Chinyorwa
Methylene blue yekusukurudza muromo pamucositis: zvakaratidzwa nemuedzo mumwe wekurwadziwa kunoenderana negomarara
Mucositis inokonzerwa nekurapwa kwegomarara inyaya yakanyatsotsanangurwa. Chemotherapy kana kurapwa kunogadzirira kuisirwa masero matsva kunokuvadza rukoko rwemukati memuromo, maronda oita, uye magumo etsinga asara pachena anoita kuti kudya, kumedza, uye kutaura zvirwadze. Pachiyero cheWHO chemucositis chinotsanangurwa mumirayiridzo yekuchengeta varwere vachitsigirwa, giredhi 2 richiri kubvumira kudya chikafu chakasimba asi giredhi 3 rinomanikidza murwere kungonwa zvinwiwa chete. Kudzora kurwadziwa nekupora kwenyama yemuromo migumisiro yakasiyana. Mushonga wekusukurudza unogona kuvandudza chekutanga pasina kuchinja chechipiri.
Musiyano iwoyo ndiwo unobatsira kunzwisisa muedzo wakanakisisa uripo pavanhu wemethylene blue yekusukurudza muromo pakushandiswa uku: muedzo wechikamu 2 wa2022 paMD Anderson wakapatsanura varwere mumapoka nemukana, wakabudiswa muBMC Medicine sechidzidzo chekurwadziwa kwemucositis kwakaoma kudzora. Hauna kuedza methylene blue pamaronda emuromo ose, utachiona hwepahuro, utachiona hwefungus hwemumuromo, kana kushandisa mushonga wekusukurudza muromo zuva nezuva. Wakaedza mushonga mumwe wakagadzirwa wekusukurudza, uchishandiswa nenzira imwe, pakurwadziwa kwairamba kuchienderera pasinei nekurapwa.
Zvakaedzwa nemuedzo
Magadzirirwo acho ari nyore: wedzera mushonga wekusukurudza unoshanda panzvimbo yaunobata pakurapwa kunowanzoitwa, uubate panzvimbo dzinorwadza, uupfire kunze, udzokorore panguva dzakarongwa, uye uyere kurwadziwa nekushanda kwemuromo pamaawa 48.
Vanhu vakuru vaiva nemucositis inorwadza pasinei nekurapwa kunowanzoitwa vakapatsanurwa nemukana kuti vawane kurapwa kwakajairika chete (n = 16) kana kurapwa kwakajairika pamwe nemethylene blue ine 0.025% (n = 15), 0.05% (n = 14), kana 0.1% (n = 15). Pavanhu 69 vakapinda, 60 vakapedza kurapwa. Mushumo wose wemuedzo unoti ruzivo rwehuwandu hwemethylene blue rwakavanzwa kune rimwe divi chete, asi boka rekuenzanisa harina kuwana mushonga webhuruu wekusukurudza, saka pakufananidza nekurapwa kwakajairika zvaisaita kuti mapoka arambe asingazivikanwi. Pakanga pasina boka rakapiwa mushonga usina chinhu chinoshanda, izvo vanyori vakanyora sechimwe chezvisingabvumiri mhedziso yakazara.
Vanhu ava vakanga vakanganiswa zvakanyanya. Pakati pevakapedza, 72% vakanga vaisirwa masero ekutanga anokura kuita mamwe masero, uye vamwe vose vakanga vawana chemotherapy inoshanda mumuviri wose kana kurapwa kweCAR-T. Pavakapinda, 90% vaiva nemucositis yegiredhi 3 reWHO uye 10% giredhi 2, vachinge vatova nekurwadziwa kwemazuva ane kukosha kwepakati kwe6. Chinyorwa hachipatsanuri mhando dzegomarara dzakaonekwa, saka hachigoni kushandiswa kutsigira zvinotaurwa nezvemhando chaiyo yegomarara.
Murwere mumwe nemumwe akapiwa bhodhoro re100 mL remushonga wakagadzirwa kuchitoro chemishonga chetsvakurudzo: tora 6 kusvika 10 mL, uubate panzvimbo dzinorwadza kwemaminitsi 5 uchiutenderedza mumuromo nekukukurudza pahuro, uupfire kunze usingaumedzi, umire usati wasukurudza kana kudya, uye udzokorore maawa 6 oga oga kwemazuva anenge 2. Kurapwa kwavaiwanzowana kwakaramba kuchienderera uye kwaigona kusanganisira kuchenesa muromo, mushonga welidocaine wekusukurudza, mushonga wakasanganiswa unonzi magic mouthwash une nystatin, mishonga yakasanganiswa yediphenhydramine nemushonga unoderedza asidhi, uye maopioid anoshanda mumuviri wose.
