Methylene blue nechirwere chepfari: mienzaniso yekubatwa nepfari neuchapupu muvanhu

Munhu anochengeta murwere achitsvaga nezvemethylene blue nechirwere chepfari anowana mashoko maviri anoita seanopokana. Mamwe anoti methylene blue yakaderedza kubatwa nepfari mumakonzo. Mamwe anoti chiitiko chakaita sepfari chakashumwa mumurwere akapiwa methylene blue. Zvose zvinogona kuva zvechokwadi panguva imwe chete, nokuti zvinopindura mibvunzo yakasiyana mumamiriro akasiyana.

Kuvhiringidzika kunobva pakutora mashoko ekuti "methylene blue nekubatwa nepfari" sechirevo chimwe chete. Pane zvirevo zviviri. Chekutanga chinobvunza kana methylene blue, painopiwa mumamiriro anodzorwa, ichichinja zviyero zvekubatwa nepfari mumuenzaniso wemhuka. Chechipiri chinobvunza kana kubatwa nepfari kwakaitika sezviitiko zvisingadiwi muvanhu vari kupiwa mushonga uyu nokuda kwezvimwe zvikonzero. Chinyorwa ichi chinochengeta mibvunzo miviri iyoyo yakaparadzana, chinoongorora zvakaitwa chaizvo neongororo mbiri dzepfari dzinonyanya kutaurwa, uye chinotaura pachena zvadzisingaratidzi. Kuti uwane mamiriro ezviri kutaurwa, ona ongororo yakafara yetsvakiridzo yemethylene blue; uye kuti unzwisise nzira yekuongorora, ona gwara rekuverenga ongororo dzemethylene blue.

Ongororo mbiri, dzichitsanangurwa zvakajeka

Hapana kuedzwa muvanhu kwakaongorora methylene blue semushonga wechirwere chepfari. Uchapupu hwekuyedza hunobva muongororo dzemhuka. Mapepa maviri anonyanya kutaurwa ose akashandisa makonzo, ose akashandisa chipimo che1 mg pa kg chakapiwa mudumbu, uye ose akashuma chiratidzo chekuderedza pfari. Asi magadzirirwo awo anoedza pfungwa dzakasiyana dzekurapa, saka migumisiro yawo inoreva zvinhu zvakasiyana.

Ongororo 1: kurapa mushure mekunge status epilepticus yatanga

Muongororo yemakonzo ya2018 yestatus epilepticus inoramba ichienderera pachayo, Cui nevamwe vakaita kuti pfari igare kwenguva refu nokukurudzira chikamu cheamygdala chinonzi basolateral nemagetsi kwemaminitsi 25, vakabva vasimbisa neEEG kuti pfari yakanga ichiri kuenderera. Izvi zvakakosha nokuti muenzaniso wemagetsi unoparadzanisa pfari pachayo nehupfu hwemakemikari emishonga inokonzera pfari. Methylene blue yakapiwa maminitsi 5 mushure mekunge mamiriro epfari aenderera atanga, izvo zvinomiririra kurapa pane kudzivirira. Kurekodha EEG kwakazoenderera kwemaawa 12, uye tishu dzeuropi dzakaongororwa paawa 24. Chinyorwa chizere chekuedzwa kwestatus epilepticus chinopa tsananguro dzekukurudzira nemagetsi nekurekodha.

Mukati memaawa 12, makonzo akapiwa mushonga akava neavhareji yezviitiko zvepfari zvakasiyana zvinoda kusvika 29 paEEG, zvichienzaniswa nezvinoda kusvika 39 mumhuka dzisina kupiwa mushonga, kuderera kunoda kusvika 26 muzana. Nguva yose yekubatwa nepfari yakaderera kubva pamaminitsi anoda kusvika 62 kusvika pamaminitsi anoda kusvika 44, kuderera kunoda kusvika 29 muzana. Mhuka dzakapiwa mushonga dzakaratidzawo kukuvadzwa kunokonzerwa neoxidation kushoma (malondialdehyde yakaderera, glutathione yakachengetedzwa zviri nani), kurasikirwa nemasero etsinga kushoma muzvikamu zvehippocampus CA1 neCA3, uye zviyero zvinoratidza apoptosis zvakachinja nenzira yairatidza kudzivirirwa.

