Inqaku
I-methylene blue kwi-COPD nakwioksijini ephantsi: oko kuxhaswa bubungqina
I-methylene blue ayilonyango olumiselweyo lwe-COPD, lwe-emphysema, okanye lokwehla okuqhelekileyo kweoksijini egazini okunxulumene ne-COPD. Ukukhangela okwenzelwe eli nqaku akufumananga lulingo kwizigulana oluneqela lothelekiso olubonisa ukuba iyakuphucula ukuphelelwa ngumoya kwi-COPD, ithintela ukwanda kwesifo, ilungisa i-emphysema, okanye inciphisa imfuneko yeoksijini emiselwe ngugqirha. Le yingxelo ngobungqina obufunyenweyo, hayi ubungqina bokuba lonke uphando olunokubakho luye lwakhutshelwa ngaphandle.
Ukubhideka kuqala kwibinzana elithi “inceda ioksijini.” Ioksijini kufuneka ingene emiphungeni, idlulele egazini, ithwalwe yihemoglobin, ize ifike kwiiseli eziyisebenzisayo. Isixhobo esibekwa encamini yomnwe siqikelela inkalo enye yaloo nkqubo. La manyathelo anokusilela ngenxa yezizathu ezahlukileyo. Ukusetyenziswa kwe-methylene blue kwezonyango kwisiphazamiso esithile sehemoglobin akuyenzi ibe sisisombululo esiqhelekileyo somlinganiselo weoksijini ephantsi.
Imibuzo emine eyahlukileyo engasemva kwebango ngeoksijini
Imephu yobungqina bendlela ehamba ngayo ioksijini. Indlela engasentla ilandela ioksijini ukusuka emiphungeni ukuya kwiiseli. Isebe lomlinganiselo lijonga igazi; alilonyathelo elongezelelekileyo lokuhambisa ioksijini. Lo mzobo wokuqala wengcinga ushwankathela umahluko ochazwe ngezantsi yaye awusosiphumo sophando.
| Inxalenye yendlela | Oko ibango kufuneka likubonise |
|---|---|
| Ukutshintshiselana ngeegesi emiphungeni | Kubantu abane-COPD, ukuphucuka okubalulekileyo ekuphelelweni ngumoya, kumthamo wokwenza umthambo, kwiigesi zegazi, okanye ekwandeni kwesifo phantsi kweemeko zonyango ezithelekisekayo. |
| Ukuthuthwa yihemoglobin | Ingxaki yehemoglobin efunyanisiweyo, efana nokunyuka kwe-methemoglobin, elandelwa yimpendulo efanelekileyo yeenkqubo zekhemikhali zomzimba kunye neyonyango. |
| Ukusetyenziswa kweoksijini ziiseli | Inzuzo kwisigulana ngenxa yongenelelo oluchazwe ngokucacileyo. Utshintsho ekusetyenzisweni kweoksijini yiseli ekhuliswe elabhoratri alwanelanga. |
| Umlinganiselo | Ukuhambelana novavanyo lwegazi olufanelekileyo noluzimeleyo, kuqwalaselwa ukuphazamiseka kokulinganisa ngokukhanya neemeko zomlinganiselo. |
1. I-COPD ichaphazela ukuhamba komoya nokutshintshiselana ngeegesi emiphungeni
Kwi-COPD, iindlela zomoya zinokucutheka zize zivalwe yincindi. Kwi-emphysema, ukonakala kweendonga zeengxowa zomoya kunciphisa indawo esebenzayo yokutshintshiselana ngeegesi. Inkcazelo ye-NHLBI nge-COPD ichaza ezi ngxaki zesakhiwo. Umoya ofikelela kummandla othile womphunga nawo kufuneka uhambelane negazi elihamba kuloo mmandla ukuze ioksijini ifunxwe ngokufanelekileyo.
Ukutshintsha ikhemistri yehemoglobin akunakumisela ukuba iingxowa zomoya ezonakeleyo ziye zachacha. Kwanomntu oziva enamandla ngakumbi akabonisi ukuba ukuhamba komoya kuphucukile. Loo mabango afuna imilinganiselo yawo, efana ne-spirometry, iimvavanyo zokuhamba ezisemgangathweni, amanqaku ovavanyo lweempawu, okanye uvavanyo lweegesi zegazi.
Umbuzo wonyango ukwabanzi kunokugcwala kwegazi ngeoksijini. Ukuphelelwa ngumoya kunokubonisa umgudu wokuphefumla, yaye abantu abane-COPD banokuba nezinye iimeko ezinegalelo kwiimpawu. Inani elikhuthazayo kwisixhobo alikuchazi ukuphelelwa ngumoya okuqhubekayo.
