Ubururu bwa metilene n'ubushobozi bwo gutekereza nyuma yo kubagwa: amagerageza ku bantu n'imikorere yagaragajwe mu nyamaswa

Rimwe na rimwe, abantu bageze mu zabukuru bava mu kubagwa gukomeye batagitekereza neza nk'uko babikoraga mbere. Imiryango irabibona. Abaganga barabipima. Ikibazo ni ukumenya niba ubururu bwa metilene, butangwa mu gihe kijyanye no gutera ikinya, burinda ubwonko. Ubwoko bubiri bw'ibimenyetso bugira icyo buvuga kuri icyo kibazo, kandi busubiza ibice byacyo bitandukanye. Igerageza ku bantu mu gihe cyo kubagwa rivuga ibyabaye ku barwayi. Ubushakashatsi bukoresha imbeba zishaje butanga igitekerezo cy'uko ubwo burinzi bushobora gukora imbere mu turemangingo tw'imyakura. Nta na bumwe busimbura ubundi.

Intambwe ya mbere ni ugutandukanya ibisubizo bibiri bikunze kwitiranywa.

Urujijo rukaze no kugabanuka kw'ubushobozi bwo gutekereza bupimwa ni ibintu bitandukanye

Urujijo rukaze nyuma yo kubagwa ni ihungabana ritangira vuba kandi rihindagurika, rigafata ubushobozi bwo kwitondera ibintu no kumenya ibibera hafi y'umuntu. Umurwayi aba atekereza neza mu isaha imwe, mu ikurikiyeho akaba afite urujijo. Ibitaro birutahura bikoresheje ibikoresho by'isuzuma bikoreshwa iruhande rw'igitanda, nka 3D-CAM, akenshi inshuro zirenze imwe ku munsi, kuko isuzuma rimwe rishobora kutarubona.

Imikorere mibi y'ubushobozi bwo gutekereza nyuma yo kubagwa ni ikindi kintu. Ni igabanuka ripimwa mu bizamini byemewe, ugereranyije n'ibipimo by'uwo murwayi ubwe mbere yo kubagwa, bikareba kwibuka, kwitondera ibintu, n'ubushobozi bwo gutegura no kuyobora ibikorwa. Ibizamini bikorwa nyuma y'iminsi cyangwa ibyumweru. Umurwayi ashobora kugira kimwe atagize ikindi.

Iri tandukaniro rifite akamaro kuko ibyo bisubizo byombi bipimwa hakoreshejwe ibikoresho bitandukanye, mu bihe bitandukanye, n'abasuzuma batandukanye. Iyo igerageza rivuze byombi, bisome nk'ibivugwa bibiri bitandukanye. Ibisobanuro ku buryo bwo gusoma inyandiko z'amagerageza witonze biri mu ngingo ivuga uko wasoma ubushakashatsi ku bururu bwa metilene.

Ibyakozwe mu igerageza ku bantu

Ibimenyetso by'ingenzi ku bantu biva mu igerageza ryagabanyije abarwayi mu matsinda ku buryo bwa tombola, ridahisha umuti uhabwa buri tsinda, ryakorewe mu Bitaro bya Huashan, ryasohotse muri Journal of Clinical Anesthesia mu 2021. Ryitabiriwe n'abarwayi 248 bafite imyaka 60 kugeza kuri 80 bari bagiye kubagwa gukomeye kwateguwe, kutari ukubaga umutima cyangwa ubwonko n'imyakura, harimo kubaga mu gatuza, amagufwa, imyanya y'inkari, no kubagwa gukomeye mu nda. Kimwe cya kabiri cyahawe ubururu bwa metilene bwa 2 mg/kg mu mutsi, buvangwa n'amazi kugeza kuri 50 mL kandi butangwa mu gihe cy'iminota 60 ako kanya nyuma yo gutangira ikinya. Ikindi kimwe cya kabiri cyahawe 50 mL z'umuti w'amazi arimo umunyu muri gahunda imwe.

