Majekiseni eMethylene Blue uye Kuiswa Kwayo neIV

Mabhodhoro madiki maviri ane mvura yebhuruu yakasviba anogona kutaridzika zvakafanana ari patafura. Rimwe rine mushonga wejekiseni usina utachiona wakagadzirirwa kuiswa mutsinga. Rimwe rine mushonga unotorwa nemuromo nechinodonhedza, dhayi yerabhoritari, kana chigadzirwa chemudziyo unochengeterwa hove chisingambofaniri kuiswa mutsinga. Ruvara harukuudzi chinhu. Magadzirirwo acho ndiwo anokuudza zvose.

Iyi ndiyo pfungwa huru yechinyorwa chino: kuva nekemikari chaiyo hakuna kufanana nekukodzera kubayiwa. Mushonga wakanyungudutswa unogona kuva nemethylene blue chaiyo ine kuchena kwekemikari kwakanyanya asi usingakodzeri kubayiwa, nokuti majekiseni anofanirawo kusava neutachiona, kuva nehuturu hushoma hunobva kumabhakitiriya, kuva netudzvimedu twakadzorwa, uye kurongedzwa mumudziyo wakakodzera. Ramba uchifunga musiyano iwoyo, uye zvimwe zvose zviri mugwaro iri zvinobva zvajeka.

Jekiseni risina utachiona rakatenderwa

Chigadzirwa chinoshandiswa sereferensi iProvayBlue, jekiseni remethylene blue rinopiwa netsamba yachiremba uye rakatenderwa kurapa methemoglobinemia inowanikwa mushure mekuzvarwa muvakuru nevana. Simba racho i5 mg/mL (0.5%), richiratidzwa zvichibva pamethylene blue trihydrate, uye rinowanikwa riri 10 mg mu2 mL ne50 mg mu10 mL mumampoule kana mabhodhoro madiki edhosi rimwe chete. Chinhu chimwe chete chisiri mushonga unoshanda chiri mariri imvura yekugadzira majekiseni, uye pH yemushonga wakanyungudutswa iri 3.0 kusvika 4.5, sezvinotsanangurwa mumashoko azvino eProvayBlue paDailyMed.

Mishonga yakawanda yakaenzana nayo isiri yezita rechiratidzo yava kushandisa chigadzirwa ichocho sereferensi, saka ProvayBlue izita rechiratidzo kwete iro jekiseni roga rakatenderwa. Chimwe chokuchenjerera: peji rechigadzirwa paDailyMed pacharo hariratidzi kuti FDA yakachitendera. Pane jekiseni rimwechete kana kupfuura re1% methylene blue rinotengeswa rine mashoko aro anoti FDA haisati yawana kuti rakachengeteka uye rinoshanda. Tarisa kana chakatenderwa uye kana chine mashoko okuti hachina utachiona uye ndechedhosi rimwe chete, pane kungofungidzira kuti bhodhoro diki ripi neripi rine mushonga webhuruu rinokodzera.

Kupiwa kwemadhosi pasi pemashoko emushonga akatenderwa kune miganhu yakamanikana. Vakuru nevana vanopiwa 1 mg/kg nemutsinga mumaminitsi 5 kusvika 30, izvo zvakaenzana ne0.2 mL/kg yemushonga wakanyungudutswa we5 mg/mL. Kana methemoglobin ikaramba iri pamusoro pe30% kana zviratidzo zvikaramba zviripo, rimwe dhosi re1 mg/kg rinogona kupiwa mushure meawa imwe. Kana madhosi maviri asingagadzirisi dambudziko, mashoko emushonga anorayira dzimwe nzira dzokurapa pane kuwedzera methylene blue. Varwere vane kuderera kwekushanda kweitsvo kuri pakati nepakati kana kwakanyanya vanopiwa dhosi rimwe chete re1 mg/kg, nokuti huwandu hwemushonga hunoramba huri mumuviri hunokwira zvakanyanya sezvo kushanda kweitsvo kuchiderera.

Kupiwa kwemushonga kune mitemo yako. Chigadzirwa ichi ndechekuiswa nemutsinga chete uye hachifaniri kubayiwa pasi peganda. Mushonga wakanyungudutswa uyu une hypotonicity, kureva kuti une zvinhu zvakanyungudutswa zvishoma pane zviri muropa, saka unogona kusanganiswa ne50 mL ye5% dextrose kuti uderedze marwadzo panzvimbo yaunopinzwa, kunyanya muvana, uye mushonga wasanganiswa unofanira kushandiswa pakarepo. Haufaniri kusanganiswa nemishonga yakanyungudutswa ine sodium chloride, nokuti chloride inoderedza kunyunguduka kwemethylene blue. Ongorora mudziyo mumwe nomumwe, shandisa zviri muampoule kana mubhodhoro diki redhosi rimwe chete kamwe chete, uye rasa zvinenge zvasara. Unofanira kuchengetwa patembiricha yemumba, wakadzivirirwa pachiedza, usingaiswi mufiriji kana kuita chando.

