Inqaku
I-methylene blue ne-POTS: kutheni iindlela zokusebenza kwemithambo yegazi zingangqini unyango
I-methylene blue ayilonyango olumiselweyo lwesindromu yokukhawuleza kwentliziyo xa umntu emi nkqo, okanye i-POTS. Kukhangelo loncwadi olwenziwe kweli nqaku, akufunyanwanga lulingo lwezonyango olulawulwayo olubonisa ukuba iphucula iimpawu ze-POTS okanye ukukwazi ukwenza imisebenzi yemihla ngemihla. Izifundo zomothuko obangelwa yi-sepsis nezemithambo yegazi esetyenziswa kuvavanyo ziphendula imibuzo eyahlukileyo.
Ingqiqo enokuhenda yeyokuba i-POTS ibandakanya ukujikeleza kwegazi, i-methylene blue inokuchasa ezinye iimpawu ezenza imithambo ikhululeke, ngoko ke i-methylene blue ifanele iphucule i-POTS. Inyathelo ngalinye kufuneka lihlolwe. Isiphumo sechiza kwindlela ethile yokusebenza kwemithambo yegazi asiqinisekisi ukuba loo ndlela ngunobangela weempawu zomntu othile, okanye ukuba ukuyitshintsha kuya kumnceda ame ngokukhululekileyo.
Izinto ekufuneka zahlulwe kuqala
Ukunganyamezeli ukuma nkqo kuthetha iimpawu ezinxulumene nokuba nkqo. I-POTS yenye yeesindromu ezichaziweyo ezikule ngxaki ibanzi. I-dysautonomia ibanzi ngakumbi, ibhekisa kwiziphazamiso zolawulo lwenkqubo yemithambo-luvo ezisebenzela ngokwayo; ayichazi ipateni enye yoxinzelelo lwegazi.
Inkcazelo evunyelwene ngayo ziingcali ze-NIH nge-POTS ichaza ukunyuka okuqhubekayo kwesantya sokubetha kwentliziyo ubuncinane ngokubetha okungama-30 ngomzuzu kwisithuba semizuzu eli-10 umntu emi nkqo, okanye ubuncinane ngama-40 kwabaneminyaka eli-12–19, kunye neempawu ezingapheliyo xa umntu emi nkqo, ukuphucuka xa elele, nokungabikho kokuhla okuqhubekayo koxinzelelo lwegazi xa kumiwe. Iimpawu kufuneka zibe sezithathe ubuncinane iinyanga ezintathu, yaye kufuneka kukhutshelwe ngaphandle ezinye izizathu zokukhawuleza kwentliziyo. Umlinganiselo oboniswe yiwotshi uwodwa awunakuqinisekisa loo ndibaniselwano.
Uxinzelelo lwegazi olusezantsi xa kumiwe lohlobo oluqhelekileyo lunomlinganiselo owahlukileyo oluchazayo: inkcazelo evunyelwene ngayo yimibutho ejongene nenkqubo yemithambo-luvo ezisebenzela ngokwayo ichaza ukuhla okuqhubekayo ubuncinane kwe-20 mmHg kuxinzelelo lwe-systolic okanye kwe-10 mmHg kuxinzelelo lwe-diastolic kwisithuba semizuzu emithathu yokuma okanye yokuthambekiswa komzimba intloko iphezulu. Umothuko we-vasoplegia ubhekisa ekulahlekeni ngesiquphe kokuqina kwemithambo yegazi ngendlela enzulu ngokwaneleyo ukuba ibeke ukujikeleza kwegazi emngciphekweni. Awufunyaniswa ngovavanyo lokuma.
