Izitofu ze-methylene blue kunye nokufakwa nge-IV

Iibhotile ezimbini ezincinci ezinolwelo oluluhlaza okwesibhakabhaka olumnyama zinokukhangeleka zifana phezu kwetafile. Enye sisitofu esingenazintsholongwane esenzelwe imithambo yegazi. Enye lulwelo oluthathwa ngomlomo ngethontsi, idayi yaselabhoratri, okanye imveliso yetanki yeentlanzi engamele ingene emthanjeni wegazi nakanye. Umbala awukuxeleli nto. Indlela ulwelo olulungiselelwe ngayo ikuxelela yonke into.

Le yeyona ngcamango iphambili yeli nqaku: ubunjalo bekhemikhali abufani nokufaneleka kwayo ukutofwa. Isisombululo sinokuba ne-methylene blue yokwenene enobunyulu bekhemikhali obuphezulu kodwa singakulungeli ukutofwa, kuba izitofu kufuneka zingabinazintsholongwane, zibe nomlinganiselo ophantsi weetyhefu zebhaktheriya, amasuntswana azo alawulwe, kwaye zipakishwe kwisikhongozeli esifanelekileyo. Gcina lo mahluko engqondweni, ibe konke okuseleyo kwesi sikhokelo kuya kucaca.

Isitofu esivunyiweyo esingenazintsholongwane

Imveliso ekusetyenzwa ngayo njengomgangatho wokuthelekisa yi-ProvayBlue, isitofu se-methylene blue esifumaneka ngomyalelo kagqirha nesivunyiweyo kwi-methemoglobinemia efunyenweyo kubantu abadala nakubantwana. Uxinzelelo lwaso yi-5 mg/mL (0.5%), oluchazwe ngokusekelwe kwi-methylene blue trihydrate, kwaye sinikezelwa njenge-10 mg kwi-2 mL kunye ne-50 mg kwi-10 mL kwii-ampule okanye kwiibhotile ezincinci zedosi enye. Ekuphela kwesithako esingasebenziyo ngaManzi okuTofa, kwaye i-pH yesisombululo yi-3.0 ukuya kwi-4.5, njengoko kuchazwe kwilebhile yangoku ye-ProvayBlue kwi-DailyMed.

Amayeza aliqela afanayo angengophawu lorhwebo ngoku asebenzisa loo mveliso njengomgangatho wokuthelekisa, ngoko i-ProvayBlue ligama lophawu lorhwebo, hayi ekuphela kwesitofu esivunyiweyo. Nasi isilumkiso: iphepha lemveliso kwi-DailyMed ngokwalo alibonisi ukuba ivunyiwe yi-FDA. Ubuncinane isitofu esinye se-methylene blue esithengiswayo esinoxinzelelo lwe-1% sichaza kwilebhile yaso ukuba i-FDA ayikafumani ukuba sikhuselekile kwaye siyasebenza. Jonga ukuba imveliso ivunyiwe na, kunye namagama athi ayinazintsholongwane kwaye yeyedosi enye, endaweni yokucinga ukuba nayiphi na ibhotile encinci eluhlaza ifanelekile.

Ukunikwa kweedosi ngokwelebhile evunyiweyo kunemida ecacileyo. Abantu abadala nabantwana banikwa i-1 mg/kg ngomthambo wegazi kwisithuba semizuzu emi-5 ukuya kwengama-30, elingana ne-0.2 mL/kg yesisombululo se-5 mg/mL. Ukuba i-methemoglobin ihlala ingaphezu kwe-30% okanye iimpawu ziyaqhubeka, kunokunikwa enye idosi enye ye-1 mg/kg emva kweyure. Ukuba iidosi ezimbini aziyisombululi ingxaki, ilebhile yalathisa kwezinye iindlela zonyango endaweni yokunika enye i-methylene blue. Izigulana ezinokungasebenzi kakuhle kwezintso okuphakathi okanye okuqatha zinikwa idosi enye kuphela ye-1 mg/kg, kuba inani leyeza umzimba ochanabeka kulo linyuka kakhulu njengoko ukusebenza kwezintso kwehla.

Indlela yokunikwa kwayo nayo inemithetho yayo. Le mveliso yeyokusetyenziswa ngomthambo wegazi kuphela kwaye ayimele inikwe phantsi kolusu. Isisombululo siyi-hypotonic, ngoko sinokuxutywa ne-50 mL ye-5% dextrose ukunciphisa intlungu kwindawo esinikwa kuyo, ngakumbi kubantwana, kwaye isisombululo esixutyiweyo kufuneka sisetyenziswe ngoko nangoko. Asimele sixutywe nezisombululo ze-sodium chloride, kuba i-chloride yehlisa ukunyibilika kwe-methylene blue. Hlola isikhongozeli ngasinye, sebenzisa okukwi-ampule okanye kwibhotile encinci yedosi enye kube kanye, uze ulahle okuseleyo. Sigcinwa kubushushu begumbi, sikhuselwe ekukhanyeni, singafakwa efrijini okanye sikhenkceziswe.