Isikhokelo sonyango se-NHLBI sichaza amayeza okwandisa iindlela zomoya, unyango olukhethiweyo lokunciphisa ukudumba, inkqubo yokubuyisela ukusebenza kwemiphunga, nonyango lweoksijini kubantu abafanelekileyo. Olu ngenelelo lujongana neemfuno ezahlukileyo. I-methylene blue ethengiswa ezivenkileni akufanele ithathe indawo yeoksijini emiselweyo, izixhobo zokuphefumlela amayeza, okanye uvavanyo lokuphefumla okuya kusiba mandundu.
2. I-methemoglobinemia sisiphazamiso segazi esahlukileyo
Ihemoglobin ngokuqhelekileyo ithwala ioksijini isebenzisa intsimbi ekwimeko ye-ferrous. I-methemoglobin iqulethe intsimbi efakwe ioksijini, ekwimeko ye-ferric, engenako ukubophelela ioksijini ngendlela eqhelekileyo. Isixa esaneleyo se-methemoglobin sinokuphazamisa ukuhanjiswa kweoksijini nokuba ioksijini iyafikelela emiphungeni.
Ulwazi lwase-US lokumiselwa kwe-ProvayBlue efakwa emthanjeni luchaza i-methemoglobinemia efunyenwe kamva njengemeko emiselwe ukuba inyangwe ngayo. I-methylene blue inegalelo ekubuyiseleni i-methemoglobin kwihemoglobin esebenzayo ngenkqubo yekhemikhali yokunciphisa. Le yinjongo echaziweyo yeekhemikhali zomzimba, hayi unyango oluqhelekileyo lomonakalo wemiphunga ongapheliyo. Inkcazelo yonyango lwe-methemoglobinemia iwuchaza ngakumbi loo mahluko.
Umntu unokuba nazo zombini ezi ziphazamiso. Ingxelo yesigulana ka-2025 ebandakanya ukuchanabeka kwi-phenazopyridine kunye ne-COPD yachaza indoda eneminyaka engama-67 ene-methemoglobin eyi-14.5%. Emva kwe-methylene blue, inqanaba elixeliweyo lehla laya kwi-9.5%. Yafumana ne-ascorbic acid, ioksijini, amayeza okwandisa iindlela zomoya, kunye nee-steroid. Esi yayisisigulana esinye esinesiphazamiso segazi esinxulumene neyeza kunye ne-COPD ngaxeshanye, ngaphandle kweqela lothelekiso. Oku akumiselanga ukuba i-methylene blue yanyanga i-COPD yaso engundoqo okanye ukuba yayinokuthatha indawo yolunye unyango.
Lo mahluko uchaphazela uvavanyo. Uxinzelelo lweoksijini kwiigesi zegazi, oludla ngokubizwa ngokuba yi-PaO₂, lulinganisa ioksijini enyibilikileyo. Lona lodwa alilinganisi ukuba ingakanani ihemoglobin engasebenzi kakuhle. I-co-oximetry yelabhoratri inokulinganisa izabelo zehemoglobin, kuquka i-methemoglobin. Abasebenzi bezonyango batolika ezo ziphumo kunye neempawu, izinto umntu achanabeke kuzo, kunye neoksijini ayinikwayo.
3. Iimvavanyo ngeemitochondria azimiseli nzuzo kwi-COPD
Iimitochondria zisebenzisa ioksijini xa iiseli zivelisa amandla. Abaphandi baphande i-methylene blue njengomnye umthwali wee-electron. Umzekelo, uphando lovavanyo lokudluliselwa kwee-electron kwiimitochondria lwaxela ukwanda kokusetyenziswa kweoksijini kwiiseli zemithambo-luvo ezikhuliswe elabhoratri, lwaza lwahlola iimodeli zezilwanyana zeemeko zemithambo-luvo. Ezi yayingezizo iziphumo kwizigulana ezine-COPD.
Ukwanda kokusetyenziswa kweoksijini kuthetha ukuba iiseli zasebenzisa ioksijini eninzi phantsi kweemeko zovavanyo. Akuthethi ukuba umphunga owonakeleyo wafunxa ioksijini eninzi, ukuba ukugcwala kwegazi ngeoksijini kwanda, okanye ukuba ioksijini eyongezelelweyo ayisafuneki. Indlela yokusebenza ecetywayo kwinqanaba elisemva isafuna ukuvavanywa kwezonyango kubantu ekuthiwa baya kuxhamla kuyo.
Iziphumo zokukhangela zifuna omnye umahluko: i-methylene blue inokuvela ephepheni lophando njengedayi. Kuphando luka-2020 lokuhambisa ulwelo emiphungeni yeempuku, abaphandi bayisebenzisa ukujonga indawo olufike kuyo ulwelo olunikwayo. Unyango lwe-emphysema olwaluvavanywa yayiyi-all-trans-retinoic acid. Ukufunda kuphela amagama athi “methylene blue,” “iimpuku,” kunye “ne-emphysema” kunokuguqula ngempazamo uvavanyo lwendlela yokuhambisa lube libango lonyango.
