanga imiti zongeraho urundi rwego rw’itandukaniro. Umuti uteguwe muri ubwo buryo ushobora gutandukana mu bukana bwa nyuma, igisukika kiwuvangwamo, icyo upakiwemo, ibindi biwugize, n’igihe ntarengwa cyo kuwukoresha. Nanone, imiti itegurwa hakoreshejwe kuvanga, nk’icyiciro, ntabwo yemejwe na FDA ku bijyanye n’umutekano cyangwa ubushobozi bwo gukora neza, nk’uko FDA ibisobanura mu bibazo n’ibisubizo byayo ku itegurwa ry’imiti hakoreshejwe kuvanga. Nubwo urushinge rwaba rurimo umuti w’izina ry’ubucuruzi, umuti rusange, cyangwa umuti uteguwe hakoreshejwe kuvanga, molekile igumana ibyago bimwe bisobanurwa ku kirango cyemewe, harimo imikoranire n’imiti igira ingaruka kuri serotonine, ibyago byo gusenyuka kw’uturemangingo dutukura tw’amaraso, n’ingaruka z’urumuri, bisobanurwa mu bice bikurikira.

Impamvu icyiciro cy’ubuziranenge cyonyine kidatuma igisukika gikwiriye guterwa

Aha ni ho urujijo rwinshi ruturuka. Igisukika kigurishwa mu maduka gishobora kwamamaza ko kirimo methylene blue yo mu cyiciro cy’ubuziranenge cya USP, kikagaragaza ko igipimo cy’ibiyigize kiri hejuru ya 98%, ariko kigakomeza kuba kidakwiriye guterwa. Icyiciro cy’ubuziranenge mu rwego rw’ubutabire gisobanura ifu: umwirondoro wayo, igipimo cy’ibiyigize, imyanda y’ibinyabutabire kama, ibisigazwa by’ibyashongesheje, ibyuma, n’ibindi bipimo bisa na byo. Umuti uterwa ugomba kuzuza ibyo bipimo n’ibindi bisabwa ku miti itangwa hatanyujijwe mu rwungano ngogozi, bitigera bigaragazwa n’icyiciro cy’ubuziranenge cyonyine.

Buri murongo ukumira ikibazo gitandukanye. Igisukika kirimo mikorobe gishobora gutangiza ubwandu mu maraso. Endotoxine zituruka kuri bagiteri zapfuye ntizivanwaho no kuyungurura bisanzwe kandi zishobora gutera umuriro ukabije cyangwa ihungabana rikomeye ry’umubiri. Uduce duto n’ibintu byifashe mu gisukika bishobora gufata mu mitsi mito y’amaraso. Ikintu kidakwiriye gupakirwamo umuti gishobora kurekura ibikigize bikajya mu muti cyangwa kunanirwa gukomeza gufunga neza. Nta na kimwe muri ibi bibazo gihindura ibara ry’ubururu cyangwa umubare w’igipimo cy’ibiyigize. Ni yo mpamvu kurebesha amaso n’ijanisha ry’ubuziranenge bidashobora kwemeza ko umuti ukwiriye kujya mu mitsi. Kugira ngo ubone ibisobanuro byuzuye ku byo gupima ubuziranenge mu buryo bwuzuye bikubiyemo, reba uko icyiciro cy’ubuziranenge cya USP kigenzurwa.

Itegeko rigomba gukurikizwa riroroshye: ntugatera methylene blue yagenewe kunyobwa, ikigega cy’amafi, cyangwa laboratwari, uko ubuziranenge bwayo bwavuzwe bwaba bumeze kose. Gutera bisaba umuti wakozwe, wapimwe, washyizweho ikirango, kandi wanditswe na muganga nk’umuti uterwa.

Ingingo z’umutekano zikomoka ku kirango cyemewe

Ikirango cyemewe cyibanda ku byago bikwiye kumenyekana mbere yo gutanga umuti mu mutsi. Icya mbere ni syndrome ya serotonine, ifite umuburo ukomeye uri mu gasanduku: methylene blue ibuza imikorere ya monoamine oxidase, bityo kuyihuza n’imiti irwanya agahinda gakabije igira ingaruka kuri serotonine, imiti imwe yo mu bwoko bwa opioide, n’indi bifitanye isano bishobora gutera ingaruka zikomeye cyangwa zica. Abarwayi basabwa kwirinda iyo miti mu gihe cy’amasaha 72 nyuma y’ingano ya nyuma bahawe, keretse umuganga asanze gutanga iyo miti icyarimwe bidashobora kwirindwa kandi agakurikiranira hafi umurwayi.