Uthelekiso: imeko, isiphumo, nomsantsa kubungqina
| Umbuzo | I-POTS | Uxinzelelo lwegazi olusezantsi xa kumiwe lohlobo oluqhelekileyo | Umothuko we-vasoplegia |
|---|---|---|---|
| Yintoni eyahlulayo? | Iimpawu ezingapheliyo xa umntu emi nkqo, kunye nokunyuka okugqithisileyo kwesantya sentliziyo, ngaphandle kokuhla okuqhubekayo kwe-BP okusetyenziselwa uxilongo | Ukuhla okuqhubekayo kwe-BP emva kokuma nkqo | Ukuncipha ngesiquphe nangokukhulu kokuqina kwemithambo yegazi, kunye nokusilela kokujikeleza kwegazi |
| Kutheni isimo somzimba sibalulekile | Ukuma kubangela ukukhawuleza kwentliziyo neempawu ezichaza le meko | Ukuma kubonisa ukuhla koxinzelelo okuyichazayo le meko | Uxinzelelo lwegazi olusezantsi neengxaki zokufikelela kwegazi kumalungu omzimba zifuna ukuhlolwa kungakhathaliseki ukuma |
| Inzuzo enentsingiselo ingaquka ntoni? | Ukuncipha kwesiyezi nokubetha ngamandla kwentliziyo xa kumiwe, ukuphucuka kokwenza imisebenzi yemihla ngemihla, nokuhlolwa kwesantya sentliziyo ne-BP kunye | Ukuncipha kweempawu nokuwa, ukuphucuka kokusebenza xa kumiwe, noxinzelelo olwamkelekileyo xa kulele | Ukubuyiselwa kokufikelela kwegazi kumalungu omzimba, ukuncipha koncedo lwamachiza aphakamisa uxinzelelo lwegazi, ukuchacha kwamalungu omzimba nokusinda |
| Bubuphi ubungqina nge-methylene blue obufunyenweyo? | Ingxoxo ngeendlela zokusebenza neengxelo ezingalawulwayo; akukho lingo lulawulwayo lokusebenza kwayo kwi-POTS | Akukho bungqina bulawulwayo bufunyenweyo obumisela unyango oluqhelekileyo loxinzelelo lwegazi olusezantsi olungapheliyo xa kumiwe | Ulingo lwezonyango kumothuko obangelwa yi-sepsis, kuquka isifundo esilawulwa nge-placebo esixoxwa ngezantsi |
| Yintoni engenakudluliselwa kwenye imeko? | I-BP ephezulu okanye utshintsho kwindlela imithambo ephendula ngayo kuphela aluqinisekisi ukuphucuka kweempawu | Impendulo kwiyunithi yokhathalelo olunzulu ayinakuqinisekisa inzuzo okanye ukhuseleko kwizigulana ezingalaliswanga esibhedlele | Ukusetyenziswa kwamachiza aphakamisa uxinzelelo lwegazi ixesha elifutshane akunakuqinisekisa unyango lweesindromu ezingapheliyo ezinxulumene nokuma nkqo |
Olu thelekiso lwahlula imibuzo yophando; alulophepha lokuxilonga. Khuphela uthelekiso lweemeko nemibuzo yengxoxo ukuze ugcine ezi ntlukwano kunye. Zikwabalulekile xa kutolikwa i-methylene blue notshintsho kuxinzelelo lwegazi.
Oko kwavavanywa ngokwenene kulingo lomothuko
Kulingo olwabiwa ngokungakhethiyo luka-Ibarra-Estrada noogxa bakhe luka-2023, abantu abadala abanomothuko obangelwa yi-sepsis bafumana i-methylene blue ngomthambo okanye i-placebo yesisombululo setyuwa, kunye nonyango lokhathalelo olunzulu. Uhlalutyo lwabandakanya izigulana ezingama-91, ezingama-45 zifumana i-methylene blue nezingama-46 zifumana i-placebo. Unyango lwalubandakanya ukufakwa kolwelo ngomthambo kangangeentsuku ezintathu, iziphumo zihlolwa ukuya kutsho kwiintsuku ezingama-28.
Isiphumo esiphambili yayilixesha elithathiweyo de kuyekwe amachiza aphakamisa uxinzelelo lwegazi. La ngamachiza asetyenziselwa ukuxhasa uxinzelelo lwegazi xa kukho umothuko. Ixesha eliphakathi lalingama-69 eeyure nge-methylene blue nangama-94 eeyure nge-placebo. Ukufa nobude bexesha lokuncediswa ukuphefumla ngomatshini zazifana phakathi kwamaqela.