Chiyero chikuru chemugumisiro chakabudiswa chaiva kuchinja kwekurwadziwa pachiyero chine mapoinzi 11 (0 kana pasina kurwadziwa, 10 pakurwadziwa kwakanyanya), kubva pakutanga kusvika pazuva 2. Kushanda kwemuromo kwakayerwa nechiyero chekuomerwa kubva pa0 kusvika pa6, chichibatanidza kudya, kumedza, uye kutaura, chimwe nechimwe chichipiwa mamakisi ekuti anokwanisa, zvinomuomera, kana haakwanisi. Giredhi reWHO rakanyorwa pakupinda chete, harina kuramba richiyerwa nenguva.
Pfupiso yemagadzirirwo emuedzo nemigumisiro
Tafura iyi inopatsanura zvinhu zvitatu: kurwadziwa, kushanda kwemuromo, uye migumisiro isingadiwi. Kupora, kubviswa kweutachiona, uye kuderedzwa kwekudiwa kwemaopioid hazvina kusimbiswa pano.
| Mubvunzo | Zvakayerwa | Mugumisiro pazuva 2 |
|---|---|---|
| Kurwadziwa kwakaderera here? | Kuchinja kwemamakisi ekurwadziwa, kubva pakutanga kusvika pazuva 2 | Avhareji yekuderera yaiva 1.69 pakurapwa kwakajairika zvichienzaniswa ne5.20, 4.54, uye 5.15 pamishonga ye0.025%, 0.05%, uye 0.1% yekusukurudza. Mamakisi epakati pazuva 2: 5.5 zvichienzaniswa ne3, 2, uye 2. |
| Kudya, kumedza, uye kutaura zvakavandudzika here? | Kuomerwa nekushanda kwemuromo, 0 kusvika 6 | Avhareji yekuderera yaiva 0.81 pakurapwa kwakajairika zvichienzaniswa ne2.47, 2.79, uye 2.87 pamishonga mitatu yekusukurudza ine huwandu hwakasiyana. Mamakisi epakati pazuva 2: 4 zvichienzaniswa ne2, 1, uye 2. |
| Zvakaitika nokukurumidza zvakadii, uye zvakagara kwenguva yakadii? | Nguva yakataurwa nevarwere | Pavanhu 44 vakapedza vachishandisa mushonga wekusukurudza, 77% vakanzwa kurerukirwa kukuru mukati memaminitsi mushure mekusukurudza kekutanga. Kurwadziwa kwakadzoka mu57%, kazhinji pakati pemaawa 4 ne8, kusisina kusimba sepakutanga. Vanenge 59% vakakumbira mumwe mushonga wekusukurudza mushure mezuva 2. |
| Maronda akapora nokukurumidza here? | Giredhi reWHO nekufamba kwenguva | Hazvina kuyerwa mushure mekupinda muchidzidzo. Vanyori vanoti nguva yekupora inoda kumwe kuongororwa. |
| Kushandiswa kwemaopioid kwakaderera here? | Huwandu hwezuva nezuva hwakaenzana nemorphine | Hazvigoni kududzirwa. Huwandu hwepakati pakutanga hwaiva hunenge 114 mg pazuva, asi huwandu hwakapiwa nokuda kwemucositis hwaisagona kupatsanurwa nehwakapiwa nokuda kwekumwe kurwadziwa. |
| Kukuvadza kupi kwakaonekwa? | Zviitiko zvisingadiwi kusvika pamazuva 30 | Kutsva kwemuromo kwenguva pfupi pakushandisa kekutanga (zviitiko 5 mumigumisiro yakadzama; pfupiso inoti 8, musiyano usina kutsanangurwa), kusanganisira mumwe akarega kupinda muchidzidzo. Ruvara rwebhuruu rwenguva pfupi rwakabviswa nekuchenesa muromo kana nekudya. Hapana zviitiko zvakakomba zvisingadiwi uye hapana ruvara rwakaramba ruripo pamazuva 30. |
Zvichienzaniswa nekurapwa kwakajairika, kuderera kwekurwadziwa kwakasvika pamuganhu unowanzoshandiswa wekusiyana kunokosha pakuongorora nhamba pamishonga ye0.025% ne0.1%, asi pa0.05% kwaiva pedyo nemuganhu iwoyo (P = .0506). Mishonga mitatu yekusukurudza ine huwandu hwakasiyana haina kusiyana mumigumisiro yayo, saka muedzo hauratidzi huwandu hwemethylene blue hwakanakisisa.
