Chinyorwa
Methylene blue pakukuvadzwa kwetsinga nemarwadzo: ndeapi mamiriro akaongororwa?
Methylene blue inoderedza kukuvadzwa kwetsinga nemarwadzo here? Mubvunzo uyu unonzwika seumwe chete, asi zvinyorwa zvetsvakurudzo zvinopindura mibvunzo yakasiyana. Dhayi inobaiwa mudhisiki remuzongoza, dhayi inobaiwa pasi peganda rakakomberedza panobuda tsvina, dhayi inopinzwa mutsinga yeropa, nedhayi inoshandiswa kusukurudza muromo zvine zita rimwe chete, asi zvinoedza pfungwa dzakasiyana dzine nzira dzakasiyana dzekushanda. Mhedzisiro yeimwe nzira haigoni kunzi inoshandawo kune dzimwe.
Funga nezvazvo sepfungwa ina dzine zita rimwe chete. Pfungwa yekutanga inoparadza kana kuderedza kunzwa kwemagumo madiki etsinga anokura achipinda mudhisiki rakakuvadzwa. Pfungwa yechipiri inoita kuti tsinga dzeganda dzisanzwe kana kuti dzideredze kushanda panzvimbo yabaiwa jekiseni. Pfungwa yechitatu inoshanda mumuviri wose kuburikidza nekutenderera kweropa, ichikanganisa hurongwa hwetsinga. Pfungwa yechina inovhara nzvimbo yakakuvadzwa kuti ideredze marwadzo ipapo. Kana wanzwisisa musiyano uyu, humbowo hunokurumidza kujeka, uye mukaha unooneka: zvinowanzotaurwa zvine chekuita nepfungwa yechitatu ichishandiswa semvura inomedzwa, iyo ndiyo chaiyo ine humbowo hushoma zvikuru muvanhu.
Tafura yehumbowo maererano nemamiriro nenzira yekushandisa
Tafura iyi ipfupiso yechinyorwa. Mutsara mumwe nomumwe unobatanidza mamiriro, nzira yekushandisa, uye kupindira kwacho, nokuti kuzviparadzanisa ndiko kunoita kuti zvinotaurwa pamusoro pekuderedza marwadzo zviwedzeredzwe.
| Mamiriro | Nzira yakaongororwa | Ongororo huru nemhedzisiro | Chinonyanya kudzikamisa humbowo |
|---|---|---|---|
| Marwadzo asingaperi ezasi kwemusana anobva mudhisiki | Jekiseni mudhisiki | Muyedzo wa2010 wekugovera varwere mumapoka zvisina kurongwa: varwere 72, 10 mg yemethylene blue pamwe nelidocaine zvichienzaniswa nemvura ine munyu pamwe nelidocaine; kuderera kukuru kwemarwadzo nekutadza kuita mabasa pamwedzi 24 | Mhedzisiro yepanzvimbo imwe chete isina kudzokororwa nemuyedzo weIMBI wakazoitwa munzvimbo dzakawanda |
| Marwadzo asingaperi ezasi kwemusana anobva mudhisiki | Jekiseni mudhisiki | Muyedzo weIMBI wenzvimbo dzakawanda: kuenzanisa mumapoka akagoverwa zvisina kurongwa munzvimbo dzakasiyana | Hauna kusimbisa mhedzisiro huru yaPeng; humbowo hwekushanda hahuwirirani |
| Kuvava panobuda tsvina nezviratidzo munzvimbo yakapoteredza | Jekiseni mukati meganda rakakomberedza panobuda tsvina | Mapoka akaongororwa pasina boka rekuenzanisa nawo (somuenzaniso varwere 30 vachipiwa 15 mL yemvura ine 1%): vakawanda vakanga vasina zviratidzo pamwedzi mumwe chete, uye vazhinji vakaramba vakadaro pagore rimwe chete | Hapana boka rakaitirwa nzira yekunyepedzera; kuongorora kwakabatanidza zvidzidzo zveboka rimwe chete muna2023 kwezvidzidzo 7 nevarwere 225 hakugoni kugadzirisa kusavapo ikoko |