Vaverengi vanoda ruzivo rwezvinoitwa nemorekuru kana rasvika muropa vanogona kutanga nekushanda kwemethylene blue mumuviri, uko kunoparadzanisa mashandiro emushonga nemibvunzo yemagadzirirwo ayo iri kukurukurwa pano.

Kuiswa nemutsinga kunze kwezvakabvumidzwa kunoshandisa morekuru rimwe chete pasi pemitemo yakasiyana

Kunze kwemethemoglobinemia, vanachiremba dzimwe nguva vanopa methylene blue nemutsinga nokuda kwemamiriro akadai sevasoplegia mushure mekuvhiyiwa kwemwoyo kana kuvhunduka kwemuviri kunokonzerwa nesepsis, uko migumisiro yayo pakusimba kwetsinga iri kuongororwa. Nzira idzi dzinowanzosanganisira madhosi akasiyana, kuiswa kwemushonga nemutsinga kunoramba kuchiitwa, kana kupiwa kakawanda kusingaenderani nehurongwa hwakatenderwa hwemadhosi maviri. Izvozvo zvinoita kuti kuve kushandiswa kunze kwezvakabvumidzwa: chigadzirwa chemushonga chingava jekiseni rakatenderwa, asi hurongwa hwekupiwa kwacho hahusi ihwo hwakatenderwa neFDA. Uchapupu hwekutanga kubva mumiedzo yevasoplegia nekuvhunduka kwemuviri kunokonzerwa nesepsis hunoratidza chikonzero nei vaongorori vachifarira izvi, uyewo chikonzero nei madhosi achiri kuongororwa pane kuti ave atogadzwa.

Mishonga inosanganiswa kuti iiswe nemutsinga inowedzera mumwe musiyano. Mushonga wakagadzirwa nokusanganisa unogona kusiyana pahuwandu hwekupedzisira hwemushonga uri mumvura, mvura inoshandiswa kuusanganisa, mudziyo, zvinhu zvisiri mushonga unoshanda, uye nguva yausingafaniri kuzoshandiswa mushure mayo. Mishonga yakagadzirwa nokusanganisa, seboka, haitenderwi neFDA nokuda kwekuchengeteka kana kushanda kwayo, sezvinotsanangurwa neFDA mumibvunzo nemhinduro dzayo pamusoro pekusanganiswa kwemishonga. Zvisinei nokuti sirinji ine mushonga wezita rechiratidzo, usiri wezita rechiratidzo, kana wakagadzirwa nokusanganisa, morekuru racho rine njodzi dzimwe chete dzinotsanangurwa mumashoko emushonga akatenderwa, dzinosanganisira kudyidzana neserotonin, njodzi yekuparara kwemasero matsvuku eropa, uye kukanganiswa nechiedza, izvo zvinokurukurwa muzvikamu zvinotevera.

Nei giredhi roga risingaiti kuti mvura ikodzere kubayiwa

Apa ndipo panonyanya kuvhiringidzika vanhu. Mushonga wakanyungudutswa unotengeswa muzvitoro unogona kushambadzwa uchinzi une methylene blue yegiredhi reUSP, uchiratidza kuti muyedzo wehuwandu hwemethylene blue uri pamusoro pe98%, asi usingakodzeri kubayiwa. Giredhi rekemikari rinotsanangura hupfu: kuzivikanwa kwahwo, muyedzo wehuwandu hwechinhu chikuru, tsvina yemakemikari eorganic, zvinonyungudutsa zvinenge zvasara, simbi, uye mimwe miedzo yakafanana. Mushonga wejekiseni unofanira kupasa miedzo iyoyo pamwe nezvimwe zvinodiwa pakupiwa kwemushonga usingapfuuri nomudumbu, izvo giredhi roga risingambofukidzi.

Mutsara mumwe nomumwe unodzivirira dambudziko rakasiyana. Mvura isina kuchena pautachiona inogona kutanga utachiona muropa. Endotoxins dzinobva kumabhakitiriya akafa dzinoramba dziripo mushure mekusefa kuri nyore uye dzinogona kukonzera fivha yakanyanya kana kuvhunduka kwemuviri. Tudzvimedu nezvinhu zvinenge zvabuda mumushonga zvikaita tsvina yakasimba zvinogona kuvharira mutsinga diki. Mudziyo usina kukodzera unogona kuburitsa zvinhu zvinopinda mumushonga kana kutadza kuramba wakavharwa zvakasimba. Hapana chimwe chezvikanganiso izvi chinoshandura ruvara rwebhuruu kana nhamba yemuyedzo wehuwandu hwechinhu chikuru. Ndicho chikonzero kutarisa nemaziso uye chikamu chekuchena zvisingagoni kuratidza kuti chigadzirwa chakakodzera kuiswa mutsinga. Kuti uwane mufananidzo wakazara wezvinofukidzwa nemiedzo yose yekuchena, ona maongororerwo egiredhi reUSP.

