Imethylene blue yokonakala kwemithambo-luvo neentlungu: zeziphi iimeko ezifundiweyo?

Ngaba imethylene blue iyakuthomalalisa ukonakala kwemithambo-luvo neentlungu? Oku kuvakala njengombuzo omnye, kodwa uncwadi lophando luphendula imibuzo emininzi eyahlukileyo. Idayi etofwa kwidiski yomqolo, idayi etofwa ngaphantsi kolusu olujikeleze umngxuma welindle, idayi efakwa emthanjeni, nedayi esetyenziselwa ukuhlamba umlomo zinegama elinye, kodwa zivavanya iingcamango ezahlukileyo ngeendlela zokusebenza ezahlukileyo. Isiphumo senye indlela asidluliselwa kwezinye.

Cinga ngazo njengeengcamango ezine ezinelebhile enye. Eyokuqala itshabalalisa okanye inciphisa uvakalelo lweziphelo ezincinci zemithambo-luvo ezikhulela kwidiski eyonakeleyo. Eyesibini ibangela ukuba imithambo-luvo yolusu ingeva okanye ithomalale kwindawo etofiweyo. Eyesithathu isebenza kuyo yonke inkqubo yomzimba, idlula egazini ichaphazele inkqubo yemithambo-luvo. Eyesine igquma umphezulu owenzakeleyo ukuze ithomalalise iintlungu zaloo ndawo. Xa uqonda lo mahluko, kulula ukuhlela ubungqina, yaye kuyabonakala okusilelayo: ibango elixhaphakileyo liphathelele ingcamango yesithathu, xa imethylene blue ithathwa njengolwelo oluginywayo, kanye apho ubungqina ebantwini bunqongophele khona kakhulu.

Itheyibhile yobungqina ngokwemeko nangendlela yokusebenzisa

Le theyibhile ishwankathela inqaku. Umqolo ngamnye udibanisa imeko, indlela yokusebenzisa, nonyango oluvavanyiweyo, kuba ukuzahlula yeyona nto ibangela ukuba amabango ngeentlungu abaxwe.

Funda ikholam yendlela yokusebenzisa ukusuka phezulu ukuya ezantsi ngaphambi kokufunda nasiphi na isihloko. Bonke ubungqina besiphumo esihle ebantwini busemqolweni wokusetyenziswa kwindawo ethile okanye ngenkqubo yonyango. Imiqolo yokusetyenziswa okusebenza kuwo wonke umzimba iqulethe ilingo elinye elincinci kakhulu neendawo ezingenabungqina.

Iintlungu zomqolo ezivela kwidiski: ilingo elinye elinesiphumo esikhulu, elinye elingakwazanga ukusiphinda

Uphando lokutofa ngaphakathi kwidiski luqala ngelingo lokuqala lika-2007 elingenalo iqela lothelekiso kwizigulana ezingama-24 ezineentlungu eziqinisekiswe ngovavanyo lwediski, ezingaphenduliyo kunyango olungabandakanyi utyando. Emva kwenaliti enye ye-10 mg yemethylene blue ngaphakathi kwidiski, ezingama-21 kwezingama-24 zaxela ukuba iintlungu zanyamalala okanye zancipha kakhulu malunga neenyanga ezili-18 zokulandelelwa. Ngaphandle kweqela lothelekiso, eso siphumo sinokuba sasibangelwa kukhetho lwezigulana, utshintsho lwendalo lwemeko, okanye ilidocaine enikwe kunye nayo. Ngoko sakhuthaza umbuzo wokusebenza konyango kunokuba siwuphendule.

Kwalandela ilingo lika-2010 elilawulwa ngeplacebo, apho izigulana nabaphandi babengazi ukuba ngubani ofumana luphi unyango kwizigulana ezingama-72, lithelekisa imethylene blue kunye nelidocaine nomxube wamanzi netyuwa kunye nelidocaine. Kwiinyanga ezingama-24 umahluko oxeliweyo wawumkhulu kakhulu: ukuncipha komndilili wamanqaku eentlungu ngamanqaku angama-52.5 xa kuthelekiswa ne-0.7, nokwaneliseka okungama-91.6% xa kuthelekiswa ne-14.3%. Inqaku lomhleli elalipapashwe kunye nalo labuza ngokuthe ngqo ukuba ingaba olu lunyango oluphelisa iintlungu zomqolo na, nto leyo ebonisa indlela elalingaqhelekanga ngayo eli bango kwiingcali ngelo xesha.

