Methylene blue pakurangarira nekuisa pfungwa pachinhu: zvakayerwa mumiedzo yevanhu

Chinyorwa cha2023 chemethylene blue nehuropi hwemunhu mupenyu chinotanga nyaya yacho nemutsara wava kudzokororwa muongororo, mumavhidhiyo, uye pamapeji ezvigadzirwa: chinhu ichi “chakaratidzwawo kuvandudza kugona kufunga, kudzidza uye kuyeuka, zvichienderana nehuwandu hwapiwa, muvanhu nemumhuka dzekuedza.”

Chikamu chemutsara iwoyo chinotaura nezvemhuka chiri nyore kutsigira. Chikamu chinotaura nezvevanhu chakavakirwa pamiedzo mishoma, uye kuiverenga kunoburitsa zvinorehwa nemashoko okuti “kugona kufunga.” Kutsvaga kwakaitirwa chinyorwa chino kwakawana tsvakurudzo shanu dzevanhu dzaiva nechiyero chekupedzisira chekugona kufunga kana chemifananidzo yeuropi, pamwe nemiedzo mitatu yekuvhiya yaiva nemugumisiro wekugona kufunga. Mumwe muyedzo wevanhu vakuru vane utano wakaratidza kuvandudzika kwekuyeuka, asi kuvandudzika ikoko hakuna kuramba kuine kukosha pakafananidzwa mapoka.

Mhando ina dzemigumisiro muvanhu dzinowanzotorwa sechinhu chimwe

Verenga tafura iyi uchidzika uye maitiro acho anooneka. Tsvakurudzo dzaiva nechiyero chaicho chekugona kufunga ndidzo dzekuvhiya, uye dzakashandisa mushonga wakapiwa nomutsinga kuvarwere vaiva pasi pemushonga wekutindivadza. Tsvakurudzo dzevazvipiri vane utano dzakayera zviratidzo zveuropi pane kufunga kwavo.

Zvakawanikwa mumuyedzo wa2016 wevanhu vakuru vane utano

Tsvakurudzo yevanhu inonyanya kutaurwa yakapa vanhu vakuru 26 vane utano huwandu humwe hwe280 mg hwekumedza, hunenge 4 mg/kg, kana kapsuru yeplacebo yakazadzwa neFD&C blue no. 2 kuti zviviri izvi zvitaridzike zvakafanana. Huropi hwevatori vechikamu hwakatorwa mifananidzo vasati vapiwa mushonga uyezve awa imwe gare gare vachiita basa rekugara vakangwarira vachipindura, rinoyera kuti munhu anoona nokukurumidza zvakadii chiratidzo chiri nyore chinoonekwa, uye basa rekufananidza muenzaniso mushure menguva, iri bvunzo yekuyeuka zvinoonekwa kwenguva pfupi.

Mapinduriro europi akachinja. Methylene blue yakawedzera chiratidzo mugoko reinsula kumativi ose maviri panguva yebasa rekuteerera (Z = 2.9 to 3.4, P = .01 to .008) uye munzvimbo dziri kumberi, pamusoro nekumashure kweuropi panguva yebasa rekuyeuka (Z = 2.9 to 4.2, P = .03 to .0003).

Migumisiro yemaitiro ndiyo inopfupikiswa zvakanyanya pakudzokororwa kwenyaya iyi.

1. Nguva yekupindura haina kuvandudzika. Boka replacebo rakabva pa230 kusvika pa220 milliseconds. Boka remethylene blue rakabva pa230 kusvika pa230 milliseconds. Kufananidza mapoka kwakapa F = 0.65, P = .43.
2. Mhinduro dzakarurama dzekurangarira dzakakwira neinenge 7% muboka rakapiwa mushonga, P = .01 pakufananidza zvaivepo mushonga usati wapiwa nezvaivepo mushure mawo muboka iroro.
3. Iyo 7% haina kuramba iine kukosha pabvunzo yekufananidza mapoka. Kufananidza zviyero zvakadzokororwa zvekuchinja kwemhinduro dzakarurama kwakapa F = 2.96, P = .09.