Obo bubungqina ngonyango olongezelelweyo ngexesha lokusilela ngesiquphe kokujikeleza kwegazi okunxulumene nosulelo. Abubonisi ukuba i-methylene blue ethathwa ngomlomo inciphisa ukukhawuleza kwentliziyo xa kumiwe, ithintela ukuziva ngathi uza kufa isiqaqa, okanye iphucula ukuya esikolweni kubantu abane-POTS. Izigulana, indlela yokunikwa kwechiza, unyango oluhamba nalo, ixesha, nesiphumo esiphambili zonke ziyahluka. Uphononongo olwahlukileyo lolingo lwe-methylene blue kwi-vasoplegia nakumothuko obangelwa yi-sepsis luhlola obo bungqina bokhathalelo olunzulu kwimeko yabo.
Kutheni inkcazelo nge-nitric oxide ingaphelelanga
I-nitric oxide ithatha inxaxheba ekukhululekeni kwemithambo yegazi, kuquka ukudluliselwa kweempawu nge-guanylate cyclase enyibilikayo nange-GMP ejikelezayo. I-methylene blue inokuphazamisa ezi nkqubo zebhayoloji, kodwa ukuyichaza nje njengesithinteli se-nitric oxide kufihla umahluko phakathi kovavanyo.
Umzekelo, uvavanyo lwemithambo yegazi lukaWolin noogxa bakhe luka-1990 lwafaka i-methylene blue kwindawo ethile yemithambo yegazi emincinane yezihlunu zamathambo eziveziweyo kwiimpuku ezazinikwe iyeza lokuzizolisa. Yanciphisa ukwanda kwemithambo okubangelwa yi-acetylcholine ne-nitric oxide. I-superoxide dismutase yathintela oko kuthintelwa, nto leyo eyaxhasa indlela yokusebenza kwe-superoxide engaphandle kweeseli kwelo lungiselelo lovavanyo. Olu yayiluvavanyo lwemithambo emincinane kwindawo ethile, hayi isifundo sonyango oluthathwa ngomlomo kubantu abane-POTS. Isiphumo salo asinakuqinisekisa inzuzo yonyango okanye ukwenzakala kwemithambo-luvo kwezo zigulana.
Ingcinga ephathelele esi sifo nayo ayiqinisekanga. Isifundo sika-2005 ngeempendulo zemithambo yegazi emincinane kwi-POTS sathelekisa abathathi-nxaxheba abali-15 abane-POTS enokuhamba kwegazi okuphantsi, abali-17 abane-POTS enokuhamba kwegazi okuqhelekileyo, nabali-13 abasempilweni abasetyenziswe njengeqela lokuthelekisa, abaneminyaka eli-14–22. Abaphandi balinganisa ukuhamba kwegazi eluswini ngexesha leemvavanyo zendawo ethile zemithambo yegazi. Iziphumo zabo zacebisa ukuncipha kokukhutshwa kwe-nitric oxide okuxhomekeke ekuhambeni kwegazi kwiqela elinokuhamba kwegazi okuphantsi. Abazange bavavanye i-methylene blue njengonyango.
Esi siphumo siphikisa ingcamango yokuba yonke i-POTS imele i-nitric oxide egqithisileyo ekufuneka icinezelwe. Kananjalo asiqinisekisi ukuba wonke umntu one-POTS une-nitric oxide enganelanga. Njengoko uphononongo lwezonyango lukaMar noRaj luchaza, ukonakala ngokuyinxenye kwemithambo-luvo elawula imisebenzi ezenzekelayo yomzimba, umthamo omncinane wegazi elijikelezayo, nokwanda komsebenzi we-adrenergic kunokuba negalelo ngeendlela ezidibanayo. Umahluko phakathi kwe-NOS, i-cGMP, nokudluliselwa kweempawu kwimithambo yegazi ubalulekile kuba igama lendlela yokusebenza aluloxilongo lomntu othile.