Ngokufanayo, ingxoxo yezigulana nge-methylene blue kunye nokukhanya okubomvu ibonisa umbuzo abantu abafuna uphendulwe. Ayiniki bungqina obusuka kuvavanyo oluneqela lothelekiso bokuba le ndibaniselwano iyayiphucula i-COPD.
4. Umlinganiselo weoksijini unokutshintsha ngaphandle kokutshintsha komphunga
I-pulse oximeter eqhelekileyo isebenzisa ukukhanya ukuqikelela ukugcwala kwegazi ngeoksijini, okuxelwa njenge-SpO₂. Ayilinganisi ngokuthe ngqo umgudu wokuphefumla, ikharbon diokside, okanye ukuveliswa kwamandla ziiseli. Isikhokelo se-FDA nge-pulse oximeter siphawula ukuba ukujikeleza kwegazi, umbala wolusu, ubushushu bolusu, nezinye izinto zinokuchaphazela ukuchaneka.
I-methylene blue ngokwayo inokuphazamisa lo mlinganiselo osebenzisa ukukhanya. Ulwazi lwayo lokumiselwa lulumkisa ukuba igazi eliqulethe le dayi linokunika umlinganiselo wokugcwala ngeoksijini ongaphantsi kowokwenene, ngakumbi xa ifakwa emthanjeni okanye kungekudala emva koko. Lucebisa ukuba kusetyenziswe isampuli yegazi lomthambo ohambisa igazi lisuka entliziyweni, ivavanywe ngenye indlela xa kufuneka kuhlolwe ukugcwala ngeoksijini kuloo meko.
Eso silumkiso asimiseli siphumo esinokuqikelelwa kuyo yonke imveliso ethengiswa ezivenkileni nejongwe ukuba ithathwe ngomlomo. Kananjalo asithethi ukuba umlinganiselo omtsha ophantsi unokungahoywa ngokukhuselekileyo kuthiwe kukuphazamiseka ngenxa yedayi. Iingxaki zokwenene zeoksijini nokuphazamiseka komlinganiselo zinokubakho ngaxeshanye. Xelela iqela elikunyanga ngokusetyenziswa kwe-methylene blue ukuze likhethe lize litolike uvavanyo ngokufanelekileyo. Isikhokelo se-methylene blue nemilinganiselo yezixhobo zokujonga ioksijini sichaza ingxaki yomlinganiselo ngokwahlukeneyo.
Ukunyuka okubonakala emva kokuthatha imveliso kunzima ngokufanayo ukutolika. Ukuphumla emva kokusebenza, ukutshintsha ukuhanjiswa kweoksijini, ukufudumeza isandla esibandayo, okanye ukutshintsha indawo yesivamvo kunokutshintsha uthelekiso. Umlinganiselo wasekhaya wangaphambi nowasemva awunako ukwahlula isiphumo seyeza kwezinye izinto.
Omakwenziwe xa ukuphefumla kusiba mandundu
Landela isicwangciso seoksijini nesokwanda kwesifo osinikwe liqela lakho lezonyango lokuphefumla. Funa uvavanyo ngokukhawuleza xa kukho ukuhla okungalindelekanga nokuqhubekayo ngaphantsi kwenqanaba ojolise kulo, okanye xa iimpawu zisiba mandundu ngokuphawulekayo. Musa ukuhlengahlengisa unyango ulandela inkqubo ye-methylene blue ekwi-intanethi.
Isikhokelo se-NHLBI ngeempawu ezingxamisekileyo sicebisa ukufuna uncedo olungxamisekileyo xa kunzima ukuphefumla okanye ukuthetha, imilebe iluhlaza okwesibhakabhaka okanye ingwevu, ukuphaphama kunciphile, okanye iimpawu zingaphenduli kunyango olucetyiswayo. Fowunela inombolo yasekuhlaleni yoncedo olungxamisekileyo kunokuba ulinde ukuzama isongezelelo.
I-methylene blue ikwanemingcipheko efanelekileyo ukuyiqwalasela: ulwazi lwayo lokumiselwa lulumkisa ngobutyhefu obukhulu be-serotonin xa isetyenziswa namayeza athile, kunye nokuqhekeka okukhulu kweeseli ezibomvu zegazi xa kukho ukunqongophala kwe-G6PD. Yiza noluhlu olupheleleyo lwamayeza neemveliso xa udibana nabasebenzi bezonyango. Umbuzo oluncedo ungqalile: yintoni echaza ingxaki yokuphefumla, yalinganiswa njani, kwaye loluphi unyango olunobungqina baloo meko ifunyanisiweyo?