Chinyorwa
Methylene blue yemarwadzo mushure mekuvhiyiwa mamota epaburi rekumashure: zvinoratidzwa nemiedzo
Chiremba anovhiya anokurudzira kuvhiyiwa kubvisa mamota epaburi rekumashure. Murwere anonzwa izwi rimwe chete: marwadzo. Mubvunzo unokurumidza kutevera. Pane mushonga unoiswa panzvimbo iri kuvhiyiwa, panguva yekuvhiya, ungaita kuti vhiki yekutanga ive nyore here? Miedzo mitatu ine kupatsanurwa kwevarwere zvisina kurongwa inoongorora mushonga mumwe: methylene blue inobaiwa muganda rakapoteredza buri rekumashure panguva yekuvhiya. Muedzo mumwe nemumwe unoshuma marwadzo mashoma pakutanga kana methylene blue yashandiswa. Muedzo mumwe nemumwe une zvausingakwanisi kuratidza, izvo zvinoganhurira mashandisirwo emhedzisiro yacho.
Peji rino rinoenzanisa miedzo iyi mitatu padivi nepadivi. Rakanyorerwa vaverengi vemhando mbiri. Murwere anogona kurishandisa kugadzirira mibvunzo yekubvunza boka rinomuvhiya. Munyori anogona kurishandisa kutarisa zvakanyatsorekodhwa netsvakurudzo yemarwadzo epanzvimbo yakaitwa chirongwa chekurapa, zuva nezuva.
Zviri kuongororwa nemiedzo iyi, nezvisiri kuongororwa
Muedzo mumwe nemumwe wakatora vanhu vakuru vaivhiyiwa kubvisa mamota epaburi rekumashure nenzira yeMilligan-Morgan, kuvhiya kunobvisa mamota kuchisiya maronda akavhurika. Mumuedzo mumwe nemumwe, nyanzvi yezvekurapa yakaisa methylene blue pedyo nenzvimbo yakavhiyiwa murwere achiri pasi pemushonga wekutindivadza. Zvakayerwa zvaiva marwadzo mushure mekuvhiyiwa, kushandiswa kwemishonga yekuwedzera yekunyaradza marwadzo, uye matambudziko.
Hapana pamiedzo iyi mitatu wakaongorora kukwenya kusingaperi paburi rekumashure, kurapwa kwekutsemuka kwepaburi rekumashure, kana zviratidzo zvemamota zvisina kuvhiyiwa. Tsvakurudzo yekukwenya inongotaurwa sechikonzero chepfungwa iri kufungidzirwa yekuti mushonga unoshanda sei, kureva kuderedza kwechinguvana kunzwa kwetsinga dzepanzvimbo yacho, kwete sechinhu chakaedzwa. Muedzo wa2024 hauna kusanganisira vaiva nekutsemuka kana fistula panguva imwe chete. Muedzo wa2026 hauna kusanganisira vaiva nekutsemuka, fistula, bundu rehurwa, kana chimwe chirwere chematumbu. Kana zviyero zvemarwadzo zvichikuvhiringidza, nzira yekuverenga muedzo wemarwadzo inotsanangura VAS neNRS usati waenzanisa nhamba. Kukwenya nekutsemuka matambudziko akasiyana; ona kutsemuka kwepaburi rekumashure nemamiriro anokonzera kukwenya kuti unzwisise zviri kuongororwa.
Maitirwo emiedzo iyi mitatu
Nzira dzekushandisa mushonga dzakasiyana zvakakwana zvekuti hadzifaniri kubatwa sekushandiswa kumwe chete. Dosi guru rinopeta diki kagumi, uye nguva yekushandisa, rukoko rwenyama, neboka rekuenzanisa zvose zvakasiyana. Kuvhiyiwa ndeimwe nzira pakati penzira dzekurapa mamota epaburi rekumashure; miedzo iyi inongobata marwadzo mushure mekuvhiyiwa.