Icya kabiri ni ibura ry’umusemburo wa glucose-6-phosphate dehydrogenase, rikaba ari impamvu ibuza gukoresha uyu muti: abarwayi bafite iryo bura bashobora kugira isenyuka rikomeye ry’uturemangingo dutukura tw’amaraso, kandi umuti ushobora kudakora kuko imikorere yawo ishingiye ku ruhererekane rw’ibikorwa by’imisemburo abo barwayi babura. Ubwivumbure bukomeye kuri methylene blue cyangwa ku rindi rangi ryo mu bwoko bwa thiazine ni indi mpamvu ibuza kuwukoresha.

Ibindi byitonderwa birimo imikorere y’impyiko yangiritse ituma ingano y’umuti umubiri uhura na yo yiyongera, kwangirika k’urusoro iyo umuti ugeze mu gafuka karimo urusoro, n’urutonde rw’ibigomba gukurikiranwa mu bana bavutse igihe cyo kuvuka kigeze bahuye n’umuti, hamwe n’ingaruka zangiza ziterwa n’umuti ufatanyije n’urumuri zamaze gutangazwa, zisaba kwikingira urumuri. Hari ibintu bibiri bidasanzwe mu gukurikirana abarwayi bifite akamaro mu bitaro: ibara ry’ubururu rituma igikoresho gipima ogisijeni gihereye ku miterere y’itera ry’amaraso kigaragaza imibare iri hasi mu buryo butari bwo, bityo gupima amaraso yo mu mutsi uvana amaraso mu mutima bikaba ari byo bihitamo; kandi umuti ushobora guhungabanya ibikoresho bikurikirana ubujyakuzimu bwo kuganzwa n’ikinya n’ibizamini by’inkari bikoresha irangi ry’ubururu. Mu makuru y’umutekano yakusanyijwe ku barwayi bakuru 31, ingaruka zikomeye zabaye hafi muri 3%, kandi ingaruka zagaragaye nibura muri 2% zarimo kuribwa umutwe, isesemi, impiswi, potasiyumu na manyeziyumu biri hasi, kwikanya kw’imikaya gutunguranye, n’ibintu bisa no gufatwa n’ibicuri.

Ibi byose si impamvu yo gushyigikira cyangwa kurwanya uburyo runaka bwo gutanga umuti butari ku kirango. Ni ukwibutsa ko ibyago bigumana na molekile, icyo umufuka wa serumu wanditseho cyose.

Ibyo kugenzura mbere yo gutanga umuti uwo ari wo wose mu mutsi

Niba uri umurwayi cyangwa umwitaho, emeza ibintu bine hamwe n’itsinda riri kumuvura: ko umuti uterwa utarimo mikorobe, wemewe cyangwa uteguwe hakoreshejwe kuvanga kugira ngo utangwe mu mutsi; ko impamvu yo kuwutanga n’ingano yawo bikurikiza uburyo bwateguwe kandi bwatekerejweho; ko imiti igira ingaruka kuri serotonine n’imimerere ya G6PD byasuzumwe; kandi ko gukurikirana umurwayi bikubiyemo gupima ogisijeni hakoreshejwe isesengura ry’amaraso aho gushingira gusa ku gikoresho gipima ogisijeni gihereye ku miterere y’itera ry’amaraso. Niba hari umuntu utanze igitekerezo cyo gutera umuti wo mu gacupa gatonyangiriza kagurishwa mu maduka cyangwa igisukika cya laboratwari, fata ibyo nk’impamvu yo guhita uhagarika icyo gikorwa, maze usabe ko farumasi y’ibitaro ari yo ibikurikirana.

Itegurwa ry’umuti ni ryo gitekerezo cy’ingenzi, naho ikirango kikaba amasezerano agenga uko ukoreshwa. Huza igisukika n’aho kigomba gutangirwa, maze ibara ry’ubururu rireke kuba intandaro y’urujijo.