Kuchinja mukati meboka ukuwo mutsauko wekuchinja pakati pemapoka usina kukosha pakuverenga kwenhamba chiratidzo chemugumisiro unogona kuva chaiwo kana kungova kusiyana kwakangoitika. Mhedziso yechinyorwa chacho yakangwarira zvakakodzera: zvakawanikwa “zvinotsigira pfungwa yokuti methylene blue inovandudza kugona kuyeuka” uye zvinopa hwaro hwemiedzo inotevera. Hwaro hahusi chinhu chakawanikwa. Ongororo yedu yeuchapupu hwakafara muvanhu inotevera kuti chii chakavakwa pahwaro ihwohwo kubvira ipapo.

Zvinoyerwa chaizvo nemabvunzo

Hapana chimwe chezviyereso izvi chinoyera “kuyeuka” kana “kuisa pfungwa pachinhu” sezvinorehwa nemuverengi. Chimwe nechimwe chinoda kuti munhu aite chimwe chinhu chakatarwa, chopa chibodzwa chemhinduro yake, uye zvinogumira chiyereso zvinogumirawo zvose zvinotaurwa zvichibva pachiri.

Saka mugumisiro unogona kuva wakasimba pakuverenga kwenhamba asi uchingoratidza chinhu chiduku. Nguva yekupindura isingachinji inobvisa pfungwa yokuti munhu ari kuona chiratidzo nokukurumidza; haibvisi pfungwa yokuti angayeuka zviri nani zvaakadzidziswa muhurukuro. Kuvandudzika kwechibodzwa chebvunzo yekufananidza muenzaniso mushure menguva kunoreva kuti mufananidzo wakazivikanwa kakawanda; hakurevi kuti munhu achayeuka zita mangwana. Gwaro rinotsanangura mayererwo ekuyeuka mutsvakurudzo dzemhuka rinotevera musiyano iwoyo mumakwara anovhiringidza uye mumabvunzo ekuziva zvinhu ari shure kwezvakawanda zvinotaurwa.

Tsvakurudzo yakafambidzana nayo haina kunyora zvibodzwa zvachose

Chirongwa chimwe chete chetsvakurudzo chakabudisa ongororo yechipiri kubva panguva imwe chete yekunyoresa vanhu, payunivhesiti imwe chete, nehuwandu hwakafanana uye placebo imwe chete, panguva ino chichitarisa kubatana kwezvikamu zvehuropi panguva yekuzorora. Vatori vechikamu makumi maviri nevasere vakanyoreswa; ongororo dzemifananidzo dzakashandisa vanenge 13 kusvika 15 paboka rimwe nerimwe.

Methylene blue yakabatana nekuderera kwekuyerera kweropa muuropi mukati menetiweki inobata kuona uye nzvimbo yezvinhu, uye nekusimba kwekubatana panguva yekuzorora pakati pezvikamu zvakawanda zviviri zviviri, kusanganisira hippocampus yekuruboshwe necerebellum yekurudyi. Zvose zviri zviviri zvinhu zvinonakidza zvakaonekwa pamusoro pemashandiro enetiweki. Hapana chiri mugumisiro wekuyeuka, uye chinyorwa chacho chinodaro pachacho: “Kushaikwa kwezvibodzwa zvemaitiro mutsvakurudzo iyi chimwewo chinhu chinoigumira.”

Mishumo miviri kubva kuboka rimwe chete, nguva imwe chete yekunyoresa vanhu, uye huwandu humwe chete zvinoreva muyedzo mumwe, kwete miviri. Uchapupu hwemifananidzo yeuropi hwekubatsira kugona kufunga muvanhu hahusati hwadzokororwa neboka rakazvimirira.

Tsvakurudzo yakazvimirira yakawana zvichienda kune rimwe divi

Kuyera kwakazvimirira kwakabva kune rimwe boka uye kwakashandisa imwe nzira yekupa mushonga. Singh nevamwe vake vakapa vakadzi vasere vane utano zvinoyerera nomutsinga zveplacebo uye zve0.5 ne1 mg/kg yemethylene blue pamazuva akasiyana, ndokuyera kuyerera kweropa muuropi, kutorwa kweokisijeni kubva muropa, uye mwero wekushandiswa kweokisijeni muuropi.

