Chinyorwa
Methylene blue nekumanikidzwa kweropa: mashandiro, kushandiswa pakurapa, nenjodzi
Methylene blue inogona kukwidza kumanikidzwa kweropa, kunyanya painopinzwa mutsinga kuvarwere vane mitsipa yeropa yakawedzera kufara zvakanyanya. Izvi zvinobatsira kutsanangura nei ichiongororwa mune dzimwe mhando dzekuvhunduka kwemuviri. Hazvisimbisi methylene blue semushonga wekumanikidzwa kweropa kwakaderera kunowanzoitika, uye haisi mushonga wakasimbiswa wekumanikidzwa kweropa kwakakwirira.
Kumunhu ari kufunga nezvechigadzirwa chinonwiwa, mubvunzo unobatsira ndeuyu wakanyatsojeka: ndehupi uchapupu hunofanotaura zvinozoitwa nechigadzirwa ichi, kana chikatorwa nenzira iyi, mumunhu ane nhoroondo iyi yeutano? Zvidzidzo zvemuzvipatara zviri pasi apa hazvipi fungidziro iyoyo.
Nei kupikiswa kwekuyerera kweropa mumitsipa kuchikosha
Mitsipa inoendesa ropa kubva pamwoyo ine tsandanyama dzakatsetseka dzinochinja kufara kwayo mukati. Tsandanyama padzinozorora, nzira inoyerera ropa inowedzera kufara; padzinosunga, inova nhete. Mukutenderera kweropa mumuviri wese, izvi zvinobatsira pakupikiswa kwekuyerera kweropa mumitsipa. Kumanikidzwa kweropa kunoenderanawo nehuwandu hweropa hunopombwa nemwoyo, saka kuchinja kupikiswa kwekuyerera hakutongi zvose zvinoitika.
Imwe nzira inozorodza tsandanyama inotanga nenitric oxide, kana kuti NO. Inomutsa soluble guanylate cyclase, inopfupikiswa kuti sGC, iyo inogadzira cyclic GMP, kana kuti cGMP, inotakura mashoko mukati memasero. Kutumirwa kwemashoko kunobva kwaitika kunokurudzira kuzorora kwetsandanyama dzakatsetseka.
Methylene blue inogona kukanganisa nzira iyi. Zvisinei, kuiti inovhara sGC chete nenzira yakanyatsosarudzika kunorerutsa zvakanyanya mashandiro ayo semushonga. Mubasa rekuedza raMayer nevamwe pamusoro pekugadzirwa kwenitric oxide, kuzorora kwemitsipa yakaparadzaniswa nemuviri uye kutumirwa kwemashoko mumasero anofukidza mukati memitsipa zvakanyanya kukanganiswa nemethylene blue kupfuura zvakakonzerwa nekumutsa sGC zvakananga. Zvakawanikwa zvakaratidzawo kukanganiswa kwekugadzirwa kweNO, kunoitika sGC isati yamutswa. Miedzo yakaita seiyi inotsanangura mashandiro anogona kuitika mumitsipa yeropa; haitauri kuti kuyerwa kwekumanikidzwa kweropa kwemunhu kumba kuchachinja zvakadii.
Mufananidzo webutiro unoratidza hukama uhwu hwakarerutswa pakati pekusunga kwemitsipa yeropa nekupikiswa kwekuyerera kweropa. Mifananidzo yemitsipa iri mairi inongotsanangura pfungwa, kwete kuchinja kwakayerwa mumurwere kana mumuedzo wehukama pakati pehuwandu hwemushonga nezvaunoita.
Zvakaedzwa chaizvo neuchapupu hwezvidzidzo zvekurapa
Vasoplegia zvinoreva kuderera kwakanyanya kwekusunga kwemitsipa yeropa, kunowanzotaurwa mumamiriro akadai sekuvhiyiwa kukuru kwemwoyo kana kurwara zvakanyanya. Murwere anogona kuva nekumanikidzwa kweropa kwakaderera kunyange mwoyo uchipomba ropa rakajairika kana rakawanda, nokuti kupikiswa kwekuyerera kwaderera. Izvi zvakasiyana nekumanikidzwa kwakaderera kunonyanya kukonzerwa nekurasikirwa neropa kana kusapomba zvakanaka kwemwoyo.
Tafura inosiyanisa kurapa mushure mekunge vasoplegia yatanga, kudzivirira muvarwere vakasarudzwa vanovhiyiwa, uye kurapa kunowedzerwa kune kumwe kurapa pakuvhunduka kwemuviri kunokonzerwa neutachiona. IV zvinoreva kupinzwa mutsinga. Izvi zvinotsanangura kushandiswa mumiedzo, kwete mirayiridzo yekupa mushonga.
