Inqaku
I-methylene blue kuqhaqho neenkqubo zoxilongo: ukwenza imephu, iimvavanyo zokuvuza, nokulandela ngomkhondo wedayi
Isigulana esilungiselela uqhaqho lwebele sifunda ukuba "idayi eluhlaza okwesibhakabhaka" iza kusetyenziswa ukwenza imephu yamaqhuqhuva aso elymph. Isizalwane esiphononongelwa umjelo ongaqhelekanga phakathi kwamalungu, obizwa ngokuba yifistula, siva nge-"fistulography" size sicinge ukuba kuza kusetyenziswa idayi. Umntu onomngxuma woqhaqho kuqhoqhoqho, obizwa ngokuba yitracheostomy, unikwa "uvavanyo lwedayi eluhlaza okwesibhakabhaka" lokujonga ukhuseleko lokuginya. Bobathathu beva igama elithi luhlaza okwesibhakabhaka baze bacinge ukuba yinkqubo enye esebenzisa idayi enye. Akunjalo.
I-methylene blue kwigumbi lotyando iqondakala kakuhle njengengcamango enye esetyenziswa kwiindawo ezinganxulumananga: idayi eyenza okungabonakaliyo kubonakale. Ilandela ukuhamba kolwelo lwel lymph, ifaka umbala kwidlala ekujoliswe kulo, ifaka umbala kulwelo lovavanyo oluvuzayo, iphawula ikhafu egqabhukileyo yombhobho wokuphefumla, okanye ibonisa unxibelelwano olufihlakeleyo phakathi kwemingxuma emibini yomzimba. Ubungqina, isixa esisetyenziswayo, nomngcipheko zahluka kakhulu phakathi kwezi ndlela zokusetyenziswa. Kwaye ezinye iinkqubo ezibizwa ngokuba "ziimvavanyo zedayi eluhlaza okwesibhakabhaka" zisebenzisa ezinye iidayi ngokupheleleyo, ngoxa ifistulography yemifanekiso yoxilongo ingasebenzisi i-methylene blue kwaphela. Eli nqaku lichaza indlela nganye yokusetyenziswa ngokwahlukeneyo. Ngombuzo obanzi wokuba zeziphi iindlela zokusetyenziswa kwezonyango ezisele zamkelwe kwaye zeziphi ezisaphandwayo, bona iindlela zokusetyenziswa kwezonyango ezigunyazisiweyo nezisaphandwayo.
Imephu yeenkqubo: ukwenza kubonakale, hayi ukunyanga
| Inkqubo | Into eyenziwa yidayi | Isixa okanye indlela eqhelekileyo yokuchanabeka | Umda ophambili |
|---|---|---|---|
| Ukuthatha isampulu kwiqhuqhuva lokuqala lelymph | Ifaka umbala kwimithambo nakumaqhuqhuva ahambisa ilymph | ~1 mL yesisombululo esiyi-1% kwindawo ethile | Izinga lokuchonga liphantsi xa isetyenziswa yodwa kunaxa idityaniswe nesiphawuli semitha |
| Ukufumana amadlala eparathyroid (ngokwembali nge-IV) | Ifaka umbala kumadlala angaqhelekanga ngokudlula kwinkqubo yomzimba | 3–7.5 mg/kg IV | Isixhobo esincedisayo kwiimeko ezikhethiweyo; umngcipheko wokudibana namachiza achaphazela iserotonin |
| Ukufumana amadlala eparathyroid (kwindawo ethile) | Iphawula indawo eyaziwayo ekujoliswe kuyo kwiintamo ezineziva | ~0.2 mL yesisombululo esiyi-~0.2% | Kuphela luchungechunge oluncinci lwezifundo zokuqwalasela |
| Uvavanyo lokufaka isaline | Ifaka umbala kulwelo oluphuma kwinxeba lelungu elidibanisa amathambo | Ixutyiwe ukuze ibe buthathaka, ayinamlinganiselo umiselweyo | Akukho kuphucuka kungqiniweyo ekukwazini kovavanyo ukubhaqa imeko |