| Marwadzo mushure mekuvhiyiwa kubvisa mamota epanobuda tsvina | Jekiseni mukati meganda rakakomberedza panobuda tsvina | Muyedzo wa2014 wekugovera varwere mumapoka zvisina kurongwa: varwere 67; marwadzo mashoma uye kushandiswa kushoma kweparacetamol mumazuva 3 ekutanga mushure mekuvhiyiwa | Kuderedza marwadzo kwenguva pfupi kwakabatana nemaitiro ekurapa, kwete kurapa marwadzo asingaperi |
| Marwadzo mushure mekuvhiyiwa kubvisa mamota epanobuda tsvina | Jekiseni mukati meganda mushure mekuvhiyiwa | Muyedzo wa2024 uyo varwere nevaongorori vaisaziva mapoka acho: varwere 97; marwadzo mashoma pamazuva 1 kusvika 7 | Kubatsira kwaingogumira pavhiki yekutanga |
| Marwadzo anobva mukukuvadzwa kwetsinga asingapinduri pakurapwa, ane zvikonzero zvakasiyana | Kupinza mutsinga yeropa | Muyedzo mudiki wekutanga wa2015 uyo varwere nevaongorori vaisaziva mapoka acho: varwere 10, 2 mg/kg zvichienzaniswa neboka rakapiwa chiyero chakaderera zvikuru; zviyero zvemarwadzo zvakaderera kwemazuva angangoita 1 kusvika 2 | Boka diki zvikuru rine mamiriro akasiyana uye chiratidzo chekubatsira chenguva pfupi |
| Marwadzo etsinga mushure meherpes zoster | Kuvharwa kwetsinga pedyo nemuzongoza kana kupinza pamwe nemushonga unoderedza kunzwa panzvimbo yakati | Kuenzanisa kwa2021 mumapoka akagoverwa zvisina kurongwa: varwere 104; marwadzo mashoma uye kushandiswa kushoma kwemishonga yekuwedzera yekunyaradza marwadzo kusvika pamwedzi 6 muboka remethylene blue | Yakashandiswa panzvimbo yakati pamwe nemushonga unoderedza kunzwa, kwete kurapa kunoshanda mumuviri wose kana mushonga unomedzwa |
| Marwadzo ezasi kwemusana mushure mekuvhiyiwa kubvisa chikamu chedhisiki | Kupinza munyama yeronda | Muyedzo wa2016 uyo mapoka matatu aibatanidzwa aisaziva kuti ndiani aipiwa chii: varwere 115; zviyero zvemarwadzo emusana zvakaderera pamaawa 24 nepamwedzi 3 | Mhedzisiro yekushandiswa kuwedzera pakuvhiya; musiyano wemarwadzo anobva pamidzi yetsinga wakanga usina kukosha kwezviverengero pamwedzi 3 |
| Marwadzo ekuzvimba kwemukati memuromo anobva mukurapwa kwegomarara | Kusukurudza muromo panzvimbo yacho, kwete kumedza | Muyedzo wechikamu 2 wa2022 wekugovera varwere mumapoka zvisina kurongwa: varwere 60; kuderera kukuru kwemarwadzo pazuva 2 pamiyero mitatu yekusimba kwemvura yekusukurudza | Mvura yekusukurudza inovhara muromo haisi humbowo hwechiyero chinomedzwa kuti chishande mumuviri wose |
| Kukuvadzwa kwetsinga kunokonzerwa nechirwere cheshuga, marwadzo etsinga yechiso yetrigeminal, CRPS | Kumedza kana kupinza mutsinga yeropa | Hapana muyedzo wekurapa muvanhu unosangana nezvinodiwa wakawanikwa | Ongororo dzenzira dzekushanda mumhuka dziripo, asi hadzigoni kutsiva miedzo muvarwere |
Verenga uchidzika muchikamu chenzira yekushandisa usati waverenga chero musoro wenyaya. Chiratidzo chimwe nechimwe chakanaka muvanhu chiri mumutsara wekushandiswa panzvimbo yakati kana panguva yemaitiro ekurapa. Mitsara yekushandiswa kunoshanda mumuviri wose ine muyedzo mudiki mumwe chete uye nzvimbo dzinoverengeka dzisina humbowo.
