Inqaku
I-methylene blue nokuqonda emva kotyando: izilingo ebantwini neendlela zokusebenza kwizilwanyana
Abantu abadala ngamanye amaxesha baphuma kutyando olukhulu bengacingi ngokucacileyo njengangaphambili. Iintsapho ziyakuqaphela oku. Abasebenzi bezonyango bayakulinganisa. Umbuzo ngowokuba ingaba i-methylene blue, xa inikwa ngexesha elijikeleze ukufakwa kwi-anesthesia, iyayikhusela na ingqondo. Iintlobo ezimbini zobungqina zijongana nalo mbuzo, yaye ziphendula iindawo zawo ezahlukeneyo. Isilingo ebantwini esenziwa ngexesha elijikeleze utyando sibika oko kwenzekileyo kwizigulana. Imodeli yeempuku ezindala icebisa indlela olunokusebenza ngayo ukhuseleko ngaphakathi kweeseli zemithambo-luvo. Akukho nanye enokuthatha indawo yenye.
Inyathelo lokuqala kukwahlula iziphumo ezimbini ezidla ngokuxutywa.
Ideliriyam nokwehla kokuqonda okulinganisiweyo zizinto ezahlukeneyo
Ideliriyam emva kotyando kukuphazamiseka okubukhali nokuguquguqukayo kokunikela ingqalelo nokuqaphela okwenzekayo. Isigulana sicinga ngokucacileyo ngenye iyure size sidideke ngelandelayo. Izibhedlele ziyibona ngezixhobo zovavanyo ezisetyenziswa ecaleni kwebhedi, ezifana ne-3D-CAM, ngokuqhelekileyo ngaphezu kwesihlandlo esinye ngosuku, kuba ukuhlola kube kanye kunokungayiboni.
Ukuphazamiseka kokuqonda emva kotyando kuyenye into. Kukwehla okulinganisiweyo kwiimvavanyo ezisesikweni xa kuthelekiswa nenqanaba lesigulana ngokwaso ngaphambi kotyando, kuquka inkumbulo, ingqalelo nokukwazi ukucwangcisa nokulawula izenzo. Uvavanyo lwenziwa emva kweentsuku okanye iiveki. Isigulana sinokuba nenye ngaphandle kwenye.
Lo mahluko ubalulekile kuba ezi ziphumo zimbini zilinganiswa ngezixhobo ezahlukeneyo, ngamaxesha ahlukeneyo, nangabavavanyi abahlukeneyo. Xa isilingo sibika zombini, zifunde njengamabango amabini ahlukeneyo. Ulwazi olusisiseko malunga nale ndlela yokufunda iingxelo zezilingo luchazwe kwinqaku elithi indlela yokufunda uphando lwe-methylene blue.
Okwenziwe sisilingo ebantwini
Obona bungqina buphambili ebantwini buvela kwisilingo esingafihlwanga nesabelwa amaqela ngokungakhethiyo eHuashan Hospital, esapapashwa kwiJournal of Clinical Anesthesia ngo-2021. Sabandakanya izigulana ezingama-248 ezineminyaka engama-60 ukuya kuma-80 ezazisenziwa utyando olukhulu olucwangcisiweyo olungelolwentliziyo nolwalungabandakanyi utyando lwemithambo-luvo, kuquka utyando lwesifuba, lwamathambo, lwenkqubo yomchamo nolukhulu lwesisu. Isiqingatha safumana i-methylene blue eyi-2 mg/kg emthanjeni, ixutywe ukuze ibe yi-50 mL yaza yafakwa kwisithuba semizuzu engama-60 kanye emva kokuqaliswa kwe-anesthesia. Esinye isiqingatha safumana i-50 mL yesisombululo setyuwa ngeshedyuli efanayo.