| Ikhafu yombhobho wokuphefumla xa kusetyenziswa ilaser | Ifaka umbala kwisaline ekwikhafu ukuze ukugqobheka kubonise umbala oluhlaza okwesibhakabhaka | Ivalelwe ngaphakathi kwikhafu | Ayenzi umbhobho umelane nelaser |
| Uvavanyo lwedayi eluhlaza okwesibhakabhaka lokuginya | Ifaka umbala ekutyeni ukuze kubonakale ukungena kwako kwindlela yokuphefumla | Alunamlinganiselo umiselweyo | Iziphumo ezingabonisi imeko nangona ikhona; "idayi eluhlaza okwesibhakabhaka" isenokuba yenye idayi |
| Ukulandela ifistula ngedayi | Ibonisa umjelo ngokufaka umbala ngokuthe ngqo | Kuxhomekeke kwindawo, ixutyiwe ukuze ibe buthathaka | Luvavanyo olwahlukileyo kwifistulography esebenzisa into ebonakala kwi-X-reyi |
Akukho nanye kwezi eyindlela yokunyanga nge-methylene blue. EUnited States, ukusetyenziswa kwayo ngonyango ngokufakwa emthanjeni okubhalwe kwileyibhile kukunyanga imethemoglobinemia efunyenweyo, ngokuqhelekileyo nge-1 mg/kg IV, njengoko kuchaziwe kulwazi lweDailyMed lokumisela iyeza. Ukuyisebenzisa ekulandeleni imikhondo kuqhaqho ubukhulu becala kukusetyenziswa okungekho kwileyibhile okanye okuxhomekeke kwisixhobo esithile, kusekelwe kolu phawu lunye lokufaka umbala.
Ukuthatha isampulu kwiqhuqhuva lokuqala lelymph: ukulandela ukuhamba kolwelo
Emva kokutofwa kwindawo ekufuphi nethumba, i-methylene blue ingena kwimithambo yelymph ize ifake umbala oluhlaza okwesibhakabhaka kwimijelo ehambisa ulwelo nakumaqhuqhuva okuqala, ukuze ugqirha wotyando akwazi ukuwachonga ngamehlo. Kumhlaza webele, idayi eluhlaza okwesibhakabhaka isesisiphawuli esamkelweyo, ngokwesithethe idityaniswa ne-radiocolloid ye-technetium-99m, kwaye isikhokelo sangoku seNICE sicebisa indlela edibanisa i-isotope nedayi eluhlaza okwesibhakabhaka. Qaphela ukuba "idayi eluhlaza okwesibhakabhaka" kwizikhokelo ayisoloko ithetha i-methylene blue ngokukodwa; i-patent blue V ne-isosulfan blue nazo ziyasetyenziswa.
Iinkqubo eziqhelekileyo zebele zisebenzisa i-methylene blue eyi-1% (10 mg/mL), rhoqo malunga ne-1 mL, kwaye indawo yokuyitofa iyahluka: ngaphantsi kwe-areola, ejikeleze i-areola, ngaphakathi kolusu, okanye ejikeleze ithumba. Ukwenza imephu nge-methylene blue kuphela kuyasebenza, kodwa ubungqina obudityanisiweyo buxhasa ukongeza isiphawuli semitha: uhlalutyo oludibanisa iziphumo zezifundo ezininzi ze-methylene blue yodwa lwaxela izinga lokuchonga eliyi-91% kunye nezinga leziphumo ezingabonisi imeko nangona ikhona eliyi-13%, ngoxa iindlela ezidityanisiweyo zibhaqa ngokuthembeka ngakumbi. Kwimelanoma, ukwenza imephu kuxhomekeke ikakhulu kwilymphoscintigraphy nge-technetium ngaphambi koqhaqho, kunye nesixhobo sokubhaqa imitha ye-gamma ngexesha loqhaqho, yaye idayi eluhlaza okwesibhakabhaka iyancedisa; isikhokelo sobugcisa se-ASCO/SSO sichaza i-1–2 mL yedayi eluhlaza okwesibhakabhaka yokuphawula izicubu eziphilayo etofwa ngaphakathi kolusu, kunikwe malunga nemizuzu eyi-5–10 ukuze ihambe kwinkqubo yelymph, kwaye sidwelisa i-methylene blue ne-isosulfan blue njengezinto ezinokukhethwa.
