Isihloko
I-methylene blue ezinjeni: ukusetshenziswa emtholampilo nemibuzo ngobuthi
Inja ikhotha amanzi aluhlaza okwesibhakabhaka ethangini lezinhlanzi elisanda kufakwa umuthi. Umnikazi ufunda ukuthi i-methylene blue ilungisa ukuphazamiseka kwegazi bese ezibuza ukuthi ithonsi elivela ebhodleleni lomuthi wezinhlanzi lingayisiza yini inja egulayo ekhaya. Zombili lezi zimo zihilela udayi ofanayo. Asikho kuzo okufanele sibe yisinqumo sokwelapha ekhaya.
Ukudideka kuvela ekuhlanganiseni imiqondo emibili enegama elifanayo. Omunye uyinqubo yasemtholampilo: udokotela wezilwane unikeza umthamo olinganisiwe emthanjeni ngenxa yesimo esithile esiphuthumayo segazi, bese eqapha igazi izinsuku eziningana. Omunye uwukuchayeka: inja igwinye umthamo ongaziwa kadayi ovela ethangini, oketshezini lokucwilisa izinhlanzi, noma ephilisini. Owokuqala kufanele wenziwe esibhedlela. Owesibili kufanele uxoxwe nodokotela wezilwane ngocingo. Lesi sihloko sigcina lezi zimo zihlukene, sichaza ukuthi kungani lingekho ishadi eliphephile lemithamo yezinja yokusebenzisa ekhaya, futhi sinikeza ithebula ongaliya emtholampilo.
Lokho odokotela bezilwane abayisebenzisela khona ngempela
Ukusetshenziswa kwayo okuqinisekisiwe ezinjeni kulinganiselwe: i-methemoglobinemia ebangelwa yi-oxidant futhi enzima ngokwanele ukuba idinge ukwelashwa. I-hemoglobin evamile ithwala umoya-mpilo ngoba insimbi yayo isesimweni se-ferrous, lapho yamukele khona ama-electron. Amakhemikhali angama-oxidant aguqula leyo nsimbi ibe sesimweni se-ferric, akhe i-methemoglobin, engakwazi ukuthwala umoya-mpilo. Izinsini zenja zingabonakala ziluhlaza okwesibhakabhaka noma zimpunga, kuyilapho igazi ngokwalo liba nsundu njengoshokoledi.
Ngaphakathi kwengqamuzana elibomvu legazi, i-methylene blue ingamukela ama-electron ibe yi-leucomethylene blue, ebuyisela ama-electron ensimbini eyenziwe i-oxidation futhi ibuyisele i-hemoglobin ekusebenzeni. Yilokho okusabela okwenza ukwelashwa kusebenze. Kuchaza ukuthi kungani lo muthi usiza kuphela uma inkinga kuwukweqisa kwe-methemoglobin. Awusizi nge-anemia evamile, ngokushoda komoya-mpilo okubangelwa yisifo samaphaphu, noma ngobuthi obungahileli i-methemoglobin.
Izimbangela ezivamile ezinjeni zihlanganisa i-acetaminophen, i-nitrate noma i-nitrite, i-benzocaine neminye imithi ehlobene nayo engama-oxidant, futhi ngezinye izikhathi ukulimala kwe-oxidation okuhlobene no-anyanisi noma ugalikhi. Nge-acetaminophen, ukwelashwa okuyinhloko kuwukususa ubuthi kanye ne-N-acetylcysteine, kanti i-methylene blue yengezwa lapho i-methemoglobin iyingxenye ebalulekile yenkinga, njengoba kuchazwe esiqondisweni se-Merck ngobuthi bemithi yokudambisa izinhlungu. Ngo-anyanisi nogalikhi, ukunakekelwa okuvamile kuwukususa ubuthi, ukunikeza umoya-mpilo, ukweseka ngokumpontshelwa igazi, nokunikeza uketshezi, ngoba umonakalo oyinhloko uwukubhujiswa kwamangqamuzana abomvu egazi okuhlobene nemizimba ye-Heinz, okuvela ngokubambezeleka phakathi nezinsuku eziningana, hhayi i-methemoglobin kuphela. Ukusebenzisa inqubo yokwelapha ubuthi be-nitrate ezilwaneni ezetshisayo enjeni kungaba yingozi, ngoba izinkomo zibekezelela imithamo elimaza izinja, okuyiphuzu elishiwo ngokucacile ezincwadini zezokwelapha izilwane ezimayelana ne-nitrate.
