Methylene blue pakuvhiya uye pakuongorora: kuratidza nzvimbo, kuedza kubuda kwemvura, uye kuronda nedhayi

Murwere ari kugadzirira kuvhiyiwa zamu anoverenga kuti “dhayi yebhuruu” icharatidza nzvimbo dzelymph nodes dzake. Hama iri kuongororwa fistula inonzwa nezve“fistulography” yofunga kuti dhayi ichashandiswa. Munhu ane tracheostomy anopiwa “muedzo wedhayi yebhuruu” kuti aongororwe kuchengeteka kwekumedza. Vose vari vatatu vanonzwa shoko rokuti bhuruu vofunga kuti inzira imwe chete inoshandisa dhayi imwe chete. Hazvina kudaro.

Methylene blue muimba yokuvhiya inonyatsonzwisiswa sepfungwa imwe inoshandiswa munzvimbo dzisina hukama: dhayi inoita kuti zvisingaoneki zvioneke. Inotevera mafambiro emvura yelymph, inopenda gland iri kutsvakwa, inoisa ruvara mumvura yokuedza iri kubuda, inoratidza cuff yenzira yekufema yakabvaruka, kana kuratidza kubatana kwakavanzika pakati pemakomba maviri omuviri. Humbowo, uwandu hunoshandiswa, uye njodzi zvinosiyana zvikuru pakati pemashandisirwo aya. Uye dzimwe nzira dzinonzi “miedzo yedhayi yebhuruu” dzinoshandisa mamwe madhayi zvachose, nepo fistulography inoshandisa mifananidzo yemwaranzi isingashandisi methylene blue zvachose. Chinyorwa chino chinotsanangura kushandiswa kumwe nokumwe kwakaparadzana. Kana uchida kunzwisisa zvakafara kuti ndeapi mashandisirwo ezvokurapa akatosimbiswa uye ndeapi achiri kuongororwa, ona mashandisirwo ezvokurapa akatenderwa neachiri kuongororwa.

Pfupiso yenzira: kuita kuti zvioneke, kwete kurapa

Hapana pane izvi chiri kurapa nemethylene blue. Kushandiswa kwekurapa nemutsinga kwakanyorwa pachiratidzo chemushonga muUnited States ndiko kweacquired methemoglobinemia, kazhinji 1 mg/kg IV, sezvakataurwa muruzivo rweDailyMed rwekunyorera mushonga. Kushandiswa kwayo kuronda pakuvhiya kunonyanya kuva kusiri kwakanyorwa pachiratidzo chemushonga kana kunoenderana nemudziyo chaiwo, kuchishandisa kugona kumwe chete kwekuisa ruvara.

Biopsy yesentinel lymph node: kutevera mafambiro elymph

Kana methylene blue yabayiwa panzvimbo iri pedyo nebundu, inopinda mutsinga dzelymph yopenda nzira dzinobudisa lymph nemanodes okutanga (sentinel) bhuruu, kuitira kuti chiremba anovhiya aone nzvimbo dzawo nemaziso. Mukenza yezamu, dhayi yebhuruu ichiri chinhu chokuronda chakasimbiswa, ichiwanzobatanidzwa netechnetium-99m radiocolloid, uye nhungamiro yeNICE yazvino inokurudzira nzira mbiri dzakabatanidzwa dzeisotope nedhayi yebhuruu. Cherechedza kuti “dhayi yebhuruu” munhungamiro hairevi nguva dzose methylene blue chaiyo; patent blue V neisosulfan blue zvinoshandiswawo.

