Chinyorwa
Methylene blue nePOTS: nei mashandiro mutsinga dzeropa asingasimbisi kuti mushonga unorapa
Methylene blue haisi mushonga wakasimbiswa wekurapa postural orthostatic tachycardia syndrome, kana kuti POTS. Pakutsvaga zvinyorwa zvechinyorwa chino, hapana ongororo yekurapa ine boka rekuenzanisa yakawanikwa ichiratidza kuti inovandudza zviratidzo zvePOTS kana kugona kuita mabasa ezuva nezuva. Zvidzidzo zveseptic shock nezvetsinga dzeropa dziri kuedzwa zvinopindura mibvunzo yakasiyana.
Pfungwa inokwezva ndeyekuti POTS ine chekuita nekutenderera kweropa, methylene blue inogona kupikisa mamwe masaini anoita kuti tsinga dzeropa dzizorore, saka methylene blue inofanira kuvandudza POTS. Danho rimwe nerimwe rinoda kuongororwa. Zvinoitwa nemushonga pane imwe nzira yekushanda kwetsinga dzeropa hazvisimbisi kuti nzira iyoyo ndiyo inokonzera zviratidzo zvemunhu, kana kuti kuishandura kuchamubatsira kumira asinganzwi kusagadzikana.
Zvinofanira kutanga zvasiyaniswa
Kusakwanisa kutsungirira kuva wakatwasuka zvinoreva zviratidzo zvine chekuita nekuva wakatwasuka. POTS ndeimwe yemhando dzakatsanangurwa mukati medambudziko iri rakakura. Dysautonomia yakatopamhama kupfuura izvi, ichireva kusagadzikana kwekudzora mabasa emuviri anoitika otomatiki; hairevi maitiro mamwe chete eBP.
Tsananguro yePOTS yakabvumiranwa nenyanzvi dzeNIH inotsanangura kuwedzera kunoramba kuripo kwekurova kwemwoyo kunosvika kanenge 30 paminiti mukati memaminitsi 10 munhu ari wakatwasuka, kana kanenge 40 kune vane makore 12–19, pamwe chete nezviratidzo zvinogara zviripo pakutwasuka, kuvandudzika pakurara pasi, uye kusavapo kweorthostatic hypotension inoramba iripo. Zviratidzo zvinofanira kunge zvagara kwemwedzi inokwana mitatu, uye zvimwe zvinogona kutsanangura kurova kwemwoyo nekukurumidza zvinofanira kubviswa. Kuverengwa kwewachi chete hakugoni kusimbisa mubatanidzwa iwoyo.
Orthostatic hypotension yakajairika ine chiyero chakasiyana chinoitsanangura: tsananguro yakabvumiranwa nemasangano ezvemabasa emuviri anoitika otomatiki inotaura kuderera kunoramba kuripo kwekanenge 20 mmHg kweBP yesystolic kana 10 mmHg kweBP yediastolic mukati memaminitsi matatu ekumira kana kurerekera musoro uchikwidzwa. Vasoplegic shock ine chekuita nekurasikirwa nekukurumidza nekukwanisa kwetsinga dzeropa kuramba dzakasunga, kwakakomba zvekutyisidzira kutenderera kweropa. Haiongororwi nebvunzo yekumira.
Kuenzanisa: mamiriro, mugumisiro, uye musiyano uripo muhumbowo
| Mubvunzo | POTS | Orthostatic hypotension yakajairika | Vasoplegic shock |
|---|---|---|---|
| Chii chinoisiyanisa? | Zviratidzo zvinogara zviripo pakutwasuka pamwe nekuwedzera kwakanyanya kwekurova kwemwoyo, pasina kuderera kweBP kunoramba kuripo kunodiwa pakuongorora | Kuderera kweBP kunoramba kuripo mushure mekutwasuka | Kuderedzwa kwakanyanya uye kunoitika nekukurumidza kwekusunga kwetsinga dzeropa, pamwe nekutadza kutenderera kweropa zvakanaka |
| Nei chimiro chemuviri chichikosha | Kumira kunokonzera kurova kwemwoyo nekukurumidza nezviratidzo zvinotsanangura mamiriro acho | Kumira kunoratidza kuderera kweBP kunotsanangura mamiriro acho | BP yakaderera nematambudziko ekusvika kweropa kunhengo zvinoda kuongororwa zvisinei nekumira |
| Kubatsira kune zvakwakakosha kungasanganisira chii? | Kushomeka kwedzungu nekurova kwemwoyo kunonzwika pakutwasuka, kugona zviri nani mabasa ezuva nezuva, kuongororwa pamwe chete kwekurova kwemwoyo neBP | Zviratidzo nekudonha zvishoma, kugona zviri nani kuita mabasa wakatwasuka, BP inogamuchirika pakurara pasi | Kudzorerwa kwekusvika kweropa kunhengo, kudiwa kushoma kwemishonga inokwidza BP, kupora kwenhengo uye kurarama |
| Humbowo hupi hwemethylene blue hwakawanikwa? | Hurukuro dzemashandiro nemishumo isina boka rekuenzanisa; hapana ongororo yekushanda kwayo muPOTS ine boka rekuenzanisa | Hapana humbowo hune boka rekuenzanisa hwakawanikwa hunosimbisa kurapwa nguva dzose kweorthostatic hypotension inogara iripo | Ongororo dzekurapa museptic shock, kusanganisira chidzidzo chine boka rinopiwa mushonga wekunyepedzera chinokurukurwa pazasi |
| Chii chisingagoni kushandiswa kune mamwe mamiriro? | BP yakakwira kana shanduko yemaitiro etsinga chete hazvisimbisi kuvandudzika kwezviratidzo | Mhinduro yemurwere ari muICU haigoni kusimbisa kubatsira kana kuchengeteka kwekurapwa kwevarwere vasingagari muchipatara | Kushandiswa kwenguva pfupi kwemishonga inokwidza BP hakugoni kusimbisa kurapwa kwezvirwere zvekutwasuka zvinogara zviripo |
Kuenzanisa uku kunopatsanura mibvunzo yezvidzidzo; hakusi pepa rekushandisa pakuongorora chirwere. Dhaunirodha kuenzaniswa kwemamiriro nemibvunzo yekukurukura kuti uchengete misiyano iyi pamwe chete. Inokoshawo pakududzira methylene blue neshanduko dzeBP.