Urujijo rukaze ni cyo gipimo cy'ibisubizo cy'ibanze. Abasuzuma bakoreshaga 3D-CAM kabiri ku munsi, isuzuma rimwe n'irindi bitandukanyijwe nibura n'amasaha atandatu, kuva ku munsi wa 1 kugeza ku wa 5 nyuma yo kubagwa cyangwa kugeza umurwayi asezerewe. Iyo isuzuma ryerekanaga urujijo, bakoresheje Memorial Delirium Assessment Scale kugira ngo barusobanure neza. Urujijo rwo mu cyumba cyo gukangukiramo rwandikwaga ukwabwo nk'urujijo rukaze rwo mu gihe cyo gukanguka mu kinya. Ubushobozi bwo gutekereza ni cyo gipimo cy'ibisubizo cya kabiri: hakoreshejwe urutonde rw'ibizamini byemewe ku munsi ubanziriza kubagwa, bikongera gukorwa hafi y'umunsi wa 7 nyuma yo kubagwa. Igabanuka ryasobanurwaga nk'ukumanuka kurenze ikinyuranyo fatizo kimwe nibura mu bizamini bibiri. Iryo ni igabanuka ryo mu minsi ya mbere, ubu rikunze kwitwa gutinda kugaruka kw'ubushobozi bwo gutekereza. Nyuma y'amezi atatu, abashakashatsi bakoresheje isuzuma ryo kuri telefoni, TICS-m, ariko nta gipimo cya TICS-m cyo mbere yo kubagwa cyari gihari cyo kugereranyaho.

Ibisubizo byo mu minsi ya mbere byari byiza kurushaho ku bahawe ubururu bwa metilene. Urujijo rukaze rwabaye ku barwayi 9 muri 124 bahawe ubururu bwa metilene (7.3 ku ijana), ugereranyije na 30 muri 124 bo mu itsinda ryo kugereranya (24.2 ku ijana). Ikigereranyo cy'amahirwe yo kugira urujijo, kimaze gukosorwa hifashishijwe ibindi bintu bigira ingaruka, cyari 0.24, gifite intera y'icyizere ya 95 ku ijana kuva kuri 0.11 kugeza kuri 0.53. Kugabanuka kw'ubushobozi bwo gutekereza mu minsi ya mbere kwabaye kuri 20 muri 124 (16.1 ku ijana), ugereranyije na 49 muri 122 (40.2 ku ijana). Urujijo rukaze rwo mu gihe cyo gukanguka mu cyumba cyo gukangukiramo rwari hafi kungana mu matsinda yombi, hafi 18 ugereranyije na 23 ku ijana. Nyuma y'amezi atatu, amanota yo kuri telefoni yari hafi kungana (amanota yo hagati 34.5 na 34.0), nta tandukaniro ryagaragaye mu mibare y'ibarurishamibare.

Iyo mibare igomba gusomerwa hamwe n'imbogamizi zayo. Igerageza ryagaragazaga ku mugaragaro ko umuti wa buri tsinda utari uhishwe. Abaganga b'ikinya bari bazi itsinda buri murwayi arimo, kandi ubururu bwa metilene butuma inkari ziba ubururu buvanze n'icyatsi mu gihe cy'iminsi itatu kugeza kuri itanu, bishobora kumenyesha abarwayi n'abasuzuma itsinda barimo. Ryakorewe mu kigo kimwe. Gukurikirana ubushobozi bwo gutekereza hakoreshejwe ibizamini byo kugereranya byakozwe neza mbere yo kubagwa byamaze hafi icyumweru; isuzuma ryo kuri telefoni nyuma y'amezi atatu ntirishobora kwerekana impinduka ugereranyije n'uko umurwayi yari ameze mbere, kuko nta manota yo kuri telefoni yo mbere yo kubagwa ahari. Ibibazo byashyizwe mu mbonerahamwe, nko kugira isesemi, kuruka, no kuzungera, byari hafi kungana mu matsinda yombi, kandi nta murwayi wari watangajwe ko yagize sindorome ya serotonine cyangwa kubura amaraso guterwa no gusenyuka kw'insoro zitukura ku rwego rukomeye mu buvuzi. Kugira umuriro byari byinshi kurushaho mu bahawe ubururu bwa metilene (16 muri 124 ugereranyije na 3 muri 124). Imikorere idasanzwe y'umwijima yagaragaye mu matsinda yombi kandi yajyanaga n'abari babazwe bakurwaho igice cy'umwijima.

