Methylene blue kumbwa: mashandisirwo, kuchengeteka, uye nguva yekufonera chiremba wemhuka

Imbwa inonanzva mvura yebhuruu kubva mutangi rehove richangobva kuiswa mushonga. Muridzi anoverenga kuti methylene blue inogadzirisa dambudziko reropa, obva azvibvunza kana donhwe rinobva mubhodhoro remushonga wehove ringabatsira imbwa iri kurwara kumba. Mamiriro acho ose anosanganisira dhayi imwe chete. Hapana paari panofanira kuitwa sarudzo yekurapa kumba.

Kuvhiringidzika kunobva pakusanganisa zvinhu zviviri zvine zita rimwe chete. Chimwe inzira yekurapa mukiriniki: chiremba wemhuka anopa dhosi rakayerwa mutsinga nokuda kwedambudziko chairo reropa rinoda kurapwa nechimbichimbi, ozotarisa ropa kwemazuva. Chimwe ndechekumedza dhayi netsaona: imbwa yamedza dhayi ine huwandu husingazivikanwi kubva mutangi, mumvura yekunyudza hove, kana mupiritsi. Chekutanga chinofanira kuitirwa muchipatara. Chechipiri chinoda kufonera chiremba wemhuka. Chinyorwa chino chinozvitsaura, chinotsanangura nei pasina chati yakachengeteka yemadhosi ekupa imbwa kumba, uye chinopa tafura yekuenda nayo kukiriniki.

Zvinoshandisirwa dhayi iyi navanachiremba vemhuka chaizvo

Mashandisirwo akasimbiswa kumbwa akaganhurirwa: methemoglobinemia inokonzerwa nechinhu chinoita oxidation uye yakakura zvakakwana kuti ide kurapwa. Hemoglobin yakajairika inotakura okisijeni nokuti simbi iri mairi iri mumamiriro eferrous, ayo akaderedzwa nechiitiko che reduction. Makemikari anoita oxidation anoshandura simbi iyoyo kuenda mumamiriro eferric, zvichiita methemoglobin, iyo isingakwanisi kutakura okisijeni. Matadza embwa anogona kuoneka ari ebhuruu kana epfumbu, nepo ropa racho richiva neruvara rwebhurawuni rwakaita sechokoreti.

Mukati memasero matsvuku eropa, methylene blue inogona kushandurwa ne reduction kuita leucomethylene blue, iyo inodzosera maerekitironi kusimbi yakaitwa oxidation, yoita kuti hemoglobin ishande zvakare. Ndicho chiitiko chinoita kuti irape. Izvi zvinotsanangura kuti nei mushonga uyu uchibatsira chete kana methemoglobin yakawandisa iri iro dambudziko. Haubatsiri pakushomeka kweropa kwakajairika, pakuderera kweokisijeni kunokonzerwa nechirwere chemapapu, kana pahuturu husingabatanidzi methemoglobin.

Zvinowanzokonzera izvi kumbwa zvinosanganisira acetaminophen, nitrate kana nitrite, benzocaine nemimwe mishonga ine ukama nayo inoita oxidation, uye dzimwe nguva kukuvara kunokonzerwa ne oxidation ine chokuita nehanyanisi kana gariki. Paacetaminophen, kurapa kukuru ndiko kubvisa chinhu chine chepfu pamwe nekupa N-acetylcysteine, uye methylene blue inowedzerwa kana methemoglobin iri chikamu chakakosha chedambudziko, sezvinotsanangurwa munhungamiro yaMerck pamusoro pehuturu hunokonzerwa nemishonga yekunyaradza marwadzo. Pahanyanisi negariki, kurapa kwakajairika kunosanganisira kubvisa chinhu chine chepfu, kupa okisijeni uye ropa rokutsigira, pamwe nezvinwiwa zvekurapa, nokuti kukuvara kukuru ndiko kuparara kwemasero matsvuku eropa kunobatanidza Heinz bodies, kunononoka kuchiitika kwemazuva, kwete methemoglobin yoga. Kushandisa kumbwa chirongwa chekurapa nitrate chakagadzirirwa mhuka dzinodzeya kungava nengozi, nokuti mombe dzinogona kutsungirira madhosi anokuvadza imbwa, sezvinonyatsotaurwa muzvinyorwa zvekurapa mhuka pamusoro penitrate.

