Chinyorwa
Methylene blue mukurapa: mashandisirwo akatenderwa neari kuongororwa
Methylene blue ine mashandisirwo akasimbiswa mukurapa, asi mvumo inopihwa kune chimwe chigadzirwa nechinangwa chakatarwa chekuchishandisa. Mushonga unopiwa nejekiseni kurwisa muchetura, piritsi rakagadzirirwa kuisa ruvara muura hukuru, uye mushonga wekumedza uchiri kuedzwa inzira dzakasiyana dzekupindira mukurapa, kunyange zviine makemikari ane ukama.
MuUnited States, ruzivo rwekunyora mushonga weProvayBlue runodoma methemoglobinemia inowanikwa mushure mekuzvarwa sechinangwa chayo chekurapa kuvakuru nevana. European Union inotenderawo mamwe magadzirirwo, Lumeblue, kuvandudza kuoneka kwezviri muura hukuru pakuongororwa necolonoscopy. Hapana pamvumo idzi inosimbisa kuti madonhwe emethylene blue anotengeswa muzvitoro anorapa chirwere chisina ukama nezvinangwa izvi.
Verengai zvikamu zvemvumo neuchapupu zvakasiyana
Kushandiswa kwakatenderwa kunoreva kuti mvumo yechigadzirwa chakadomwa inosanganisira chinangwa, nzira yekupihwa, neboka revarwere zvakatsanangurwa. Kushandiswa kunze kwezvakanyorwa pamushonga kunoreva kuti mushonga wakatenderwa unoshandiswa nenzira isiri pane zvakanyorwa pamusoro pawo. Kushandiswa kuri kuongororwa kunoreva kuti vatsvakurudzi vari kuongorora mashandisirwo acho. Mashandisirwo anogona kunge ari kunze kwezvakanyorwa pamushonga mukurapa uye achiri kuongororwa mumiedzo.
Tsananguro idzi pachadzo hadziratidzi kusimba kweuchapupu. Muedzo mudiki unogona kupa chiratidzo chinobatsira pasina kusimbisa kubatsira mukushandiswa nguva dzose. Ukuwo, mushonga wakasimbiswa wekurwisa muchetura pachiitiko chekukurumidzira chisingawanzoitiki unogona kutsigirwa neruzivo rwekurapa rwakaunganidzwa nemapoka ezviitiko zvevarwere, kwete nemiedzo mikuru inodzorwa nekuenzanisa nemushonga usina chinoshanda inotarisirwa pazvirwere zvinogara kwenguva refu.
Tafura iri pasi inoongorora zvinyorwa zvezvigadzirwa zvakadomwa zveUS, EU, neUK sezvazvaive musi wa12 Gunyana 2026. Inopa gwara rekunzwisisa mashandisirwo mukurapa, kwete rondedzero yakazara yechigadzirwa chose munyika imwe neimwe. Pamitsara yetsvakurudzo, “kunze kwezvakanyorwa pamishonga zvakaongororwa” zvinoreva mishonga yemethylene blue yakadomwa pamusoro, kwete kutaura nezvemvumo munzvimbo dzose kana mvumo yezvishandiso zvose.