Icyo ubushakashatsi ku mbeba zishaje bwongeraho

Ubushakashatsi butandukanye ku mbeba zifite amezi 18 bubaza ikibazo cy'imikorere, aho kuba ikibazo cy'ibisubizo by'ubuvuzi. Imbeba 45 z'ingabo zo mu bwoko bwa C57BL/6J zagabanyijwe mu matsinda atatu ya cumi n'eshanu: izahawe ogisijeni gusa, izahawe sevoflurane ya 3 ku ijana mu gihe cy'amasaha abiri, cyangwa izahawe iyo sevoflurane imwe nyuma y'amasaha abiri zitewe inshuro imwe ubururu bwa metilene bwa 5 mg/kg mu mwanya wo mu nda ukikije ingingo. Kwiga no kwibuka byapimwe hakoreshejwe inzira z'amayobera zo mu mazi za Morris, kandi ingirangingo zo muri hipokampe zasuzumwe harebwa imiterere ya mitokondiriya na poroteyine ziyobora kwigabanya kwa mitokondiriya.

Sevoflurane yongereye umusemburo usenya poroteyine wa SENP3, ikura poroteyine nto ihindura imikorere (SUMO2/3) kuri Drp1 igenga kwigabanya, igabanyamo mitokondiriya uduce, kandi ituma imbeba zititwara neza mu nzira z'amayobera. Gutanga ubururu bwa metilene mbere byahinduye buri ntambwe muri urwo ruhererekane: gukura SUMO kuri Drp1 byaragabanutse, gucikamo uduce biragabanuka, amanota yo kwibuka aba meza kurushaho. Abanditsi bagaragaza uko Drp1 iba ifite SUMO nk'umwanya ufungura cyangwa ufunga ihuriro hagati yo guhabwa ikinya n'ibyangirika kuri mitokondiriya no ku bushobozi bwo gutekereza.

Iyo ni inzira ifatika kandi ishobora kugeragezwa, kandi ituma ikimenyetso cyabonetse ku bantu kiba kitagitunguranye cyane mu rwego rw'ibinyabuzima. Ariko zirikana ibyo ubwo buryo bw'ubushakashatsi butari byo. Izi mbeba zari zishaje ariko ubundi zifite ubuzima bwiza, zahawe ikinya gusa, zitabazwe kandi zidafite izindi ndwara zibana. Umuti watewe mu nda amasaha abiri mbere yo guhabwa ikinya, uburyo bwo kuwutanga mbere butandukanye n'ubwo kuwushyira mu mutsi nyuma yo gutangira ikinya mu buvuzi. Ibimenyetso byo mu ngirangingo za hipokampe y'imbeba ntibyemeza ko iyo nzira ari yo isobanura ibisubizo byabonetse ku bantu.