Zvose zvitatu zvakaderera. Kuyerera kweropa muuropi hwose kwakaderera neinenge 8% pahuwandu hwose huviri, uye mwero wekushandiswa kweokisijeni wakaderera zvine kukosha pakuverenga kwenhamba. Vanyori vainge vafungidzira kuwedzera uye vakataura zvakajeka kuti zvakaitika zvakanga zvakapesana nezvavaitarisira, vachipa tsananguro mbiri: huwandu uhwu huri panoshanduka mashandiro emethylene blue kubva pakukurudzira kuenda pakudzivisa, uye huropi hune utano hungangova nenzvimbo shoma yekuvandudzwa.

Kupinduka ikoko ndiko kunoita kuti kufunga kuti “zvakawanda zviri nani” kusashanda pachinhu ichi. Gwaro rehormesis rinotsanangura chimiro chemutsara wakakombama; huwandu hunotsanangurwa sehunosimudzira mutsvakurudzo idzi ndi0.5 kusvika 4 mg/kg, uye zvinyorwa zvinohushandisa zvinoti pamusoro pe10 mg/kg zvazvinoita zvinopinduka.

Chiyero chekugona kufunga chakachinja ndechekuvhiringidzika kwakanyanya mushure mekuvhiya

Delirium kuvhiringidzika kwakanyanya kunotanga mumaawa kusvika mumazuva, kazhinji muvanhu vakwegura mushure mekuvhiya kukuru. Haisi chinhu chimwe chete nekuyeuka pane makiyi, asi inoyerwa nezviyereso zvakasimbiswa, uye mugumisiro une chekuita nekugona kufunga.

Miedzo mitatu yekugovera vanhu mumapoka zvisina kurongwa yakaedza kana huwandu hwemushonga hunopiwa nomutsinga panguva yekuvhiya huchideredza izvi.

Muyedzo wa2021 wakataurawo kuti kuderera kwekugona kufunga munguva yekutanga mushure mekuvhiya, kwakayerwa pazuva rechinomwe, kwakaderera kubva pa40.2% kusvika pa16.1% (OR 0.30, 95% CI 0.16 to 0.57, P < .001). Ongororo yakabatanidza migumisiro yemiedzo mitatu muna2026, ichibata varwere 779, yakawana chiyero chakabatanidzwa chemikana che0.35 (95% CI 0.23 to 0.53), pasina kusiyana kune kukosha pakuverenga kwenhamba pakati petsvakurudzo.

Migumisiro iyi yakakura zvichienzaniswa nezvinowanikwa mukurapa panguva yakapoteredza kuvhiya, asi yakauyawo nezvakaipa. Mumuyedzo wekuiswa majoini matsva, fivha mushure mekuvhiya yakawanda muboka rakapiwa mushonga, 16.5% ichienzaniswa ne7.4% (P = .039). Miedzo yekuvhiya rwatata nekuiswa majoini matsva yakazoteverwa netsamba dzakabudiswa dzakanyorerwa mupepeti, zvinowanzoitika kana mugumisiro watanga kuchinja marapirwo, uye zvinoratidzawo kuti mashoko ayo ari kunyatsoongororwa.

Panewo humwe uchapupu hwekuyera pamwe chete neuhu. Ongororo yenetiweki yakabatanidza tsvakurudzo muna2026 muThe BMJ yakabatanidza miedzo 158 nevarwere 41,084 kuti ironge mishonga yekudzivirira kuvhiringidzika kwakanyanya maererano nesimba reuchapupu hwayo. Yakasarudza dexmedetomidine seyakavimbika zvikuru, pamwe necorticosteroids, mishonga inokurudzira mareceptor emelatonin, parecoxib, olanzapine, neinsulin inopiwa nomumhino. Methylene blue yakanga isiri pakati pemishonga yakadomwa neongororo iyoyo.

Nei kubudirira mukamuri rekuvhiya kusingashanduki kuva kubudirira pakudzidza

Misiyano mina inoparadzanisa mamiriro aya.