Mamwe mashandisirwo maviri anofanira kutsanangurwa zvakajeka. Kubaya dhayi pedyo nebundu kuti paonekwe sentinel lymph node, inova lymph node yekutanga inogamuchira mvura inobva munzvimbo yebundu, kushandisa dhayi panguva yemaitiro ekurapa kenza kumbwa, kwete kurapa muviri wose. Kushandiswa kwayo mukuedza kurapa distributive kana vasoplegic shock, uko dhayi inopiwa kuti ideredze kutumirwa kwemasaini enitric oxide, kuchiri kuongororwa kumbwa. Ongororo ya2026 yekuvhiyiwa kwembwa pachishandiswa bypass inotaura pachena kuti hapana humbowo hwemukiriniki mukurapa mhuka hunotsigira mashandisirwo acho pashock iyoyo, uye madhosi akakwirira mumiedzo akawedzera kuipa kweBP nekushanda kwemwoyo. Saka pfupiso yechokwadi ndeyekuti pane basa rimwe rakasimbiswa, rimwe rekushandisa dhayi panguva yemaitiro ekurapa, uye mamwe ose achiri ekuedza. Mirayiridzo yematangi ehove, zvirongwa zvekurapa vanhu, uye mashandisirwo ekupenda masampuli murabhoritari hazvifaniri kungoshandiswa kumbwa.

Nei pasina chati yemadhosi ekupa kumba

Zvinobuda pakutsvaga zvinovimbisa chati yemadhosi emethylene blue ekupa imbwa. Pamushonga uyu, chati haisi chishandiso chakakodzera, nokuti musiyano pakati pedhosi rinobatsira nerinokuvadza mudiki, kutariswa kwemamiriro embwa chikamu chekurapa, uye nhamba yoga haiiti kuti sarudzo ive yakachengeteka.

Zvinyorwa zvakaburitswa zvekurapa mhuka zvinonyanya kupa dhosi re1 kusvika 1.5 mg pa kg, rinopiwa zvishoma nezvishoma mutsinga, semusanganiswa une chikamu chimwe muzana, kamwe chete, pakurapa methemoglobinemia. Chinyorwa chaMerck chehuturu hunokonzerwa nemishonga yekunyaradza marwadzo chinopa muganhu iwoyo uye chinoti dhosi ripiwe mukati memaminitsi akati wandei. Zvinyorwa zvakadzama zvemushonga uyu mukurapa mhuka zvinoti panofanira kupiwa dhosi rimwe chete zvishoma nezvishoma, ropa richitariswa kwemazuva matatu kusvika mana, uye zvinotaura kushomeka kweropa kwakanyanya zvokuda kuwedzerwa ropa pamadhosi anosvika 5 mg pa kg. Dhosi rekupenda nhengo panguva yekuvhiya, raishandiswa muma1970s uye raiva pedyo ne3 mg pa kg, rakakonzera kushomeka kweropa kwakaonekwa pava paya uye, mune imwe nyaya, kukuvara kwetsvo kwakazouraya mushure mekuparara kwemasero matsvuku eropa. Musiyano pakati pekubatsira nekukuvadza mudiki.

Nhamba iyoyo inopindurawo mibvunzo mishoma pane zvainoratidzika. Haitauri kuti methemoglobin iripo here chaizvo, kuti chinokonzera dambudziko chinopindura mushonga uyu here, kuti imbwa iri kutora mimwe mishonga ipi, kana kuti itsvo nemasero matsvuku eropa zvinogona kutsungirira chinhu chinoita oxidation here. Chati haigoni kuyera methemoglobin ichishandisa co-oximetry, haigoni kuongorora smear yeropa kuti ione Heinz bodies, uye haigoni kutarisa kuderera kwehematocrit mushure memazuva matatu. Kiriniki inogona kuita izvozvo. Ndicho chikonzero tafura iri pasi apa ichipa madhosi semashoko ekiriniki ekukurukura nachiremba wemhuka, kwete semirayiridzo. Usapa methylene blue kumba, usashandura mushonga wetangi rehove kuita dhosi rembwa, uye usashandisa mashoko ari paleibheri yemushonga wevanhu, akadai seruzivo rwekupa PROVAYBLUE, segwara remadhosi.

