Chinyorwa
Methylene blue nekugona kufunga mushure mekuvhiyiwa: miedzo muvanhu nemaitiro mumhuka
Vanhu vakwegura dzimwe nguva vanobuda mukuvhiyiwa kukuru vasingachafungi zvakajeka sezvavaiita kare. Mhuri dzinozviona. Vanachiremba vanozviyera. Mubvunzo ndewekuti methylene blue, kana yapihwa panguva yakapoteredza kutindivadza, inodzivirira uropi here. Mhando mbiri dzeuchapupu dzinotaura nezvemubvunzo iwoyo, uye dzinopindura zvikamu zvawo zvakasiyana. Muedzo wevanhu wakaitwa panguva yakapoteredza kuvhiyiwa unoshuma zvakaitika kuvarwere. Muenzaniso wembeva dzakwegura unopa tsananguro yekuti kudzivirirwa kungashanda sei mukati memasero etsinga. Hapana imwe inogona kutsiva imwe.
Danho rekutanga nderekusiyanisa migumisiro miviri inowanzovhenganiswa.
Kuvhiringidzika kwepfungwa nekuderera kwekugona kufunga kwakayerwa zvinhu zvakasiyana
Kuvhiringidzika kwepfungwa mushure mekuvhiyiwa, kunonzi delirium, kukanganisika kwekukwanisa kuterera nekuziva zviri kuitika kunotanga kamwe uye kunochinja-chinja. Murwere anenge achifunga zvakajeka pane imwe nguva, ozovhiringidzika paawa inotevera. Zvipatara zvinozviona zvichishandisa nzira dzekuongorora padivi pemubhedha dzakadai se3D-CAM, kazhinji kanopfuura kamwe pazuva, nokuti kuongorora kamwe chete kunogona kutadza kuzviona.
Kukanganisika kwekugona kufunga mushure mekuvhiyiwa kwakasiyana. Kuderera kunoyerwa nemiedzo yakarongeka kuchienzaniswa nezviyero zvemurwere wacho asati avhiyiwa, zvichiongorora ndangariro, kuterera, nekugona kuronga nekudzora zviito. Miedzo inoitwa kwapera mazuva kana mavhiki. Murwere anogona kuva nechimwe pasina chimwe.
Musiyano uyu unokosha nokuti migumisiro miviri iyi inoyerwa nezvishandiso zvakasiyana, panguva dzakasiyana, nevaongorori vakasiyana. Kana muedzo ukashuma zvose zviri zviviri, zviverengei semashoko maviri akaparadzana. Ruzivo rwekutanga pamusoro penzira iyi yekuverenga zvinyorwa zvemiedzo runowanikwa muchinyorwa chekuti ungaverenga sei tsvakurudzo yemethylene blue.
Zvakaitwa nemuedzo wevanhu
Uchapupu hukuru hwevanhu hunobva mumuedzo wakaitwa paHuashan Hospital, wakagovera vanhu mumapoka zvisina kurongwa asi usingavanzi mapoka acho, wakabudiswa muJournal of Clinical Anesthesia muna 2021. Wakanyoresa varwere 248 vane makore 60 kusvika 80 vaivhiyiwa zvakakura zvainge zvakarongwa kare, kusanganisira kuvhiyiwa kwechipfuva, mapfupa nemajoini, nhengo dzekubudisa weti, nekuvhiyiwa kukuru kwedumbu, asi usingasanganisiri kuvhiyiwa kwemwoyo kana kweuropi netsinga. Hafu yakapihwa methylene blue 2 mg/kg mutsinga, yakasanganiswa nemvura kusvika pa50 mL ikapinzwa mukati memaminitsi 60 pakarepo mushure mekutanga kutindivadza. Hafu yakapihwa 50 mL yemvura ine munyu nenguva imwe cheteyo.