Tafura yemashandisirwo mukurapa
| Mashandisirwo | Nzvimbo ine mitemo yayo nemvumo | Nzira yekupihwa nemagadzirirwo | Uchapupu kubva kuvanhu nemiganhu yahwo |
|---|---|---|---|
| Methemoglobinemia inowanikwa mushure mekuzvarwa | US: ProvayBlue yakatenderwa neFDA kuvakuru nevana. | Mumutsinga, mvura yemushonga ye5 mg/mL isina utachiona. | Kurapa oxidation yehemoglobin isina kujairika kunotsigirwa nezvakanyorwa pamushonga; izvi hazvisimbisi kurapwa kwekuneta kwakajairika kana chirwere chemapapu. |
| Methemoglobinemia inokonzerwa nemishonga kana makemikari | EU: Proveblue yakatenderwa kurapa zviratidzo zvinongoerekana zvaitika, kusanganisira muvana. | Mumutsinga, jekiseni re5 mg/mL. | Chinangwa chakatsigirwa chekurwisa muchetura chine zvirambidzo zvakanangana nechigadzirwa. Chirwere chinovapo pakuzvarwa hachisi icho chinangwa chakataurwa pano. |
| Methemoglobinemia inokonzerwa nemishonga kana makemikari | UK: inosanganisirwa muSmPC yeProveblue, kuvakuru nevana. | Mumutsinga, jekiseni re5 mg/mL. | Ruzivo rwechigadzirwa muUK runotsanangura kupihwa kwemushonga nekutarisiswa kwevarwere nenyanzvi dzekurapa; dzimwe nzira dzekupihwa hadzitsivanisi iyi. |
| Kuita kuti nzvimbo dzisina kujairika muura hukuru nerectum dzioneke | EU: Lumeblue yakatenderwa pacolonoscopy yevakuru yekutsvaga zvirwere kana yekutevera mamiriro azvo. | Mapiritsi ekumedza e25 mg anoburitsa mushonga zvishoma nezvishoma, akagadzirirwa kuuburitsa muura hukuru. | Ongororo yekuenzanisa yakavandudza kuwanikwa kweadenoma/carcinoma. Ichi chinhu chinobatsira pakuongorora chirwere, kwete kurapa gomarara. |
| Vasoplegia mushure mekuvhiyiwa kwemwoyo | US/EU/UK: kunze kwezvakanyorwa pamajekiseni zvakaongororwa; kushandiswa nenyanzvi kunze kwezvakanyorwa pamushonga. | Methylene blue yemumutsinga maererano nemaitiro akatarwa muzvipatara. | Levin nevamwe vakapatsanura varwere 56 vane vasoplegia mushure mekuvhiyiwa mumapoka nechisarudzo chemukana. Miedzo midiki ine chokuita nemapoka akasarudzwa evarwere vakavhiyiwa, kwete zvikonzero zvose zveBP yakaderera. |
| Kuvhunduka kwemuviri kunokonzerwa nesepsis | US/EU/UK: kunze kwezvakanyorwa pamishonga zvakaongororwa; mushonga wekuwedzera uri kuongororwa. | Mvura yemushonga yemumutsinga inowedzerwa pakurapwa kwakajairika kwevarwere vanoda kutarisirwa zvakanyanya. | Muedzo wevarwere 91 vakapatsanurwa mumapoka nechisarudzo chemukana wakapfupisa nguva yekurapwa nemishonga inokwidza BP; mwero werufu wakanga wakafanana. |
| Kukanganisika kweuropi kwakabatana neifosfamide | US/EU/UK: kunze kwezvakanyorwa pamishonga zvakaongororwa; kurapa kana kudzivirira nenyanzvi kunze kwezvakanyorwa pamushonga. | Methylene blue yemumutsinga mumashandisirwo akarondedzerwa mukurapa gomarara. | Pelgrims nevamwe vakarondedzera zviitiko 12, vasere vacho vachirapwa nemethylene blue. Kupora kusingabvi mumuedzo une mapoka akapatsanurwa nechisarudzo chemukana hakugoni kusimbisa zvakakonzerwa nemushonga. |
| Kutsvaga nekutaridza ma lymph node anotanga kugamuchira lymph kubva panzvimbo iri kuongororwa | US/EU/UK: kunze kwezvakanyorwa pamishonga yekurwisa muchetura zvakaongororwa; kushandiswa mumaitirwo ekurapa kunoda chigadzirwa chakakodzera uye ongororo yepanzvimbo. | Kubaya mvura yedhayi yekuvhiya munyama yepanzvimbo; kwete kupa mushonga wekurwisa muchetura mumuviri wose. | Ongororo yekuenzanisa muUK yakatevera varwere 329 yakaongorora kuwanikwa kwema lymph node nedhayi chete kana nedhayi pamwe nechinhu chinoteverwa nemwaranzi. Kururama kwacho kunoenderana nemaitirwo acho. |