| Muedzo | Varwere vakaongororwa | Nzira yekushandisa methylene blue | Boka rekuenzanisa nekumwe kurapwa |
|---|---|---|---|
| Sim naTan 2014 | 67 (methylene blue 37, boka rekuenzanisa 30), kubviswa kwemamota nediathermy kuchisiya maronda akavhurika | 4 mL yemethylene blue ye1 percent (40 mg) yakasanganiswa ne16 mL yebupivacaine ye0.5 percent, yakabayiwa mukati meganda rakapoteredza buri rekumashure vasati vatanga kucheka nyama | Bupivacaine imwe chete pamwe nemvura ine munyu panzvimbo yedhayi yebhuruu; paracetamol yakajairwa pamwe nediclofenac zvakashumwa mukuunganidzwa kwechipiri kwemashoko |
| Azhough 2024 | 97 (methylene blue 48, boka rekuenzanisa 49), giredhi III kana IV, boka rimwe chete revanovhiya, kutindivadza kwepamusana | 5 mL yemethylene blue ye1 percent (50 mg) yakaiswa munzvimbo shanu mukati meganda, 1 mL panzvimbo imwe neimwe, anenge 2 cm kubva pamucheto weronda, mushure mekubvisa mamota | 5 mL yebupivacaine ye0.5 percent mushure mekubvisa mamota; ketorolac nenguva dzakarongwa, tramadol yekuwedzera kana marwadzo achida, kozoti naproxen pamwe neacetaminophen necodeine pakubuda muchipatara |
| Zhu 2026 | 60 (30 muboka rimwe nerimwe), mamota emukati neekunze akabatana, chiremba anovhiya mumwe chete, kutindivadza kwepazasi pemusana | Methylene blue yakaderedzwa kusimba kusvika pa0.1 percent (1 mL ye1 percent pamwe ne9 mL yemvura ine munyu), 0.5 kusvika 1 mL paronda rimwe nerimwe ichiparadzirwa sechimiro chefeni pamwe nekukwizwa kwenguva pfupi, huwandu hwose 5 mL kana pasi (5 mg kana pasi), mushure mekubvisa mamota | Hapana jekiseni repanzvimbo; lornoxicam 8 mg kana murwere aikumbira, paine maawa angangoita 6 kana kupfuura pakati pemadosi |
Zvinhu zviviri zvemagadzirirwo emiedzo zvakakosha. Chekutanga, miedzo ya2014 na2024 inoenzanisa dhayi nebupivacaine inobaiwa munyama, saka musiyano upi zvawo unoratidza kuwedzera kunounzwa nedhayi pamusoro pemushonga wekutindivadza panzvimbo, asi muedzo wa2026 unoenzanisa dhayi nekusabaiwa jekiseni repanzvimbo. Chechipiri, kuvanza kuti murwere ari muboka ripi kunova kusina kusimba pose panooneka ruvara rwebhuruu. Vanyori va2026 vanoti kuchinja kweruvara rwenyama neweti kwakaita kuti kuvanza mapoka zvakanaka kusakwanisika, zvichisiya zviyero zvemarwadzo zvinotaurwa nevarwere zvichigona kurerekera kune rimwe divi.
Marwadzo pazuva rimwe nerimwe mushure mekuvhiyiwa
Maitiro anowanikwa mumiedzo yose ndeekuti mapoka anosiyana pakutanga, ozoswedera pamwe chete. Muedzo mumwe nemumwe unoshandisa chiyero chakasiyana, saka verenga mumwe nemumwe maererano nechiyero chawo. Nzira dzinoshandiswa zvakajairwa dziri mukudzora marwadzo mushure mekuvhiyiwa, izvo zvinobata mishonga yekunyaradza marwadzo yakajairwa nemagadzirirwo ekushandisa mishonga yekuwedzera.
Mumuedzo une kupatsanurwa kwevarwere zvisina kurongwa uye kuvanza mapoka kudivi rimwe chete wemethylene blue inobaiwa mukati meganda mushure mekubviswa kwemamota nediathermy kuchisiya maronda akavhurika, varwere vaichengeta bhuku vachishandisa chiyero chemarwadzo chemutsara unooneka. Avhareji yemarwadzo yaiva yakaderera zvakakosha pachiverengero nemethylene blue pamazuva 1 kusvika 3 mushure mekuvhiyiwa, pamwe nekushandiswa kushoma kweparacetamol panguva iyoyo, uye pasina kubatsira kwakakosha pachiverengero mushure mezuva 3. Avhareji chaidzo hadziwanikwi muchidimbu chechinyorwa chinokwanisa kuverengwa, saka wongororo ino haigadziri nhamba dzezuva rimwe nerimwe.