Kupesana kwayo: mushonga wokurwisa chepfu uye chinhu chinoita oxidation panguva imwe chete

Funga nezvemethylene blue seine mabasa maviri mubhodhoro rimwe chete. Kana yapiwa muhuwandu hushoma, zvishoma nezvishoma, ichitariswa nenyanzvi uye masisitimu ereductase achishanda, inobatsira kuita reduction uye inoderedza methemoglobin. Kana huwandu hwayo hwakwira, kana kuti nzira dzinodzivirira masero matsvuku eropa dzaremerwa, inoita oxidation yokonzera kukuvara kwayaifanira kugadzirisa: kuwanda kwemethemoglobin, Heinz bodies, kukuvara kwemembrane, uye kuparara kwemasero matsvuku eropa.

Kupesana ikoko kunoenderana nedhosi uye kunogona kunonoka kuoneka. Kushomeka kweropa kunogona kuoneka mushure memazuva matatu kusvika mana kubva pakupiwa kwedhosi, ndicho chikonzero zvinyorwa zvichisimbisa kuongororwazve kweropa kunyange kana imbwa ichiita seyavandudzika mukati mehafu yeawa. Kuparara kwakanyanya kwemasero matsvuku eropa kunogona kuburitsa hemoglobin ichipinda muplasma nemuweti, zvokuvadza itsvo. Madhosi akakwirira akapiwa mutsinga mune imwe ongororo yembwa akawedzera methemoglobin mukati meminiti pane kuidzikisa.

Pane zvinhu zviviri zvinoda kunyatsotariswa. Methylene blue inodzivisa zvine simba kushanda kwemonoamine oxidase, uye kudzivisa uku kunogona kudzoserwa. Leibheri yemushonga wevanhu ine yambiro iri mubhokisi pamusoro peserotonin syndrome kana mushonga uyu wabatanidzwa nemishonga inobata serotonin. Pambwa, nhoroondo yemishonga inokosha inosanganisira trazodone, fluoxetine nemimwe mishonga inodzivisa kutorwazve kweserotonin, clomipramine, selegiline, nemishonga yakadai setramadol. Zviratidzo zvinosanganisira kusagadzikana kana kuchinja kwemafungiro nekuziva, kupisa kwemuviri kwakanyanya, kurova kwemwoyo nokukurumidza kana BP isina kugadzikana, kudedera, kuoma kwemhasuru, kusakwanisa kufamba zvakarongeka, uye pfari. Yambiro yakasimba iyi inonyanya kubva pahumbowo hwevanhu, saka kuti izvi zvinoitika kakawanda sei kumbwa hazvisati zvanyatsoyerwa, asi nhoroondo yemishonga inofanira kutaurwa pose panofonerwa kuti paongororwe kukurumidza kunodiwa pakurapa.

Rudzi rwemhuka runokoshawo. Imbwa dzinogona kuita kushomeka kweropa kunobatanidza Heinz bodies kubva pamushonga uyu, asi katsi dziri panjodzi huru zvikuru nokuti hemoglobin yadzo ine zvikamu zvakawanda zvinogona kuitwa oxidation uye masero adzo matsvuku eropa haabvisi kukuvara zvakanaka. Chirongwa chekupa imbwa mushonga hachifaniri kumboshandurirwa katsi kungoenderana nehuremu. Mutemo wehurumende yemubatanidzwa weUnited States, 21 CFR chikamu 500.27, unonyora nezvekushomeka kweropa kunobatanidza Heinz bodies kwakazouraya katsi dzakapiwa zvigadzirwa zvemethylene blue zveurinary zvinonwiwa nomuromo zvichitevedza mirayiridzo yepaleibheri. Nhoroondo iyoyo inoyeuchidza kuti kupa mushonga nomuromo hakurevi kuti unenge usingakuvadzi.