Zvakaedzwa chaizvo neongororo yeshock
Muongororo yaIbarra-Estrada nevamwe ya2023 yakagovera varwere kumapoka nenzira isina kurongwa, vanhu vakuru vane septic shock vakapiwa methylene blue nomutsinga kana mushonga wekunyepedzera wemvura ine munyu, pamwe chete nekurapwa muchikamu chekuchengetwa kwakanyanya. Kuongororwa kwemigumisiro kwaisanganisira varwere 91, 45 vachipiwa methylene blue uye 46 mushonga wekunyepedzera. Kurapwa kwaisanganisira kupinzwa kwemushonga nomutsinga kwemazuva matatu, migumisiro ichiongororwa kusvika pamazuva 28.
Mugumisiro mukuru waiyerwa waiva nguva yaipfuura mishonga inokwidza BP isati yamiswa. Iyi mishonga inoshandiswa kutsigira BP kana munhu ari mushock. Nguva yepakati yaiva maawa 69 kune vakapiwa methylene blue nemaawa 94 kune vakapiwa mushonga wekunyepedzera. Kufa nenguva yekushandiswa kwemuchina wekubatsira kufema zvakanga zvakafanana pakati pemapoka.
Uhwu humbowo hwechinhu chinowedzerwa pakurapa kutadza kutenderera kweropa kunoitika nekukurumidza uye kune chekuita nehutachiona. Hahuratidzi kuti methylene blue inonwiwa inoderedza kurova kwemwoyo nekukurumidza pakumira, inodzivirira kunzwa sekunge munhu ava kufenda, kana inovandudza kuenda kuchikoro kwevane POTS. Varwere, nzira yekupiwa mushonga, kurapwa kunopiwa pamwe nawo, nguva, uye mugumisiro mukuru waiyerwa zvose zvakasiyana. Ongororo yakaparadzana yezvidzidzo zvemethylene blue muvasoplegia neseptic shock inoongorora humbowo uhwo hwekurapwa kwevarwere vari munjodzi mumamiriro ahwo chaiwo.
Nei tsananguro yenitric oxide isina kukwana
Nitric oxide inobatsira mukuzorora kwetsinga dzeropa, kusanganisira kutumirwa kwemasaini kuburikidza nesoluble guanylate cyclase necyclic GMP. Methylene blue inogona kukanganisa mashandiro aya emuviri, asi kungoitsanangura sechinhu chinovhara nitric oxide kunovanza misiyano iri pakati pezviedzo.
Semuenzaniso, chiedzo chetsinga dzeropa chaWolin nevamwe cha1990 chakaisa methylene blue panzvimbo yakafumurwa yetsinga diki dzinotenderedza ropa mumhasuru dzemakonzo akanga apiwa mushonga wekuita kuti asanzwe. Yakaderedza kuwedzera kwetsinga kwaiitika nekuda kweacetylcholine nenitric oxide. Superoxide dismutase yakadzivirira kudziviswa ikoko, zvichitsigira mashandiro ane chekuita nesuperoxide iri kunze kwemasero mumamiriro echiedzo ichocho. Ichi chaiva chiedzo chetsinga diki panzvimbo imwe chete, kwete chidzidzo chekurapa vanhu vane POTS nemushonga unonwiwa. Mugumisiro wacho haugoni kusimbisa kubatsira kwekurapa kana kukuvadzwa kwetsinga dzinotumira mashoko mumuviri muvarwere ivavo.