Mienzaniso yemaitiro ezamu inoshandisa 1% methylene blue (10 mg/mL), kazhinji inenge 1 mL, ichibayiwa pasi penzvimbo yakasviba yakatenderedza munyatso, kumativi enzvimbo iyoyo, mukati meganda, kana kumativi ebundu. Kuratidza nzvimbo nemethylene blue yoga kunoshanda, asi humbowo hwakaunganidzwa hunotsigira kuwedzera radiotracer: kuongororwa kwakabatanidza zvidzidzo zvemethylene blue yoga kwakataura kuti yakawana manodes mu91% uye yaiva nemhedzisiro inopotsa dambudziko mu13%, nepo nzira dzakabatanidzwa dzichiwana manodes zvakavimbika kupfuura iyi. Mumelanoma, kuratidza nzvimbo kunonyanya kushandisa technetium lymphoscintigraphy kusati kwavhiyiwa, pamwe negamma probe panguva yokuvhiya, uye dhayi yebhuruu inowedzerwa; nhungamiro yehunyanzvi yeASCO/SSO inotsanangura 1–2 mL yedhayi yebhuruu inoshandiswa pamatishu ari mupenyu, ichibayiwa mukati meganda uye pachipiwa anenge 5–10 maminitsi kuti ifambe munzira dzelymph, ichidoma methylene blue neisosulfan blue sezvinogona kusarudzwa.

Nzira itsva yokuratidza nzvimbo nefluorescence inoshandisa indocyanine green (ICG) inoita kuti nzira dzelymph dzioneke panguva iyoyo pasina mwaranzi inoita ionization, asi inoda midziyo yechiedza chepedyo neinfrared, uye kugamuchirwa kwayo munhungamiro kuchiri kusiyana. Zvinorehwa pakushandisa ndeizvi: methylene blue chinhu chokuronda chakachipa uye chiri nyore kunzwisisa nemaziso, asi kushaya simba kwayo ndekwekuti manodes anoonekwa chete kana afukunurwa pakuvhiya.

Methylene blue ine zvayakaipira zvakati pano. Inogona kuita kuti ganda nematishu zvirambe zvakapendwa kwenguva refu, kuunza kuchinja kunokonzerwa nekuzvimba, kufa kwematishu emafuta, uye dzimwe nguva kufa kweganda; mifananidzo yezamu inotorwa mushure mokuvhiya inogona kuratidza nzvimbo dzisina kuenzana dzakabatana nedhayi dzinoratidzika sokunge kenza yadzoka. Vanachiremba vanovhiya vanofanira kuzivisa vezvekuongorora nemifananidzo nevezvekuongorora matishu pose panenge pabayiwa dhayi mukati kana pedyo nemuenzaniso wetishu. Madhayi ebhuruu anogonawo kukonzera kusawirirana kwomuviri nedhayi kunoitika pakarepo; kuongororwa kwakabatanidza zvidzidzo zvenzira dzesentinel-node dzinopfuura 60,000 kwakawana kuti anaphylaxis yakakonzerwa nedhayi yebhuruu yakaitika pamwero weanenge 0.061%, uye methylene blue yakabatana nemwero wakaderera pane isosulfan blue. Mashoko akafara ekuchengeteka akaunganidzwa muzvinokanganisa muviri nekuchengeteka.

Kutsvaga parathyroid: kushandiswa kwekare kunopararira mumuviri, zvino kwava kusarudzwa

Methylene blue inopiwa nemutsinga kuti iwane magland eparathyroid asina kujairika inzira yekare ichiri kushandiswa chete sechinhu chokuwedzera chinosarudzwa. Kare, uwandu hwakati kurei hwaipiwa nemutsinga mutsipa usati wavhurwa kuti uongororwe, kuitira kuti matishu asina kujairika ave bhuruu; maitiro akabudiswa anoshandisa uwandu hunenge huri pakati pe3 ne7.5 mg/kg IV. Ongororo yakarongeka yakawana zvidzidzo 39 zvokucherechedza uye isina miedzo yaigovera vanhu mumapoka zvisina kusarudzwa: mwero wokupendwa wakanzi wakakwirira, asi kuwedzera kwayo pundutso kana ichishandiswa pamwe nenzira dzazvino dzokutsvaga nzvimbo kwakanga kusati kwasimbiswa.

Maitiro azvino anoshandisa ultrasound nemimwe mifananidzo isati yavhiyiwa, kuziva marongerwo enhengo panguva yokuvhiya, uye kutarisa hormone yeparathyroid panguva yokuvhiya. Nhungamiro yeAAES inodoma methylene blue pakati pezvinhu zvinoverengeka zvinogona kuwedzerwa kuti zvinhu zvioneke, kwete senzira huru yokutsvaga nzvimbo.