1. Vanhu vari kutaurwa. Miedzo yakanyoresa vanhu vanopfuura makore 60 vaivhiyiwa zvikuru, boka rine njodzi yakakwirira yekuvhiringidzika kunyange risati rapiwa mushonga. Kudzivirira kuvhiringidzika muuropi huri panjodzi hakusi chinhu chimwe chete nekuvandudza huropi huri kushanda zvakanaka.
2. Nzira yekupa mushonga nemamiriro acho. Mugumisiro wose wakanaka wakabva pamushonga wakapiwa uchiyerera nomutsinga panguva yekutindivadza. Kapsuru inoisa muviri pamushonga nenzira yakasiyana; kuenzanisa nzira dzekupa mushonga kunotsanangura kuti mushonga wakamedzwa unosvika muuropi wakawanda sei.
3. Mugumisiro. Kuvhiringidzika kwakanyanya chiitiko chekurapa chinoongororwa nevarapi vachishandisa zviyereso zvakarongwa. Kuramba wakaisa pfungwa pabasa masikati ose hakusi zvakadaro, uye muyedzo usingakwanisi kuvanzira vatori vechikamu zvakanaka kuti vari muboka ripi uchanetseka kukuyera.
4. Tsananguro yakarongwa yemashandiro. Zvinyorwa zvekuvhiya zvinoti mugumisiro unobva pakuderera kwekuzvimba kunoitika mumuviri wose uye pakuchengetedzwa kwechipingamupinyi chiri pakati peropa nehuropi, IL-6 ichiderera. Iyi tsananguro yakasiyana nenyaya yekufambiswa kwemaerekitironi mumitochondria inoshandiswa kutengesa kuvandudzwa kwekuisa pfungwa pachinhu, uye uchapupu hwevanhu hunotsigira yekutanga zviri nani zvikuru kupfuura yechipiri.

Muyedzo mumwe wevanhu wakawana kuyeuka kuri nani

Mumuyedzo wa2014 muAmerican Journal of Psychiatry, vanhu vakuru 42 vaitya zvikuru nzvimbo dzakavharirwa vakapiwa 260 mg yemethylene blue kana placebo pakarepo mushure mezvirongwa zvitanhatu zvekutarisana nekutya, chimwe nechimwe chemaminitsi mashanu, mukamuri yakavharirwa. Kuyeuka mamiriro avakadzidziswa maari, kwakayedzwa mushure mezuva rimwe uye mushure memazuva 30, kwakanga kuri nani muboka rakapiwa mushonga.

Mugumisiro wekutya waienderana nemamiriro. Vatori vechikamu vakapedza chirongwa chekutarisana nekutya vasinganyanyi kutya vakaita zviri nani mwedzi gare gare kana vainge vapiwa methylene blue; avo vane zvirongwa zvakapera zvisina kumira zvakanaka vaiwanzova nemigumisiro yakaipa zvikuru. Saka chinhu chiri pedyo zvikuru nemugumisiro wakaratidzwa wekuyeuka mutsvakurudzo dzevanhu kuyeuka chiitiko chimwe chekudzidza murabhoritari, kwakavandudzwa apo mushonga wakapiwa mushure mechiitiko chacho. Gwaro rekurapa nekutarisana nezvinotyisa rinoongorora maitiro iwayo.

Kwawakatsvakwa asi ukasawanikwa

Muyedzo wakareba zvikuru wemethylene blue nekugona kufunga muvanhu wakatora mwedzi mitanhatu. Mutsvakurudzo yebipolar disorder yakagovera vanhu zvisina kurongwa uye ichivachinjanisa marapirwo, varwere 37 vainge vachitotora lamotrigine vakapiwa 15 mg sechiyero chekuenzanisa chaitaridzika sechinoshanda kana 195 mg sehuwandu hunoshanda. Zvibodzwa zvekuora mwoyo nekuzvidya mwoyo zvakavandudzika pahuwandu hukuru. Mushumo wechinyorwa chacho pamusoro pekugona kufunga mutsara mumwe chete: “Migumisiro yemethylene blue pazviratidzo zvekukanganisika kwekugona kufunga yakanga isina kukosha pakuverenga kwenhamba.”

Tsvakurudzo yakashandisa mushonga unoshanda muboka rekuenzanisa nokuti methylene blue inochinja ruvara rweweti, uye vanyori vakafunga kuti placebo isina chinhu chinoshanda yaisazokwanisa kuviga kuti munhu ari muboka ripi. Dambudziko iri rekuvanzira vanhu mapoka rinodzokororwa mundima iyi yose, uye gwaro rinotsanangura nei zvakaoma kuvanzira vanhu mapoka mumiedzo yemethylene blue rinobata zvarinoita pakududzira migumisiro inobva pane zvinonzwiwa kana kutaurwa nemunhu.

