Inqaku
Ulwelo lwe-methylene blue lokuhlamba umlomo lwe-mucositis: oko kwaboniswa lulingo olunye lwentlungu yomhlaza
I-mucositis ebangelwa lunyango lomhlaza yimeko ethile. Unyango lwekhemotherapy okanye unyango lokulungiselela ukufakelwa kweeseli lonakalisa ulwelwesi lomlomo, kwakheke izilonda, zize iziphelo zemithambo-luvo ezivele ngaphandle zenze ukutya, ukuginya nokuthetha kube buhlungu. Ngokwendlela ye-WHO yokuhlela ubunzima be-mucositis echazwe kwizikhokelo zokhathalelo oluxhasayo, ibakala 2 lisavumela ukutya okuqinileyo, ngoxa ibakala 3 linyanzela isigulana ukuba sisebenzise ulwelo kuphela. Ukulawula intlungu nokuphola kwezicubu ziziphumo ezahlukeneyo. Ulwelo lokuhlamba umlomo lunokuphucula esokuqala lungakhange lutshintshe esesibini.
Lo mahluko unceda ukuqonda olona vavanyo lubalaseleyo lufumanekayo olwenziwe ebantwini ngolwelo lwe-methylene blue lokuhlamba umlomo kule njongo: ulingo lwesigaba 2 lwango-2022 lwase-MD Anderson olwabela izigulana kumaqela ngokungakhethiyo, olwapapashwa kwi-BMC Medicine njengophando lwentlungu ye-mucositis engalawulekiyo. Aluzange luvavanye i-methylene blue kwizilonda zomlomo ngokubanzi, usulelo lomqala, usulelo lokungunda emlonyeni, okanye ukusetyenziswa kolwelo lokuhlamba umlomo yonke imihla. Lwavavanya ulwelo olunye olulungiselelwe ukuhlamba umlomo, olusetyenziswe ngendlela enye, ngenxa yentlungu engaphenduliyo kunyango.
Oko kwavavanywa lulingelo
Uyilo lulula: yongeza ulwelo lokuhlamba umlomo olusebenza kwindawo olufakwa kuyo kukhathalelo oluqhelekileyo, lugcine kwizicubu ezibuhlungu, lutshice, phinda ngokweshedyuli, uze ulinganise intlungu nokusebenza emva kweeyure ezingama-48.
Abantu abadala abane-mucositis ebuhlungu nangona befumana ukhathalelo oluqhelekileyo babelwa ngokungakhethiyo kunyango oluqhelekileyo kuphela (n = 16) okanye kunyango oluqhelekileyo olongezwe i-methylene blue ku-0.025% (n = 15), ku-0.05% (n = 14), okanye ku-0.1% (n = 15). Kubathathi-nxaxheba abangama-69, abangama-60 balugqiba unyango. Ingxelo epheleleyo yolingo ithi kwasetyenziswa ukufihla ulwazi lokuxinana kolwelo kwelinye icala, kodwa iqela lothelekiso alizange lifumane ulwelo oluluhlaza okwesibhakabhaka lokuhlamba umlomo, ngoko xa kuthelekiswa nokhathalelo oluqhelekileyo, kwakungekho kufihlwa kolwazi ngokwenene. Kwakungekho qela lifumana i-placebo, nto leyo ababhali abayidwelisa njengomda wophando.
Eli qela lezigulana lalichaphazeleke kakhulu. Kwabo balugqibayo unyango, ama-72% ayefakelwe iiseli ezisiqu, yaye abanye babefumene ikhemotherapy esebenza kuwo wonke umzimba okanye unyango lwe-CAR-T. Ekuqaleni, ama-90% ayene-mucositis yebakala 3 le-WHO, aze ama-10% abe nebakala 2, intlungu sele ikhona kangangeentsuku ezi-6 ngokwexabiso eliphakathi. Iphepha alizahluli iintlobo zomhlaza ezafunyaniswa, ngoko akunakubotshelelwa kulo amabango aphathelele kuhlobo oluthile lomhlaza.
Isigulana ngasinye safumana ibhotile ye-100 mL elungiselelwe kwikhemesti yophando: thabatha i-6 ukuya kwi-10 mL, uyigcine kwiindawo ezibuhlungu kangangemizuzu emi-5 ngokuyijikelezisa emlonyeni nokuhlambulula umqala ngayo, uyitshice ungayiginyanga, ulinde ngaphambi kokuhlamba umlomo okanye ukutya, uze uphinde rhoqo emva kweeyure ezi-6 kangangeentsuku ezi-2. Ukhathalelo olwalusele lukhona lwaqhubeka yaye lwalunokuquka ucoceko lomlomo, ulwelo lwe-lidocaine lokuhlamba umlomo, umxube wokuhlamba umlomo owaziwa ngokuba yi-magic mouthwash oqulethe i-nystatin, imixube ye-diphenhydramine neyeza lokunciphisa iasidi, nee-opioid ezisebenza kuwo wonke umzimba.