Uku ndiko kushandiswa kunonyanya kukosha yambiro yokudyidzana kwemishonga. Methylene blue inodzivisa monoamine oxidase zvakasimba, uye kudzivisa uku kunogona kudzoserwa; ongororo yakarongeka yakataura kukanganiswa kwetsinga dzenjere muvarwere 25, vose vachitora mishonga inobata serotonin. Imwe ongororo yezvinyorwa pamusoro peserotonin syndrome yakabatana nemethylene blue yakawana zviitiko 50, zvose zvichisanganisira mishonga yokurapa kuora mwoyo inobata serotonin, zvizhinji zvacho zvakabatana nekuvhiyiwa kweparathyroid kana kurapwa kwevasoplegia. Uwandu hweparathyroid hwaishandiswa kare hunogona kupfuura zvikuru mwero wekurapa wazvino we1 mg/kg, saka kudyidzana uku kunobata kupararira kwemushonga mumuviri, kwete donhwe redhayi riri patishu.

Imwe nzira yakasiyana, inoshandisa uwandu huduku zvikuru, yakatsanangurwa pamitsipa inenge ichivhiyiwazve kana ine mavanga: kubaya uchitungamirirwa neultrasound zvakananga muchinhu chinotozivikanwa chiri kutsvakwa, mapoka maduku achishandisa anenge 0.2 mL yemushonga we1% wakarerutswa nechiyero che1:5 (inenge 0.2%) kuvhiya kusati kwatanga. Humbowo hunongobva mumapoka maduku akaongororwa.

Muedzo wokuzadza nesaline: dhayi haisi iyo inoita kuti muedzo ushande

Mumuedzo wokuzadza nesaline kuti paonekwe kana ronda rekukuvara rakapinda mujoini, saline inobayiwa mujoini uye ronda rinotariswa kuti pane mvura iri kubuda here. Dzimwe nguva methylene blue inowedzerwa kungoita kuti mvura iri kubuda ioneke zviri nyore. Chinhu chinokosha chakawanikwa ndechekuti hazvina kuratidzwa kuti dhayi inovandudza muedzo: muchidzidzo chemabvi chevarwere 58, chaitevera varwere uye chaivagovera mumapoka zvisina kusarudzwa, mwero wemhedzisiro yaipotsa dambudziko waiva 69% nemethylene blue uchienzaniswa ne66% nesaline yoga, uye uwandu hwaidiwa kuti muedzo uratidze dambudziko hwaiva hwakafanana. Ongororo yakarongeka ya2025 yakawana kuti 8 pazvidzidzo 23 zvokuzadza nesaline zvakanga zvashandisa dhayi, asi kushanda kwomuedzo kwaitungamirirwa nejoini, nzvimbo yeronda, uwandu hwakabayiwa, uye maitiro, kwete nekuwedzera dhayi. Hapana mwero wakatarwa wekukora kwemushonga wakasimbiswa kuti ushandiswe pachinangwa ichi. Methylene blue pano chinhu chokuisa ruvara chinogona kusarudzwa mumaitiro ekare kana ekuedza, kwete chikamu chinoita kuti muedzo ukwanise kuona dambudziko.

Machubhu enzira yekufema anoshandiswa nelaser: dhayi yakavharirwa mukati mecuff

Kushandiswa uku kwakasiyana nezvimwe zvose zviri papeji ino: dhayi inowanzoiswa mukati mecuff yechubhu inopinzwa munzira yekufema, kwete mumuviri womurwere. Pakuvhiya nzira yekufema nelaser, nhungamiro yokudzivirira moto panguva yokutindivadza inokurudzira chubhu yakakodzera inokwanisa kumira laser uye, pazvinogoneka, kuzadza cuff nesaline panzvimbo pemhepo. Kuisa ruvara musaline iyoyo nemethylene blue kunoreva kuti kuboorwa nelaser kunobudisa mvura yebhuruu inooneka pakarepo. Hapana mwero mumwe wokukora kwemushonga wakatarwa unoshanda kwose; chinangwa ndechokuisa ruvara runooneka, sezvinotsanangurwa mumazano eASA ekudzivirira moto muimba yokuvhiya.

