Methylene blue neokisijeni pakumanikidzwa kwepamusoro: kuongorora zvinonzi zvinobatsira pakurapa kwakasanganiswa

Peji rekiriniki rinopa methylene blue HBOT kuti ibatsire simba, kugona kufunga, kana kupora. Dzimwe nguva panowedzerwa pani yechiedza chitsvuku, uye pasuru yacho inonzi methylene blue red light hyperbaric oxygen. Peji racho rinotaura nezvemitochondria, kuendeswa kweokisijeni, uye zvinyorwa zvishoma zvetsvakurudzo. Mutengo unobhadharwa pachikamu chimwe nechimwe chekurapa. Mubvunzo unodiwa nemuverengi wakanyanyonangana kupfuura kungoti chikamu chimwe nechimwe chinonzwika chine musoro here. Ndewekuti pane munhu akaedza musanganiswa uyu chaiwo ndokuyera kana uchibatsira kupfuura chikamu chimwe nechimwe chiri chega here.

Mubvunzo iwoyo ndiwo uri kuongororwa pano. Pasuru iyi ine nzira dzinosvika ina dzinogona kuchinjwa imwe neimwe yakazvimirira: kumanikidzwa mukamuri, huwandu hweokisijeni, magadzirirwo emushonga nenguva yaunopiwa, uye kuoneswa kuchiedza. Humbowo hwechikamu chimwe hahusi humbowo hwepasuru yose, uye mhedzisiro yakanakisisa yekuedza musanganiswa wacho zvakananga inoratidza kuwedzerwa kwekuuraya kunokonzerwa nemushonga unomutswa nechiedza, kwete kusimudzirwa kwekushanda kwemitochondria kwose kwose.

Nzira ina dzekurapa dzinoshandisa zita rimwe chete

Kumanikidzwa ndiyo pfungwa yokutanga. Kurapa neokisijeni pakumanikidzwa kwepamusoro, kunowanzonzi HBOT, kunoreva kufema okisijeni yakanyanya kuwanda pakumanikidzwa kunopfuura kwemhepo yakapoteredza, kazhinji kuri pakati pe1.9 ne3.0 atmospheres absolute, munhu achifema okisijeni kwenguva inenge maminitsi 90 kusvika 120, ichisanganisira nguva dzekufema mhepo yakajairika. Mukamuri remunhu mumwe chete, okisijeni ndiyo inoshandiswa kukwidza kumanikidzwa; mukamuri revanhu vakawanda, mhepo ndiyo inoshandiswa kukwidza kumanikidzwa asi murwere achifema okisijeni kuburikidza nehood kana mask. Kumanikidzwa nechikamu cheokisijeni mumhepo zvinogona kuchinjwa zvakasiyana, saka kutaura kuti hyperbaric ine kumanikidzwa kudiki pasina nhamba mbiri idzi hakutsananguri chimwe chazvo.

Kuendeswa kweokisijeni ndiyo pfungwa yechipiri. Pa2 atmospheres munhu achifema okisijeni yakachena, okisijeni yakanyungudika muplasma inokwira zvakanyanya kupfuura yakajairika, ichiwedzera kune okisijeni yakasungirirwa kuhemoglobin. Chikamu ichocho chakanyungudika ndicho chinoita kuti nzira iyi ishandiswe pazvinhu zvinobvumirwa zvakadai segasi rinovhara tsinga uye matishu akaisirwa ane matambudziko, zviri murondedzero yeUndersea and Hyperbaric Medical Society yemamiriro anorapwa nenzira iyi. Ndicho zvakare chinokonzera kukuvadza: kukuvara kwenzeve nemasinus kunokonzerwa nekumanikidzwa, kukuvadzwa kwemapapu neokisijeni, kutadza kuona zviri kure kwenguva pfupi, uye pfari pakumanikidzwa kweokisijeni kwakanyanya.