Abafundi abafuna ulwazi olusisiseko malunga nento eyenziwa yile molekyuli yakufika egazini bangaqala ngokufunda indlela i-methylene blue esebenza ngayo emzimbeni, apho indlela elisebenza ngayo iyeza yahlulwe kwimibuzo yokulungiselelwa kwalo ekuxoxwa ngayo apha.

Ukufakwa ngaphandle kwemiyalelo yelebhile kusebenzisa imolekyuli efanayo phantsi kwemithetho eyahlukileyo

Ngaphandle kwe-methemoglobinemia, oogqirha ngamanye amaxesha banika i-methylene blue ngomthambo wegazi kwiimeko ezifana ne-vasoplegia emva kotyando lwentliziyo okanye umothuko obangelwa yi-sepsis, apho kuphandwa khona iziphumo zayo ekuqiniseni nasekukhululeni imithambo yegazi. Ezi nkqubo zidla ngokubandakanya iidosi ezahlukileyo, ukufakwa okuqhubekayo, okanye ukunikwa ngokuphindaphindiweyo okungahambelani nenkqubo evunyiweyo yeedosi ezimbini. Oku kuzenza zibe kukusetyenziswa ngaphandle kwemiyalelo yelebhile: imveliso yeyeza inokuba sisitofu esivunyiweyo, kodwa inkqubo yokunikwa kwayo ngokwayo ayiyiyo evunyiweyo yi-FDA. Ubungqina bokuqala bovavanyo kwi-vasoplegia nakumothuko obangelwa yi-sepsis bubonisa isizathu sokuba abaphandi babe nomdla, kwanokuba kutheni ukunikwa kweedosi kusaphandwa kunokuba kube sekugqitywe ngako.

Izisombululo zokufakwa ezilungiselelwe ngokuxutywa zizisa omnye umahluko. Iyeza elilungiselelwe ngokuxutywa linokwahluka ngokoxinzelelo lwalo lokugqibela, ulwelo lokulixuba, isikhongozeli, izithako ezincedisayo, kunye nomda wexesha lokusetyenziswa. Amayeza alungiselelwe ngokuxutywa, njengodidi, awavunywanga yi-FDA ngokhuseleko okanye ukusebenza kwawo, njengoko i-FDA ichaza kwimibuzo neempendulo zayo malunga nokulungiselela amayeza ngokuxutywa. Nokuba isirinji iqulethe iyeza lophawu lorhwebo, elingengophawu lorhwebo, okanye elilungiselelwe ngokuxutywa, imolekyuli ineengozi ezifanayo ezichazwe kwilebhile evunyiweyo, kuquka ukusebenzisana namayeza achaphazela i-serotonin, umngcipheko wokuqhekeka kweeseli ezibomvu zegazi, kunye nobuntununtunu ekukhanyeni, ekuxoxwa ngazo kumacandelo alandelayo.

Kutheni ibakala lobunyulu lilodwa lingalwenzi ulwelo lulungele ukutofwa

Kulapha apho kubakho khona ukubhideka okukhulu. Isisombululo esithengiswa ezivenkileni sinokupapashwa njenge-methylene blue yebakala le-USP, sibonise uvavanyo lomxholo olungaphezu kwe-98%, kodwa singakulungeli ukutofwa. Ibakala lekhemikhali lichaza umgubo: ubunjalo bawo, umlinganiselo womxholo, ukungcola okuvela kwimixube ye-organic, izinyibilikisi ezishiyekileyo, iintsimbi, kunye novavanyo olufanayo. Iyeza elitofwayo kufuneka liphumelele olo vavanyo kunye neemfuneko ezongezelelekileyo zamayeza anikwa ngaphandle kwendlela yokwetyisa, ezingagutyungelwa libakala lodwa.

Umqolo ngamnye uthintela ingxaki eyahlukileyo. Ulwelo olungangenazintsholongwane lunokubangela usulelo egazini. Ii-endotoxin ezivela kwiibhaktheriya ezifileyo azisuswa kukuhluza okulula kwaye zinokubangela umkhuhlane oqatha okanye umothuko. Amasuntswana nezinto eziqinileyo eziphuma kwisisombululo zinokuxinga kwimithambo emincinci. Isikhongozeli esingafanelekanga sinokukhupha izinto zaso ziye kulwelo okanye sisilele ukuhlala sitywiniwe. Akukho nanye kwezi ziphene etshintsha umbala oluhlaza okanye inani lovavanyo lomxholo, yiyo kanye loo nto ukuhlola ngamehlo nepesenti yobunyulu zingenako ukwenza imveliso ifaneleke ukunikwa ngemithambo yegazi. Ukuze ufumane umfanekiso opheleleyo wento equkwa luvavanyo olupheleleyo lobunyulu, jonga indlela eliqinisekiswa ngayo ibakala le-USP.