Isiphumo esiphambili esasipapashiwe yayilutshintsho kwintlungu kuluhlu olunamanqanaba ali-11 (u-0 xa kungekho ntlungu, u-10 xa intlungu imbi kakhulu) ukusuka ekuqaleni ukuya kumhla 2. Ukusebenza komlomo kwakulinganiswa ngamanqaku obunzima obu-0 ukuya ku-6, adibanisa ukutya, ukuginya nokuthetha, nganye inikwe amanqaku okuba iyakwazi ukwenziwa, kunzima ukuyenza, okanye ayinakwenziwa. Ibakala le-WHO labhalwa kuphela xa izigulana zazingeniswa kuphando, alizange lilandelwe ngokuphindaphindiweyo.
Isishwankathelo soyilo lolingo neziphumo
Le theyibhile igcina imiba emithathu yahlukile: intlungu, ukusebenza komlomo, neziphumo ezingathandekiyo. Ukuphola, ukupheliswa kosulelo, nokuncitshiswa kwemfuneko yee-opioid akuzange kuqinisekiswe apha.
| Umbuzo | Oko kwalinganiswa | Isiphumo kumhla 2 |
|---|---|---|
| Ngaba intlungu yehla? | Utshintsho kumanqaku entlungu, ukusuka ekuqaleni ukuya kumhla 2 | Umyinge wokwehla wawuyi-1.69 ngokhathalelo oluqhelekileyo xa uthelekiswa no-5.20, 4.54, no-5.15 kulwelo lokuhlamba umlomo lwe-0.025%, 0.05%, nolwe-0.1%. Amanqaku aphakathi kumhla 2: 5.5 xa kuthelekiswa no-3, 2, no-2. |
| Ngaba ukutya, ukuginya nokuthetha kwaphucuka? | Ubunzima bokusebenza komlomo, 0 ukuya ku-6 | Umyinge wokwehla wawuyi-0.81 ngokhathalelo oluqhelekileyo xa uthelekiswa no-2.47, 2.79, no-2.87 kumanqanaba amathathu okuxinana kolwelo lokuhlamba umlomo. Amanqaku aphakathi kumhla 2: 4 xa kuthelekiswa no-2, 1, no-2. |
| Kwenzeka ngokukhawuleza kangakanani, yaye kwahlala ixesha elingakanani? | Amaxesha axelwe zizigulana | Kwabangama-44 abalugqibayo unyango ngolwelo lokuhlamba umlomo, ama-77% aziva ukukhululeka okukhulu kwimizuzu nje emva kokuhlamba umlomo okokuqala. Intlungu yaphinda yavela kuma-57%, ubukhulu becala phakathi kweeyure ezi-4 nezisi-8, kodwa ingasenamandla angako. Malunga nama-59% acela ulwelo olungakumbi emva komhla 2. |
| Ngaba izilonda zaphola ngokukhawuleza ngakumbi? | Ibakala le-WHO ngokuhamba kwexesha | Akuzange kulinganiswe emva kokungeniswa kuphando. Ababhali bathi ixesha lokuphola lifuna uphando olongezelelekileyo. |
| Ngaba ukusetyenziswa kwee-opioid kwehla? | Izixa zemihla ngemihla ezilingana ne-morphine | Akunako ukutolikwa. Ixabiso eliphakathi ekuqaleni lalimalunga ne-114 mg ngosuku, kodwa izixa ezazijoliswe kwi-mucositis zazingenakwahlulwa kwezo zazisetyenziselwa ezinye iintlobo zentlungu. |
| Zeziphi iziphumo eziyingozi ezavela? | Iziganeko ezingathandekiyo ukuya kwiintsuku ezingama-30 | Ukutshisa komlomo okwethutyana ekusetyenzisweni kokuqala (iimeko ezi-5 kwiziphumo ezineenkcukacha; isishwankathelo sithi zisi-8, umahluko ongasonjululwanga), kuquka umntu omnye owarhoxayo. Amabala aluhlaza okwesibhakabhaka okwethutyana aphela ngococeko okanye ngokutya. Akukho ziganeko zingathandekiyo ezinzulu yaye kwakungekho mabala asisigxina kwiintsuku ezingama-30. |
Xa kuthelekiswa nokhathalelo oluqhelekileyo, ukuncitshiswa kwentlungu kwafikelela kumda oqhelekileyo wokubaluleka ngokweenkcukacha-manani kumanqanaba e-0.025% nawe-0.1%, kodwa i-0.05% yayisemdeni (P = .0506). Amanqanaba amathathu okuxinana kolwelo lokuhlamba umlomo ayengahlukanga omnye komnye, ngoko ulingo aluchongi elona nqanaba lokuxinana lifanelekileyo.