Miganhu yacho iri pachena. Mhuka dzinoda kusvika 12 muboka rimwe nerimwe ndidzo dzakaongororwa nezvepfari, chipimo chimwe chete ndicho chakaedzwa saka hapana girafu rinoratidza kuti migumisiro inochinja sei nekuchinja kwechipimo, kutevera mhuka kwakatora maawa pane mwedzi, uye pakanga pasina kuenzanisa nemushonga wepfari unoshandiswa kazhinji. Mugumisiro unotsigira chiratidzo chekuderedza pfari nekudzivirira masero etsinga munguva pfupi mumuenzaniso mumwe wemakonzo westatus epilepticus. Hauratidzi kuti methylene blue inodzivirira chirwere chepfari chinogara kwenguva refu, uye hautauri chinhu nezvechipimo kana kuchengeteka muvanhu vane chirwere chepfari.

Ongororo 2: kupa mushonga pamberi pechiitiko chimwe nechimwe chepfari chinokonzerwa

Muongororo yemakonzo ya2026 yekindling inokonzerwa nepentylenetetrazole, Jing nevamwe vakashandisa nguva yakapesana. Makonzo akapiwa chinhu chinokonzera pfari kakawanda (35 mg pa kg yepentylenetetrazole, zuva rimwe richisvetukwa, ka15), uye methylene blue yakapiwa maminitsi 30 pamberi pekupiwa kwega kwega. Uku kugadzirwa kweongororo kunotevedzera kudzivirira: kunoedza kana kupa mushonga wekudzivirira kakawanda kuchikanganisa kukura kwemamiriro ekukurumidza kubatwa nepfari anokonzerwa nekindling, kwete kana mushonga uchimisa pfari iri kuenderera kana kurapa chirwere chepfari chakatovapo.

Pfari yasvika pachikamu chakazara chekindling yakatanga mu30 muzana yemakonzo akapiwa mushonga pachine nguva, zvichienzaniswa neanoda kusvika 85 muzana yeasina kupiwa mushonga. Uyu musiyano mukuru pakati pemapoka, uye kukosha kweP kwakashumwa kwaiva 0.0078. Kupa mushonga pachine nguva kwakanonotsawo kutanga kwepfari yetonic-clonic inobata muviri wose uye kwakapfupisa nguva yayo payakaitika. EEG, kupona kwemasero ehippocampus, zviyero zvekukuvadzwa kunokonzerwa neoxidation, uye zviyero zvendangariro mukuyedzwa kwekutsvaga nzira mumvura zvose zvakaratidza migumisiro iri nani muboka rakapiwa mushonga.

Magadzirirwo aya ane miganhu yawo. Mushonga wakanga uripo pamberi pekuedza kwega kwega kukonzera pfari, saka kuedzwa uku hakugoni kuparadzanisa kuderedzwa kwepfari nekukanganiswa kwekukura kwekindling. Zvakare, chipimo chimwe chete ndicho chakashandiswa, mapoka madiki akaongororwa tishu nemaitiro akanga aine mhuka shoma, kindling inomiririra chimwe chikamu asi kwete zvose zvinoitika mumuviri muchirwere chepfari chevanhu, uye mapepa maviri aya ane vamwe vanyori vakafanana (Cui naLuo vari pane ose). Saka uku hakusi kudzokororwa kwakazvimirira zvizere. Mugumisiro unotsigira kuderera kwekukura kwekindling mumakonzo anopiwa chipimo chekudzivirira kakawanda. Hautsigiri kuti methylene blue mushonga wemunhu anenge atova nechirwere chepfari.