Ideliriyam yayisisiphumo esiphambili esasivavanywa. Abavavanyi basebenzisa i-3D-CAM kabini ngosuku, kushiywa ubuncinane iiyure ezintandathu phakathi kovavanyo, ngeentsuku 1 ukuya ku-5 emva kotyando okanye de isigulana sikhutshwe esibhedlele, baza bavavanya ngakumbi abo bafunyaniswe benedeliriyam ngeMemorial Delirium Assessment Scale. Ukudideka kwigumbi lokuchacha kwabhalwa ngokwahlukeneyo njengedeliriyam xa kuvukwa kwi-anesthesia. Ukuqonda kwakusisiphumo sesibini: uthotho lweemvavanyo ezisesikweni ngosuku olungaphambi kotyando nangexesha elimalunga nosuku 7 emva kotyando, apho ukwehla kwakuchazwa njengokuhla okungaphezu komlinganiselo omnye wokutenxa okuqhelekileyo ubuncinane kwiimvavanyo ezimbini. Oku kukwehla kwangethuba, ngoku okudla ngokubizwa ngokuba kukulibaziseka kokuchacha kokuqonda okuhambelana nemithambo-luvo. Kwiinyanga ezintathu abaphandi basebenzisa uvavanyo lokuhlola ngomnxeba, i-TICS-m, kodwa kwakungekho nqanaba le-TICS-m langaphambi kotyando lokuthelekisa.
Iziphumo zangethuba zathanda i-methylene blue. Ideliriyam yavela kwizigulana eziyi-9 kwezili-124 ezafumana i-methylene blue (7.3 ekhulwini), xa kuthelekiswa nezingama-30 kwezili-124 kwiqela lothelekiso (24.2 ekhulwini), ngomlinganiselo olungisiweyo wamathuba oyi-0.24 kunye nesithuba sokuzithemba se-95 ekhulwini esisuka ku-0.11 ukuya ku-0.53. Ukwehla kokuqonda kwangethuba kwenzeka kuma-20 kwezili-124 (16.1 ekhulwini), xa kuthelekiswa nama-49 kwezili-122 (40.2 ekhulwini). Ideliriyam xa kuvukwa kwi-anesthesia kwigumbi lokuchacha yayifana phakathi kwamaqela, malunga ne-18 xa kuthelekiswa ne-23 ekhulwini. Kwiinyanga ezintathu, amanqaku ovavanyo ngomnxeba ayephantse afane (amaxabiso aphakathi ayi-34.5 nama-34.0), kungekho mahluko ngokweenkcukacha-manani.
Loo manani kufuneka afundwe kunye nemida yawo. Isilingo sachazwa ngokucacileyo njengeso singafihlwanga. Oogqirha be-anesthesia babesazi ukuba izigulana zabelwe liphi iqela, yaye i-methylene blue yenza umchamo ube luhlaza okwesibhakabhaka oxutywe noluhlaza kangangeentsuku ezintathu ukuya kwezintlanu, nto leyo enokutyhila iqela kwizigulana nakubavavanyi. Sasiqhutyelwa kwiziko elinye. Ukulandelelwa kokuqonda kusetyenziswa uvavanyo olufanelekileyo lwenqanaba lokuqala kwathatha malunga neveki; uvavanyo lokuhlola ngomnxeba kwiinyanga ezintathu alunakubonisa utshintsho ukusuka kwinqanaba lokuqala kuba akukho manqaku okuqala ovavanyo ngomnxeba. Iziganeko ezidwelisiweyo ezifana nesicaphucaphu, ukugabha nesiyezi zazifana phakathi kwamaqela, yaye akukho sigulana esabikwa sine-serotonin syndrome okanye i-anemia ebangelwa kukuchithakala kweeseli ezibomvu zegazi eyayibalulekile ngokwezonyango. Umkhuhlane wawuxhaphake ngakumbi nge-methylene blue (16 kwezili-124 xa kuthelekiswa ne-3 kwezili-124). Ukusebenza kwesibindi okungaqhelekanga kwavela kumaqela omabini yaye kwakunxulumene neemeko zotyando lokususa inxalenye yesibindi.