Magadzirirwo emushonga ndiyo pfungwa yechitatu. Murima, dhayi iyi inopinda mumatenderedzwa eredox uye inoshanda semumwe mutakuri wemaerekitironi, ichigamuchira maerekitironi kuti igadzire leucomethylene blue yobva yaaendesa mberi ichiramba ichitenderera, sezvinotsanangurwa mukushanda kwemethylene blue semupfuudziri wemaerekitironi. Chigadzirwa, nzira yachinopiwa nayo, chipimo chiri mumg pakg, uye nguva yachinopiwa zvichienzaniswa nenguva yekurapa mukamuri zvose zvinopinda pano. Mirayiridzo yejekiseni muUS inosanganisira kurapa methemoglobinemia yakawanikwa, pachipimo che1 mg pakg maererano neruzivo rwekupihwa kweProvayBlue, asi ichi hachisi chipimo chakasimbiswa pakurapa kwakasanganiswa kunoitwa nesarudzo pasina chimbichimbi.

Kuoneswa kuchiedza ndiyo pfungwa yechina, inongowanikwa mune zvimwe zvinopiwa. Chiedza chitsvuku che630 kusvika 680 nm chinopindirana nenzvimbo inotorwa chiedza nedhayi pedyo ne664 nm uye chinogona kumutsa kushanduka kwemakemikari kunokonzerwa nechinhu chinonzwa chiedza; chiedza che810 nm chiri pedyo neinfrared hachinyanyi kumutsa dhayi yacho zvakananga, sezvinoongororwa mumethylene blue nekurapa nechiedza chitsvuku. Kureba kwesaisai rechiedza, simba rechiedza rinosvika panzvimbo, simba rose rechiedza rinosvika panzvimbo panguva yekuoneswa, uye nguva iri pakati pekupiwa kwemushonga nekuoneswa kuchiedza ndizvo zvinosarudza mashandiro acho, maererano negwaro rekureba kwesaisai rechiedza, simba rechiedza rinosvika panzvimbo, uye marongerwo enzvimbo. Chiedza chitsvuku chisina nhamba idzodzo chakafanana nekutaura nezvehyperbaric pasina kutsanangura kumanikidzwa.

Zvakanyatsoedzwa netsvakurudzo pamusoro pemusanganiswa uyu

Hapana muedzo unodzorwa pavanhu wakawanikwa pakuongorora uku unoratidza kuti methylene blue pamwe neHBOT chaiyo zvinowedzera kubatsira muviri wose kupfuura zvikamu zvacho zviviri zvichishandiswa zvakasiyana. Humbowo huripo hunowira mumapoka matatu, uye rimwe nerimwe rinopindura mubvunzo wakasiyana.

Muedzo wakanyanyonangana nemusanganiswa uyu wakaitwa kunze kwemuviri murabhoritari. Bisland nevamwe vake vakaisa S. aureus neP. aeruginosa, zviri zvakasununguka mumvura uye zviri mumatanda anonamatira anonzi biofilm, padhayi nechiedza chitsvuku chakasefwa che600 kusvika 800 nm, paine uye pasina okisijeni yakachena pa2 atmospheres, sezvakanyorwa mutsvakurudzo iyi yeokisijeni nekurapa nemushonga unomutswa nechiedza. Kuwedzera okisijeni iri pakumanikidzwa kwakawedzera kuuraya mabhakitiriya neanopfuura nhanho imwe yelogarithm pa5 J paskweya cm uye neanopfuura nhanho mbiri dzelogarithm pa10 J paskweya cm. Iko kuwedzera kubatsira kweokisijeni pakurapa nemushonga unomutswa nechiedza mudhishi rerabhoritari, kwete humbowo hwekuti okisijeni iri pakumanikidzwa pamwe nedhayi zvinovandudza kugona kufunga kana simba muvanhu.

Muedzo wemhuka wakanyanya kuswedera pakuedza kusanganiswa kwezvinhu zvakasiyana wakashandisa okisijeni yakawanda pakumanikidzwa kwemhepo kwakajairika, kwete HBOT. Rodriguez nevamwe vake vakapa makonzo ane tsinga yeropa yakavharwa kwemaminitsi 60 mhepo kana okisijeni, pamwe nechinotakura mushonga chisina dhayi kana dhayi ye1 mg pakg, mutsvakurudzo iyi yekupora mushure mesitiroko. Musanganiswa wakavandudza kupora kwekushanda kwemuviri kupfuura chikamu chimwe nechimwe chiri chega, kunyange zvazvo ukuru hwenzvimbo dzakafa nekushaya ropa hwakafanana nehwaionekwa pakushandisa dhayi yega. Sezvo pasina chinhu chakaiswa pakumanikidzwa kwepamusoro, izvi zvinotsigira kudyidzana kweokisijeni nedhayi pasina kutaura kana 2 kusvika 3 atmospheres kuchiwedzera chimwe chinhu kupfuura okisijeni pachayo.