Kuvhiringidzika kwepfungwa ndiko kwaiva mugumisiro mukuru waiongororwa. Vaongorori vakashandisa 3D-CAM kaviri pazuva, paine musiyano wemaawa asingasviki pasi pematanhatu, kubva pazuva 1 kusvika pazuva 5 mushure mekuvhiyiwa kana kusvika pakubudiswa muchipatara, uye vakatsanangura kuongororwa kwakawana kuvhiringidzika vachishandisa Memorial Delirium Assessment Scale. Kuvhiringidzika mukamuri rekupengenuka kwakanyorwa kwakasiyana sekuvhiringidzika pakupengenuka kubva mukutindivadza. Kugona kufunga ndiko kwaiva mugumisiro wechipiri: miedzo yakati wandei yakarongeka pazuva rakatangira kuvhiyiwa uye zvakare pedyo nezuva 7 mushure mekuvhiyiwa, kuderera kuchitsanangurwa sekudzikira kunopfuura chiyero chimwe chekutsauka kubva paavhareji mumiedzo inosvika miviri kana kupfuura. Uku kuderera kwemunguva yekutanga, zvino kunowanzonzi kunonoka kudzoka kwekugona kufunga. Pamwedzi mitatu vaongorori vakashandisa kuongorora kweparunhare, TICS-m, asi pakanga pasina chiyero cheTICS-m chakatorwa vasati vavhiyiwa chekufananidza nacho.
Migumisiro yekutanga yakaratidza zvakanaka kumethylene blue. Kuvhiringidzika kwepfungwa kwakaitika mu9 pavarwere 124 vakapihwa methylene blue (7.3 muzana), zvichienzaniswa ne30 pavanhu 124 veboka rekuenzanisa (24.2 muzana), paine reshiyo yemikana yakagadziridzwa ye0.24 ine muganhu wechivimbo we95 muzana kubva pa0.11 kusvika pa0.53. Kuderera kwekutanga kwekugona kufunga kwakaitika mu20 pavanhu 124 (16.1 muzana), zvichienzaniswa ne49 pavanhu 122 (40.2 muzana). Kuvhiringidzika pakupengenuka mukamuri rekupengenuka kwainge kwakafanana pakati pemapoka, kunenge 18 zvichienzaniswa ne23 muzana. Pamwedzi mitatu, zviyero zveparunhare zvainge zvakada kufanana (zviyero zvepakati 34.5 ne34.0), pasina musiyano wakakosha maererano nenhamba.
Nhamba idzi dzinofanira kuverengwa pamwe chete nezvinodziganhurira. Muedzo wacho wakanga wakajeka kuti mapoka aisavanzwa. Vanachiremba vekutindivadza vaiziva kuti murwere akapihwa chii, uye methylene blue inoshandura weti kuva yebhuruu-girinhi kwemazuva matatu kusvika mashanu, izvo zvinogona kuita kuti varwere nevaongorori vazive boka racho. Wakaitirwa panzvimbo imwe chete. Kuongororwa kwekugona kufunga uchishandisa zviyero zvakakodzera zvepamberi kwakateverwa kweinenge vhiki; kuongorora kweparunhare kwemwedzi mitatu hakugoni kuratidza shanduko kubva pachiyero chepamberi nokuti hapana chiyero cheparunhare chepamberi chiripo. Zviitiko zvakanyorwa mumatafura zvakadai sekusvotwa, kurutsa, nedzungu zvainge zvakafanana pakati pemapoka, uye hapana murwere akashumwa aine serotonin syndrome kana kushomeka kweropa kunokonzerwa nekuparara kwemasero matsvuku kwaikosha pakurapa. Kupisa muviri kwakanyanya kuitika muboka remethylene blue (16 pavanhu 124 zvichienzaniswa ne3 pavanhu 124). Kusashanda zvakanaka kwechiropa kwakaonekwa mumapoka ose uye kwakabatana nezviitiko zvekuvhiyiwa kubvisa chikamu chechiropa.