Umthetho osebenzayo mfutshane: ungaze utofe imveliso ye-methylene blue eyenzelwe ukusetyenziswa ngomlomo, kwitanki yeentlanzi, okanye elabhoratri, nokuba bunjani ubunyulu obuchazwe kuyo. Ukutofa kufuna imveliso eyenziwe, yavavanywa, yabhalwa ilebhile, yaza yamiselwa ngugqirha njengesitofu.

Iingongoma zokhuseleko ezisuka kwilebhile evunyiweyo

Ilebhile evunyiweyo igxininisa iingozi ekufanele zaziwe ngaphambi kokusetyenziswa ngomthambo wegazi. Eyokuqala yi-serotonin syndrome, enesilumkiso esikwibhokisi: i-methylene blue ithintela i-monoamine oxidase, ngoko ukuyidibanisa namayeza okudakumba achaphazela i-serotonin, ii-opioid ezithile, namayeza anxulumene nawo kunokubangela ukusabela okuqatha okanye okubulalayo. Izigulana zixelelwa ukuba ziwaphephe loo mayeza kangangeeyure ezingama-72 emva kwedosi yokugqibela, ngaphandle kokuba ugqirha ugqiba ukuba ukunikwa kwawo kunye akunakuphetshwa aze abeke iliso ngokusondeleyo.

Eyesibini kukunqongophala kwe-glucose-6-phosphate dehydrogenase, okuyimeko engavumeli ukusetyenziswa kweli yeza: izigulana ezinale meko zisengozini yokuqhekeka okuqatha kweeseli ezibomvu zegazi, kwaye iyeza lisenokungasebenzi kuba ukusebenza kwalo kuxhomekeke kwindlela ye-enzyme ezi zigulana ezingenayo. Ukwalana okuqatha ne-methylene blue okanye nenye idayi ye-thiazine yenye imeko engavumeli ukusetyenziswa kwalo.

Ezinye izilumkiso ziquka ukungasebenzi kakuhle kwezintso okwandisa inani leyeza umzimba wonke ochanabeka kulo, ukwenzakala kwemveku xa ichanabeke kulo ngaphakathi kwisingxobo se-amniotic kunye noluhlu lwezinto ekufuneka zibekwe iliso kwiintsana ezisandul’ ukuzalwa ekupheleni kwexesha lokukhulelwa ezichanabeke kulo, kwakunye nokwenzakala okubangelwa kukukhanya okuxeliweyo, okufuna ukukhuselwa ekukhanyeni. Zimbini izinto ezingaqhelekanga zokubeka iliso ezibalulekileyo ezibhedlele: umbala oluhlaza wenza izifundo zesixhobo sokulinganisa ioksijini ngomnwe zibe sezantsi ngobuxoki, ngoko kukhethwa uhlalutyo lwegazi lomthambo ohambisa igazi elisuka entliziyweni, kwaye unokuphazamisa izixhobo zokubeka iliso kubunzulu bokulaliswa ngexesha lotyando novavanyo lomchamo olusebenzisa idayi eluhlaza. Kwidatha yokhuseleko yabantu abadala engama-31, ukusabela okuqatha kwenzeka malunga ne-3%, kwaye ukusabela okwabonwa ubuncinane kwi-2% kwakuquka intloko ebuhlungu, isicaphucaphu, urhudo, i-potassium ne-magnesium eziphantsi, ukuxhuzula kwemisipha, kunye neziganeko ezifana nokuxhuzula komzimba.

Akukho nanye kwezi zinto eyingxoxo exhasa okanye echasa nayiphi na inkqubo ethile yokusetyenziswa ngaphandle kwemiyalelo yelebhile. Sisikhumbuzo sokuba iingozi zihamba nemolekyuli, nokuba ibhalwe ntoni na kwingxowa yokufakwa kolwelo.

Izinto ekufuneka ziqinisekiswe ngaphambi kokusetyenziswa nge-IV

Ukuba usisigulana okanye ungumkhathaleli, qinisekisa izinto ezine neqela elinyangayo: ukuba imveliso sisitofu esingenazintsholongwane esivunyiweyo okanye esilungiselelwe ngokuxutywa ukusetyenziswa ngomthambo wegazi, ukuba imeko esinyangelwayo nedosi zilandela inkqubo ekhethwe ngononophelo, ukuba amayeza achaphazela i-serotonin kunye nemeko ye-G6PD ziye zajongwa, nokuba ukubekwa kweliso kuquka ukulinganiswa kweoksijini ngohlalutyo lwegazi kunokuxhomekeka kuphela kwisixhobo sokulinganisa ioksijini ngomnwe. Ukuba nabani na ucebisa ukutofa ulwelo lwethontsi oluthengwa evenkileni okanye isisombululo saselabhoratri, yithathe loo nto njengesizathu sokuma kwangoko uze ucele ukubonisana nekhemesti yesibhedlele endaweni yoko.

Indlela elilungiselelwe ngayo iyeza yeyona ngcamango iphambili, kwaye ilebhile sisivumelwano. Dibanisa ulwelo nendlela efanelekileyo yokulunika, uze umbala oluhlaza uyeke ukuba ngumthombo wokubhideka.