Mishumo yevanhu ndeyezviitiko zvemunhu mumwe nomumwe. Munhu wemakore 52 ane methemoglobinemia yakawanikwa yakanyanya akapiwa okisijeni nedhayi ye1 mg pakg mutsinga, zvichiteverwa neHBOT painenge 2.2 atmospheres kwemaminitsi 90, sezvinotsanangurwa mumushumo uyu wechiitiko chechimbichimbi. Kurapa kwekununura kunopiwa zvakatevedzana hakugoni kupatsanura kuchinja kwechirwere pachacho nemigumisiro yedhayi, okisijeni, uye kumanikidzwa. Chimwe chiitiko chine dapsone chinopa mufananidzo wakasiyana: 2.5 atmospheres kwemaawa 2 zvakabatsira zvishoma dhayi ye1.5 mg pakg isati yashanda nokukurumidza, sezvakanyorwa muchiitiko ichi chekurapa zvakatevedzana. Izvozvo zvinoratidza kusatsigira kutsiva dhayi neHBOT, asi hazviedzi kurapa kwacho kuchipiwa panguva imwe chete. Zvinyorwa zvemakonzo zve810 nm zvinowanzotaurwa zvinoedza dhayi nechiedza pasina kamuri zvachose, zvakanyorwa paPMID 35059872 nePMID 31372913, saka hazvigoni kusimbisa chirongwa chekurapa chemukamuri.

Nei okisijeni yakawanda nedhayi yeredox zvisingorevi kubatsirana kwakawedzerwa nguva dzose

Kutenderera kwedhayi muredox pachako kunoshandisa okisijeni: dhayi yakapiwa mutsinga pamwero wemicromolar yakawedzera kushandiswa kweokisijeni nemuviri wose nemwero unenge hafu mumakonzo, dhayi yakagamuchira maerekitironi ichiaendesa zvakananga kuokisijeni, mutsvakurudzo iyi yekushandurwa kwezvinhu mumuviri. Zvainoita pamhando dzeokisijeni dzinokurumidza kupinda mukushanduka kwemakemikari zvinoenderana nezvinhu zviri kushandiswa: zvakawedzera paishandiswa zvinhu zvecomplex I zvikadzikira paishandiswa succinate mumitochondria yemwoyo yakaparadzaniswa (tsvakurudzo yezvinhu zvinoshandiswa). Pasina chiedza pane fungidziro mbiri dzichiri kugona kuva dzechokwadi: okisijeni yakawedzerwa inobatsira dhayi kudzorerwa muchimiro chine oxidation apo kutakurwa kwemaerekitironi kwakakanganisika, kana kuti inowedzera kufamba kweoxidation kunobva pakutenderera kwedhayi. Hapana mutemo unoti dhayi inowedzera kudzivirira oxidation sezvo kumanikidzwa kuchikwira.

Kuwedzera chiedza chitsvuku kunochinja mashandiro acho. Dhayi yamutswa nechiedza inoendesa simba kana maerekitironi kuokisijeni yogadzira zvinhu zvinokonzera oxidation, kusanganisira singlet oxygen, ndokusaka okisijeni yakawedzerwa yakawedzera kuuraya mabhakitiriya mudhishi rerabhoritari. Kushanduka kumwe chete kwemakemikari kunokuvadza panenge pasina kufanira: dhayi yakaoneswa kuchiedza mumitochondria yechiropa chemakonzo yakaparadzaniswa yakakonzera kuumbwa kwezvinhu zvinokonzera oxidation, kupera kweglutathione, kuparadzaniswa kwematanho anowanzoita pamwe pakugadzira simba, uye kuderera kwekubudiswa kweATP, mutsvakurudzo iyi yekukuvadzwa kwemitochondria nemushonga une chiedza. Kubatsirana kwakawedzerwa kwakaratidzwa ndiko kukuvadza masero kunoitwa nemushonga wamutswa nechiedza, kwakakodzera kuuraya utachiona pane kupa simba kumatishu ane utano.