Indlela entsha yokwenza imephu ngokukhanya kwefluorescence nge-indocyanine green (ICG) ibonisa imithambo yelymph ngexesha lokwenene ngaphandle kwemitha eyenza ii-ion, kodwa ifuna izixhobo zokukhanya okukufuphi ne-infrared, kwaye ukwamkelwa kwayo kwizikhokelo kusahluka. Intsingiselo esebenzayo: i-methylene blue sisiphawuli esingabizi kakhulu nesilula ukusiqonda ngamehlo, kwaye ubuthathaka baso kukuba amaqhuqhuva abonakala kuphela xa sele eveziwe ngoqhaqho.
I-methylene blue ineengxaki ezithile apha. Inokubangela ukuba ulusu nezicubu zihlale zinombala ixesha elide, utshintsho olunxulumene nokudumba, ukufa kwezicubu zamafutha, yaye ngamanye amaxesha ukufa kwezicubu zolusu; imifanekiso yoxilongo lwebele emva koqhaqho inokubonisa izilonda ezingamile kakuhle ezinxulumene nedayi, ezinokufana nokubuya kwesifo. Oogqirha botyando kufuneka bazise amasebe emifanekiso yoxilongo nawohlalutyo lwezicubu nanini na xa idayi itofwe ngaphakathi okanye kufuphi nesampulu. Iidayi eziluhlaza okwesibhakabhaka zinokubangela nokwaliwa ngokukhawuleza; uhlalutyo oludibanisa iziphumo zeenkqubo zamaqhuqhuva okuqala ezingaphezu kwe-60,000 lwafumanisa izinga lilonke le-anaphylaxis enxulumene nedayi eluhlaza okwesibhakabhaka elimalunga ne-0.061%, kwaye i-methylene blue yayinxulumene namazinga asezantsi kune-isosulfan blue. Iinkcukacha ezibanzi zokhuseleko ziqokelelwe kwiziphumo ebezingalindelekanga nokhuseleko.
Ukufumana amadlala eparathyroid: indlela endala echaphazela umzimba wonke, ngoku esetyenziswa kwiimeko ezikhethiweyo
Ukufaka i-methylene blue emthanjeni ukuze kufunyanwe amadlala eparathyroid angaqhelekanga yindlela endala esasele isetyenziswa kuphela njengesincedisi kwiimeko ezikhethiweyo. Ngokwembali, iidosi ezinkulu noko zazifakwa emthanjeni ngaphambi kokuhlolwa kwentamo ngoqhaqho, ukuze izicubu ezingaqhelekanga zibe luhlaza okwesibhakabhaka; iinkqubo ezipapashiweyo zisukela malunga ne-3 ukuya kwi-7.5 mg/kg IV. Uphononongo olucwangcisiweyo lwafumana izifundo zokuqwalasela eziyi-39 kwaye akukho zilingo ezinezabelo ezabelwe ngokungakhethiyo: kwaxelwa ukuba amazinga okufakwa kombala ayephezulu, kodwa kwakungekaqinisekiswa ukuba le ndlela yongeza ixabiso xa isetyenziswa kunye neendlela zale mihla zokufumana indawo.
Indlela esetyenziswa ngoku ixhomekeke kwi-ultrasound nakweminye imifanekiso yoxilongo ngaphambi koqhaqho, ekwakhekeni kwamalungu okubonwa ngexesha loqhaqho, nasekubekeni iliso kwihomoni yeparathyroid ngexesha loqhaqho. Isikhokelo se-AAES sidwelisa i-methylene blue phakathi kwezixhobo ezininzi ezinokuncedisa ekwenzeni izinto zibonakale, kunokuba ibe yindlela ephambili yokufumana indawo.
Le ikwayindlela yokusetyenziswa apho isilumkiso sokudibana kwamachiza sibaluleke kakhulu. I-methylene blue sisithinteli esinamandla se-monoamine oxidase esisebenza ngendlela enokubuyiselwa umva, kwaye uphononongo olucwangcisiweyo lwaxela umonakalo oyityhefu kwinkqubo yemithambo-luvo kwizigulana eziyi-25, zonke zazithatha amayeza achaphazela iserotonin. Olunye uphononongo loncwadi lwezenzululwazi ngesifo seserotonin esinxulumene ne-methylene blue lwafumana iimeko eziyi-50, zonke zibandakanya amayeza okulwa udandatheko achaphazela iserotonin, uninzi lunxulumene noqhaqho lweparathyroid okanye unyango lwevasoplegia. Iidosi zeparathyroid ezazisetyenziswa ngokwembali zinokuyigqitha kakhulu idosi yangoku yonyango eyi-1 mg/kg, ngoko oku kudibana kwamachiza kunxulumene nokuchanabeka komzimba wonke, kungekhona nethontsi ledayi kwizicubu.