Tafura yemuenzaniso nemamiriro: chishandiso chikuru chechinyorwa chino

Tafura iri pasi ndiyo nzvimbo huru yekutarisa mashoko ari papeji ino. Mutsara mumwe nomumwe unotanga watsanangura mamiriro, wozotaura basa rakaitwa nemethylene blue uye zvinogona kana zvisingagoni kuratidzwa nezvakaonekwa. Kupiwa kwemushonga mukuedzwa nemishumo yezviitiko zvisingadiwi zvakaiswa mumitsara yakasiyana nemaune.

Mamiriro	Basa remethylene blue	Nguva	Chiyero chemugumisiro	Zvainoratidza
Status epilepticus yakakonzerwa nemagetsi mumakonzo, 2018	Kurapa kwekuedza, 1 mg/kg mudumbu	5 min mushure mekunge mamiriro epfari atanga; EEG kwe12 h	Kuwanda kwezviitiko zvepfari paEEG nenguva yose yepfari; tishu dzehippocampus pa24 h	Chiratidzo chekuderedza pfari munguva pfupi mumuenzaniso mumwe; kwete kudzivirira chirwere chepfari chinogara kwenguva refu, kwete kushanda muvanhu
Kindling inokonzerwa nepentylenetetrazole inopiwa kakawanda mumakonzo, 2026	Kupa mushonga pachine nguva mukuedzwa, 1 mg/kg pamberi pekuedza kwega kwega kukonzera pfari	30 min pamberi pechimwe nechimwe chezviitiko 15 zvekupiwa chinhu chinokonzera pfari	Chikamu chakasvika pakindling yakazara, nguva pfari isati yatanga uye nguva yainogara, EEG, maitiro ane chokuita nendangariro, zviyero zvemutishu	Kukura kwekindling kushoma pakupiwa chipimo chekudzivirira; kwete kurapa chirwere chepfari chakatovapo
Methemoglobinemia yakawanikwa, kushandiswa mutsinga kwakanyorerwa nachiremba	Kurapa kwakatenderwa kwechimwe chirwere	Panguva yekurapwa, kazhinji 1 mg/kg	Kuongorora kuchengeteka	Chiitiko chimwe chakakomba chakaita sepfari muboka revarwere 24 vakaongororwa kuchengeteka, maererano nemashoko epamutemo aripo emethylene blue inopiwa mutsinga; mushumo une chokuita nenguva yakaitika chiitiko, kwete mwero wekuwanda kwacho uye kwete uchapupu hwechikonzero
Serotonin syndrome pamwe nemishonga inowedzera kushanda kweserotonin	Chinhu chinogona kukonzera izvi kuburikidza nekudzivisa kushanda kwemonoamine oxidase	Mushure mekushandiswa pamwe nemishonga yekuora mwoyo kana mimwe ine hukama nayo	Mamiriro anoonekwa pakurapa, anogona kusanganisira pfari	Kudyidzana kunozivikanwa kune yambiro iri mubhokisi mumashoko ekunyorerwa mushonga; ona serotonin syndrome uye kudyidzana nemishonga yekuora mwoyo nemimwe mishonga inowedzera kushanda kweserotonin; ongororo yakarongeka yakawana zviitiko 50 zvakabudiswa, zvose zvine kushandiswa panguva imwe chete kwemishonga yekuora mwoyo inowedzera kushanda kweserotonin
Encephalopathy inokonzerwa neifosfamide	Kurapa kunopiwa kweencephalopathy kusiri pakati pemashandisirwo akatenderwa pamushonga	Panguva kana mushure mekukuvadzwa kwetsinga neifosfamide	Kuvhiringidzika, pfari, koma, kupora	Pfari pano inotarisirwa kubva kuencephalopathy pachayo, saka haifaniri kungonzi yakakonzerwa nemethylene blue; uchapupu hwekubatsira hunonyanya kubva pamishumo yevarwere mumwe nomumwe, uye varwere 28 pava38 vakapiwa mushonga vakashumwa kuti vakaita zviri nani mune imwe ongororo yekurapwa kweifosfamide encephalopathy

Nei nguva nezviyero zvemigumisiro zvichisarudza zvinorehwa neongororo

Zvinhu zviviri ndizvo zvinopa zvinorehwa zvikuru mutsvakiridzo yepfari: nguva yakapiwa mushonga, uye zvakayerwa.