Kuchengeteka kunoenderana nebasa racho, kwete nedhayi chete

Pfungwa imwe neimwe inoda kuongororwa kwayo pachayo, uye musanganiswa unowedzera nzvimbo dzekudyidzana dzisingagoni kufukidzwa nepeji rinongotaura nezvekuchengeteka kwedhayi.

Kuongorora munhu asati apinda mukamuri kunotanga nenjodzi dzekumanikidzwa neokisijeni: pneumothorax isina kurapwa, chirwere chemapapu chinovhara kufamba kwemhepo kana chine mapundu emhepo, kutadza kuenzanisa kumanikidzwa munzeve, nhoroondo yepfari, kuvhiyiwa chipfuva kana maziso nguva pfupi yapfuura, uye midziyo yakaiswa mumuviri. Kudzivirira moto kunofanira kuva chikamu chehurongwa hwekushanda. Tsamba yeFDA pamusoro pekushandisa midziyo yehyperbaric zvakachengeteka inoda kutevedzwa kwemirayiridzo yemugadziri, kubatanidza midziyo nepasi pakudzivirira magetsi, kudzidziswa kwevashandi, kutarisirwa nguva dzose, kugadziriswa kwemidziyo, kusabvumirwa kwezvinhu zvemagetsi zvinorambidzwa, uye zvipfeko zvakakodzera pasi peNFPA 99 neASME PVHO-1. Pani yechiedza haifaniri kungopinzwa mukamuri rine okisijeni yakawanda; kukodzera kwayo kunofanira kunge kwakanyorwa mumirayiridzo yekamuri uye muhurongwa hwekudzivirira moto.

Kuongorora munhu asati apiwa mushonga kunotevera mirayiridzo yedhayi. Kushomeka kweG6PD kwakanyorwa sechikonzero chekusashandisa mushonga; dhayi inodzivisa monoamine oxidase uye ine yambiro iri mubhokisi pamusoro peserotonin syndrome kana yashandiswa nemishonga inobata serotonin nemamwe maopioid. Chiremba anonyora mushonga ndiye anofanira kutungamirira chero kuchinjwa kwemishonga, uye pamuviri pamwe nekushanda kweitsvo nechiropa zvinofanira kuongororwa. Dhayi inokanganisawo kuyerwa kweokisijeni muropa ne pulse oximetry, saka kuzara kweokisijeni muropa kunoda imwe nzira yekuyera kana kururama kuchikosha. Kusiyana uku kunokosha kuvaverengi vanouya nezviyero zvakaderera zveokisijeni muzvirwere zvemapapu kana mamiriro ekuneta akadai seME/CFS.

Kamuri rakabvumirwa neFDA harirevi kuti sangano iri rakaongorora methylene blue HBOT kana chero chirongwa chemitochondria, kugona kufunga, kana kurarama kwenguva refu. Makamuri anowanzova midziyo yeClass II inobvumirwa kuburikidza nenzira ye510(k), ichiitirwa mamiriro akanyorwa mumirayiridzo yayo pachayo. Tsamba yeFDA iri pamusoro ishoko rekuchengeteka, kwete kutsigira kuti kurapa kunoshanda.

Rondedzero yekuongorora humbowo hwemusanganiswa: chishandiso chakagadzirirwa chinyorwa ichi

Shandisa rondedzero iyi pakuongorora chinyorwa chetsvakurudzo kana peji rekiriniki. Chirongwa chekurapa chinovimbika chinotsanangura mutsara mumwe nomumwe mukunyora. Kana paine mutsara usipo, zvinotaurwa hazvina kunyatsotsanangurwa, kwete kuti zvinoratidza tariro yekubatsira.