Pane yambiro mbiri dzinokosha. Mamwe machubhu elaser ekare aiisa makristaro edhayi mukati mecuff kana mugadziriro yepilot, uye chiitiko chakabudiswa chinotsanangura makristaro akanga asina kunyunguduka achivhara chubhu yepilot zvokuti cuff yaisakwanisa kubudiswa mweya, ndokusaka mirayiridzo inoenderana nemudziyo chaiwo ichikosha. Uye methylene blue pachayo haiiti kuti chubhu yakajairika ikwanise kumira laser; kudzivirira moto kunoenderanawo nemagadzirirwo echubhu, kudzivirirwa kwecuff, uye kuderedza huwandu hwezvinhu zvinobatsira kupisa.

Miedzo yekumedza: “dhayi yebhuruu” inogona kunge isiri methylene blue

Mumuedzo unowanzoitwa padivi pomubhedha womurwere ane tracheostomy, chikafu kana mvura inoiswa ruvara uye zvinobuda munzira yekufema zvinotariswa kuti zvava nebhuruu here; mhedzisiro inoratidza bhuruu inotsigira kuti chikafu kana mvura yapinda munzira yekufema. Mazwi anoshandiswa anogona kunzwisiswa zvisizvo zviri nyore: maitiro akabudiswa e“muedzo wedhayi yebhuruu” neeMuedzo Wakagadziridzwa weEvans Blue Dye akashandisa Evans blue, methylene blue, uye madhayi ezvokudya, saka “muedzo wedhayi yebhuruu” haungorevi methylene blue.

Dambudziko guru ndemhedzisiro dzinopotsa dambudziko. Kugona kuona dambudziko mumaitiro akasiyana kunobva paanenge 38% kusvika pa95%, uye nhungamiro inonyanya kuona muedzo sechiratidzo chokuwedzera chinotsigira kuti dambudziko riripo kana chiri chakanaka: muedzo usingaratidzi dambudziko haubvisi mukana wokuti chikafu kana mvura zviri kupinda munzira yekufema. Kuongorora kunosimbisa zvakazara, kana kuchidiwa, kunoshandisa midziyo yakadai sefiberoptic endoscopy yekuongorora kumedza kana videofluoroscopy. Hapana uwandu hwedhayi hwakasimbiswa kuti ndihwo hwakanakisisa.

Usavhiringidza izvi netsika yekare yokuramba uchiisa ruvara muzvokudya zvinopiwa nechubhu uchishandisa FD&C Blue No. 1. Iyoyo idhayi yakasiyana uye muitiro wakasiyana, wakabatana nekupinda kwedhayi mumuviri uye kukuvadza kwakakomba muvarwere vairwara zvakanyanya, uye wakazoregedzerwa kukurudzirwa.

Kuronda fistula hakusi fistulography

Kuronda nemethylene blue panzvimbo chaiyo nefistulography inoshandisa mifananidzo yemwaranzi inzira dzakasiyana dzekuongorora dzinowanzovhiringidzwa. Pakuronda panzvimbo chaiyo, dhayi inoiswa paburi rinofungidzirwa kuva refistula kana mugomba renhengo, uye chiremba anotarisa kuti bhuruu riri kubuda kumwe here kana kuti anotevera matishu akapendwa pakuvhiya: kubaya nepaburi rekunze kuti pawanikwe mugero wefistula yepanhengo yokubudisa tsvina, kuisa ruvara mumvura yokugezesa dundira kuti paonekwe kubuda kwayo ichipinda munzira yesikarudzi kana pachifungidzirwa fistula pakati pedundira nenzira yesikarudzi, uye mamwe mashandisirwo akafanana anoenderana nenzvimbo chaiyo. Maitiro anoenderana nenzvimbo, uye kukora kwemushonga hakuna mwero mumwe wakatarwa.