Mumuedzo unovanza mapoka kumativi maviri wemethylene blue inobaiwa mukati meganda mushure mekubviswa kwemamota, varwere vainyora marwadzo avo makurusa pazuva rimwe nerimwe panguva yekurara vachishandisa chiyero chine nhanho 11 kubva pa0 kusvika pa10, kwemazuva 14. Musiyano waiva wakakosha pachiverengero pamazuva 1 kusvika 7, p iri pasi pe0.001 zuva rimwe nerimwe, uye usina kukosha pachiverengero pamazuva 8 kusvika 14:
- Zuva 1: methylene blue 4.08 kuwedzera kana kubvisa 1.23, boka rekuenzanisa 5.20 kuwedzera kana kubvisa 1.40.
- Zuva 2: methylene blue 3.94 kuwedzera kana kubvisa 1.17, boka rekuenzanisa 5.22 kuwedzera kana kubvisa 0.87.
- Zuva 3: methylene blue 3.90 kuwedzera kana kubvisa 1.10, boka rekuenzanisa 5.02 kuwedzera kana kubvisa 0.95.
- Zuva 4: methylene blue 3.71 kuwedzera kana kubvisa 1.25, boka rekuenzanisa 4.71 kuwedzera kana kubvisa 1.21.
- Zuva 5: methylene blue 3.60 kuwedzera kana kubvisa 1.27, boka rekuenzanisa 4.67 kuwedzera kana kubvisa 1.21.
- Zuva 6: methylene blue 3.46 kuwedzera kana kubvisa 1.27, boka rekuenzanisa 4.31 kuwedzera kana kubvisa 1.21.
- Zuva 7: methylene blue 3.35 kuwedzera kana kubvisa 1.27, boka rekuenzanisa 3.92 kuwedzera kana kubvisa 1.21.
- Mazuva 8 kusvika 14: mapoka ose ari maviri anodzikira achisvika panenge pa2.5 kusvika 3.5, pasina musiyano wakakosha pachiverengero pakati pemapoka pazuva ripi zvaro remazuva aya epashure (p dzose dziri pamusoro pe0.2).
Mutsvakurudzo ya2026 ine kupatsanurwa kwevarwere zvisina kurongwa yekubaya methylene blue yakaderedzwa kusimba munyama mushure mekuvhiyiwa kweMilligan-Morgan, marwadzo pakuzorora pachiyero chinooneka che0 kusvika 10 aiva akaderera nemethylene blue pamaawa 6, 24, 48, ne72, p iri pasi pe0.001 panguva imwe neimwe. Avhareji chaidzo dzinongoratidzwa pagirafu, kwete mutafura yenhamba, saka wongororo ino inoshuma maitiro acho isingashanduri kureba kwemitsara yegirafu kuita nhamba dzinoita sedzakarurama zvakanyanya asi dzisiri.
Mishonga yekuwedzera yekunyaradza marwadzo
Kushandiswa kwemishonga yekuwedzera ndiko kunosiyana miedzo pamhando yekushuma mashoko.
Muedzo wa2014 unoshuma kushandiswa kweparacetamol kwakaderera zvakakosha pachiverengero nemethylene blue pamazuva 1 kusvika 3, zvichienderana nenguva yawaideredza marwadzo, asi chidimbu chechinyorwa chinokwanisa kuverengwa hachipi huwandu, zvikamu zvevarwere, kana p chaiyo.
Muedzo wa2024 wakaronga ketorolac yenguva dzakatarwa pamwe netramadol yekuwedzera uye kurekodha mapiritsi aishandiswa kumba, asi mhedzisiro yakaburitswa haishumi kushandiswa kwemishonga muboka rimwe nerimwe. Kusavapo kwemashoko iwayo chinhu chinoonekwa pachacho: chiratidzo chekunyaradzwa kwemarwadzo chinotsamira pazviyero zvemarwadzo chete.
Muedzo wa2026 ndiwo unopa mashoko akajeka kupfuura mimwe pano. Huwandu hwose hwelornoxicam mumaawa 72 hwaiva neavhareji ye22.67 kuwedzera kana kubvisa 17.01 mg nemethylene blue, zvichienzaniswa ne56.80 kuwedzera kana kubvisa 9.32 mg muboka risina kubaiwa jekiseni, p iri pasi pe0.001. Cherechedza kusafanana uku: boka rekuenzanisa raipiwa mushonga wekunyaradza marwadzo chete kana rakumbira, asi boka redhayi raiwana kurapwa kumwe chete panguva yekuvhiya.