Miedzo mikuru zvikuru yekuyeuka muvanhu yakashandisa chinhu chakasiyana

Muyedzo mukuru zvikuru wemushonga wemhuri yemethylene blue pakurangarira waiva chirongwa cheAlzheimer's, uye hauna kushandisa methylene blue. Wakashandisa hydromethylthionine mesylate, chimiro chakareduzwa chemusimboti mumwe chete wephenothiazine chakadzikamiswa semunyu, chakagadzirwa kudzivisa kuungana kwetau. Muyedzo uchangobva kuitwa wechikamu 3 wakanyoresa vatori vechikamu 598 vane kuderera kuduku kwekugona kufunga kana dementia yeAlzheimer's yakapfava kusvika pakati nepakati munzvimbo 82, uye zviyero zvawo zviviri zvikuru zvemugumisiro pamavhiki 52 hazvina kuzadziswa. Chikonzero chakataurwa chinodzidzisa: boka rekuenzanisa rakavandudzika, izvo vanyori vanoti zvakakonzerwa nemushonga wekuenzanisa pachawo, 4 mg yemethylthioninium chloride kaviri pavhiki, yakasarudzwa sechinhu chisingashandi chinochinja ruvara rweweti kuti vanhu vasaziva mapoka avo. Musiyano une kukosha pakuverenga kwenhamba wakaoneka chete muboka duku raiva nekuderera kuduku kwekugona kufunga, pamavhiki 78 ne104, muongororo yekutanga kurapwa panguva dzakasiyana. Mushumo wechikamu 3 wakambobudiswa hauziwo chinyorwa chinotsanangurwa pano; mushumo wekare wechikamu 3 kubva muchirongwa chimwe chete wakawana migumisiro yawo ine kukosha pakuverenga kwenhamba kubva muongororo dzakagadziridzwa mapoka asati aburitswa pachena, dzichifananidza mapoka maduku aisina kugoverwa zvisina kurongwa uye aitora mushonga mumwe chete. Gwaro remiedzo yeAlzheimer's rinotsanangura zvinoratidzwa nemiedzo iyoyo.

Tsvakurudzo yakakodzera kutendwa yaizotaridzika sei

Muyedzo waigona kutsigira zvinotaurwa pamusoro pekuyeuka kana kuisa pfungwa pachinhu waizoda vanhu vakuru vane utano vasina dambudziko riripo rekugona kufunga, huwandu hwemushonga hunodzokororwa kwemavhiki, nzira yekuenzanisa inoviga kuti kapsuru ipi ine chii, migumisiro inotsvakwa yakatarwa pachine nguva, uye boka revatsvakurudzi rakazvimirira. Hapana pane izvozvo chisina musoro. Kungoti hazvisati zvaitwa.

Kana uchiri kufunga kuishandisa

Pfungwa mbiri dzekuchengeteka dzinotangira hurukuro ipi neipi yekubatsira kwayo. Methylene blue inodzivisa monoamine oxidase A, izvo zvinoreva kuti inofanira kutariswa pamwe chete nemishonga inonyorerwa yekuora mwoyo nemimwe mishonga inobata serotonin, uye chinonetsa iserotonin syndrome, kwete kungodyidzana kuduku kwemishonga. Haifaniriwo kushandiswa kana munhu aine kushomeka kweG6PD nokuda kweanaemia inokonzerwa nekuparara kwemasero matsvuku eropa. Gwaro rekuchengeteka negwaro rekudyidzana kwemishonga zvinoronga mibvunzo iyoyo maererano nemapoka emishonga.

Kana kuyeuka kana kuisa pfungwa pachinhu zvachinja zvechokwadi, danho rokutanga harisi chinhu chinowedzerwa pakudya. Chirwere chethyroid, kumira kwekufema panguva yekurara, kushomeka kweB12, kuora mwoyo, nemishonga yakawanda inonyorerwa zvinokonzera chiratidzo chaicho icho mushonga unotengwa kuti uvandudze kufunga unenge uchitsvakirwa kugadzirisa, uye gwaro reuchapupu hwethyroid rinoratidza kuti chikonzero chinorapika chinowanzovapo zvakadii.