Fistulogram kana sinogram chaiyo inzira yokutora mifananidzo: chinhu chinonyatsooneka pamifananidzo yemwaranzi chinobayiwa mumugero, uye fluoroscopy kana CT inoratidza marongerwo awo. Hausi muedzo wemethylene blue. Hapana pane idzi nzira chinongotsiva MRI, CT, endoscopy, kana kuongororwa murwere akatindivadzwa kana fistula yakaoma kunzwisisa.

Pane chikanganiso chimwe chinoenderana nenzira yokupa mushonga chinofanira kusimbiswa: methylene blue inopiwa nemunzira yokubudisa tsvina inogona kupinda mumuviri yozobudiswa muweti gare gare. Chidzidzo chevanhu vakazvipira chakaratidza izvi mushure meenema ye50-mg uye chakagumisa kuti dhayi inoiswa mukati merectum haifaniri kushandiswa kusimbisa fistula inofungidzirwa kuva pakati peura hukuru nedundira, nokuti weti yebhuruu inogona kuvapo pasina fistula. Taura nzvimbo yenhengo nenzira yokutora mifananidzo, pane kuona mubvunzo wose wefistulography somuedzo mumwe chete.

Miganhu inobata nzira dzakawanda inofanira kuyeukwa

Kupararira mumuviri kune zvinhu zvine chekuita nekushanda kwemushonga zvinofanira kufungwa nezvazvo zvisingawaniki pakuronda panzvimbo chaiyo. Kana methylene blue yakakwana iri muropa, inotora chiedza chinoshandiswa nemidziyo yokutarisa mamiriro omurwere, saka pulse oximetry inogona kuratidza mwero weoxygen yakabatwa neropa uri pasi peuri chaizvo. Kupiwa kwayo ichipararira mumuviri kunogona kukonzera kuparara kwakakomba kwemasero matsvuku eropa muvanhu vane kushomeka kweG6PD, uye mashoko azvino echiratidzo chemushonga unobayiwa anoti kushomeka kweG6PD chikonzero chokusashandisa mushonga uyu. Zvakare, njodzi inobva pakubaya uwandu huduku zvikuru panzvimbo chaiyo kana padhayi yakavharirwa mucuff yenzira yekufema haina kuenzana neyekupiwa mg/kg dzinoverengeka nemutsinga, asi “panzvimbo chaiyo” hazvingorevi kuti hapana chinopinda mumuviri: nzira yokupa, uwandu, uye mamiriro ematishu zvinokosha.

Pfungwa yokupedzisira ine chokuita nokuziva dhayi yacho. Kuita kuti zvinhu zvioneke pakuvhiya kunoenderana nokuziva chaizvo kuti ndeipi dhayi iri musirinji: methylene blue, isosulfan blue, patent blue V, Evans blue, uye madhayi ezvokudya zvinoshanda zvakasiyana uye zvine njodzi dzakasiyana, asi zvose zvinowanikwa munzira dzinongonzi miedzo ye“dhayi yebhuruu”. Kuchenjerera kumwe chete kunoshanda kunze kwechipatara. Zvigadzirwa zvinotengeswa semethylene blue zvinosiyana zvikuru pamhando yazvo nemagwaro anozvitsigira, uye zvinhu zvakagadzirirwa kupenda machira hazvitsivi zvinhu zvakagadzirwa zvikaedzwa nokuda kwechinangwa chazvo chakataurwa. Kana kuchena kuchikosha, tsvaga kugadzirwa kunoenderana nezvinodiwa zvemishonga, kuedzwa kwakazara kweUSP kune chitupa cheongororo cheboka rimwe nerimwe rakagadzirwa, uye kusimbiswa kwakazvimirira, pane kungoongororwa simbi dzinorema chete. Nhungamiro yokuverenga chitupa cheongororo inotsanangura zvikamu zvinofanira kutariswa. Zvinyorwa zvakadzama zvinotsigira mashoko aya zvakanyorwa muraibhurari yetsvakurudzo.