Oko kongezwa yimodeli yeempuku ezindala
Uphononongo olwahlukileyo kwiimpuku ezineenyanga ezili-18 ubudala lubuza ngendlela yokusebenza, kungekhona ngesiphumo kwizigulana. Iimpuku ezingamashumi amane anesihlanu ezingamadoda zohlobo lwe-C57BL/6J zahlulwa zaba ngamaqela amathathu aneempuku ezilishumi elinesihlanu ngalinye: ioksijini kuphela, i-sevoflurane eyi-3 ekhulwini kangangeeyure ezimbini, okanye kwaloo sevoflurane kodwa kwandulelwa kwiiyure ezimbini ngaphambili yinaliti enye ye-methylene blue eyi-5 mg/kg efakwe kumngxuma wesisu. Ukufunda nenkumbulo kwavavanywa ngeMorris water maze, yaye izicubu zehippocampus zahlolwa kujongwa ukumila kweemitochondria neeproteni ezilawula ukwahlukana kwazo.
I-sevoflurane yandisa i-enzyme eqhekeza iiproteni ebizwa ngokuba yi-SENP3, yasusa iproteni encinane eguqula ukusebenza kwezinye iiproteni (SUMO2/3) kumlawuli wokwahlukana obizwa ngokuba yi-Drp1, yaqhekeza iimitochondria, yaza yenza ukusebenza kuvavanyo lwemaze kube kubi ngakumbi. Ukunikwa kwe-methylene blue kwangaphambili kwabuyisela umva ikhonkco ngalinye kolo thotho: ukususwa okuncinane kwe-SUMO kwi-Drp1, ukuqhekeka okuncinane, namanqaku enkumbulo angcono. Ababhali bachaza imeko yokuncanyathiselwa kwe-SUMO kwi-Drp1 njengotshintsho oludibanisa ukuchanabeka kwi-anesthesia nomonakalo kwiimitochondria nakukuqonda.
Leyo yindlela yokusebenza ecacileyo nenokuvavanywa, yaye yenza isiphumo esibonwe ebantwini singamangazi kangako ngokwebhayoloji. Kodwa qaphela zonke izinto le modeli engazimelanga. Ezi yayiziimpuku ezindala kodwa ezazisempilweni ngenye indlela, ezanikwa i-anesthesia kuphela, kungekho tyando okanye esinye isifo esihamba naso. Ichiza lafakwa ngenaliti esiswini kwiiyure ezimbini ngaphambi kokuchanabeka, uyilo lokunikwa kwangaphambili olwahlukileyo ekufakweni emthanjeni emva kokuqaliswa kwe-anesthesia kwisilingo sezigulana. Ubungqina obukwizicubu zehippocampus yeempuku abuqinisekisi ukuba kwaloo ndlela yokusebenza ichaza isiphumo esibonwe ebantwini.
Ezi zifundo zimbini xa zithelekiswa
| Umbuzo | Isilingo esingafihlwanga ebantwini | Imodeli yeempuku ezindala |
|---|---|---|
| Abathathi-nxaxheba | Izigulana zotyando ezingama-248, iminyaka engama-60 ukuya kuma-80, isibhedlele esinye | Iimpuku ezindala ezingamadoda ezingama-45, amaqela amathathu ane-15 ngalinye |
| Ukuchanabeka | Utyando olukhulu phantsi kwe-anesthesia epheleleyo | I-sevoflurane kuphela, akukho tyando |
| Inkqubo yokunikwa kwe-methylene blue | 2 mg/kg IV kwisithuba semizuzu engama-60 emva kokuqaliswa kwe-anesthesia | 5 mg/kg kumngxuma wesisu, kwiiyure ezi-2 ngaphambi kwe-anesthesia |
| Isiphumo sedeliriyam | I-3D-CAM kabini ngosuku, ngeentsuku 1 ukuya ku-5; yancipha nge-methylene blue | Ayilinganiswanga; iimpuku azinakubika le meko |
| Isiphumo sokuqonda | Ukwehla kuthotho lweemvavanyo ngosuku 7; kwancipha nge-methylene blue; akukho mahluko kwiinyanga ezi-3 kuvavanyo lokuhlola ngomnxeba | IMorris water maze; ukunikwa kwangaphambili kwagcina inkumbulo |
| Isiphumo sendlela yokusebenza | Ayivavanywanga kwizicubu | I-SENP3 yehippocampus, ukuncanyathiselwa kwe-SUMO kwi-Drp1, ukumila kweemitochondria |