Marwadzo emusana anobva mudhisiki: muyedzo mumwe une mhedzisiro huru, kudzokorora kumwe kwakakundikana
Nyaya yejekiseni mudhisiki inotanga nemuyedzo mudiki wekutanga wa2007 usina boka rekuenzanisa naro muvarwere 24 vane marwadzo akasimbiswa nekuongororwa kwedhisiki uye asina kupindura pakurapwa kusina kuvhiyiwa. Mushure mejekiseni rimwe chete mudhisiki re10 mg yemethylene blue, 21 pa24 vakati marwadzo akanga apera kana kuti adzikira zvikuru mukuteverwa kwemwedzi ingangoita 18. Pasina boka rekuenzanisa naro, mhedzisiro iyoyo yaigona kubva mukusarudzwa kwevarwere, kufamba kwemamiriro acho ega, kana lidocaine yakapiwa pamwe chete nayo. Saka yakakurudzira kuongororwa kwemubvunzo wekushanda kwacho, kwete kuupindura.
Ongororo yakatevera yaiva muyedzo wa2010 waishandisa mushonga wekunyepedzera seboka rekuenzanisa, varwere nevaongorori vasingazivi mapoka acho muvarwere 72, ichienzanisa methylene blue pamwe nelidocaine nemvura ine munyu pamwe nelidocaine. Pamwedzi 24, misiyano yakataurwa yakanga yakakura zvikuru: kuderera kweavhareji yechiyero chemarwadzo kwakanga kuri mapoinzi 52.5 zvichienzaniswa ne0.7, uye kugutsikana kuri 91.6% zvichienzaniswa ne14.3%. Chinyorwa chemupepeti chaiperekedza ongororo chakabvunza pachena kuti izvi zvaiva mushonga unopedza marwadzo emusana here, zvichiratidza kuti zvakataurwa izvi zvaiita sezvakasiyana zvikuru kune nyanzvi panguva iyoyo.
Zvinotaurwa zvakakura zvakadaro zvinoda kudzokororwa, uye kudzokorora hakuna kusimbisa mhedzisiro yacho. Muyedzo weIMBI wakazoitwa munzvimbo dzakawanda wakaedza methylene blue inobaiwa mudhisiki, asi hauna kusimbisa mhedzisiro yaPeng. Mapoka madiki akaongororwa nevamwe vakazvimirira pasina mapoka ekuenzanisa nawo aiwanzoratidza mwero wakaderera wekupindura kana kubatsira kwaiderera nokufamba kwenguva. Pfupiso yakatendeseka ndeyekuti humbowo hahuwirirani: kubudirira kunoshamisa panzvimbo imwe chete kuchienzaniswa nekutadza kudzokorora mhedzisiro munzvimbo dzakawanda. Maitiro aya haasimbisi nzira yekurapa, uye haatauri chinhu pamusoro pekumedza methylene blue, iyo isingambopindi mudhisiki iri pachiyero chekusimba chakafanana. Pfupiso yedu yehumbowo hwemarwadzo asingaperi inoisa kusawirirana uku pamwe nezvimwe zvinopindirwa zvine maitiro ekurapa.
Jekiseni rakakomberedza panobuda tsvina: zviratidzo zvechokwadi, asi kushandiswa kushoma
Methylene blue inobaiwa mukati meganda kuti igadzirise kuvava panobuda tsvina kusingapinduri pakurapwa ndiyo ine nhoroondo refu zvikuru yemapoka evarwere akaongororwa, kutanga muna1990 uye ichienderera nemapoka evarwere 25, 30, 49, uye 103. Mwero wekupindura unoratidzika kuva wakakwirira, kazhinji vazhinji vachisara vasina zviratidzo mushure mejekiseni rimwe kana maviri, asi boka rimwe nerimwe harina boka rekuenzanisa naro. Kuvava kunoita kuti murwere asvike pakuitirwa nzira inopinda mumuviri kunogona kuchinja-chinja, uye majekiseni pachawo anogona kuunza mhedzisiro yekutarisira kubatsirwa. Saka mwero wekudzikira kwezviratidzo usina boka rekuenzanisa nawo haugoni kusimbisa kuti mushonga unoshanda.