Zvisina kuedzwa nemuedzo uyu
Muverengi anoona mugumisiro wakanaka pakurwadziwa obva aufungidzira uchishandawo pane imwe nyaya iri pedyo. Kuwedzerwa kwemhedziso kwega kwega kuri pasi apa kunoda muedzo wako.
Chekutanga, kurapwa kweutachiona. Muedzo wakayera kurwadziwa nekushanda kwemuromo pamucositis inoenderana nechemotherapy. Hauna kuedza utachiona hwemumuromo hunokonzerwa nemabhakitiriya, fungus, kana mavhairasi, rukoko runoungana pamazino, kuzvimba kwemazino epamuromo, kana kungochengeta mweya wemumuromo uchinhuwirira zvakanaka. Kushandiswa kwemumwe mushonga une nystatin pakurapwa kwaienderera mberi hakuiti kuti mushonga wakaedzwa wekusukurudza uve unorwisa fungus. Pfupiso yedu inopatsanura maronda emuromo akajairika nemucositis inokonzerwa nekurapwa kwegomarara inochengeta mashandisirwo aya akaparadzana.
Chechipiri, kushandiswa kwemethylene blue yekusukurudza muromo kune vanhu vose. Vakapinda vaiva nemucositis yegiredhi 2 kusvika 3 yairamba kurapwa uye vaichengetwa nenyanzvi dzegomarara. Vanhu vane utano vakazvipira, maronda emuromo akajairika, uye kurwadziwa kwehuro hazvina kuongororwa. Muganhu iwoyo unotsanangurwawo mugwaro redu rezvinotaurwa nezvemuromo nehuro.
Chechitatu, kupora kwerukoko rwemukati memuromo. Pasina kuramba kuchiyerwa giredhi kana maronda, mamakisi ekurwadziwa akaderera haagoni kuratidza kuti nyama yemuromo yakapora nokukurumidza. Vanyori vanotaura izvi zvakajeka.
Chechina, methylene blue inomedzwa. Varwere vakapfira mushonga wekusukurudza kunze. Kupinda kwemushonga muropa, kudyidzana kwawo nemimwe mishonga, uye kukuvadza kunobva pakumedza dhayi hazvisi izvo zvakaedzwa. Kupfira kunze pane kumedza chikamu chenzira yakashandiswa, kwete chinhu chidiki.
Nei mushonga unotengeswa muchitoro usingagoni kungotsiva wakaedzwa
Mushonga wakagadzirwa nokuda kwechidzidzo nebhodhoro rinotengeswa muchitoro zvinogona kuva neruvara rumwe chete asi zvichisiyana pazvinhu zvose zvinotaridza mashandiro nenjodzi: huwandu hwemethylene blue, huwandu hwemvura, nguva yaunobata nyama yemuromo, zvimwe zvinoumba mushonga, kuchena kwawo maererano neutachiona, uye mirayiridzo. Muedzo uyu wakashandisa mishonga yakagadzirwa ine huwandu hunenge 0.25 kusvika 1 mg pa mL, kuibata kwemaminitsi 5 akayerwa, uye kushandisa mushonga maawa 6 oga oga. Chigadzirwa chemuchitoro chine humwe huwandu, kungochitenderedza mumuromo kwechinguvana, kana murayiridzo wekuchimedza hazvidzokorori chero mamiriro iwayo.
Mabhodhoro emuedzo akabva kuchitoro chemishonga chetsvakurudzo. Methylene blue inotengeswa muzvitoro inosiyana pagiredhi nekuongororwa, uye kukanganisa huwandu hwayo mumuromo une maronda hakusi chinhu chidiki. Kuenzanisa kunoda huwandu hwacho chaihwo, rondedzero yakazara yezvinoumba mushonga, uye chitupa chinobata mushonga wakapedzwa kusanganiswa, kwete chinhu chakasvibirira chega. Tsananguro yedu yekuongororwa kwemushonga wakapedzwa kusanganiswa inotsanangura gwaro iroro.