| Nzira yekupa nemamiriro ekurapa | Vanhu vakaongororwa nezvakafananidzwa | Zvakayerwa kana zvakawanikwa | Zvisingagoni kusimbiswa nezvakawanikwa |
|---|---|---|---|
| Methylene blue yeIV mushure mekuvhiyiwa kwemwoyo | Levin nevamwe, 2004: varwere 56 vane vasoplegia mushure mekuvhiyiwa vakagoverwa zvisina kusarura kuti vagamuchire methylene blue kana placebo | Vasoplegia yakagara pasi pemaawa matanhatu muvarwere vose vakarapwa; vasere muboka rekuenzanisa vakaramba vainayo kupfuura maawa 48. Vakafa vaiva 0/28 zvichienzaniswa ne6/28. | Muedzo mudiki, wemamiriro ekuvhiyiwa akasarudzika, haugoni kusimbisa kuti mushonga unowedzera kupona kwevanhu vose kana kuti unorapa kumanikidzwa kweropa kwakaderera muvarwere vasina kupinzwa muchipatara. |
| Methylene blue yeIV pamberi pekuvhiyiwa kwekugadzira nzira inodarika mitsipa yemwoyo yakavharika | Ozal nevamwe, 2005: varwere 100 vakasarudzwa vane njodzi yakakwirira; mvura yemushonga ye1% yakapinzwa mutsinga zvishoma nezvishoma vasati vavhiyiwa, zvichienzaniswa nekusapiwa methylene blue | Vasoplegia yakaitika muvarwere 0/50 zvichienzaniswa ne13/50. Uku kwaiva kudzivirira panguva yakapoteredza kuvhiyiwa, kwete kurapa kumanikidzwa kwakaderera kunogara kwenguva refu. | Zvakawanikwa hazvipembedzi kunwiwa kwemushonga kudzivirira dambudziko, kana kuratidza kuti ndiani angabatsirwa kunze kwemamiriro aya ekuvhiyiwa. |
| Methylene blue yeIV yakawedzerwa pakurapa kuvhunduka kwemuviri kunokonzerwa neutachiona | Ibarra-Estrada nevamwe, 2023: vanhu vakuru 91 vakaongororwa; mushonga wakapinzwa mutsinga zvishoma nezvishoma kwemaawa matanhatu pazuva, uchipiwa katatu, zvichienzaniswa neplacebo yesodium chloride yakafanana nawo | Nguva yepakati nepakati kusvika pakumiswa kwemishonga inosunga mitsipa yeropa yaiva maawa 69 zvichienzaniswa ne94. Kufа nenguva yekushandisa muchina unobatsira kufema zvakanga zvakafanana. | Kukurumidza kumiswa kwemishonga inosunga mitsipa yeropa hakusi uchapupu hwekuwedzera kupona kana hwekukwira kwekumanikidzwa kweropa kunogona kufanotaurwa muvanhu vane utano. |
| Mushonga weIV une mvumo yekurapa methemoglobinemia isiri yekuzvarwa nayo | Mashoko ekunyorerwa kwePROVAYBLUE; kurapa hemoglobin isina kumira zvakanaka, kwete muedzo wekumanikidzwa kweropa | Kumanikidzwa kweropa kwakakwirira kuri pakati pezvinetso zvakashumwa zvinokonzerwa nezvigadzirwa zvemhando yemethylene blue. | Kuverengwa kwedambudziko parondedzero yezvinogona kukonzerwa nemushonga hakufungidziri mukana kana kukura kwekukwira kwekumanikidzwa kunobva pachigadzirwa chinonwiwa chinotengwa muzvitoro. |
| Kushandiswa nevatengi kwemushonga unonwiwa nokuda kwekumanikidzwa kweropa kwakakwirira kana kwakaderera | Hapana muedzo wekurapa une boka rekuenzanisa, unoshanda zvakananga kumamiriro aya, wakawanikwa muzvinyorwa zvakatsvakwa nokuda kwechinyorwa chino | Zvidzidzo zveIV zviri pamusoro hazvipi chinangwa chekumanikidzwa kweropa kana chirongwa chekunwa mushonga chakasimbiswa. | Kusawanikwa kwemuedzo hakusi uchapupu hwekuchengeteka kana uchapupu hwekuti nguva dzose panonwiwa mushonga uyu kumanikidzwa kunochinja. |
Mumuedzo wekuvhunduka kwemuviri kunokonzerwa neutachiona, mapoka ose ari maviri akagamuchira kurapwa kwakanyanya, kusanganisira norepinephrine, hydrocortisone, uye vasopressin pazvaidiwa. Kurapa kwakatanga mukati memaawa 24 ekutanga kupiwa norepinephrine. Vanachiremba vaigadzirisa mishonga inosunga mitsipa yeropa kuti vasvike pachinangwa chekumanikidzwa kweropa; mubvunzo mukuru waiva wokuti varwere vaizoda mishonga iyoyo kwenguva pfupi here. Varwere vaiva nezvinhu zvakati kuti zvinokosha zvinowedzera njodzi, kusanganisira kushandiswa kweSSRI nguva pfupi yapfuura nenhoroondo yekushomeka kweG6PD, havana kubatanidzwa. Zvisarudzo izvi zvekuronga muedzo zvinokosha pakududzira zvose kubatsira nekuchengeteka.