Zvikamu: modhi yekamuri nemamiriro ekubvumirwa kwayo; yemunhu mumwe kana yevanhu vakawanda; nhamba chaiyo yeatmospheres absolute; chikamu cheokisijeni chinofemwa nemurwere; nguva yekufema okisijeni pamwe nenguva dzekufema mhepo yakajairika; nguva yose mukamuri; huwandu hwezvikamu zvekurapa uye kuti zvinoitwa kangani. Chigadzirwa chemushonga nemagadzirirwo acho; nzira yachinopiwa nayo; chipimo chiri mumg pakg; chipimo chikuru chose chinobvumirwa kuungana; nguva iri pakati pekupiwa kwemushonga nekupinda mukamuri. Kana chiedza chichisanganisirwa: kureba kwesaisai rechiedza; simba rechiedza rinosvika panzvimbo; simba rose rechiedza rinosvika panzvimbo panguva yekuoneswa; nguva yekuoneswa; nguva yacho ichienzaniswa nekupiwa kwedhayi; uye kana panobva chiedza pari mukati kana kunze kwekamuri, paine zvinyorwa zvinoratidza kukodzera kushandiswa pakumanikidzwa kwepamusoro.

Zvekuenzanisa nazvo: patsvakurudzo, mapoka anofanira kusanganisira musanganiswa, chikamu chimwe nechimwe chiri chega, uye kana zvichibvira boka rinopiwa kurapa kwekunyepedzera kana kurapwa kwakajairika, vanhu vachigoverwa kumapoka zvisina kurongwa uye mhedzisiro huru ichitarwa pachine nguva. Mutsara wezviyero usati waitwa kurapa uye mushure mekuitwa kwepasuru yose haugoni kuratidza kuti kubatsira kwabva pamusanganiswa. Papeji rekiriniki, bvunza kuti zvinyorwa zviri kutaurwa zvakanyatsoedza mapoka api pane aya. Kutaura nezvemiedzo yedhayi yega pamwe nemiedzo yeHBOT yega kuvaka musanganiswa nerondedzero yezvinyorwa, kwete humbowo hwekubatsirana kwakawedzerwa.

Mhedzisiro: taura chinoyerwa, nzira yekuchiyera, uye nguva yachinoyerwa. Zviyero zvekushanda kwemuviri, ukuru hwenzvimbo dzakakuvara, nhamba dzeutachiona, uye zvibodzwa zvezviratidzo zvirwere zvinhu zvakasiyana zvinoda midziyo yakasiyana yekuyera. Kuchinja kwezviyero zvinongomiririra mhedzisiro panguva yekurapa, kwakadai senhamba yakakwira pachidzitiro apo munhu ari kufema okisijeni, hakuratidzi kubatsira kunoramba kuripo.

Matanho ekuchengeteka: kuongorora kwakanyorwa kwechirwere chemapapu, kuenzanisa kumanikidzwa munzeve, nhoroondo yepfari, mamiriro eG6PD, mishonga inobata serotonin nemaopioid, pamuviri, uye kushanda kweitsvo nechiropa; kutarisirwa nguva dzose nevashandi vakadzidziswa nezvehyperbaric; nzira dzekuita kana paine kukuvara nekumanikidzwa kana kukuvadzwa neokisijeni; hurongwa hwekukurumidza kuderedza kumanikidzwa kana paine chimbichimbi; matanho ekudzivirira moto nerondedzero yezvinhu zvinorambidzwa; kunyora zviitiko zvinokuvadza; uye hurongwa hwakajeka hwekutarisa okisijeni zvichifungwa kuti dhayi inokanganisa pulse oximetry.

Kana peji risingagoni kupa ruzivo rwuri pamitsara iyi, shandisa nzira imwe chete yekusimbisa yaungashandisa kuongorora chirongwa chekurapa chawawana paindaneti. Kumbira chinyorwa chakaedza pasuru yacho chaiyo, verenga kuti chakaedza mapoka api, uye usarangarira mashandiro anoita seane musoro semhedzisiro yakayerwa. Musanganiswa unonzwika uchienderana unogona kunge usati waedzwa, uye panyaya iyi kudyidzana kumwe chete kwakaedzwa kunowedzera kushanduka kwemakemikari kwausingatombodi kunangidzirwa kumatishu ane utano.