Humbowo hwakasimba hwekuenzanisa hunowanika panyaya iri pedyo, yemarwadzo mushure mekuvhiyiwa. Miedzo miviri yakagovera varwere mumapoka zvisina kurongwa, yemethylene blue inobaiwa mukati meganda rakakomberedza panobuda tsvina panguva yakapoteredza kuvhiyiwa kubvisa mamota, yakawana zviyero zvemarwadzo zvakaderera nekushandiswa kushoma kwemishonga yekuwedzera yekunyaradza marwadzo pamazuva 1 kusvika 3 mumuyedzo wevarwere 67 uye pamazuva 1 kusvika 7 mumuyedzo wevarwere 97. Ihwohwo humbowo chaihwo hwekuderedza marwadzo panhano yekurapa, chiyero, uye vhiki zvakanyatsotsanangurwa. Hahusi humbowo hwekukuvadzwa kwetsinga kusingaperi, uye nzira yekushanda iri kukurukurwa ndeyekuderedza kunzwa kwetsinga panzvimbo yeronda, izvo donhwe rinomedzwa risingagoni kudzokorora. Tsananguro yekushanda kunoita methylene blue patsinga nemitochondria inotsanangura kuti nei kushanda kwemakemikari panzvimbo yakati kuchigumira ipapo.
Kushandiswa kunoshanda mumuviri wose pamarwadzo anobva mukukuvadzwa kwetsinga: muyedzo mudiki mumwe chete
Panyaya inonyanya kunetsa vatengi vakawanda, yekuti methylene blue inoshanda mumuviri wose ingaderedza marwadzo anobva mukukuvadzwa kwetsinga, nhoroondo yose yemiedzo muvanhu ine mapoka ekuenzanisa nayo inoita seiri muyedzo mudiki mumwe chete wa2015 muvarwere 10 vane marwadzo asingaperi anobva mukukuvadzwa kwetsinga, ane zvikonzero zvakasiyana uye asingapinduri pakurapwa. Methylene blue yakapinzwa mutsinga yeropa pa2 mg/kg yakaderedza zviyero zvemarwadzo kupfuura boka rakapiwa chiyero chakaderera zvikuru pazuva rekurapwa nezuva rakatevera, kubatsira kwacho kuchinge kwapera mukati memazuva mashoma. Varwere vatatu vakaratidza kuderera kwemarwadzo anokonzerwa nekubata kana kudzvanya kwaisingafaniri kurwadza.
Varwere gumi vane mamiriro akasiyana uye kudzikira kwemarwadzo kwemazuva maviri zvinopa chikonzero chekutsvakurudza zvakare, kwete hwaro hwekurapa. Mumwe chete aiva nemarwadzo etsinga mushure meherpes zoster, saka uyu hausiwo muyedzo wemarwadzo iwayo. Hapana muyedzo muvanhu unosangana nezvinodiwa wemethylene blue inoshanda mumuviri wose wakawanikwa pakukuvadzwa kwetsinga dziri kunze kweuropi nemuzongoza kunokonzerwa nechirwere cheshuga, marwadzo etsinga yechiso yetrigeminal, kana chirwere chemarwadzo akaoma enzvimbo yakati yemuviri. Ongororo dzemarwadzo etsinga mushure meherpes zoster dzekupinza pedyo nemuzongoza, dzimwe nguva dzinobudiswa neinjini dzekutsvaga, dzakabatanidza methylene blue nemushonga unoderedza kunzwa panzvimbo yemuzongoza. Izvozvo zviri mupfungwa yemaitiro ekurapa, kwete yekushanda mumuviri wose.