| Oko sikuqinisekisayo | Isalathiso sezonyango sangethuba esinemida yokufihlwa kwamaqela neyokwenziwa kwiziko elinye | Indlela yokusebenza kweemitochondria ehambelana nokhuseleko |
Iprotocol yesibini, enkulu ngakumbi, icacisa ukuba olu phando lusingise phi. Isilingo esibhalisiweyo sotyando lodakada i-NCT04529265 sacwangcisa izigulana ezingama-314 ezineminyaka engama-55 ukuya kuma-80, ukufihlelwa kwamaqela kubathathi-nxaxheba nakubavavanyi beziphumo, needosi ezimbini ngexesha lotyando ezifikelela kwi-3 mg/kg zizonke. Ideliriyam ngexesha lokuhlala esibhedlele yayisisiphumo esiphambili, kanti ukuqonda ngosuku 7, izalathisi zokudumba nokulandelelwa komhlaza ixesha elide yayiziziphumo zesibini. Ingxelo yobhaliso ibonisa ukugqitywa ngoDisemba 2024, yaye iziphumo sele zipapashwe kwiJournal of Clinical Anesthesia ngo-2026. Olo phindo lufihlwe amaqela sisifundo ekufuneka silandelwe ngaphambi kokuphakamisa isiphumo sesilingo esingafihlwanga sibe libango eliqinisekisiweyo.
Ukhuseleko kwigumbi lotyando aludluliselwa ekusetyenzisweni ekhaya
Zonke iziphumo zokuqonda ezingentla zivela ekusetyenzisweni okulawulwayo kokufakwa emthanjeni ngexesha lotyando. Kuloo meko kukho oogqirha be-anesthesia, izixhobo zokubeka iliso, amachiza okuvuselela isigulana nokuhlolwa kwamayeza anokusebenzisana nalo. Akukho nanye kwezi edluliselwa ekuthathweni ngomlomo ekhaya.
Kukho izilumkiso ezibini ezithile. I-methylene blue ithintela i-monoamine oxidase, ngoko ukuyidibanisa namayeza oxinzelelo lwengqondo asebenza kwi-serotonin kunokubangela i-serotonin syndrome. Lo mngcipheko uchazwe njengesilumkiso esikwibhokisi kulwazi lokumiselwa kohlobo olutofwayo; amayeza anokusebenzisana nalo achazwe kwinqaku elithi ukusebenzisana kwe-methylene blue namanye amayeza. Izigulana ezinqongophele nge-G6PD zisemngciphekweni wokuchithakala kweeseli ezibomvu zegazi. Ukutshintsha kombala womchamo nolusu kube luhlaza okwesibhakabhaka, okungenabungozi ngokwako, kukwasisizathu sokuba izilingo zexesha elizayo kufuneka zisebenze nzima ngakumbi ekufihleni amaqela kunokuba kwenziwa kwisifundo esingafihlwanga. Imigaqo ngokubanzi yokhuseleko ekuphatheni nasekufumaneni imveliso ishwankathelwe kwinqaku elithi iziseko zokhuseleko lwe-methylene blue.
Isishwankathelo
Isilingo esinye esingafihlwanga kwizigulana zotyando ezindala sibika ideliriyam enciphe kakhulu nokwehla okuncinane kokuqonda okulinganiswe kwangethuba emva kwedosi enye efakwe emthanjeni ngexesha lotyando, kungekho mahluko kokuqonda kwiinyanga ezintathu, kunye nobuthathaka bokufihlwa kwamaqela obuchazwe ngababhali ngokwabo. Imodeli ye-anesthesia kwiimpuku ezindala inika inkcazelo ehambelanayo yeemitochondria malunga nendlela olo khuseleko olunokwenzeka ngayo. Ziphathe njengeengxelo ezimbini ezahlukeneyo: isalathiso sezonyango esisalinde ukuphindwa kufihlwe amaqela, nendlela yokusebenza esalinde ukuqinisekiswa ebantwini. Abafundi abalandela iziphumo zenkumbulo ekwaluphaleni ngokubanzi banokufuna nokufunda i-methylene blue nenkumbulo ekwaluphaleni.