Zvinowedzerwa nemuenzaniso wembeva dzakwegura
Imwe tsvakurudzo yembeva dzine mwedzi 18 inobvunza nezvemaitiro anoita kuti chinhu chiitike, kwete nezvemugumisiro pakurapa vanhu. Mbeva hono makumi mana neshanu dzerudzi rweC57BL/6J dzakakamurwa mumapoka matatu ane gumi neshanu: okisijeni chete, sevoflurane ye3 muzana kwemaawa maviri, kana sevoflurane imwe cheteyo asi dzatanga dzapihwa jekiseni rimwe remethylene blue re5 mg/kg mukati memhango yedumbu maawa maviri zvisati zvaitika. Kudzidza nendangariro zvakaedzwa nemuedzo wenzira dzakavhiringikana mumvura weMorris, uye tishu yehippocampus yakaongororwa kuona chimiro chemitochondria nemapuroteni anodzora kupatsanuka kwemitochondria.
Sevoflurane yakawedzera enzyme inoputsa mapuroteni inonzi SENP3, ikabvisa puroteni diki inoshandura kushanda (SUMO2/3) paDrp1, inodzora kupatsanuka, ikaita kuti mitochondria iputsike kuita zvidimbu, uye ikaderedza kugona kwembeva mumuedzo wenzira dzakavhiringikana. Kupiwa methylene blue pachine nguva kwakadzorera shure chikamu chimwe nechimwe cheketani iyoyo: kubviswa kweSUMO paDrp1 kwakaderera, kupatsanuka kuita zvidimbu kwakaderera, uye zviyero zvendangariro zvakava nani. Vanyori vanotsanangura mamiriro ekunamirwa kweSUMO paDrp1 sechinja chinobatanidza kupiwa mushonga wekutindivadza nekukuvadzwa kwemitochondria nekugona kufunga.
Iyoyo inzira yakajeka inogona kuedzwa, uye inoita kuti chiratidzo chakaonekwa muvanhu chisanyanya kushamisa kubva pamaonero ezvinoitika mumuviri. Asi cherechedzai zvose zvisingamiririrwi nemuenzaniso uyu. Idzi dzaiva mbeva dzakwegura asi dzisina humwe hurwere, dzakapihwa mushonga wekutindivadza chete, dzisina kuvhiyiwa uye dzisina zvimwe zvirwere pamwe chete. Mushonga wakabaiwa mudumbu maawa maviri usati wapiwa wekutindivadza, nzira yekupa mushonga pachine nguva yakasiyana nekupinzwa kwawo mutsinga mushure mekutanga kutindivadza mumuedzo wevarwere. Uchapupu hwematishu muhippocampus yembeva hahusimbisi kuti nzira imwe cheteyo ndiyo inotsanangura mugumisiro muvanhu.
Tsvakurudzo mbiri dziri parutivi neparutivi
| Mubvunzo | Muedzo wevanhu usina kuvanza mapoka | Muenzaniso wembeva dzakwegura |
|---|---|---|
| Vakabatanidzwa | Varwere 248 vaivhiyiwa, vane makore 60 kusvika 80, chipatara chimwe | Mbeva hono 45 dzakwegura, mapoka matatu e15 |
| Zvakaitwa | Kuvhiyiwa kukuru vakatindivadzwa muviri wose | Sevoflurane chete, pasina kuvhiyiwa |
| Nzira yekupa methylene blue | 2 mg/kg IV mukati memaminitsi 60 mushure mekutanga kutindivadza | 5 mg/kg mukati memhango yedumbu, maawa 2 kutindivadza kusati kwatanga |
| Mugumisiro wekuvhiringidzika kwepfungwa | 3D-CAM kaviri pazuva, mazuva 1 kusvika 5; wakaderera nemethylene blue | Hauna kuyerwa; mbeva hadzigoni kushuma pfungwa iyi |
| Mugumisiro wekugona kufunga | Kuderera mumiedzo yakati wandei pazuva 7; kwakaderera nemethylene blue; hapana musiyano pamwedzi 3 pakuongororwa kweparunhare | Muedzo wenzira dzakavhiringikana mumvura weMorris; kupa mushonga pachine nguva kwakachengetedza ndangariro |
| Mugumisiro wemaitiro ari mukati memuviri | Hauna kuedzwa mumatishu | SENP3 muhippocampus, kunamirwa kweSUMO paDrp1, chimiro chemitochondria |