Amabango angaqhelekanga afuna ukuphindwa kovavanyo, yaye ukuphindwa kwalo akuzange kuqinisekise isiphumo. Ilingo le-IMBI lamaziko amaninzi elenziwa kamva lavavanya imethylene blue etofwa ngaphakathi kwidiski kumaziko ahlukeneyo, kodwa alizange liqinisekise isiphumo sikaPeng. Amaqela amancinci azimeleyo ezigulana angenamaqela othelekiso ngokuqhelekileyo axela amazinga aphantsi okuphendula kunyango okanye amazinga ayehla ngokuhamba kwexesha. Isishwankathelo esinyanisekileyo kukuba ubungqina abuvumelani: impumelelo enkulu yeziko elinye xa ithelekiswa nokungaphumeleli ukuyiphinda kumaziko amaninzi. Le meko ayimiseli unyango, yaye ayithethi nto ngokuginya imethylene blue, engaze ifike kwidiski ngobuxinaniso obufanayo. Isishwankathelo sethu sobungqina beentlungu ezingapheliyo sibeka le mpikiswano ecaleni kwezinye iinkqubo zonyango.

Ukutofa kwindawo ejikeleze umngxuma welindle: iziphumo zokwenene, kodwa ezisebenza kumda omncinci

Imethylene blue etofwa ngaphakathi kolusu ukunyanga ukurhawuzelela komngxuma welindle okungaphenduliyo kunyango ineyona rekhodi inde yothotho lwezigulana, eqala ngo-1990 iqhubeke ngamaqela ezigulana ezingama-25, 30, 49, nezili-103. Amazinga okuphendula kunyango abonakala ephezulu, ngokufuthi uninzi lungenazimpawu emva kwenaliti enye okanye ezimbini, kodwa lonke uthotho alunalo iqela lothelekiso. Ukurhawuzelela okwenza isigulana sikhethe inkqubo yonyango engena emzimbeni kunokunyuka kwehle, yaye iinaliti ngokwazo zinokudala iziphumo ezibangelwa lulindelo. Ngoko amazinga okuthomalala angenamaqela othelekiso awanakungqina ukusebenza konyango.

Ubungqina obunamandla ngakumbi bothelekiso bufumaneka kwimeko ekufutshane nale: iintlungu emva kotyando. Amalingo amabini okwabiwa ngokungakhethiyo emethylene blue etofwa ngaphakathi kolusu olujikeleze umngxuma welindle ngexesha elijikeleze utyando lokususa amaqhakuva emithambo afumanisa amanqaku eentlungu aphantsi nokusetyenziswa okuncinci kwamayeza ongezelelweyo okuthomalalisa iintlungu ngeentsuku 1 ukuya kwezi-3 kwilingo lezigulana ezingama-67, nangeentsuku 1 ukuya ku-7 kwilingo lezigulana ezingama-97. Obu bubungqina bokwenene bokuthomalalisa iintlungu kwinkqubo yonyango, kwidosi, nakwiveki echaziweyo. Ayibobungqina bokonakala kwemithambo-luvo okungapheliyo, yaye indlela yokusebenza ekuxoxwa ngayo kukunciphisa uvakalelo lwemithambo-luvo kwindawo yenxeba, nto leyo ithontsi eliginywayo elingenakuyenza. Inkcazelo yendlela imethylene blue esebenza ngayo kwimithambo-luvo nakwi-mitochondria ichaza ukuba kutheni isenzo sekhemikhali kwindawo ethile sihlala kuloo ndawo.

Ukusetyenziswa okusebenza kuwo wonke umzimba kwiintlungu ezibangelwa kukonakala kwemithambo-luvo: ilingo elinye elincinci kakhulu

Kwibango elibaluleke kakhulu kubathengi abaninzi, elokuba imethylene blue esebenza kuwo wonke umzimba ithomalalisa iintlungu ezibangelwa kukonakala kwemithambo-luvo, yonke irekhodi yophando olulawulwayo ebantwini ibonakala ililingo elinye kuphela: ilingo lokuqala lika-2015 kwizigulana ezili-10 ezineentlungu ezingapheliyo ezibangelwa kukonakala kwemithambo-luvo, ezinezizathu ezahlukeneyo nezingaphenduliyo kunyango. Imethylene blue efakwe emthanjeni nge-2 mg/kg yavelisa amanqaku eentlungu aphantsi kuneqela elifumana idosi ephantsi kakhulu ngomhla wonyango nangosuku olulandelayo, kodwa inzuzo yayisele iphantse yaphela kwiintsuku ezimbalwa. Izigulana ezintathu zabonisa ukuncipha kweentlungu ezibangelwa kukuchukunyiswa okanye luxinzelelo oluqhele ukuba lungabi buhlungu.