| Zvigadzirwa zvinosanganisa mishonga yezviratidzo zvine chokuita neweti | US: chinyorwa cheUribel Tabs chakaongororwa chinoratidza mushonga usina kutenderwa, kunyange zvazvo chakanyorwa semushonga unopihwa netsamba yachiremba. | Mapiritsi ekumedza ane zvinhu zvakawanda, kusanganisira methylene blue nezvimwe zvinoshanda. | Kuiswa kwechinyorwa chemushonga parondedzero hakusi kutenderwa neFDA. Zvinotaurwa pamusoro pechigadzirwa chine mishonga yakasanganiswa hazvigoni kusimbisa kuti methylene blue yoga inorapa utachiona. |
| Tsvakurudzo yekuyeuka nekushanda kwetsinga | US/EU/UK: kunze kwezvakanyorwa pamishonga yemethylene blue zvakaongororwa; kuri kuongororwa. | Methylene blue yekumedza mumiedzo mipfupi; magadzirirwo akasiyana emethylthioninium mumiedzo yedementia. | Muedzo wevanhu 26 vane utano vakazvipira wakayera kuchinja kwenguva pfupi mukuita mabasa nemifananidzo yekuongorora. Hauna kuedza kurapa dementia kana kubatsira kunogara mumabasa emazuva ose. |
| Kuderedza kutapurirana kwemarariya | Muedzo muMali; hachisi chinangwa chiri mune zvakanyorwa pamishonga zveUS/EU/UK zvakaongororwa. | Methylene blue yekumedza yakawedzerwa pamusanganiswa wakatarwa wemishonga yemarariya. | Muedzo wechikamu 2 une vatori vechikamu 80 wakaongorora kutapurirwa kweumhutu muvanhurume vane G6PD yakajairika vane utachiona husina zviratidzo. Zvakawanikwa hazvisimbisi kushandiswa kwayo yoga kurapa marariya yakakomba. |
| Kurapa nyama dzakakomberedza mazino uchishandisa chiedza chinomutsa dhayi | Muedzo muIraq; hachisi chinangwa chiri mune zvakanyorwa pamishonga inoshanda mumuviri wose zvakaongororwa. Mamiriro emvumo yechishandiso kana magadzirirwo anoshandiswa panzvimbo anoda kusimbiswa zvakasiyana. | Methylene blue inoiswa panzvimbo pamwe nechiedza chinoimutsa, ichiperekedza kurapa kwekuchenesa nezvishandiso. | Muedzo wevarwere 18 wakaenzanisa mativi akasiyana emuromo mumunhu mumwe wakarondedzera kuvandudzika kwenyama dzakakomberedza mazino. Nzvimbo 332 dzakayerwa dzaive dzisiri varwere 332 vakasiyana. |
Nei nzira yekupihwa ichichinja mubvunzo wekurapa
Mumethemoglobinemia, iron iri muhemoglobin inenge yaitwa oxidation kubva pachimiro chayo chinoshanda cheferrous, Fe²⁺, kuenda kuferric iron, Fe³⁺. Methylene blue inotora chikamu munzira yereduction inobatsira kudzorera hemoglobin pachimiro chinoshanda. Tsananguro yemashandiro emushonga weProveblue inotsanangura kuchinja uku. Chinangwa chekurapa idambudziko chairo riri muropa, kwete kushomeka kwesimba kwose kwose. Tsananguro yedu yekurapwa kwemethemoglobinemia muchipatara inotevera musiyano uyu zvakadzama.
Lumeblue inoshandisa chimwe chimiro: kuisa ruvara. Chifukidzo chayo chinononotsa kuburitswa kwemushonga kuitira kuti dhayi ikwanise kuisa ruvara pachikamu chemukati cheura pakugadzirira kuongororwa. Pfupiso yeongororo yeEMA inorondedzera kuwanikwa mu56% zvichienzaniswa ne48% yevatori vechikamu mukuenzanisa kukuru. Kubatsira kwakayerwa kwaiva kuwana nzvimbo dzisina kujairika, zvakasimbiswa nekuongororwa kwenyama. Kwakanga kusiri kuderera kwebundu kana kuderera kwakaonekwa kwenzufu dzegomarara.
Musiyano iwoyo unotsanangurawo kuti nei jekiseni redhayi rekuvhiya rinopihwa panzvimbo, mvura yekumedza, nemushonga wemumutsinga zvisingagoni kutsivaniswa nekungofananidza huremu hwedhayi. Nzvimbo inosvika mushonga, kusava neutachiona, maitiro ekuburitsa mushonga, nemaitirwo ekurapa ndizvo zvinotara zvinoitwa nechigadzirwa. Mashoko akadzama ari mumajekiseni nemagadzirirwo emishonga yemumutsinga uye mashandisirwo pakuvhiya nepakuongorora zvirwere.