Zvekusukurudza, maronda, nemajoini: humbowo hwepanzvimbo yakati husingagoni kushandiswa kune imwe nzira
Zvimwe zviratidzo muvanhu zvose ndezvekushandiswa panzvimbo yakati. Muyedzo wechikamu 2 wa2022 wekugovera varwere mumapoka zvisina kurongwa wakawana kuti methylene blue yekusukurudza muromo pamiyero mitatu yekusimba yakaderedza marwadzo ekuzvimba kwemukati memuromo anobva mukurapwa kwegomarara kupfuura kutarisirwa kwakajairika pazuva 2. Mvura yekusukurudza inovhara nyama yakakuvadzwa yemukati memuromo uye inopfira kunze. Kuishandisa sehumbowo hwemadonhwe anomedzwa kunovhiringidza kubatwa kwemushonga panzvimbo yakati nekupiwa kwechiyero chinoshanda mumuviri wose.
Saizvozvowo, kuvhara nyama iri kuvhiyiwa nemethylene blue yakaderedzwa kusimba panguva yekubvisa chikamu chedhisiki rezasi kwemusana kwakaderedza zviyero zvemarwadzo emusana mumuyedzo wevarwere 115 uyo mapoka matatu aibatanidzwa aisaziva kuti ndiani aipiwa chii, ukuwo muyedzo wejekiseni mujoini refacet uchitaura zviyero zvakaderera zvemarwadzo nekutadza kuita mabasa pamwedzi 3 ne6. Mhedzisiro imwe neimwe yakabatana nenzvimbo yakaiswa mushonga. Hapana yadzo inoshanda sehumbowo hwechigadzirwa chinomedzwa.
Zvinoratidzwa nemhuka, uye apo nzira yekushanda inogona kuva nemigumisiro inopesana
Mienzaniso yemarwadzo anobva mukukuvadzwa kwetsinga mumakonzo ndiyo inopa tsananguro yekuti kushanda kwacho kungabvira sei, inowanzotaurwa. Methylene blue yakapinzwa mumvura yakakomberedza musana yakavhara kunzwa marwadzo zvakanyanya kubva mukupisa kwakanga kwatosimbiswa kwemaawa angangoita 4 mushure mekusungwa kwetsinga yesciatic mukuedza kwekutanga kwa1992, zvichienderana nekuti nzira yenitric oxide kuenda kucGMP mumusana ine basa. Ongororo dzakazotevera dzekukuvadzwa kunokonzerwa nekudzvinyirirwa kwetsinga kwenguva refu dzakawana kuti methylene blue yaideredza kupindura kuzvinhu zvinorwadza pachayo uye yaigona kuvhara kuwedzera kwekunzwa marwadzo kwakakonzerwa nesildenafil, zvichiratidza zvakare basa rekufambiswa kwezviratidzo nenitric oxide. Ongororo ya2021 yakawedzera nzira yechipiri yekushanda: kudzvinyirira zvakananga kutumirwa kwezviratidzo netsinga, kwakafanana nemigumisiro pazviteshi zvesodium, nekudzvinyirira kwenguva refu kupfuura lidocaine mune zvakashandiswa kuedza.
Pane chinhu chimwe chinoda kuchengetwa mutsananguro nokuti vatengesi vanochisiya. Zvinyorwa zveongororo yenitric oxide isati yasvika pamiedzo muvanhu hazvisi zvose zvinoratidza kuti methylene blue inoreva kuderedzwa kwemarwadzo. Mune dzimwe nzira dzekuedza, kufambiswa kwezviratidzo nenitric oxide pachako ndiko kunobatsira kuderedza marwadzo, uye methylene blue inovhara kubatsira ikoko. Mukuedza kukuvadzwa kwetsinga kunokonzerwa nechirwere cheshuga, methylene blue yakavhara kuderera kwekupindura kuzvinhu zvinorwadza kwakabatana nesildenafil, uye pachayo yakawedzera kunzwa marwadzo zvakanyanya. Migumisiro yenzira yekushanda inoenderana nemuenzaniso wekuyedza uye nzira yezviratidzo iri kushanda. Ichi chimwezve chikonzero nei zvakawanikwa mumhuka zvisingagoni kutorwa semazano ezviyero zvekushandisa.