Izigulana ezilishumi ezahlukeneyo neentsuku ezimbini zokuthomalala zisisizathu sophando olongezelelweyo, hayi isiseko sonyango. Mnye kuphela umthathi-nxaxheba owayeneentlungu zemithambo-luvo emva kweshingles, ngoko eli ayilolingo laloo meko. Akukho lingo ebantwini elihlangabezana neemfuno lokusetyenziswa kwemethylene blue esebenza kuwo wonke umzimba elichongiweyo lokonakala kwemithambo-luvo esemaphethelweni omzimba ngenxa yesifo seswekile, lweentlungu zomthambo-luvo we-trigeminal, okanye lwe-complex regional pain syndrome. Uphando lokufaka ecaleni komqolo kwiintlungu zemithambo-luvo emva kweshingles, oluthi maxa wambi luvezwe ziinjini zokukhangela, lwaludibanisa imethylene blue nesibulali-ntlungu sendawo emqolo. Oko kungena kwingcamango yenkqubo yonyango, kungekhona kweyokusetyenziswa okusebenza kuwo wonke umzimba.

Imixube yokuhlamba umlomo, amanxeba namalungu: ubungqina bendawo ethile obungenakudluliselwa kwenye indlela

Obunye ubungqina obusebantwini bonke bubhekisa ekusetyenzisweni kwindawo ethile. Ilingo lesigaba 2 lokwabiwa ngokungakhethiyo lika-2022 lafumanisa ukuba umxube wemethylene blue wokuhlamba umlomo ngobuxinaniso obuthathu wanciphisa iintlungu zokudumba kwenwebu yomlomo ngenxa yonyango lomhlaza ngaphezu konyango oluqhelekileyo ngomhla 2. Umxube wokuhlamba umlomo ugquma inwebu eyonakeleyo uze utshicelwe. Ukuwucaphula njengobungqina bamathontsi aginywayo kubhidanisa ukusetyenziswa kumphezulu nethamo elisebenza kuwo wonke umzimba.

Ngokufanayo, ukugquma iithishu zotyando ngemethylene blue exutywe yancitshiswa ubuxinaniso ngexesha lotyando lokususa idiski kumazantsi omqolo kwehlisa amanqaku eentlungu zomqolo kwilingo lezigulana ezili-115 apho amaqela amathathu ayengazi ukuba ngubani ofumana luphi unyango, ngoxa ilingo lokutofa kwilungu le-facet lomqolo laxela amanqaku aphantsi eentlungu nokukhubazeka kwiinyanga ezi-3 nezi-6. Isiphumo ngasinye sibotshelelwe kwindawo efakwe kuyo. Akukho nasinye esidluliselwa kwimveliso ethathwa ngomlomo.

Oko kuboniswa zizilwanyana, nalapho indlela yokusebenza ineziphumo ezichaseneyo

Imifuziselo yeentlungu ezibangelwa kukonakala kwemithambo-luvo kwiimpuku inika isizathu sokucinga ukuba indlela yokusebenza inokuba sengqiqweni, esisoloko sicatshulwa. Imethylene blue efakwe kwisithuba solwelo olujikeleze intambo yomqolo yathintela uvakalelo olugqithisileyo kwiintlungu zobushushu olwalusele lukhona malunga neeyure ezi-4 emva kokubotshwa komthambo-luvo we-sciatic kuvavanyo lwangaphambili luka-1992, nto leyo ehambelana nendima yendlela ye-nitric oxide eya kwi-cGMP kumqolo. Uphando lwamva lokwenzakala okubangelwa kukucinezelwa okungapheliyo lwafumanisa ukuba imethylene blue ngokwayo yanciphisa ukuva iintlungu, yaye yakwazi ukuthintela ukwanda kovakalelo olugqithisileyo kwiintlungu okubangelwa yisildenafil, kwakhona lubonisa indima yokuthunyelwa kwemiqondiso yi-nitric oxide. Uphononongo luka-2021 longeza indlela yesibini yokusebenza: ukuthintela ngokuthe ngqo ukuthunyelwa kwemiqondiso yimithambo-luvo, okufana neziphumo ezikwiitshaneli zesodium, nokuthintela okuhlala ixesha elide kunokwelidocaine kumalungiselelo avavanyiweyo.

Omnye umahluko obalulekileyo kufuneka ugcinwe kuba abathengisi bayawushiya. Uncwadi lophando lwe-nitric oxide olwandulela amalingo ezonyango alubonisi ngokufanayo ukuba imethylene blue isoloko ithomalalisa iintlungu. Kwezinye iindlela zovavanyo, ukuthunyelwa kwemiqondiso yi-nitric oxide ngokwako kubangela ukuthomalala kweentlungu, yaye imethylene blue ikuthintela oko kuthomalala. Kuvavanyo lokonakala kwemithambo-luvo ngenxa yesifo seswekile, imethylene blue yathintela ukuncipha kokuva iintlungu okunxulumene nesildenafil, yaye ngokwayo yandisa uvakalelo olugqithisileyo kwiintlungu. Iziphumo zendlela yokusebenza zixhomekeke kumfuziselo nakwindlela yemisebenzi yomzimba efundwayo, nto leyo engesinye isizathu sokuba iziphumo zezilwanyana zingafundwa njengeengcebiso zedosi.