Matambudziko nekutevera varwere
Hapana muedzo unoshuma chiratidzo chikuru chedambudziko rekuchengeteka panzvimbo yakarapwa, asi hapana wakagadzirirwa kuona kukuvara kusingawanzoitiki kana kunoitika gare gare. Kuti unzwisise njodzi, ona mashoko ekuchengeteka kwemethylene blue pamwe chete nematafura ematambudziko ari pasi apa.
Chidimbu chemuedzo wa2014 chinosimbisa mhedzisiro imwe inokwezva kutariswa: reshiyo yenjodzi yekutadza kubudisa weti kamwe kamwe pakasashandiswa methylene blue yaiva 2.32, ne95 percent confidence interval kubva pa1.75 kusvika pa3.07. Kuwanda kwemamwe matambudziko hakuna kusiyana zvakakosha pachiverengero.
Muedzo wa2024 unoshuma matambudziko pamazuva 14. Kutadza kubudisa weti kwakaitika mu5 ve48 vakapiwa methylene blue uye 5 ve49 veboka rekuenzanisa. Kutadza kudzora kubuda kwetsvina kwechinguvana kwakaitika mu3 zvichienzaniswa ne1, uye kubuda ropa kwepashure mu0 zvichienzaniswa ne2. Kufa kweganda, utachiona, kuita kweganda panzvimbo pakurapwa, nekutetepa kweburi zvaiva zero mumapoka ose ari maviri, uye kukwenya kwakaitika kamwe chete muboka rimwe nerimwe. Hapana musiyano wakasvika pakukosha pachiverengero.
Muedzo wa2026 unongoshuma maawa 72 chete. Utachiona hweganda nenyama iri pasi paro yakapoteredza buri rekumashure, kufa kweganda, nekugwamba kweropa kwakapoteredza buri rekumashure zvaiva zero mumapoka ose ari maviri. Haupi nhamba dzakaunganidzwa zvine hurongwa dzekutadza kubudisa weti, kubuda ropa, utachiona, kutadza kudzora kubuda kwetsvina, kunonoka kupora, kana kudzoka kwemamota. Kuva kwebhuruu kwenyama neweti kunobvumwa sedambudziko rekuvanza mapoka, kwete kunyorwa mutafura sechiitiko.
Nguva yekutevera varwere ndiyo muganhu mukuru mumiedzo yose mitatu: anenge mazuva 14 mumiedzo miviri yekutanga uye maawa 72 mune wechitatu. Kunonoka kupora, kugona kudzora kubuda kwetsvina kwemwedzi yakawanda, nekudzoka kwemamota hazvigoni kutongwa nemashoko aya.
Tafura yehumbowo pazuva rimwe nerimwe mushure mekuvhiyiwa
Tafura iri pasi apa inounganidza mashoko makuru epeji rino. Inoratidza marwadzo, kushandiswa kwemishonga yekuwedzera, mapoka ekuenzanisa, matambudziko, nekutevera varwere pamwe chete.
| Muedzo | Chiratidzo chemarwadzo pazuva rimwe nerimwe | Mishonga yekuwedzera yekunyaradza marwadzo | Musiyano neboka rekuenzanisa | Matambudziko | Kutevera varwere |
|---|---|---|---|---|---|
| Sim naTan 2014, n yakaenzana ne67 | VAS yakaderera nemethylene blue pamazuva 1 kusvika 3; hapana musiyano wakakosha pachiverengero mushure mezuva 3; avhareji chaidzo hadzisi muchidimbu chinokwanisa kuverengwa | Paracetamol yakashandiswa zvishoma nemethylene blue pamazuva 1 kusvika 3; huwandu hahuna kupiwa | Methylene blue pamwe nebupivacaine zvichienzaniswa nebupivacaine pamwe nemvura ine munyu; zvinoparadzanisa kuwedzera kunounzwa nedhayi | Reshiyo yenjodzi yekutadza kubudisa weti 2.32 pasina methylene blue; zvimwe zviitiko hazvina kusiyana zvakakosha pachiverengero | Bhuku remarwadzo remazuva anenge 14 |