Oko olu lingo lungazange lukuvavanye
Umfundi ubona isiphumo esihle sentlungu aze asandise aye kumbandela osondeleyo. Ukusetyenziswa ngakunye okwandisiweyo ngezantsi kufuna ulingo lwako.
Okokuqala, unyango losulelo. Ulingo lwalinganisa intlungu nokusebenza kwi-mucositis enxulumene nekhemotherapy. Aluzange luvavanye usulelo lomlomo olubangelwa ziibhaktheriya, ngumngundo okanye ziintsholongwane, umaleko oncamathela emazinyweni, ukudumba kweentsini, okanye ukugcina umoya womlomo uhlaziyekile ngokwesiqhelo. Ukusetyenziswa komxube oqulethe i-nystatin kukhathalelo olwalusele lukhona akutshintshi ulwelo oluvavanywayo lube liyeza lokulwa umngundo. Amagqabantshintshi ethu ahlula izilonda zomlomo eziqhelekileyo kwi-mucositis enxulumene nomhlaza agcina ezi njongo zonyango zahlukile.
Okwesibini, ukusetyenziswa ngokubanzi kolwelo lwe-methylene blue lokuhlamba umlomo. Abathathi-nxaxheba babene-mucositis yebakala 2 ukuya ku-3 engaphenduliyo kunyango, bephantsi kokhathalelo lomhlaza. Amavolontiya asempilweni, izilonda zomlomo eziqhelekileyo, nomqala obuhlungu akuzange kuphandwe. Lo mda ukwaxoxwa kwisikhokelo sethu samabango aphathelele umlomo nomqala.
Okwesithathu, ukuphola kolwelwesi lomlomo. Ngaphandle kokuhlelwa kwamabakala ngokuphindaphindiweyo okanye ukulinganiswa kwezilonda, amanqaku entlungu asezantsi akanakungqina ukuba izicubu zavaleka ngokukhawuleza ngakumbi. Ababhali bayayicacisa le ngongoma.
Okwesine, i-methylene blue eginyiweyo. Izigulana zalutshica ulwelo lokuhlamba umlomo. Ukufunxeka kwalo emzimbeni, ukusebenzisana kwalo namanye amayeza, neziphumo eziyityhefu zedayi eginyiweyo zazingeyiyo indlela yokusetyenziswa eyavavanywayo. Ukutshica endaweni yokuginya yinxalenye yonyango oluvavanywayo, asiyonkcukacha incinane.
Isizathu sokuba isisombululo esithengiswa ezivenkileni singatshintshiselani neso sophando
Umxube wophando nebhotile ethengiswa evenkileni zinokuba nombala ofanayo kodwa zahluke kuzo zonke iimpawu ezimisela isiphumo nomngcipheko: ukuxinana, umthamo, ixesha lokudibana nezicubu, izithako ezincedisayo, umgangatho ngokubhekiselele kwiintsholongwane, nemiyalelo. Olu lingo lwalusebenzisa imixube elungiselelweyo enokuxinana okumalunga ne-0.25 ukuya kwi-1 mg nge-mL, ukudibana nezicubu okubekelwe imizuzu emi-5, nokusetyenziswa rhoqo emva kweeyure ezi-6. Imveliso ethengiswa evenkileni enokuxinana okwahlukileyo, ejikeleziswa emlonyeni ixesha elifutshane, okanye enomyalelo wokuyiginya ayiphindi nayiphi na kwezo meko.
Iibhotile zolingo zazivela kwikhemesti yophando. I-methylene blue ethengiswa ezivenkileni iyahluka ngokwenqanaba lomgangatho novavanyo, yaye iimpazamo zokuxinana emlonyeni onezilonda azincinane. Uthelekiso lufuna ukuxinana okuchanekileyo, uluhlu olupheleleyo lwezithako, nesatifikethi esibandakanya isisombululo esigqityiweyo, kungekhona isithako esingekalungiswa kuphela. Inkcazelo yethu yovavanyo lwesisombululo esigqityiweyo ichaza olo xwebhu.