Okunye ukusetshenziswa okubili kudinga ukuchazwa ngokucacile. Ukujova endaweni ezungeze isimila ukuze kutholakale indawo ye-sentinel lymph node kuwukusebenzisa udayi enqubweni yezokwelapha umdlavuza ezinjeni, hhayi ukwelapha umzimba wonke. Ukusetshenziswa kokuhlola ekushaqekeni kwegazi kohlobo lwe-distributive noma lwe-vasoplegic, lapho udayi unikezwa khona ukuze unciphise ukudluliselwa kwezimpawu ze-nitric oxide, kusacwaningwa ezinjeni. Ucwaningo lwango-2026 lwenqubo ye-bypass ezinjeni lusho ngokucacile ukuthi abukho ubufakazi basemtholampilo yezilwane bokuwusebenzisa kulolo hlobo lokushaqeka, futhi imithamo ephezulu ezivivinyweni yenza umfutho wegazi nokusebenza kwenhliziyo kube kubi kakhulu. Ngakho isifinyezo esithembekile siwukuthi kunomsebenzi owodwa oqinisekisiwe, umsebenzi owodwa wokusebenzisa udayi enqubweni, kanti okunye kusahlolwa. Imiyalelo yamathangi ezinhlanzi, izinqubo zokwelapha abantu, kanye nokusetshenziswa ekungcoliseni amasampula elabhorethri akukwazi ukudluliselwa ekwelapheni izinja.
Kungani lingekho ishadi lemithamo yokusebenzisa ekhaya
Imiphumela yosesho ithembisa ishadi lemithamo ye-methylene blue yezinja. Kulo muthi, ishadi lingaba yithuluzi elingafanele, ngoba ibanga eliphephile lincane, ukuqapha kuyingxenye yokwelashwa, futhi inani lomthamo lodwa alenzi isinqumo siphephe.
Izincwadi ezishicilelwe zezokwelapha izilwane zivame ukunikeza ibanga elingu-1 kuya ku-1.5 mg nge-kg, elinikezwa emthanjeni kancane, njengesixazululo esiyiphesenti elilodwa, kanye kuphela, ngenxa ye-methemoglobinemia. Umbhalo we-Merck ngobuthi bemithi yokudambisa izinhlungu ubala lelo banga, unikezwa phakathi nemizuzu eminingana. Izincwadi ezinemininingwane yomuthi kwezokwelapha izilwane zicacisa umthamo owodwa onikezwa kancane, kulandelwe ukuqapha igazi izinsuku ezintathu kuya kwezine, futhi zibika i-anemia enzima ngokwanele ukuba idinge ukumpontshelwa igazi emithamo ecishe ibe ngu-5 mg nge-kg. Umthamo wokufaka umbala ngesikhathi sokuhlinzwa, ngendlela eyayisetshenziswa ngeminyaka yawo-1970, owawucishe ube ngu-3 mg nge-kg, wabangela i-anemia eyavela kamuva futhi, kwesinye isimo, ukulimala kwezinso okwabulala ngemva kokubhujiswa kwamangqamuzana abomvu egazi. Umehluko phakathi kokusiza nokulimaza mncane.