Ongororo yakakura yemiedzo yekurapa vasoplegia nekuvhunduka kwemuviri kunokonzerwa neutachiona inoongorora uchapupu hwekurapa varwere vanorwara zvakanyanya mune zvakadzama.
Methylene blue inoderedza kumanikidzwa kweropa here?
Tsananguro yemashandiro mumitsipa yeropa iri pamusoro inonongedzera pakuderedza kuzorora kwakanyanya, kwete kurapa kumanikidzwa kweropa kwakakwirira. Nhamba yakaderera mushure mekunge munhu atora methylene blue haigoni, pachayo, kusimbisa kuti zvakakonzerwa nemushonga. Mamiriro ekugara kana kumira kwemuviri, kuzorora, nzira yekuyera, mimwe mishonga, uye dambudziko raita kuti ropa riyerwe zvose zvinogona kuchinja kuenzanisa.
Saizvozvo, nhamba yakakwirira chinhu chinofanira kuongororwa, kwete kusimbisa kuti mashandiro anodiwa atanga. Kurapa kunobatsira kunoda uchapupu pamusoro pezviratidzo, kushanda kwemuviri, zvinetso zvinokonzerwa nemushonga, nemigumisiro, pamwe chete nenhamba iri pamudziyo wekuyera.
Musiyano mumwe chete uyu unoshanda kune zvinotaurwa nezvemethylene blue pamusoro pePOTS nekusakwanisa kutsungirira kumira. Zviratidzo zvinoitika pakumira nekuchinja kwekumhanya kwekurova kwemwoyo zvinoda uchapupu hwazvo hwekurapa; vanhu vane kuvhunduka kwemuviri kunobva kuvasoplegia iboka rakasiyana revanhu vanodzidzwa.
Mishonga inoshandiswa nemunhu inochinja mubvunzo
Enda nerondedzero yakazara yemishonga yako kuna chiremba kana nyanzvi yemishonga usati wafunga kushandisa methylene blue. Mamiriro matatu anofanira kutariswa rimwe nerimwe:
- Mishonga inoshanda paserotonin nemaopioid. Chinyorwa chemushonga weIV chinoyambira nezveserotonin syndrome inogona kuuraya kana mishonga iyi yasanganiswa. Kumanikidzwa kweropa kusingagadzikani kunogona kuitika pamwe chete nekusagadzikana, kupisa muviri, kudikitira, kudedera, kana kuoma kwetsandanyama. Iyi injodzi yechepfu, kwete mashandiro anodiwa mumitsipa yeropa. Ona gwaro rekudyidzana kwemethylene blue nemimwe mishonga.
- Mishonga inoshanda paNO necGMP. Manitrate nemishonga inovhara PDE5 yakadai sesildenafil zvinoshandisa nzira iyi yekutumira mashoko. Chinyorwa chesildenafil chinotsanangura mashandiro ayo ekufaranudza mitsipa yeropa nekudyidzana kwayo nemanitrate. Miseve inonongedzera kumativi akapesana mumufananidzo wenzira yemashandiro hairatidzi kuti methylene blue inogona kudzimisa zvakachengeteka zvinoitwa nemumwe mushonga.
- Mushonga wekumanikidzwa kweropa wakatonyorerwa. Nhamba inoyerwa mushure memethylene blue haisi hwaro hwekusatora, kutsiva, kana kuwedzera kurapa kwakanyorerwa. Nyora chigadzirwa, kusimba kwemushonga, huwandu, nzira yekutora, nguva, nhamba dzakayerwa, nezviratidzo kuitira kuti akanyora mushonga aongorore zvakatorwa.
Kumanikidzwa kweropa kunongova chikamu chimwe chete cheongororo yekuchengeteka kwose. Somuenzaniso, chinyorwa cheIV chinorambidza kushandiswa kana paine kushomeka kweG6PD nokuda kwenjodzi yekuparara kwemasero matsvuku eropa. Nhamba yakajairika inoyerwa nechishandiso chinosunga ruoko haigoni kuratidza kuti dambudziko iroro kana kudyidzana kwemishonga hazvipo.
Apo nhamba yakayerwa inoda kutariswa nokukurumidza
Kuvanhu vakuru vasina pamuviri, American Heart Association inokurudzira kutora matanho nokukurumidza kana nhamba dziri pamusoro pe180 pakurova kwemwoyo uye/kana 120 pakati pekurova kwemwoyo. Kana paine kurwadza pachipfuva, kushaya mweya, kushaya simba, kuchinja kwekuona, kana kunetseka kutaura, fonera rubatsiro rwechimbichimbi pakarepo. Kana pasina zviratidzo zvitsva zvinonetsa, yerazve mushure meminiti imwe chete kana kupfuura, uye kurumidza kubata nyanzvi yezveutano kana ichiramba yakakwirira kudaro.
Tsvaka rubatsiro rwechimbichimbi kana munhu adonha, achinetseka kufema zvakanyanya, kana pachifungidzirwa serotonin syndrome mushure mekutora mushonga, pasinei nenhamba yakayerwa nechishandiso chinosunga ruoko. Usatora imwe methylene blue kuti ugadzirise nhamba yakakwirira kana yakaderera.