Chinhu chakashandiswa chinhu chinogona kusiyana mutsvakurudzo dzose dziri pamusoro

Huwandu hwose hunotsanangurwa pano hwaiva huwandu hwakayerwa hwechinhu chakatarwa, kubva kumugadziri wemishonga, huine chitupa cheongororo chakabatanidzwa nacho. Bhodhoro rinobva kumutengesi asina kusimbiswa harina kudaro. Kutevedzera gwaro reUSP rinotsanangura mwero wechinhu ndiyo nzira inogona kutariswa nemutengi, uye chinhu chisingautevedzeri chingangove chemhando yekushandiswa pamachira, chinogona kuva netsvina yemakemikari ane kabhoni yakadai seAzure B, zvisaririra zvezvinonyungudutsa, nesimbi dzinorema pahuwandu hunoganhurirwa nezvinodiwa zvemhando yemishonga. Zvinoratidzwa nezvisingaratidzwi nezita reUSP zvinotsanangura mhando yacho pachayo.

Vatengesi vakawanda vanotsanangura chigadzirwa sechakayedzwa nebato rakazvimirira vanongotsvaga simbi dzinorema chete, vopa boka rimwe iroro rebvunzo sekunge richiratidza kutevedzera zvose zvinodiwa. Blupreme inoedza zvose zvinodiwa neUSP: kuzivikanwa kwechinhu, kuchena, tsvina yemakemikari ane kabhoni, zvisaririra zvezvinonyungudutsa, tsvina yezvinhu zvekemikari, zvisaririra mushure mekupiswa, miganhu yezvipenyu zvidukuduku, uye endotoxins dzemabhakitiriya. Boka rimwe nerimwe rezvigadzirwa rinotumirwa riine chitupa cheongororo, uye kuchiverenga zvakarurama kunoreva kufananidza nhamba yeboka nerabhoritari nebhodhoro rauinaro. Hapana pane izvozvo chinogadzira kubatsira kwekugona kufunga, uye chigadzirwa chisingakwanisi kupa magwaro anosimbisa kuti chii hachisi nzvimbo yakakodzera yokutanga kuedza zvinotaurwa nezvacho.

Mhedziso

Hapana muyedzo wakapa methylene blue kuvanhu vakuru vane utano ukaratidza kuti kuyeuka kana kuteerera kwavo kwakanga kuri nani kupfuura neplacebo. Muyedzo wa2016 wakachinja zviratidzo zveuropi, ukasiya nguva yekupindura isina kuchinja, uye ukawana kuvandudzika kwekurangarira kwakanga kusina kukosha pakuverenga kwenhamba pakafananidzwa mapoka. Chinyorwa chakafambidzana nawo hachina kunyora zvibodzwa zvebvunzo. Boka rakazvimirira rakawana kuyerera kweropa nekushandiswa kweokisijeni zvichiderera, kwete zvichikwira.

Mugumisiro wekugona kufunga muvanhu unotsigirwa neuchapupu unobva pakuvhiya, apo huwandu hwakapiwa nomutsinga kuvarwere vakwegura hwakaderedza mwero wekuvhiringidzika kwakanyanya mushure mekuvhiya neinenge hafu mumiedzo mitatu neongororo yakabatanidza migumisiro yayo. Icho chinhu chaicho chakawanikwa pamusoro pevarwere vanenge varwara zvakanyanya panguva iyoyo, uye ongororo huru yakazvimirira yakabatanidza uchapupu hwekudzivirira kuvhiringidzika kwakanyanya haina kusarudza mushonga uyu. Izvi zviduku zvikuru pane zviri kutaurwa pakutengesa, uye ndezvemuchipatara.

Mepu yemashandiro acho mumasero inotsanangura zvinoitwa nechinhu ichi mumienzaniso yerabhoritari, ongororo yeuchapupu hweADHD inotevera mubvunzo wekuteerera muvanhu vakaonekwa kuti vane mamiriro iwayo, uye raibhurari yetsvakurudzo inoronga tsvakurudzo dziri shure kwezvose zvinotaurwa papeji ino.