| Zvainosimbisa | Chiratidzo chekutanga muvarwere chine zvipingamupinyi zvekuvanza mapoka nekuitirwa panzvimbo imwe chete | Nzira ine chekuita nemitochondria inoenderana nekudzivirirwa |
Chirongwa chemuedzo wechipiri, chakakura, chinonyatsojekesa kuti tsvakurudzo iyi iri kuenda kupi. Muedzo wekuvhiyiwa kwerwatata wakanyoreswa seNCT04529265 wakaronga varwere 314 vane makore 55 kusvika 80, kuvanza mapoka kune vari kutora chikamu pamwe nevaongorori vemigumisiro, uye kupa mushonga kaviri panguva yekuvhiyiwa uchisvika pa3 mg/kg pamwe chete, kuvhiringidzika kwepfungwa panguva yekugara muchipatara kuri mugumisiro mukuru, uye kugona kufunga pazuva 7, zviratidzo zvekuzvimba mumuviri, nekuteverwa kwenguva refu kune chekuita negomarara zviri migumisiro yechipiri. Chinyorwa chiri murejista chinoratidza kupedzwa muna Zvita 2024, uye migumisiro yacho yakazobudiswa muJournal of Clinical Anesthesia muna 2026. Kudzokorora ikoko kunovanza mapoka ndiko kunofanira kutariswa tisati takwidziridza zvakawanikwa mumuedzo usina kuvanza mapoka kuti zvive chirevo chakanyatsosimbiswa.
Kuchengeteka mukamuri rekuvhiyira hakungofambiswi kuenda kumba
Mugumisiro wose wekugona kufunga uri pamusoro unobva mukushandiswa kwemushonga mutsinga uchitarisirwa panguva yekuvhiyiwa. Nzvimbo iyoyo ine vanachiremba vekutindivadza, midziyo yekutarisa mamiriro emurwere, mishonga yekudzorera mashandiro akakosha emuviri, nekuongororwa kwemishonga inogona kudyidzana nawo. Hapana pazviri chinongoshanda pakunwa mushonga kumba.
Pane yambiro mbiri dzakananga. Methylene blue inodzivisa monoamine oxidase, saka kuisanganisa nemishonga yekurapa kuora mwoyo inobata serotonin kunogona kukonzera serotonin syndrome, njodzi ine yambiro iri mubhokisi muruzivo rwekunyorerwa mushonga unobaiwa; mishonga inodyidzana nayo yakatsanangurwa mukudyidzana kwemethylene blue nemimwe mishonga. Varwere vane kushomeka kweG6PD vari panjodzi yekuparara kwemasero matsvuku eropa. Kuchinja kweweti neganda kuva zvebhuruu, uko kusina kukuvadza pachako, ndiko zvakare kunoita kuti miedzo yeramangwana itofanira kushanda zvakanyanya pakuvanza mapoka kupfuura zvakaitwa nemuedzo usina kuvanza mapoka. Misimboti yekuchengeteka pakubata nekuwana mushonga yakapfupikiswa muzvinokosha zvekuchengeteka kwemethylene blue.
Pfupiso
Muedzo mumwe usina kuvanza mapoka muvarwere vakwegura vaivhiyiwa unoshuma kuvhiringidzika kwepfungwa kwakaderera zvikuru uye kuderera kushoma kwekugona kufunga kwakayerwa munguva yekutanga mushure mekupiwa mushonga kamwe chete mutsinga panguva yekuvhiyiwa, pasina musiyano wekugona kufunga pamwedzi mitatu, uye uine kusakwana kwekuvanza mapoka kunotaurwa nevanyori vawo. Muenzaniso wembeva dzakwegura dzakapihwa mushonga wekutindivadza unopa tsananguro yakabatana ine chekuita nemitochondria yekuti kudzivirirwa kwakadaro kungaitika sei. Bataizve izvozvo semashoko maviri akaparadzana: chiratidzo chemuvarwere chakamirira kudzokororwa mumuedzo unovanza mapoka, uye nzira iri mukati memuviri yakamirira kusimbiswa muvanhu. Vaverengi vari kutevera migumisiro ine chekuita nendangariro pakukwegura zvakafara vangadawo kuverenga methylene blue nendangariro pakukwegura.