Lelo nani liphinde liphendule imibuzo embalwa kunalokho okungase kubonakale. Alisho ukuthi i-methemoglobin ikhona ngempela yini, ukuthi imbangela iyasabela yini kulo muthi, ukuthi inja ithatha miphi eminye imithi, noma ukuthi izinso namangqamuzana abomvu egazi kungayibekezelela yini i-oxidant. Ishadi alikwazi ukukala i-methemoglobin nge-co-oximetry, alikwazi ukuhlola isampula legazi eligcotshwe engilazini ukuze kutholakale imizimba ye-Heinz, futhi alikwazi ukuqapha ukwehla kwe-hematocrit ezinsukwini ezintathu kamuva. Umtholampilo uyakwazi. Yingakho ithebula elingezansi libala amabanga emithamo njengolwazi lwasesemtholampilo lokuxoxisana nodokotela wezilwane, hhayi njengemiyalelo. Unganikezi i-methylene blue ekhaya, ungaguquli ukwelashwa kwethangi lezinhlanzi kube umthamo wenja, futhi ungasebenzisi ilebula yabantu, njengolwazi lokubhalela umuthi lwe-PROVAYBLUE, njengesiqondiso somthamo.
Ukuphikisana: isinqanda-buthi ne-oxidant ngesikhathi esifanayo
Cabanga nge-methylene blue njengemisebenzi emibili ebhodleleni elilodwa. Uma kunikezwa umthamo ophansi, kancane, ngaphansi kokuqondiswa, futhi izinhlelo ze-reductase zisebenza, isiza ngokubuyisela ama-electron futhi yehlise i-methemoglobin. Uma ukuchayeka kukhulu, noma izivikelo zamangqamuzana abomvu egazi zingasakwazi ukumelana nakho, isebenza njenge-oxidant futhi idale umonakalo eyayihloselwe ukuwulungisa: i-methemoglobin eyengeziwe, imizimba ye-Heinz, ukulimala kolwelwesi lwamangqamuzana, nokubhujiswa kwamangqamuzana abomvu egazi.
Lokhu kuphikisana kuncike emthamo futhi imiphumela ingabambezeleka. I-anemia ingavela ezinsukwini ezintathu kuya kwezine ngemva komthamo, yingakho izincwadi zigcizelela ukuhlolwa kwegazi okulandelayo ngisho noma inja ibukeka ingcono phakathi nengxenye yehora. Ukubhujiswa okukhulu kwamangqamuzana abomvu egazi kungadedela i-hemoglobin ku-plasma nasemchameni futhi kulimaze izinso. Ocwaningweni lwezinja, imithamo ephezulu enikezwa emthanjeni yakhuphula i-methemoglobin phakathi nomzuzu kunokuba iyehlise.
Ukusebenzisana okubili kudinga ukunakwa okukhethekile. I-methylene blue iyisivimbi esinamandla, esibuyiseleka emuva, se-monoamine oxidase. Ilebula yokusetshenziswa kubantu inesexwayiso esisebhokisini nge-serotonin syndrome lapho ihlanganiswa nemithi ethinta i-serotonin. Enjeni, umlando obalulekile wemithi uhlanganisa i-trazodone, i-fluoxetine nezinye izivimbi zokubuyiselwa kwe-serotonin emangqamuzaneni, i-clomipramine, i-selegiline, nemithi efana ne-tramadol. Izimpawu zihlanganisa ukungahlaliseki noma ukushintsha kwesimo sengqondo, ukushisa komzimba okuphezulu, ukushaya kwenhliziyo okusheshayo noma umfutho wegazi ongazinzile, ukuqhaqhazela, ukuqina kwemisipha, ukungakwazi ukuhambisa umzimba ngokuhleleka, nokuquleka. Lesi sexwayiso esinamandla sisekelwe kakhulu ebufakazini obuvela kubantu, ngakho izinga lokwenzeka ezinjeni alikalinganiswa kahle, kodwa umlando wemithi kufanele ube yingxenye yazo zonke izingcingo zokuhlola ukuphuthuma kwesimo.
