Inqaku
Imethylene blue noxinzelelo lwegazi: iindlela esebenza ngazo, ukusetyenziswa kunyango, neengozi
Imethylene blue inokunyusa uxinzelelo lwegazi, ingakumbi xa ifakwa emthanjeni kwizigulana ezinemithambo yegazi eyandiswe ngokugqithiseleyo. Eso siphumo sinceda ekuchazeni isizathu sokuba iphandwe kwiintlobo ezithile zokothuka komzimba. Asiyiqinisekisi imethylene blue njengonyango loxinzelelo lwegazi oluphantsi oluqhelekileyo, yaye ayilonyango oluqinisekisiweyo loxinzelelo lwegazi oluphezulu.
Kumntu ocinga ngokusebenzisa imveliso ethathwa ngomlomo, umbuzo oluncedo ungqale ngakumbi: bubuphi ubungqina obuqikelela isiphumo sale ndlela yokwenziwa kwemveliso, xa ithathwa ngale ndlela, kumntu onale mbali yezempilo? Izifundo zasesibhedlele ezingezantsi aziboneleli ngolo qikelelo.
Kutheni ukuxhathisa kwemithambo yegazi kubalulekile
Imithambo ethwala igazi lisuka entliziyweni inezihlunu ezigudileyo ezitshintsha ububanzi bayo bangaphakathi. Ukukhululeka kwazo kwandisa umjelo ohamba kuwo igazi; ukushwabana kwazo kuyawunciphisa. Kuyo yonke inkqubo yokujikeleza kwegazi, oku kunegalelo ekuxhathiseni kwemithambo yegazi emzimbeni. Uxinzelelo lwegazi lukwaxhomekeke kubungakanani begazi elimpontshwa yintliziyo, ngoko ukutshintsha ukuxhathisa akumisi yonke impendulo yomzimba.
Enye indlela yokukhululeka iqala ngenitric oxide, okanye i-NO. Ivuselela i-soluble guanylate cyclase, efinyezwa ngokuthi sGC, evelisa umthwali womyalezo ongaphakathi kwiseli obizwa ngokuba yi-cyclic GMP, okanye i-cGMP. Imiqondiso ebangelwa yile nkqubo ikhuthaza ukukhululeka kwezihlunu ezigudileyo.
Imethylene blue inokuphazamisa le ndlela. Noko ke, ukuyibiza ngokuba sisithinteli se-sGC esikhetha yona kuphela ngokugqibeleleyo kwenza indlela elisebenza ngayo eli yeza ibonakale ilula kakhulu kunokuba injalo. Kumsebenzi wolingo kaMayer noogxa bakhe wokwenziwa kwenitric oxide, ukukhululeka kwemithambo yegazi eyahlulwe emzimbeni kunye nemiqondiso kwiiseli ezingaphakathi kwimithambo yegazi zazichaphazeleka ngakumbi yimethylene blue kuneziphumo eziveliswa ngokuvuselela i-sGC ngokuthe ngqo. Iziphumo zikwabonisa ukuba kwakukho iimpembelelo ekwenziweni kwe-NO, okwenzeka ngaphambi koko kule nkqubo. Ulingo olunje luchaza indlela enokwenzeka yokusebenza kwimithambo yegazi; aluxeleli umntu ukuba umlinganiselo wakhe woxinzelelo lwegazi wasekhaya uza kutshintsha kangakanani.
Umfanekiso weqweqwe ubonisa olu lwalamano lwenziwe lula phakathi kwenqanaba lokuqina kwemithambo yegazi nokuxhathisa kwayo. Imizobo yemithambo yegazi ibonisa ingcamango, kungekhona utshintsho olulinganisiweyo kwisigulana okanye kulingo lwempendulo kwiidosi ezahlukeneyo.
Oko kwavavanywa ngokwenene bubungqina bezifundo zonyango
Ivasoplegia ithetha ukuncipha kakhulu kwenqanaba lokuqina kwemithambo yegazi, nto leyo edla ngokuxoxwa kwimeko efana notyando olukhulu lwentliziyo okanye ukugula okumandundu. Isigulana sinokuba noxinzelelo oluphantsi nangona ubungakanani begazi elimpontshwa yintliziyo buqhelekile okanye buphezulu, kuba ukuxhathisa kwehlile. Oku kwahlukile kuxinzelelo oluphantsi olubangelwa ikakhulu kukulahlekelwa ligazi okanye kukungampompi kakuhle kwentliziyo.