Chekutanga inguva. Mushonga unopiwa pamberi pekuedza kwega kwega kukonzera pfari, sezvakaitwa muongororo yekindling, unogona kuita seunoshanda nokungoderedza simba rechiitiko chimwe nechimwe chinokonzerwa kana kunonotsa kukura kwekindling. Mushonga unopiwa mushure mekunge pfari yatanga, sezvakaitwa muongororo yestatus epilepticus, unotarisana nemuedzo wakaoma uye une chokuita zvikuru nemamiriro ekurapa. Hapana magadzirirwo eongororo aya anoenderana nemamiriro emunhu ane chirwere chepfari chakatovapo anomwa mushonga wepfari zuva nezuva. Ndokusaka nguva dzekupiwa mushonga mumhuka dzisingagoni kushandurwa kuva zano rekurapa.

Chechipiri zviyero zvemigumisiro. Kuwanda kwezviitiko zvepfari paEEG mukati memaawa 12, chikamu chinokura kindling, uye kusabatwa nepfari muvanhu migumisiro yakasiyana. Zviyero zvemutishu zvakaita seglutathione kana kuwanda kwemasero zvinotsanangura nzira dzinogona kunge dziri kushanda, uye maitiro ekutsvaga nzira mumvura anoratidza zvingave zvine chokuita nekushanda kwendangariro mumakonzo. Asi hapana chimwe chezviiyero izvi chiri chiyero chemugumisiro wekurapwa kwechirwere chepfari muvanhu. Kuwanikwa kwemugumisiro wakanaka mutishu pamwe chete nekuderera kwepfari kusiri kukuru kunosimbisa tsananguro yezviri kuitika mumuviri; hakushanduri zvakawanikwa nezvepfari kuti zvive uchapupu hwekurapa muvanhu.

Zvinorehwa neizvi pazvisarudzo zvekurapa

Zviratidzo zvekuderedza pfari mumhuka chikonzero chekuita imwe tsvakiridzo, kwete chikonzero chekuchinja kurapwa. Hapana munhu anofanira kutanga, kumisa, kana kuchinja mushonga wepfari waakanyorerwa achivakira paongororo dzemakonzo, uye methylene blue haisi mushonga wakatenderwa wechirwere chepfari mune chero chimiro chayo. Munhu ari kufunga kuishandisa anofanira kutanga akurukura runyorwa rwose rwemishonga yake nachiremba wake, nokuti kudyidzana kune chokuita neserotonin kwataurwa pamusoro ndiyo njodzi ine chokuita nepfari ine uchapupu hwakajeka zvikuru muzvinyorwa zvevanhu, uye inogona kudzivirirwa.

Pfupiso yakatendeseka inokwana mundima imwe chete. Ongororo mbiri diki pamakonzo, pachipimo chakafanana che1 mg pa kg, dzinoshuma pfari shoma kana isina kunyanya kukomba: imwe mushonga paunopiwa mushure mestatus epilepticus yakakonzerwa nemagetsi, imwe paunopiwa pamberi pekuedza kakawanda kukonzera pfari nemakemikari. Zvinyorwa zvekuchengeteka muvanhu zvinewo zviitiko zvakaita sepfari, asi zvakawanda zviri mumamiriro ekudyidzana kwemishonga nevarwere vanorwara zvakanyanya, pane pakurapwa kwechirwere chepfari. Hapana boka reuchapupu rinoratidza kuti rimwe harina kururama, uye hapana rinoratidza kuti methylene blue mushonga wechirwere chepfari. Mibvunzo yakajairika pamusoro pemigumisiro isingadiwi nezvinofanira kungwarirwa yakaunganidzwa mumibvunzo inowanzo bvunzwa nezvekuchengeteka kwemethylene blue.