Tafura yemashandisirwo mukiriniki nekumedza netsaona

Enda netafura iyi kuna chiremba wemhuka pane kuita zvarinotaura uri wega. Inotsaura kushandiswa mukiriniki kuchitariswa nenyanzvi nekumedza netsaona; ndiwo musiyano unochengeta sarudzo dzakachengeteka. Ikurukure nevashandi vekiriniki; haivatsivi pakuona kuti dambudziko nderei.

Mamiriro	Zvazviri	Zvinotariswa nachiremba wemhuka
Methemoglobinemia yakanyanya inobva pachinhu chinoita oxidation	Mashandisirwo akasimbiswa mukiriniki. Methemoglobin yakayerwa, imbwa ine zviratidzo, uye chinhu chakakonzera oxidation chinozivikanwa.	Dhosi rimwe chete rinopiwa zvishoma nezvishoma mutsinga, rinosvika 1 kusvika 1.5 mg pa kg remusanganiswa une chikamu chimwe muzana, kamwe chete, pamwe neco-oximetry uye kutariswa kwehematocrit nesmear yeropa kwemazuva 3 kusvika 4. Kurapa kunonangana nechakonzera dambudziko kunoenderera mberi pamwe chete nazvo, somuenzaniso N-acetylcysteine yeacetaminophen.
Kushomeka kwereductase kunogarwa nhaka	Mashandisirwo asingawanzoitiki anotungamirirwa nenyanzvi. Methemoglobinemia inodzokorora pasina chepfu.	Kurapa mutsinga kunoenderana nenyaya yacho, pedyo ne1 mg pa kg, dzimwe nguva kuchizoteverwa nekurapa nomuromo kunotariswa. Chirongwa chenguva refu chinongofanira kuitwa pasi pekutarisirwa nenyanzvi.
Kuratidza sentinel lymph node	Kushandisa dhayi panguva yekuvhiya bundu.	Kubaya pedyo nebundu kunoitwa nachiremba anovhiya, kwete kupa dhosi rinopararira mumuviri wose. Zvinoitika muropa inyaya yakasiyana nekufamba kwedhayi.
Shock kana kuderera kwekusunga kwetsinga dzeropa	Kuchiri kuedzwa kumbwa. Hapana chirongwa chakagamuchirwa chekushandisa nguva dzose.	Sarudzo ndeyekuti imbwa ingapinzwa here muongororo, kwete yekuirapa kumba. Madhosi akakwirira anogona kuwedzera kuipa kweBP, kushanda kwemwoyo nemapapu.
Yanwa mvura yetangi rehove yakaiswa mushonga	Kumedza netsaona, kwete kurapwa. Musanganiswa wakareruka asi huwandu hwakanwiwa hahuzivikanwi.	Leibheri yechigadzirwa, kuwanda kwedhayi mumushonga wekutanga, huwandu hwemvura mutangi, huwandu hunofungidzirwa kuti hwakanwiwa, huremu hwemuviri, nguva, zviratidzo, nemishonga yose. Kunwa mvura shoma ine dhayi yakareruka nekumedza mushonga wakanyanya kusimba inyaya dzakasiyana.
Yananzva mushonga wekunyudza hove kana kutsenga chigadzirwa chakasimba kana piritsi	Kumedza netsaona kunonyanya kunetsa.	Mashoko mamwe chete echigadzirwa pamwe nemamirigiramu pachinhu chimwe chete uye nhamba huru yezvinhu zvingave zvisipo. Zvimwe zvinoumba piritsi zvinoshandura kuongororwa kwenjodzi.
Imbwa iri kutora trazodone, SSRI, clomipramine, selegiline, tramadol	Njodzi yekudyidzana kwemishonga inowedzera kune chero mamiriro ari pamusoro.	Rondedzero yose yemishonga nezvinowedzera kudya isati yaitwa chero sarudzo. Zviratidzo zveserotonin syndrome zvinoda kuongororwa nechimbichimbi.