Kuchazwe enye indlela eyahlukileyo, enokuchanabeka okuncinci kakhulu, yeentamo eziphinda ziqhaqhwe okanye ezineziva: ukutofa ngokuthe ngqo kwindawo eyaziwayo ekujoliswe kuyo, kukhokelwe yi-ultrasound, kwaye izifundo ezincinci zisebenzisa malunga ne-0.2 mL yesisombululo esiyi-1% esixutywe ngomlinganiselo we-1:5 (malunga ne-0.2%) kanye ngaphambi koqhaqho. Ubungqina buphelele kuchungechunge oluncinci lwezifundo zokuqwalasela.
Uvavanyo lokufaka isaline: idayi ayisiyiyo eyenza uvavanyo lusebenze
Kuvavanyo lokufaka isaline lokujonga ukuba ukwenzakala kuvule ngaphakathi kwelungu elidibanisa amathambo, isaline itofwa kwelo lungu kuze kujongwe ukuba ulwelo luyavuza na enxebeni. Ngamanye amaxesha i-methylene blue iyongezwa nje ukuze ulwelo oluphumayo lubonakale lula. Isiphumo esibalulekileyo kukuba akukaboniswa ukuba idayi iyaluphucula uvavanyo: kuphononongo lwedolo olwalucwangciswe lwaza lwaqhutywa ngokulandelela izigulana eziyi-58, ezabelwa kumaqela ngokungakhethiyo, amazinga eziphumo ezingabonisi imeko nangona ikhona ayeyi-69% nge-methylene blue xa kuthelekiswa ne-66% ngesaline yodwa, kwaye kwakufuneka izixa zolwelo ezifanayo ukuze uvavanyo lubonise imeko. Uphononongo olucwangcisiweyo luka-2025 lwafumanisa ukuba izifundo eziyi-8 kweziyi-23 zokufaka isaline zazisebenzise idayi, kodwa indlela uvavanyo olusebenza ngayo yayixhomekeke kwilungu elidibanisa amathambo, kwindawo yenxeba, kumthamo otofiweyo, nakwindlela yokwenza, kunokuba ixhomekeke ekongezweni kwedayi. Akukho mlinganiselo wobuxinaniso oqhelekileyo oqinisekisiweyo wale njongo. Apha i-methylene blue yinto yokufaka umbala enokukhethwa kwiinkqubo zembali okanye zovavanyo, hayi icandelo elenza uvavanyo lukwazi ukubhaqa imeko.
Imibhobho yendlela yokuphefumla xa kusetyenziswa ilaser: idayi ivalelwe ngaphakathi kwikhafu
Oku kusetyenziswa kusebenza ngokwahlukileyo kuzo zonke ezinye ezikweli phepha: idayi idla ngokufakwa ngaphakathi kwikhafu yombhobho ofakwa kuqhoqhoqho, hayi emzimbeni wesigulana. Kuqhaqho lwendlela yokuphefumla ngelaser, izikhokelo zokuthintela umlilo ngexesha lokubulawa kweentlungu zincoma umbhobho ofanelekileyo omelana nelaser, kwaye, apho kunokwenzeka, ukuzalisa ikhafu ngesaline endaweni yomoya. Ukufaka umbala kuloo saline nge-methylene blue kuthetha ukuba ukugqobheka okubangelwe yilaser kuvelisa ukuvuza okuluhlaza okwesibhakabhaka okubonakala ngoko nangoko. Akukho buxinaniso bumiselwe kuzo zonke iimeko; injongo kukufaka umbala obonakalayo, njengoko kuchazwe kwingcebiso ye-ASA yokuthintela nokulawula imililo kwigumbi lotyando.