| Azhough 2024, n yakaenzana ne97 | NRS yemarwadzo makurusa ezuva yakaderera nemethylene blue pamazuva 1 kusvika 7 (musiyano uri pedyo ne1.1 pakutanga, 0.6 pazuva 7); hapana musiyano pamazuva 8 kusvika 14 | Nzira yakatarwa asi kushandiswa muboka rimwe nerimwe hakuna kushumwa | Methylene blue 50 mg zvichienzaniswa nebupivacaine; zvinoparadzanisa kuwedzera kunounzwa nedhayi | Kutadza kubudisa weti 5 zvichienzaniswa ne5; kutadza kudzora kubuda kwetsvina kwechinguvana 3 zvichienzaniswa ne1; kubuda ropa 0 zvichienzaniswa ne2; kufa kwenyama neutachiona 0 zvichienzaniswa ne0; hapana wakakosha pachiverengero | Mazuva 14 |
| Zhu 2026, n yakaenzana ne60 | VAS pakuzorora yakaderera nemethylene blue pamaawa 6, 24, 48, 72, p iri pasi pe0.001 panguva imwe neimwe; avhareji dziri pagirafu chete | Huwandu hwose hwelornoxicam 22.67 zvichienzaniswa ne56.80 mg, p iri pasi pe0.001 | Methylene blue yakaderedzwa kusimba 5 mg kana pasi zvichienzaniswa nekusabaiwa jekiseni; ndiwo musiyano mukuru pamagadzirirwo emapoka | Utachiona hweganda nenyama iri pasi paro, kufa kwenyama, kugwamba kweropa 0 zvichienzaniswa ne0; kutadza kubudisa weti, kubuda ropa, kupora, kudzoka kwemamota hazvina kushumwa zvine hurongwa | Maawa 72 |
Zvazvinoreva pakukurukura nachiremba anovhiya
Miedzo mitatu midiki yakaitwa panzvimbo imwe neimwe, ichishandisa madosi matatu akasiyana edhayi ichiaenzanisa nemhando mbiri dzakasiyana dzemapoka ekuenzanisa, inobvumirana kuti marwadzo anova mashoma mumazuva ekutanga mushure mekubviswa kwemamota kana methylene blue yawedzerwa panguva yekuvhiya. Chiratidzo chakatora nguva refu kupfuura zvimwe chakagara mazuva 7. Mashoko ekushandiswa kwemishonga yekuwedzera anotsigira maitiro aya mumiedzo miviri uye haawanikwi mune wechitatu. Kutevera varwere kwenguva pfupi nemapoka madiki hazvigoni kuratidza kuti hapana zvinogona kuitika zvisingawanzoonekwa kana zvinozoitika gare gare.
Mibvunzo yakakodzera kubvunza chiremba anovhiya:
- Ndeipi nzira yekuvhiya yakarongwa, uye ndedzipi nzira dzekurapa panzvimbo dzinotoshandiswa nguva dzose ipapo?
- Pane kubayiwa kwedhayi yebhuruu munyama kunopiwa here, nedosi ripi uye murukoko rwupi, uye ichienzaniswa neimwe nzira ipi?
- Ndeipi mishonga yakajairwa neyekuwedzera yekunyaradza marwadzo yakarongwa, uye kushandiswa kwayo kunorekodhwa sei?
- Kutadza kubudisa weti, kubuda ropa, utachiona, nekugona kudzora kubuda kwetsvina zvinoteverwa sei, uye kwemavhiki mangani?
- Kuva kwebhuruu kweganda kana weti kwechinguvana kunotarisirwa kutaridzika sei, uye kunopera rini?
Kune vanyori vari kuongorora tsvakurudzo yemarwadzo anokonzerwa nezvirongwa zvekurapa, rondedzero yezvekutarisa ipfupi: kusimba chaiko kwemushonga, vhoriyamu, nedosi rose; rukoko rwenyama nenguva yekushandisa zvichienderana nekubviswa kwenyama; mushonga unoshanda uri mujekiseni reboka rekuenzanisa; mishonga yekunyaradza marwadzo yakajairwa inopiwa nenguva dzakarongwa kana pakukumbirwa; huwandu hwemishonga yekuwedzera muboka rimwe nerimwe; zviyero zvemarwadzo zvinotaurwa pazuva rimwe nerimwe; uye tafura yematambudziko ine nhamba dzevarwere dzakavakirwa pairi nenguva yekutevera varwere. Pasina mashoko iwayo, chirevo chakabatanidzwa pamusoro pedosi hachitsigirwi, nokuti dhayi ye50 mg inobaiwa mukati meganda ichienzaniswa nebupivacaine nedhayi ye5 mg inobaiwa pasi peganda ichienzaniswa nekusashandiswa kwechimwe chinhu inzira dzakasiyana dzekurapa.