Uhlobo lwesilwane nalo lubalulekile. Izinja zingaba ne-anemia ehlobene nemizimba ye-Heinz ngenxa yalo muthi, kodwa amakati asengozini enkulu kakhulu ngoba i-hemoglobin yamakati inamaqembu amaningi angathinteka yi-oxidation futhi amangqamuzana awo abomvu egazi awasusi kahle umonakalo. Inqubo yezinja akufanele neze iguqulwe ibe ngeyekati ngokuyilinganisa ngesisindo. Umthethonqubo kahulumeni wobumbano wase-US 21 CFR isigaba 500.27 ubhala nge-anemia ebulalayo ehlobene nemizimba ye-Heinz emakatini anikezwa imikhiqizo ye-methylene blue yokwelapha izinkinga zomchamo ngomlomo ngokwemiyalelo yelebula. Lowo mlando ukhumbuza ukuthi ukunikeza ngomlomo akusho ngokuzenzakalelayo ukuthi umuthi awunabungozi obukhulu.
Ithebula lokusetshenziswa emtholampilo nokuchayeka
Yisa leli thebula kudokotela wezilwane kunokuba wenze elikushoyo ngokwakho. Lihlukanisa ukusetshenziswa okuqondisiwe emtholampilo nokuchayeka ngengozi, okuyiwona mehluko ogcina izinqumo ziphephile. Lixoxe nabasebenza emtholampilo; alithathi indawo yokuxilonga.
| Isimo | Siyini | Lokho udokotela wezilwane akucabangelayo |
|---|---|---|
| I-methemoglobinemia enzima ebangelwa yi-oxidant | Isizathu esiqinisekisiwe sokusebenzisa umuthi emtholampilo. I-methemoglobin ekaliwe, inja enezimpawu, nembangela ye-oxidant eyaziwayo. | Umthamo owodwa onikezwa kancane emthanjeni, ocishe ube ngu-1 kuya ku-1.5 mg nge-kg wesixazululo esiyiphesenti elilodwa, kanye kuphela, kuhambisane ne-co-oximetry nokuqapha i-hematocrit nesampula legazi eligcotshwe engilazini izinsuku ezingu-3 kuya kwezingu-4. Ukunakekelwa okuqondene nembangela kuyaqhubeka ngesikhathi esifanayo, isibonelo i-N-acetylcysteine uma imbangela kuyi-acetaminophen. |
| Ukushoda kwe-reductase okutholakala ngofuzo | Isizathu esingavamile esidinga uchwepheshe. I-methemoglobinemia ephindaphindayo ngaphandle kobuthi. | Ukwelashwa emthanjeni okuncike esimweni, ngomthamo ocishe ube ngu-1 mg nge-kg, ngezinye izikhathi kulandelwe inkambo yomuthi womlomo eqaphwayo. Uhlelo lwesikhathi eside lwenziwa kuphela ngaphansi kokunakekelwa uchwepheshe. |
| Ukuthola indawo ye-sentinel lymph node | Ukusebenzisa udayi enqubweni yokuhlinza isimila. | Umjovo endaweni ezungeze isimila owenziwa udokotela ohlinzayo, hhayi umthamo owenzelwe umzimba wonke. Imiphumela egazini iyindaba ehlukile ekusakazekeni kukadayi. |
| Ukushaqeka kwegazi noma ukwehla kokudonseka kwemithambo yegazi | Kusahlolwa ezinjeni. Ayikho inqubo evamile eyamukelwe. | Kucatshangelwa ukufaneleka kokubamba iqhaza ocwaningweni, hhayi ukusetshenziswa ekhaya. Imiphumela emfundweni yegazi, enhliziyweni nasemaphashini ingaba mibi kakhulu emithamo ephezulu. |
| Iphuze amanzi ethangi lezinhlanzi afakwe umuthi | Ukuchayeka, hhayi ukwelashwa. Umuthi uxutshwe namanzi amaningi kodwa umthamo ophuziwe awaziwa. | Ilebula yomkhiqizo, ukugxila komuthi wasebhodleleni, umthamo wamanzi ethangini, umthamo olinganiselwe ophuziwe, isisindo somzimba, isikhathi, izimpawu, nayo yonke imithi. Ukuphuza kancane amanzi anomuthi oxutshwe kakhulu nokuphuza umuthi ogxilile yizimo ezihlukene. |