Abaphandi bacebisa ukuba kukho isiphumo sokuthomalalisa intlungu kwindawo yolwelo kwimicu yemithambo-luvo yentlungu evele ngaphandle, mhlawumbi kunye nemiqondiso yasekuhlaleni yokunciphisa ukudumba, baza baqaphela ukuba ulwelo aluzange luphelise ukuva incasa okanye ukusabela komzimba okubangela ukuba umntu arhawuzele emqaleni njengoko bekuya kwenza iyeza eliqhelekileyo lokwenza indawo ingavi. Loo ngcamango yenza ukukhululeka kweempawu kubonakale kusengqiqweni. Ayingqini ukuba naluphi na ulwelo oluluhlaza okwesibhakabhaka lusebenza nakwesiphi na isilonda somlomo.
Imeko yokhuseleko nemida
Ukunyamezeleka kwexesha elifutshane kweli qela likhethiweyo akuqinisekisi ukhuseleko ngokubanzi. Ulingo aluzange lubandakanye abantu abanokusilela kwe-glucose-6-phosphate dehydrogenase, abakhulelweyo, abancancisayo, okanye abane-mucositis enxulumene nonyango lwemitha. I-methylene blue esebenza kuwo wonke umzimba inomngcipheko wokusebenzisana okuyingozi namayeza achaphazela i-serotonin, okubangela i-serotonin syndrome, umngcipheko wokuqhekeka kweeseli ezibomvu zegazi kubantu abanokusilela kwe-G6PD, kunye nezilumkiso zokukhulelwa. Akukalinganiswa kakuhle ukuba ungakanani umngcipheko womzimba wonke osebenzayo kulwelo lokuhlamba umlomo olutshicwa ngokuchanekileyo, ngoko kubalulekile ukuphonononga amayeza asetyenziswayo.
Lindela ukutshintsha kombala ube luhlaza okwesibhakabhaka okwethutyana, xela ukutshisa okuqhubekayo emva kokusetyenziswa kokuqala, yaye musa ukuguqula ulwelo olufanele lutshicwe lube sisixa esiginywayo ngaphandle kokuphononongwa ngugqirha.
Ulandelelo lokusebenza konyango kuhlalutyo olupapashiweyo lwaluyiyure ezingama-48; ukubekwa esweni kokhuseleko kwaqhubeka ukuya kwiintsuku ezingama-30. Iqela lophando lalincinane, unyango olwalusele lukhona lwalwahlukahluka, yaye kwiqela lothelekiso ulwazi lwalungafihlwanga. Isiphumo sisalathiso sesigaba 2 sokulawula iimpawu, asiyomgangatho wonyango. Isikhokelo sethu sokufunda uphando lwe-methylene blue sibonisa indlela yokuhlola ukwabiwa ngokungakhethiyo, ukufihlwa kolwazi, iziphumo ezijoliswe kuzo, nolandelelo ngaphambi kokwenza isigqibo ngolingo olunye.
Imibuzo yokubuza iqela lonyango lomhlaza
Intlungu ye-mucositis sele inokhathalelo oluxhasayo olumiselweyo, yaye naluphi na ulwelo lokuhlamba umlomo oluvavanywayo lufanele luxoxwe njengenxalenye yolo cwangciso. Imibuzo eluncedo iquka ukuba leliphi ibakala le-mucositis elikhoyo, ngawaphi amanyathelo aqhelekileyo asele esetyenziswa, ngawaphi amayeza anokusebenzisana ne-methylene blue, nokuba imeko ye-G6PD iyaziwa na, nesiphi isiphumo esiya kuchaza impumelelo okanye isizathu sokuyeka (amanqaku entlungu, ukukwazi ukuginya ulwelo, okanye isiphumo esingathandekiyo). Yiza nesalathiso esichanekileyo solingo neenkcukacha zomxube kunebango lemveliso eliqhelekileyo. Uluhlu lwethu lokukhangela iingongoma zengxoxo nengcali yezonyango ludwelisa iinkcukacha zemveliso nezophando ekufanelekile ukuziprinta.
Ngoko ke, into eyaphandwayo inomda omxinwa: ulwelo lokuhlamba umlomo olulungiselelweyo, olutshicwayo, nolusetyenziswa ngokuphindaphindiweyo lwayinciphisa intlungu ye-mucositis engaphenduliyo kunyango lwaza lwaphucula ukutya, ukuginya nokuthetha kwiintsuku ezi-2 kuthelekiso oluncinane apho ulwazi lwalungafihlwanga, ngaphandle kokubonisa ukuphola okukhawulezayo, ukwehla kwemfuneko yee-opioid, unyango losulelo, okanye inzuzo ngokubanzi yolwelo lokuhlamba umlomo.