Itheyibhile yahlula unyango emva kokuvela kwevasoplegia, uthintelo kwizigulana ezithile ezikhethelwe utyando, kunye nonyango olongezelelweyo lokothuka komzimba okubangelwa lusulelo. I-IV ithetha ukufakwa emthanjeni. Ezi ziindlela zokusetyenziswa eziye zavavanywa kwizifundo, hayi imiyalelo yokunikezela iyeza.
| Indlela yokunikezela kunye nemeko yonyango | Iqela elifundiweyo nothelekiso | Oko kwalinganiswa okanye kwafunyanwa | Oko isiphumo singenakukuqinisekisa |
|---|---|---|---|
| Imethylene blue ye-IV emva kotyando lwentliziyo | ULevin nabanye, 2004: izigulana ezingama-56 ezinevasoplegia emva kotyando zabelwa ngokungakhethiyo kwimethylene blue okanye kwiplacebo | Ivasoplegia yathatha ngaphantsi kweeyure ezintandathu kuzo zonke izigulana ezanyangwayo; ezisibhozo kwiqela lothelekiso zaqhubeka zichaphazeleka ngaphezu kweeyure ezingama-48. Abaswelekileyo babeyi-0/28 xa kuthelekiswa ne-6/28. | Ulingo oluncinci lotyando oluthile alunakuqinisekisa inzuzo ngokubanzi ekusindeni okanye unyango loxinzelelo lwegazi oluphantsi kwizigulana ezingalaliswanga esibhedlele. |
| Imethylene blue ye-IV ngaphambi kotyando lokwenza indlela entsha yokuhamba kwegazi idlule imithambo evalekileyo yentliziyo | UOzal nabanye, 2005: izigulana ezili-100 ezikhethiweyo ezinomngcipheko ophezulu; isisombululo se-1% esifakwa emthanjeni ngaphambi kotyando sithelekiswa nokunganikwa methylene blue | Ivasoplegia yavela kwizigulana eziyi-0/50 xa kuthelekiswa ne-13/50. Oku yayiluthintelo malunga nexesha lotyando, hayi unyango loxinzelelo oluphantsi olungapheliyo. | Iziphumo azithetheleli ukusetyenziswa ngomlomo ngenjongo yothintelo okanye zichonge ukuba ngoobani abanokuzuza ngaphandle kwale meko yotyando. |
| Imethylene blue ye-IV eyongezwa kukhathalelo lokothuka komzimba okubangelwa lusulelo | UIbarra-Estrada nabanye, 2023: abantu abadala abangama-91 abahlalutywayo; ukufakwa emthanjeni iiyure ezintandathu yonke imihla kangangeedosi ezintathu, xa kuthelekiswa neplacebo yesodium chloride elungiselelwe ukuba ifane nayo | Ixesha eliphakathi lokuyeka amayeza aqinisa imithambo yegazi laliziiyure ezingama-69 xa kuthelekiswa nama-94. Izinga lokufa nexesha lokuncediswa ukuphefumla zazifana. | Ukuyeka kwangethuba amayeza aqinisa imithambo yegazi akubobungqina bokuphucuka kokusinda okanye bokunyuka koxinzelelo lwegazi okunokuqikelelwa kubantu abasempilweni. |
| Iyeza le-IV eligunyazisiweyo lemethemoglobinemia efunyenweyo | Ulwazi lokumisela i-PROVAYBLUE; unyango lwehemoglobin engaqhelekanga, hayi ulingo loxinzelelo lwegazi | Uxinzelelo lwegazi oluphezulu luphakathi kweziphumo ezibi ezixeliweyo kwiimveliso zodidi lwemethylene blue. | Ukudweliswa kwesiphumo esibi akuqikeleli ithuba okanye ubungakanani bokunyuka koxinzelelo xa kusetyenziswa imveliso ethengiswa eluntwini ethathwa ngomlomo. |
| Ukusetyenziswa ngomlomo ngabathengi kuxinzelelo lwegazi oluphezulu okanye oluphantsi | Akukho lingo lonyango elinamaqela othelekiso elisebenza ngokuthe ngqo kule meko elifunyenwe kuncwadi oluphendlwe ukulungiselela eli nqaku | Izifundo ze-IV ezingentla aziniki njongo yoxinzelelo okanye inkqubo yokusetyenziswa ngomlomo eqinisekisiweyo. | Ukungafunyanwa kolingo akubobungqina bokhuseleko, kungengobungqina bokuba konke ukusetyenziswa ngomlomo kutshintsha uxinzelelo. |
Kulingo lokothuka komzimba okubangelwa lusulelo, omabini amaqela afumana ukhathalelo olunzulu, kuquka inorepinephrine, ihydrocortisone, kunye nevasopressin xa yayifuneka. Unyango lwaqala kwiiyure ezingama-24 emva kokuqalisa inorepinephrine. Oogqirha bahlengahlengisa amayeza aqinisa imithambo yegazi ukuze kufikelelwe kwinjongo yoxinzelelo; umbuzo ophambili wawukukuba ingaba izigulana zaziwadinga ixesha elifutshane na loo mayeza. Izigulana ezinemiba emininzi ebalulekileyo yomngcipheko, kuquka ukusetyenziswa kwe-SSRI kutshanje kunye nembali yokunqongophala kwe-G6PD, azifakwanga kulingo. Ezo zigqibo zoyilo lolingo zibalulekile xa kuchazwa inzuzo nokhuseleko.
Uphononongo olubanzi lwezilingo zonyango lwevasoplegia nokothuka komzimba okubangelwa lusulelo luhlolisisa ubungqina bokhathalelo lwezigulana ezigula ngokumandundu ngokweenkcukacha ezingakumbi.
Ngaba imethylene blue iyalwehlisa uxinzelelo lwegazi?