Zvinonyatsosimbiswa nezvakawanikwa zvinovimbisa mumiedzo
Muedzo wekuvhunduka kwemuviri kunokonzerwa nesepsis unopa muenzaniso unobatsira wekuverenga zvinopfuura musoro wenyaya unoratidza kubudirira. Waiva muedzo wakaitwa panzvimbo imwe, uchienzaniswa nemushonga usina chinoshanda, umo methylene blue yakawedzerwa pakutanga pakurapa kwaitovepo. Nguva yepakati kusvikira mishonga inokwidza BP yagona kumiswa yaiva maawa 69 nemethylene blue zvichienzaniswa nemaawa 94 nemushonga usina chinoshanda. Mwero werufu nenguva yekushandisa muchina unobatsira kufema zvakanga zvakafanana. Izvi zvinotsigira kuenderera mberi nekuongorora kana ichideredza kudiwa kwemishonga inokwidza BP; hazviratidzi kubatsira pakurarama. Miedzo yevasoplegia nekuvhunduka kwemuviri kunokonzerwa nesepsis inoda kududzirwa zvakasiyana nokuti varwere vayo nezvikonzero zvekutadza kutenderera kweropa zvinosiyana.
Tsvakurudzo yezvetsinga inowedzera dambudziko remagadzirirwo emushonga. Muedzo weLMTM wechikamu 3 une vatori vechikamu 891 wakaongorora leuco-methylthioninium bis(hydroxymethanesulfonate), magadzirirwo emethylthioninium ari muchimiro chereduction, kwemwedzi 15 muvanhu vane chirwere cheAlzheimer chiri pakati pekureruka nepakati. Ongororo huru dzakatemerwa pamberi hadzina kuwana kubatsira pakufunga kana pamabasa emazuva ose pamiyero yakakwira yakaedzwa zvichienzaniswa neboka rekuenzanisa rakapiwa mwero wakaderera. Kududzirwa kwezvakawanikwa mumapoka madiki hakutsivi mhedziso huru iyoyo, uye magadzirirwo aya haasi bhodhoro rakajairika remethylene blue.
Uyu muedzo mumwe chete muchirongwa chetsvakurudzo chiri kuenderera mberi, kwete mutongo pamusoro pemakemikari ose kana ongororo dzose dzakazouya. Verengai ongororo yemuedzo weAlzheimer kuti muone uchapupu huri kuchinja. Kungwarira kwakafanana kunoshandawo kutsvakurudzo yegomarara: kuuraya masero akakuriswa murabhoritari, kuvandudza chiyero chinobva pamifananidzo yekuongorora, uye kubatsira varwere kurarama kwenguva refu zvinhu zvakasiyana zvinowanikwa mutsvakurudzo.
Kuchengeteka chikamu chemagadzirirwo emushonga, kwete chinhu chinongotarisiswa choga
Zvakanyorwa pajekiseni reUS zvinoyambira nezveserotonin syndrome yakakomba kana richishandiswa nemishonga ine chokuita neserotonin nemaopioid, zvinorambidza kushandiswa kana paine kushomeka kweG6PD, uye zvinotsanangura kukanganiswa kwezviyero zvepulse oximeter. Izvi zvikonzero zvinobatika zvinoita kuti nyanzvi dzekurapa dziongorore rondedzero chaiyo yemishonga nemamiriro ezvawanikwa murabhoritari. Chiyero cheokisijeni chinoratidzika kunge chaderera mushure mekupihwa mushonga hachiratidzi pachacho kuti kuendeswa kweokisijeni kwanyanya kuipa.
SmPC yeUK inotsanangurawo zvirambidzo pakuiswa muchetura nechlorate nepane mamwe mamiriro ane chokuita nenitrite. Saka “mushonga wekurwisa muchetura” hazvirevi kuti wakakodzera muchetura wose. Kutadza kufema zvakanyanya, kudonha, kana kuvhiringidzika kunongoerekana kwaitika kunoda kuongororwa nokukurumidza, kwete kuedza dhayi yebhuruu kumba.
Pakurapa kuri kufungwa nezvako, tangai maziva chigadzirwa chaicho, nzira yekupihwa, chirwere chakaonekwa, nemhedzisiro inotarisirwa. Uyai nemashoko iwayo kurondedzero yezvinofanira kubvunzwa pakukurukura nenyanzvi yekurapa uye verengai gwara remigumisiro isingadiwi nezvirambidzo zvekushandisa. Mubvunzo unobatsira ndewekuti uchapupu hunotsigira here nzira iyoyo chaiyo yekupindira mumamiriro iwayo chaiwo.