Zimbini izilumkiso ezibalulekileyo. Eminye imibhobho yelaser yakudala yayiquka iikristale zedayi ngaphakathi kwikhafu okanye kwinkqubo elawula ukuzaliswa kwayo, kwaye ingxelo epapashiweyo ichaza iikristale ezinganyibilikanga ezavala umbhobho wokulawula ikhafu, nto leyo eyabangela ukuba ikhafu ingakwazi ukukhutshwa ulwelo; yiyo loo nto imiyalelo yesixhobo ngasinye ibalulekile. Kwaye i-methylene blue ngokwayo ayenzi umbhobho oqhelekileyo umelane nelaser; ukuthintela umlilo kuxhomekeke nakwindlela umbhobho owenziwe ngayo, ekukhuseleni ikhafu, nasekunciphiseni ubuxinaniso bezinto ezixhasa ukutsha.
Iimvavanyo zokuginya: "idayi eluhlaza okwesibhakabhaka" isenokungabi yi-methylene blue
Kuvavanyo oluqhelekileyo olwenziwa ecaleni kwebhedi kwisigulana esinetracheostomy, ukutya okanye ulwelo lufakwa umbala kuze kukhangelwe umbala oluhlaza okwesibhakabhaka kwiincindi zoqhoqhoqho; isiphumo esibonisa loo mbala sixhasa ukuba ukutya okanye ulwelo kungene kwindlela yokuphefumla. Amagama asetyenziswayo anokungaqondwa lula: iinkqubo ezipapashiweyo "zovavanyo lwedayi eluhlaza okwesibhakabhaka" nezovavanyo oluguquliweyo lwedayi ye-Evans blue zisebenzise i-Evans blue, i-methylene blue, kunye needayi zokutya, ngoko "uvavanyo lwedayi eluhlaza okwesibhakabhaka" aluthethi ngokuzenzekelayo i-methylene blue.
Ingxaki ephambili ziziphumo ezingabonisi imeko nangona ikhona. Ukukwazi ukubhaqa imeko kwiinkqubo ezahlukeneyo kusukela malunga ne-38% ukuya kwi-95%, kwaye izikhokelo ziluthatha olu vavanyo ikakhulu njengomqondiso oncedisayo wokuxhasa ubukho bemeko xa isiphumo siyibonisa: uvavanyo olungayibonisiyo alukukhuphi ukungena kokutya okanye kolwelo kwindlela yokuphefumla. Xa kufuneka uhlolo oluqinisekileyo, kusetyenziswa iimvavanyo ngezixhobo ezifana nokuhlola ukuginya nge-endoscope enemisonto yokukhanya okanye ivideofluoroscopy. Akukho sixa sedayi esigqibeleleyo siqinisekisiweyo.
Musa ukukubhidanisa oku nendlela yakudala yokusoloko kufakwa umbala wesondlo esinikwa ngendlela yokwetyisa nge-FD&C Blue No. 1. Leyo yidayi eyahlukileyo nendlela eyahlukileyo, eyayinxulumene nokufunxeka idlulele emzimbeni wonke kunye netyhefu eyingozi kwizigulana ezigula kakhulu, yaza kamva ayakhuthazwa.
Ukulandela ifistula akuyofistulography
Ukulandela nge-methylene blue kwindawo ethile nefistulography yemifanekiso yoxilongo ziindlela ezahlukeneyo zoxilongo ezidla ngokubhidaniswa. Ekulandeleni kwindawo ethile, idayi ifakwa kumngxuma okrokrelwa ukuba ngowefistula okanye kumngxuma welungu lomzimba, aze umchwephesha wezonyango ajonge ukuba umbala oluhlaza okwesibhakabhaka uyavela na kwenye indawo okanye alandele izicubu ezifakwe umbala ngexesha loqhaqho: ukutofa ngomngxuma wangaphandle ukuze kufunyanwe umjelo wefistula yempundu, ukufaka umbala kulwelo lokuhlamba isinyi ukuze kubonakale ukuvuza kungene kwilungu lobufazi xa kukrokrelwa ifistula phakathi kwesinyi nelungu lobufazi, kunye nezinye iindlela ezifanayo ezixhomekeke kwindawo. Iinkqubo zixhomekeke kwindawo kwaye ubuxinaniso abunamlinganiselo umiselweyo.