Mutemo wokushandisa mupfupi: usambobaya chigadzirwa chemethylene blue chekutorwa nemuromo, chemudziyo wehove, kana cherabhoritari, pasinei nekuchena kwachinonzi chinako. Kubaya kunoda chigadzirwa chakagadzirwa, chakaongororwa, chakanyorwa mashoko, uye chakanyorerwa nemurapi semushonga wejekiseni.

Zvinokosha nezvekuchengeteka zvinobva pamashoko emushonga akatenderwa

Mashoko emushonga akatenderwa anounganidza njodzi dzinokosha kuziva usati wamboushandisa nemutsinga. Yokutanga iserotonin syndrome, iyo ine yambiro iri mubhokisi: methylene blue inodzivisa monoamine oxidase, saka kuisanganisa nemishonga yekurapa kuora mwoyo inowedzera kushanda kweserotonin, mamwe maopioid, nemishonga yakabatana nayo kunogona kukonzera dambudziko rakakomba kana rinouraya. Varwere vanoudzwa kudzivisa mishonga yakadaro kwemaawa 72 mushure medhosi rokupedzisira, kunze kwekunge murapi aona kuti kupiwa pamwe chete hakudzivisiki uye achinyatsoongorora murwere.

Yechipiri kushomeka kweglucose-6-phosphate dehydrogenase, kunova mamiriro anoita kuti mushonga uyu usafanira kushandiswa: varwere vane kushomeka uku vari panjodzi yekuparara kwakanyanya kwemasero matsvuku eropa, uye mushonga unogona kusashanda nokuti kushanda kwawo kunotsamira panzira yeenzayimu isipo muvarwere ava. Kusawirirana kwakanyanya kwemumuviri nemethylene blue kana imwe dhayi yethiazine ndiyo imwe mamiriro anoita kuti mushonga uyu usafanira kushandiswa.

Zvimwe zvokuchenjerera zvinosanganisira kuderera kwekushanda kweitsvo kunoita kuti huwandu hwemushonga mumuviri hukwire, kukuvadzwa kwemwana asati azvarwa kana mushonga wapinda mumvura yakamupoteredza muchibereko, pamwe nerondedzero yezvinofanira kuongororwa muvacheche vakazvarwa nguva yakwana vakambosangana nawo, uye kukuvadzwa kunokonzerwa nechiedza kwakambotaurwa, kunoda kudzivirirwa pachiedza. Pane zvinhu zviviri zvakasiyana pakuongorora zvinokosha muzvipatara: ruvara rwebhuruu runoita kuti zviverengero zvemudziyo unoyera oxygen muropa kuburikidza neganda zvive zvakaderera zvisiri izvo, saka kuongororwa kweropa rinobva mutsinga dzinotakura ropa kubva pamwoyo ndiko kunodiwa, uye runogona kukanganisa midziyo inoyera kudzika kwekutindivadzwa pamwe nemiedzo yeweti inoshandisa dhayi yebhuruu. Mumashoko ekuchengeteka akaunganidzwa kubva kuvarwere vakuru 31, matambudziko akakomba akaitika munenge 3%, uye matambudziko akaonekwa muinenge 2% kana kupfuura aisanganisira kutemwa nemusoro, kuda kurutsa, manyoka, kuderera kwepotassium nemagnesium, kugwinha kwetsandanyama, uye zviitiko zvakafanana nepfari.

Hapana pane izvi chiri chikonzero chokutsigira kana kuramba chero hurongwa hwakati hwokushandisa kunze kwezvakabvumidzwa. Ichi chiyeuchidzo chokuti njodzi dzinoramba dziri pamorekuru, zvisinei nezvinotaurwa pabhegi rekuisa mushonga nemutsinga.

Zvaunofanira kusimbisa usati washandisa chero mushonga neIV

Kana uri murwere kana muchengeti wemurwere, simbisa zvinhu zvina nechikwata chiri kurapa: kuti chigadzirwa ijekiseni risina utachiona rakatenderwa kana rakagadzirwa nokusanganisa kuti rishandiswe nemutsinga, kuti chikonzero chokushandisa nedhosi zvinotevera hurongwa hwakanyatsofungwa, kuti mishonga inokanganisa serotonin pamwe nemamiriro eG6PD zvakaongororwa, uye kuti kuongorora kunosanganisira kuyerwa kweoxygen kuburikidza nekuongorora ropa pane kungovimba nemudziyo unoyera oxygen kuburikidza neganda chete. Kana chero munhu akakurudzira kubaya mushonga wemuzvitoro uri mubhodhoro rine chinodonhedza kana mushonga wakanyungudutswa werabhoritari, tora izvozvo sechikonzero chokumira zvachose uye kumbira rubatsiro rwechikamu chemishonga chechipatara panzvimbo pazvo.

Magadzirirwo emushonga ndiyo pfungwa huru, uye mashoko emushonga ndiwo chibvumirano. Ita kuti mvura yacho ienderane nenzira yokupiwa kwayo, uye ruvara rwebhuruu runorega kuva chinokonzera kuvhiringidzika.