Vatsvakurudzi vakafungidzira kuti mushonga uyu unoderedza kurwadziwa nokushanda patsinga dzinonzwa kurwadziwa dzasara pachena, zvichida uchibatsirawo nezviratidzo zvemumasero zvinoderedza kuzvimba panzvimbo yacho, uye vakaona kuti mushonga wekusukurudza hauna kubvisa kunzwa kuravira kana mhinduro yehuro yekuedza kurutsa sezvinoitwa nemushonga wakajairika unovharira kunzwa. Pfungwa iyoyo inoita kuti kurerutswa kwezviratidzo kuve kunonzwisisika. Hairatidzi kuti mvura yose yebhuruu inoshanda paronda ripi neripi remumuromo.
Mamiriro ekuchengeteka nemiganhu
Kukwanisa kushandisa mushonga kwenguva pfupi muboka iri rakasarudzwa hakuratidzi kuti wakachengeteka kuvanhu vose. Muedzo hauna kubatanidza vanhu vane kushomeka kweglucose-6-phosphate dehydrogenase, vane pamuviri, vanoyamwisa, uye vane mucositis inokonzerwa neradiotherapy. Methylene blue inoshanda mumuviri wose ine kudyidzana kwakakomba nemishonga inobata serotonin kunogona kukonzera serotonin syndrome, njodzi yekuparara kwemasero matsvuku eropa muvanhu vane kushomeka kweG6PD, uye zvinoda kungwarirwa pakuzvitakura. Kuti njodzi idzi dzemuviri wose dzinoshanda zvakadii pamushonga wekusukurudza wakapfirwa kunze nenzira yakarurama hazvina kunyatsoyerwa, saka kuongorora mishonga inoshandiswa kwakakosha.
Tarisira kuchinja kweruvara kuita bhuruu kwenguva pfupi, zivisa kana kutsva kuchiramba kuripo mushure mekushandisa kekutanga, uye usashandura mushonga wekusukurudza unofanira kupfirwa kunze kuita mushonga unomedzwa pasina kuongororwa nenyanzvi yezvekurapa.
Kuongororwa kwemashandiro kwakabudiswa kwakatevera varwere kwemaawa 48; kuongororwa kwekuchengeteka kwakaramba kuchienderera kusvika pamazuva 30. Boka raiva diki, kumwe kurapwa kwavaisowana kwaisiyana, uye boka rekuenzanisa rakanga risingavanzwi. Mugumisiro wacho chiratidzo chechikamu 2 chekudzora zviratidzo, kwete nzira yakatogamuchirwa yekurapa. Gwaro redu rekuverenga tsvakurudzo yemethylene blue rinoratidza maongororerwo ekupatsanurwa mumapoka nemukana, kuvanzwa kwemapoka, zviyero zvemigumisiro, uye kuteverwa kwevarwere usati waita chimwe chinhu uchivimba nemuedzo mumwe chete.
Mibvunzo yekuenda nayo kuchikwata chinorapa gomarara
Kurwadziwa kwemucositis kunotova nenzira dzakagamuchirwa dzekuchengeta murwere achitsigirwa, uye mushonga wose wekusukurudza uri kuedzwa unofanira kukurukurwa uri mukati meurongwa ihwohwo. Mibvunzo inobatsira inosanganisira kuti mucositis iripo ndeyegiredhi ripi, nzira dzipi dzakajairika dziri kutoshandiswa, mishonga ipi inogona kudyidzana nemethylene blue, kana mamiriro eG6PD achizivikanwa, uye kuti mugumisiro upi uchashandiswa kuona kubudirira kana kumisa kushandisa mushonga (mamakisi ekurwadziwa, kukwanisa kumedza zvinwiwa, kana mugumisiro usingadiwi). Uya neruzivo chairwo rwekutsvaga muedzo wacho uye rwemagadzirirwo emushonga pane kungouya nezvinotaurwa nezvechigadzirwa. Rondedzero yedu yekukurukura nachiremba inoratidza ruzivo rwechigadzirwa nechidzidzo rwakakodzera kudhindwa.
Saka nyaya yakaongororwa ine muganhu mudiki: mushonga wakagadzirwa wekusukurudza, waipfirwa kunze uye uchidzokororwa kakawanda, wakaderedza kurwadziwa kwemucositis kwairamba kurapwa uye wakavandudza kudya, kumedza, uye kutaura mumazuva 2 mukuenzanisa kudiki uko mapoka aisina kuvanzwa, pasina kuratidza kupora nokukurumidza, kuderera kwekudiwa kwemaopioid, kurapwa kweutachiona, kana kubatsira kwekusukurudza muromo kuvanhu vose.