Ubushakashatsi bwombi bugereranyijwe

Porotokole ya kabiri, nini kurushaho, isobanura neza aho uru rwego rw'ubushakashatsi rugana. Igerageza ryanditswe ryo kubaga impindura NCT04529265 ryateganyije abarwayi 314 bafite imyaka 55 kugeza kuri 80, guhisha amatsinda ku bitabiriye no ku basuzuma ibisubizo, no gutanga umuti inshuro ebyiri mu gihe cyo kubagwa, wose hamwe ungana na 3 mg/kg. Urujijo rukaze mu gihe cyo kuba mu bitaro ni rwo rwari igipimo cy'ibisubizo cy'ibanze, naho ubushobozi bwo gutekereza ku munsi wa 7, ibimenyetso by'ububyimbirwe, no gukurikirana ibijyanye na kanseri igihe kirekire bikaba ibipimo bya kabiri. Inyandiko yo mu gitabo cy'amagerageza yerekana ko ryasojwe mu Kuboza 2024, kandi kuva icyo gihe ibisubizo byasohotse muri Journal of Clinical Anesthesia mu 2026. Iryo gerageza risubiramo ubushakashatsi amatsinda ahishwe ni ryo ryo kwitondera mbere yo gufata icyabonetse mu igerageza ridahisha amatsinda nk'umwanzuro wemejwe.

Umutekano wo mu cyumba cyo kubagiramo ntuhita uba uwo mu rugo

Ibisubizo byose ku bushobozi bwo gutekereza byavuzwe hejuru biva ku ikoreshwa rigenzurwa ryo gutanga umuti mu mutsi mu gihe cyo kubagwa. Aho hantu haba hari abaganga b'ikinya, ibikoresho byo gukurikirana umurwayi, imiti yo kumuzahura, n'isuzuma ry'imiti ishobora kugira imikoranire n'uyu muti. Nta na kimwe muri ibyo gihita kijyana no kuwunywa mu rugo.

Hari ibyitonderwa bibiri byihariye. Ubururu bwa metilene bubangamira umusemburo wa monoamine oxidase, bityo kubuhuza n'imiti ivura agahinda gakabije ikora kuri serotonine bishobora gutera sindorome ya serotonine. Amabwiriza yo kwandika umuti uterwa agaragaza iyi ngaruka mu muburo uri mu gasanduku; imiti igira imikoranire na wo isobanurwa mu ngingo ivuga imikoranire y'ubururu bwa metilene n'indi miti. Abarwayi bafite ibura rya G6PD bashobora kugira isenyuka ry'insoro zitukura. Guhinduka ubururu kw'inkari n'uruhu, ubwabyo kutagira ingaruka mbi, ni na byo bituma amagerageza azaza agomba gushyira imbaraga nyinshi mu guhisha amatsinda kurusha uko byakozwe muri iri gerageza ridahisha amatsinda. Amahame rusange y'umutekano mu gufata no gushaka aho umuti uturuka avugwa mu ncamake mu ngingo ivuga iby'ibanze ku mutekano w'ubururu bwa metilene.

Umwanzuro

Igerageza rimwe ridahisha umuti wa buri tsinda, ryakorewe ku barwayi bageze mu zabukuru babazwe, rivuga ko urujijo rukaze no kugabanuka kw'ubushobozi bwo gutekereza bupimwa mu minsi ya mbere byabaye bike cyane nyuma yo guhabwa inshuro imwe umuti mu mutsi mu gihe cyo kubagwa. Nta tandukaniro mu bushobozi bwo gutekereza ryabonetse nyuma y'amezi atatu, kandi abanditsi ubwabo bagaragaza intege nke zijyanye no kudahisha amatsinda. Ubushakashatsi bw'ikinya ku mbeba zishaje butanga ibisobanuro bifitanye isano neza bishingiye kuri mitokondiriya by'uko ubwo burinzi bushobora kubaho. Fata ibyo nk'ibivugwa bibiri bitandukanye: ikimenyetso cy'ubuvuzi gitegereje gusubirwamo mu igerageza rihisha amatsinda, n'imikorere itegereje kwemezwa ku bantu. Abasomyi bakurikirana mu buryo bwagutse ibisubizo ku kwibuka mu gihe cyo gusaza bashobora no gushaka gusoma ubururu bwa metilene no kwibuka mu gihe cyo gusaza.