Fungidziro pamusoro pechirwere pachacho hainawo chokwadi. Chidzidzo cha2005 chemhinduro dzetsinga dzeropa diki muPOTS chakaenzanisa vanhu 15 vane POTS ine kuyerera kweropa kwakaderera, 17 vane POTS ine kuyerera kweropa kwakajairika, uye vanhu 13 vane utano vaishandiswa sehwaro hwekuenzanisa, vane makore 14–22. Vatsvakurudzi vakayera kuyerera kweropa muganda vachiedza mhinduro dzetsinga panzvimbo iyoyo. Zvavakawana zvakaratidza kuti kuburitswa kwenitric oxide kunoenderana nekuyerera kweropa kungave kwakaderera muboka raiva nekuyerera kwakaderera. Havana kuedza methylene blue semushonga wekurapa.
Izvi zvinopikisa pfungwa yekuti POTS yose inomiririra nitric oxide yakawandisa inofanira kudzikiswa. Hazviratidziwo kuti munhu wese ane POTS ane nitric oxide shoma. Sezvinotsanangurwa muongororo yekurapa yaMar naRaj, kukanganisika kwechikamu chetsinga dzinodzora mabasa emuviri anoitika otomatiki, huwandu hushoma hweropa rinotenderera, uye kuwedzera kwemashandiro eadrenergic zvinogona kubatsira kukonzera mamiriro acho nenzira dzinopindirana. Misiyano pakati peNOS, cGMP, nekutumirwa kwemasaini mutsinga dzeropa inokosha nokuti zita renzira yekushanda kwemuviri harisi kuongororwa kwemamiriro emurwere mumwe chete.
Zvatinogona kudzidza kubva kumishumo yevarwere inopesana
Hurukuro yePhoenix Rising inosanganisira mushumo wekuti POTS yakanyanya kuipa pakushandisa methylene blue. Ukuwo, hurukuro yePOTS paReddit ine mushumo wekuvandudzika kwekurova kwemwoyo kwakaitika pakarepo, kuchinzi kwakakonzerwa nemethylene blue. Mishumo iyi inotsanangura zvakaitika nemibvunzo; haisimbisi chakakonzera kuvandudzika kana kuipa.
Mibvunzo inobatsira ndeyakananga. Zviratidzo zvakayerwa munhu ari muchimiro chimwe chete here? BP yakashanduka pamwe chete nekurova kwemwoyo here? Mishonga kana zvimwe zvinowedzerwa zvakashandurwa here? Munhu wacho akanzwa zviri nani kwenguva pfupi chete here, kana kuti akakwanisazve kupedza nguva inobatsira akatwasuka mumazuva akatevera? Mushumo usina mashoko aya haugoni kusiyanisa zvinoitwa nemushonga neshanduko dzakaitika panguva imwe chete kana kungosiyana kwezviratidzo kunowanzoitika.
Kune vanhu vane ME/CFS zvakare, kunzwa simba pakarepo hakupinduri kuti kuita mabasa kwakazokonzera kuipa kwakanonoka here. ME/CFS, methylene blue, nekusanzwa zvakanaka mushure mekushandisa simba inokurukura mugumisiro iwoyo wakaparadzana. Mishumo inofadza kana inotyisa haipi chikonzero chakakwana chehurongwa hwekuzviedza kumba.
Chii chingaita kuti zvinotaurwa nezvePOTS zvive zvinogutsa?
Chidzidzo chinobatsira chaizobatanidza varwere vane kuongororwa kwakanyorwa, chotsanangura chimiro chemushonga nenzira yekuupiwa, choshandisa chinhu chinovimbika chekuenzanisa, uye choyera zviratidzo pamwe nekugona kuita mabasa. Kurova kwemwoyo neBP zvinofanira kuongororwa pamwe chete. Kutevera varwere kunofanira kutora nguva yakareba zvakakwana kuti kuongorore kubatsira kunoramba kuripo nezvinokuvadza, pane kutora kuverengwa kumwe chete kwakanaka sekupora. Izvi zvinodiwa pakuedza zvinotaurwa, kwete humbowo hwekuti kurapwa kwacho kunoshanda.
Kuchengeteka kwakakosha pachikumbiro ichi chaicho. Mashoko eUS ekurayira kupiwa kweProvayBlue nomutsinga anoyambira nezveserotonin syndrome inogona kuuraya kana ichishandiswa nemishonga inopindirana nayo, uye anorambidza kushandiswa kune vane kushomeka kweG6PD nokuda kwenjodzi yeanemia inokonzerwa nekuparara kwemasero matsvuku eropa. Yakabvumirwa kurapa methemoglobinemia inowanikwa mushure mekuzvarwa, kwete POTS. Mashoko iwayo haasimbisi hurongwa hwemushonga unonwiwa wezviratidzo zvinoitika pakutwasuka.
Enda nezvinotaurwa chaizvo, chigadzirwa, runyorwa rwemishonga yauri kushandisa, uye mugumisiro waunoda kunyanzvi yezvekurapa inoziva zviratidzo zvako zvinoitika pakutwasuka. Mibvunzo yekubvunza usati wafunga nezvemethylene blue inobatsira kuronga hurukuro iyoyo. Mubvunzo usati wapindurwa ndewekuti inopa kubatsira kwakakosha uye kunoramba kuripo kuvarwere vane POTS here, kwete kuti inogona kushandura tsinga dzeropa mune mamwe mamiriro here.