Oko sinokukuxelelwa ziingxelo eziphikisanayo zezigulana
Ingxoxo ye-Phoenix Rising iquka ingxelo yokuba i-POTS yaba mandundu kakhulu ngexesha lokusebenzisa i-methylene blue. Ngokwahlukileyo, ingxoxo ye-POTS kwi-Reddit iqulethe ingxelo yokuphucuka kwangoko kwesantya sentliziyo okubhekiswa kwi-methylene blue. Ezi ngxelo zichaza amava nemibuzo; aziqinisekisi unobangela wokuphucuka okanye wokuba mandundu.
Imibuzo eluncedo kufuneka icace. Ngaba iimpawu zalinganiswa umzimba ukwisimo esifanayo? Ngaba uxinzelelo lwegazi lwatshintsha kunye nesantya sentliziyo? Ngaba amayeza okanye ezinye izongezelelo zatshintshwa? Ngaba umntu waziva engcono ixesha elifutshane kuphela, okanye wakwazi kwakhona ukuma nkqo ixesha eliluncedo kwiintsuku ezalandelayo? Ingxelo engenazo ezo nkcukacha ayinakwahlula isiphumo sechiza kutshintsho olwenzeka ngaxeshanye okanye kutshintsho oluqhelekileyo lweempawu.
Kubantu abakwanayo ne-ME/CFS, ukuziva benamandla kwangoko akuphenduli umbuzo wokuba umsebenzi ubangele ukuba mandundu okulibazisekileyo na. I-ME/CFS, i-methylene blue, nokungaziva kakuhle emva kokuzibhokoxa ixoxa ngeso siphumo sahlukileyo. Iingxelo ezizele yimincili nezothusayo azithetheleli inkqubo yokuzilinga ekhaya.
Yintoni enokwenza ibango nge-POTS likholise?
Isifundo esiluncedo siya kubhalisa izigulana ezinoxilongo olubhaliweyo, sichaze indlela elungiselelwe ngayo imveliso nendlela enikwa ngayo, sisebenzise into yokuthelekisa ethembekileyo, size silinganise zombini iimpawu nokukwazi ukwenza imisebenzi. Isantya sentliziyo noxinzelelo lwegazi kufuneka zihlolwe kunye. Ukulandelela kufuneka kube kude ngokwaneleyo ukuhlola inzuzo eqhubekayo neziphumo ezingathandekiyo, kunokuba kuthathwe umlinganiselo omnye omhle njengokuchacha. Ezi ziimfuneko zokuvavanya ibango, hayi ubungqina bokuba unyango luyasebenza.
Ukhuseleko lubalulekile kwesi siphakamiso kanye. Ulwazi lwase-US lokumisela i-ProvayBlue enikwa ngomthambo lulumkisa ngesindromu ye-serotonin enokubulala xa kusetyenziswa amachiza asebenzisana nayo, yaye luyakwalela ukusetyenziswa kwayo kubantu abanesiphene se-G6PD ngenxa yomngcipheko we-anemia ebangelwa kukuqhekeka kweeseli ezibomvu zegazi. Imeko evunyiweyo yokusetyenziswa kwayo yi-methemoglobinemia efunyenweyo, hayi i-POTS. Loo nkcazelo yemveliso ayiqinisekisi inkqubo yokuthatha ngomlomo ngenxa yeempawu ezinxulumene nokuma nkqo.
Yisa ibango elithile, imveliso, uluhlu lwamayeza owathathayo ngoku, nesiphumo osinqwenelayo kwingcali yezonyango eqhelene neempawu zakho ezinxulumene nokuma nkqo. Imibuzo omawuyibuze ngaphambi kokucinga ngokusebenzisa i-methylene blue inceda ukucwangcisa loo ncoko. Umbuzo ongekaphendulwa kukuba ingaba ivelisa inzuzo enexabiso nehlala ixesha elide kwizigulana ze-POTS, hayi ukuba ingayitshintsha na imithambo yegazi kwenye imeko.