Ifistulogram okanye isinogram yokwenene yinkqubo yemifanekiso yoxilongo: into yokwenza umahluko ebonakala kwi-X-reyi itofwa kumjelo, kuze ifluoroscopy okanye i-CT yenze imephu yokwakheka kwawo. Ayilovavanyo lwe-methylene blue. Akukho nanye kwezi ndlela enokuthi ithathe indawo ye-MRI, i-CT, i-endoscopy, okanye uhlolo phantsi kokubulawa kweentlungu kwifistula entsonkothileyo kuzo zonke iimeko.
Kukho umgibe omnye oxhomekeke kwindlela yokufaka ekufuneka ugxininiswe: i-methylene blue efakwa ngomngxuma wempundu inokufunxeka ize kamva ikhutshwe ngomchamo. Uphononongo lwabantu abazivolontiyileyo lwabonisa oku emva kwe-enema eyi-50-mg, lwaza lwagqiba kwelokuba idayi efakwa ngaphakathi kwinxalenye yokugqibela yamathumbu akufanele isetyenziselwe ukuqinisekisa ifistula ekrokrelwayo phakathi kwamathumbu amakhulu nesinyi, kuba umchamo oluhlaza okwesibhakabhaka unokubakho ngaphandle kwefistula. Chaza indawo yomzimba nendlela yemifanekiso yoxilongo endaweni yokuphatha yonke imibuzo ngefistulography njengovavanyo olunye.
Imida echaphazela iindlela ezininzi ekufuneka ikhunjulwe
Ukuchanabeka komzimba wonke kufuna ingqalelo kwiziphumo zechiza engafunekiyo ngendlela efanayo ekulandeleni kwindawo ethile. Xa kukho i-methylene blue eyaneleyo egazini, ifunxa ukukhanya okusetyenziswa zizixhobo zokubeka iliso, ngoko umlinganiselo weoksijini ngesixhobo se-pulse oximetry unokubonisa ukuhlutha kweoksijini okungaphantsi kokwenene. Ukuyifaka ngendlela echaphazela umzimba wonke kunokubangela ukuqhekeka okukhulu kweeseli ezibomvu zegazi kubantu abaswele i-G6PD, kwaye ileyibhile yangoku yeyeza elitofwayo idwelisa ukuswela i-G6PD njengemeko engavumeli ukusetyenziswa kwalo. Kwakhona, umngcipheko wokutofa izixa ezincinane kakhulu kwindawo ethile okanye wedayi evalelwe ngaphakathi kwikhafu yombhobho wokuphefumla awulingani nowezixa ezininzi ze-mg/kg ezifakwa emthanjeni, kodwa "kwindawo ethile" akuthethi ngokuzenzekelayo ukuba akukho nto ifunxekayo idlulele emzimbeni wonke: indlela yokufaka, isixa, nemeko yezicubu zibalulekile.
Inqaku lokugqibela liphathelele ekuchongeni idayi. Ukwenza izinto zibonakale kuqhaqho kuxhomekeke ekwazini kanye ukuba yeyiphi idayi ekwisirinji: i-methylene blue, i-isosulfan blue, i-patent blue V, i-Evans blue, needayi zokutya ziziphatha ngokwahlukileyo kwaye zinemingcipheko eyahlukileyo, nangona zonke zivela kwiinkqubo ezibizwa nje ngokuba ziimvavanyo "zedayi eluhlaza okwesibhakabhaka". Ukuchaneka okufanayo kuyafuneka nangaphandle kwesibhedlele. Iimveliso ezithengiswa njenge-methylene blue zahluka kakhulu ngomgangatho nangamaxwebhu, kwaye izinto zomgangatho wokufaka umbala kumalaphu azithathi indawo yezinto ezenziwe zaza zavavanyelwa injongo yazo echaziweyo. Xa ubunyulu bubalulekile, khangela ukuveliswa ngokwemigangatho yamayeza, uvavanyo olupheleleyo lwe-USP olunesatifikethi sohlalutyo sebhetshi ethile, kunye nokuqinisekiswa okuzimeleyo, kunokuxhomekeka kuvavanyo lweentsimbi ezinzima kuphela. Isikhokelo sokufunda isatifikethi sohlalutyo sichaza ukuba zeziphi iinkalo ekufuneka zihlolwe. Imithombo eneenkcukacha ezinzulu idweliswe kwithala lophando.