Oko kungafundwanga, nomda wokhuseleko

Akukho lingo lokwabiwa ngokungakhethiyo okanye uthotho oluthembekileyo lwezigulana ekunyangweni kwazo ngemethylene blue eginywa ngomlomo oluchongiweyo lweentlungu ezingapheliyo ezibangelwa kukonakala kwemithambo-luvo, lokonakala kwemithambo-luvo ngenxa yesifo seswekile, lweentlungu zomthambo-luvo we-trigeminal, lwe-complex regional pain syndrome, okanye lweentlungu zemithambo-luvo emva kweshingles. Ekuphela kwelingo elithe ngqo lokusetyenziswa okusebenza kuwo wonke umzimba kwiintlungu ezibangelwa kukonakala kwemithambo-luvo lilingo lokuqala lokufaka emthanjeni kwizigulana ezili-10, elinesiphumo esathatha iintsuku 1 ukuya kwezi-2. Iziphumo zokutofa ngaphakathi kwidiski, ngaphakathi kolusu, ngaphakathi kwilungu, ecaleni komqolo, nezokuhlamba umlomo azinakudluliselwa ngokwemigaqo yokusebenza kwamayeza kumathontsi athengiswayo. Ubuxinaniso bawo kwindawo ekujoliswe kuyo bohluka ngamandla alishumi aliqela, yaye awabandakanyi ukufakwa kwindawo ethile ngenkqubo yonyango.

Ukubhidaniswa kweendlela zokusebenzisa kukwahamba nesilumkiso sokhuseleko. Izithuba ezikumqolo azinakutshintshwa omnye nomnye: ukufakwa ngaphakathi kwidiski, ecaleni komqolo, kwisithuba esingaphandle kwenwebu eqinileyo yentambo yomqolo, nakwisithuba solwelo olujikeleze intambo yomqolo kuyahluka ngokusebenza kwamayeza nangobutyhefu. Umonakalo omkhulu kwimithambo-luvo emva kokufakwa kwemethylene blue kwisithuba solwelo olujikeleze intambo yomqolo wakhokelela kwisilumkiso esicacileyo sengozi. Ngokwahlukileyo, imethylene blue inentsebenziswano namayeza achaphazela iserotonin, yaye ayifanele ukusetyenziswa xa kukho ukunqongophala kwe-G6PD. Ngoko nasiphi na isigulana esineentlungu esicinga ukuyisebenzisa kufuneka kuqala sifunde isishwankathelo seziphumo ebezingalindelekanga neemeko ezingavumeli ukusetyenziswa kwayo size sithethe nengcali yezonyango, sisebenzisa le mibuzo yokubuza ngemethylene blue.

Indlela yokusebenzisa obu bungqina

Nabani na ovavanya imethylene blue ngenxa yeentlungu kufuneka abuze imibuzo emithathu ngesicatshulwa ngasinye sophando. Yeyiphi kanye imeko, kuba ukuchacha emva kotyando lokususa amaqhakuva emithambo yomngxuma welindle akufani nokonakala kwemithambo-luvo ngenxa yesifo seswekile. Yeyiphi kanye indlela yokusebenzisa, kuba ukufaka ngaphakathi kwidiski okanye ngaphakathi kolusu akufani nedosi eginywayo. Kwaye sisiphi isiphumo esilinganisiweyo, silinganiswe kwithuba elingakanani, kuba iintsuku zokuthomalala emva kwenkqubo yonyango azifani neenyanga zokulawula ukonakala kwemithambo-luvo.

Ngokobungqina obukhoyo ngoku, iziphumo zokuthomalalisa iintlungu zemethylene blue ebantwini ziphelele ekusetyenzisweni kwindawo ethile okanye ngenkqubo yonyango, yaye ukusebenza kwayo akufani kuzo zonke iimeko ezivavanyiweyo. Ubungqina bokusetyenziswa okusebenza kuwo wonke umzimba buphelele kwilingo lokuqala elinye elincinci kakhulu lokufaka emthanjeni, yaye akukho bungqina bezonyango buxhasa imethylene blue ethengiswayo ethathwa ngomlomo kwiintlungu ezibangelwa kukonakala kwemithambo-luvo okanye kwiintlungu ezingapheliyo.