Zvisati zvaongororwa, uye muganhu wekuchengeteka
Hapana muyedzo wekugovera varwere mumapoka zvisina kurongwa kana boka revarwere rakaongororwa mukurapa rinovimbika rakawanikwa remethylene blue inomedzwa nokuda kwemarwadzo asingaperi anobva mukukuvadzwa kwetsinga, kukuvadzwa kwetsinga kunokonzerwa nechirwere cheshuga, marwadzo etsinga yechiso yetrigeminal, chirwere chemarwadzo akaoma enzvimbo yakati yemuviri, kana marwadzo etsinga mushure meherpes zoster. Muyedzo mumwe chete wakananga wekushandiswa kunoshanda mumuviri wose pamarwadzo anobva mukukuvadzwa kwetsinga ndiwo muyedzo mudiki wevarwere 10 wekuisa mutsinga yeropa, une chiratidzo chekubatsira kwemazuva 1 kusvika 2. Mhedzisiro yekupinza mudhisiki, mukati meganda, mukati mejoini, pedyo nemuzongoza, uye yekusukurudza haigoni kutambanudzirwa kumadonhwe anotengeswa tichitarisa mashandiro emushonga mumuviri. Madonhwe acho ane kusimba kwemushonga panzvimbo yaunenge uchida kuti ushande kwakasiyana nezviyero zvakakura zvikuru, uye haaiswi panzvimbo iyoyo nenzira yemaitiro ekurapa.
Kuvhiringidza nzira dzekushandisa kunounzawo yambiro yekuchengeteka. Nzvimbo dzakasiyana dzemuzongoza hadzigoni kuchinjaniswa: kupinza mudhisiki, pedyo nemuzongoza, kunze kwechifukidziro chemusana, uye mumvura yakakomberedza musana zvakasiyana pamashandiro emushonga uye pakukuvadza kwawo. Kukuvadza kwakakomba kwetsinga mushure mekupinza methylene blue mumvura yakakomberedza musana kwakaita kuti pave neyambiro yakajeka yengozi. Pamusoro pezvo, methylene blue inodyidzana nemishonga inokanganisa serotonin uye haifaniri kushandiswa kana paine kushomeka kweG6PD. Saka chero murwere ane marwadzo ari kufunga kuishandisa anofanira kutanga averenga pfupiso yemigumisiro isingadiwi nemamiriro asingabvumiri kushandiswa kwayo uye ataure nenyanzvi yezvekurapa, achishandisa mibvunzo iyi yekubvunza pamusoro pemethylene blue.
Mashandisiro ehumbowo uhwu
Chero munhu ari kuongorora methylene blue nokuda kwemarwadzo anofanira kubvunza mibvunzo mitatu pachinyorwa chimwe nechimwe chinotaurwa sehumbowo. Mamiriro acho chaiwo ndeapi, nokuti kupora mushure mekuvhiyiwa kubvisa mamota epanobuda tsvina hakusi kukuvadzwa kwetsinga kunokonzerwa nechirwere cheshuga. Nzira yacho chaiyo ndeipi, nokuti kupinza mudhisiki kana mukati meganda hakusi chiyero chinomedzwa. Uye chii chakayerwa, mukati menguva yakareba sei, nokuti mazuva ekudzikira kwemarwadzo mushure memaitiro ekurapa haasi mwedzi yekudzora kukuvadzwa kwetsinga.
Pahumbowo huripo, zviratidzo zvekuderedza marwadzo nemethylene blue muvanhu zvinongogumira pakushandiswa panzvimbo yakati kana panguva yemaitiro ekurapa, uye kushanda kwacho hakuwirirani pamamiriro akasiyana. Humbowo hwekushandiswa kunoshanda mumuviri wose hunongogumira pamuyedzo mudiki zvikuru mumwe chete wekuisa mutsinga yeropa, uye hapana humbowo hwemiedzo yekurapa hunotsigira methylene blue inotengeswa ichimedzwa nokuda kwemarwadzo anobva mukukuvadzwa kwetsinga kana marwadzo asingaperi.