Inkcazelo yendlela esebenza ngayo kwimithambo yegazi engentla yalatha ekunciphiseni ukukhululeka okugqithiseleyo, kungekhona ekunyangeni uxinzelelo lwegazi oluphezulu. Umlinganiselo ophantsi emva kokuba umntu ethathe imethylene blue awunakuqinisekisa, ngokwawo, ukuba oko sisiphumo seyeza. Indlela yokuma okanye yokuhlala komzimba, ukuphumla, indlela yokulinganisa, amanye amayeza, kunye nemeko ekhokelele ekulinganiseni zonke zinokulutshintsha uthelekiso.
Ngokufanayo, umlinganiselo ophezulu sisiphumo esifuna ukuhlolwa, kungekhona isiqinisekiso sokuba indlela yokusebenza enqwenelekayo ivuselelwe. Unyango oluluncedo kwizigulana lufuna ubungqina ngeempawu, ukusebenza komzimba, iziphumo ezibi, kunye neziphumo zonyango, hayi inani elikwisixhobo sokujonga kuphela.
Umahluko ofanayo usebenza kumabango ngemethylene blue aphathelele i-POTS nokungakwazi ukunyamezela ukuma nkqo. Iimpawu ezivela xa umntu emile kunye notshintsho kwisantya sokubetha kwentliziyo zifuna ubungqina bazo bezifundo zonyango; izigulana ezinokothuka komzimba okubangelwa yivasoplegia liqela elahlukileyo lophando.
Amanye amayeza asetyenziswayo ayawutshintsha umbuzo
Yisa uluhlu olupheleleyo lwamayeza kugqirha okanye kusokhemesti ngaphambi kokuba ucinge ngokusebenzisa imethylene blue. Iimeko ezintathu zifuna ingqalelo eyahlukileyo:
- Amayeza achaphazela iserotonin kunye neeopioid. Ileyibhile yemveliso ye-IV ilumkisa ngengxaki yokugqithisa kweserotonin enokubulala xa la mayeza edityanisiwe. Uxinzelelo lwegazi olungazinzanga lunokuvela kunye nokuphazamiseka nokungaphumli, umkhuhlane, ukubila, ukungcangcazela, okanye ukuqina kwezihlunu. Oku yinkxalabo yokwenzakaliswa ngamayeza, hayi impendulo enqwenelekayo yemithambo yegazi. Jonga isikhokelo sonxibelelwano lwemethylene blue namanye amayeza.
- Amayeza asebenza kwi-NO nakwi-cGMP. Iinitrate nezithinteli ze-PDE5 ezifana nesildenafil zibandakanya le nkqubo yemiqondiso. Ileyibhile yesildenafil ichaza indlela eyandisa ngayo imithambo yegazi nonxibelelwano lwayo neenitrate. Iintolo ezikhomba kumacala achaseneyo kumzobo wale nkqubo azibonisi ukuba imethylene blue inokuzitshitshisa ngokukhuselekileyo iziphumo zelinye iyeza.
- Unyango loxinzelelo lwegazi osele ulumiselwe. Umlinganiselo emva kwemethylene blue awusosiseko sokutsiba, sokutshintsha, okanye sokwandisa unyango olumiselweyo. Bhala phantsi imveliso, uxinaniso, ubungakanani, indlela yokuyithatha, ixesha, imilinganiselo, kunye neempawu ukuze lowo umisela iyeza akwazi ukuhlola ukusetyenziswa kwayo.
Uxinzelelo lwegazi yinxalenye enye kuphela yohlolo lokhuseleko ngokubanzi. Umzekelo, ileyibhile ye-IV iyakwalela ukusetyenziswa xa kukho ukunqongophala kwe-G6PD ngenxa yomngcipheko wokuqhekeka kweeseli ezibomvu zegazi. Umlinganiselo oqhelekileyo ofunyenwe ngesixhobo esibhijelwa engalweni awunakukhupha ukuba kukho loo ngxaki okanye unxibelelwano olubi namanye amayeza.
Xa umlinganiselo ufuna ingqalelo engxamisekileyo
Kubantu abadala abangakhulelwanga, i-American Heart Association icebisa inyathelo elingxamisekileyo xa imilinganiselo ingaphezulu kwe-180 systolic kunye/okanye i-120 diastolic. Xa kukho intlungu esifubeni, ukuphelelwa ngumoya, ubuthathaka, utshintsho ekuboneni, okanye ubunzima bokuthetha, tsalela iinkonzo zongxamiseko ngoko nangoko. Ukuba akukho zimpawu zintsha ezixhalabisayo, phinda ulinganise emva komzuzu omnye ubuncinane, uze uqhagamshelane nengcali yezempilo ngokukhawuleza ukuba umlinganiselo usahleli uphezulu kangako.
Funa uncedo olungxamisekileyo xa kukho ukuwa, ubunzima obukhulu bokuphefumla, okanye ukukrokrelwa kwengxaki yokugqithisa kweserotonin emva kokusetyenziswa, nokuba uthini umlinganiselo wesixhobo esibhijelwa engalweni. Musa ukuthatha imethylene blue engakumbi ukuze ulungise inani eliphezulu okanye eliphantsi.