Kana imbwa yamedza dhayi netsaona: zvokuita iye zvino

Chekutanga, imisa kunwazve uye chengeta mashoko anodiwa: bhodhoro rechigadzirwa kana mufananidzo weleibheri, kuwanda kwedhayi mumusanganiswa, huwandu hwakaiswa mumvura yakawanda sei kana raiva tangi, huwandu hunofungidzirwa kuti hwakamedzwa, nguva, huremu hwembwa, zviratidzo zviripo, zvirwere zvinozivikanwa, nemishonga yose nezvinowedzera kudya. Kuongorora kukurumidza kunodiwa pakurapa chepfu kunotsamira parondedzero iyoyo chaiyo. Nhungamiro yakajairika kubva kuASPCA pamusoro pechepfu kumhuka dzinochengetwa mudzimba inokumbira varidzi kuti vachengete mudziyo uye vafone pane kumirira zviratidzo, uye basa reASPCA rinobatsira panyaya dzechepfu nemamwe mabasa akadai sePet Poison Helpline aripo kuti agamuchire kufona uku pamwe nekiriniki yenguva dzose kana chipatara chezviitiko zvinoda rubatsiro rwechimbichimbi.

Usapa methylene blue semushonga wokurwisa chepfu kumba. Usaita kuti imbwa irutse kunze kwekunge chiremba wemhuka kana nyanzvi yechepfu yanyatsokurayira kudaro, nokuti kuita kuti irutse hakuna kukodzera kana kuti kune ngozi pane zvimwe zvinhu zvinenge zvamedzwa uye kana paine zvimwe zviratidzo. Usapa hydrogen peroxide nokuzvisarudzira wega. Pazvinokwanisika, dzivirira kuti imbwa inananzve dhayi iri pamvere dzayo painozvichenesa, sukurudza dhayi iri paganda sezvinorayirwa nekiriniki, uye chengeta chigadzirwa chiri kure nemaziso.

Tsvaga kuongororwa kwechimbichimbi nokukurumidza kana paine kunetseka kufema, matadza ebhuruu kana epfumbu, kupera simba kwakanyanya kana kudonha, kusaziva, pfari, kusagadzikana kwakanyanya kana kudedera pamwe nekupisa kwemuviri kwakanyanya, kana matadza akacheneruka kana eyero pamwe neweti yakasviba kana ine ruvara rutsvuku rwebhurawuni. Ziva kuti zvinogona kunonoka: imbwa inoita seyakanaka manheru ezuva rayamedza dhayi inogona kuzotanga kushomeka kweropa kunokonzerwa nekuparara kwemasero matsvuku mazuva anotevera, saka kuongorora kukurumidza kwekurapa kunosanganisira zvose husiku ihwohwo nekuongororwazve kweropa pava paya. Ongororo yemaitiro ekurapa methemoglobinemia inotanga nokukurumidza muJournal of Veterinary Internal Medicine inokurudzira kutarisa hematocrit kwemazuva akati wandei mushure mekuitwa kwesarudzo dzekurapa nokuda kwechikonzero ichi chaicho.

Muganhu mumwe wokupedzisira unoita kuti mamwe mapeji ose ari panzvimbo ino arambe ari panzvimbo yawo. Nhungamiro dzekurapa hove, matanho ekubvisa dhayi mumvura mushure mekuisa mushonga mutangi rehove, kemisitiri yedhayi, uye nzira dzekupenda masampuli zvinotsanangura matangi, midziyo yegirazi, nemamaikorosikopu. Hapana pazviri chinopa mirayiridzo yemushonga wembwa. Mubvunzo wembwa unogara uchipera nenzira imwe chete: fonera chiremba wemhuka, enda neleibheri nenhamba dzacho, uye rega kuongororwa kweropa kutungamirire sarudzo.