| Ikhothe uketshezi lokucwilisa izinhlanzi noma ihlafune umuthi ogxilile noma iphilisi | Ukuchayeka okukhathaza kakhulu. | Imininingwane efanayo yomkhiqizo kanye nama-milligram kuyunithi ngayinye nenani eliphezulu lamayunithi angekho. Ezinye izithako zephilisi ziyakushintsha ukuhlolwa kwesimo. |
| Inja ethatha i-trazodone, i-SSRI, i-clomipramine, i-selegiline, i-tramadol | Ingozi yokusebenzisana kwemithi eyengezeka kunoma yisiphi isimo esingenhla. | Uhlu oluphelele lwemithi nezithasiselo ngaphambi kwanoma yisiphi isinqumo. Izimpawu ze-serotonin syndrome zidinga ukuhlolwa okuphuthumayo. |
Uma inja ichayekile: okufanele kwenziwe manje
Okokuqala, yinqande ekuphuzeni okwengeziwe bese ugcina ubufakazi: ibhodlela lomkhiqizo noma isithombe selebula, ukugxila komuthi, ukuthi kungene umuthi ongakanani emanzini angakanani uma bekuyithangi, umthamo olinganiselwe ogwinyiwe, isikhathi, isisindo senja, izimpawu zamanje, izifo ezaziwayo, nayo yonke imithi nezithasiselo. Ukuhlolwa kokuphuthuma kwesimo sobuthi kuncike kulolo hlu ngqo. Isiqondiso esivamile se-ASPCA ngobuthi ezilwaneni ezifuywayo sicela abanikazi bagcine isitsha futhi bashaye ucingo kunokuba balinde izimpawu, kanti insizakalo ye-ASPCA yokulawula ubuthi nezinsizakalo ezifana ne-Pet Poison Helpline zikhona ukuze kusizwe ngalolu cingo, kanye nomtholampilo ojwayelekile noma isibhedlela sezimo eziphuthumayo.
Unganikezi i-methylene blue njengesinqanda-buthi sasekhaya. Ungayiphoqi inja ukuba ihlanze ngaphandle uma udokotela wezilwane noma uchwepheshe wobuthi ekuyalela ngokuqondile, ngoba ukuhlanza akufanele noma kuyingozi kwezinye izinhlobo zokuchayeka nakwezinye izimpawu. Unganikezi i-hydrogen peroxide ngokuzinqumela. Uma kungenzeka, vimbela inja ukuba ikhothe udayi oseboyeni bayo lapho izihlanza, geza udayi osesikhumbeni njengoba umtholampilo uyala, futhi ugcine umkhiqizo ungathinti amehlo.
Funa ukuhlolwa okuphuthumayo ngokushesha uma kukhona ukuphefumula kanzima, izinsini eziluhlaza okwesibhakabhaka noma ezimpunga, ubuthakathaka obukhulu noma ukuwa, ukulahlekelwa ukwazi, ukuquleka, ukungahlaliseki okukhulu noma ukuqhaqhazela okuhambisana nokushisa komzimba okuphezulu, noma izinsini eziphaphathekile noma eziphuzi ezihambisana nomchamo omnyama noma onsundu ngokubomvu. Khumbula ukubambezeleka: inja ebukeka iphilile kusihlwa ngosuku lokuchayeka isengaba ne-anemia ebangelwa ukubhujiswa kwamangqamuzana abomvu egazi ezinsukwini ezilandelayo, ngakho ukuhlolwa kokuphuthuma kwesimo kuhlanganisa kokubili lobo busuku nokuhlolwa kwegazi okulandelayo. Ukubuyekezwa kokulawulwa kwe-methemoglobinemia esheshayo ku-Journal of Veterinary Internal Medicine kuncoma ukuhlolwa kwe-hematocrit izinsuku eziningana ngemva kwezinqumo zokwelashwa ngenxa yalesi sizathu ngqo.
Umngcele owodwa wokugcina ugcina wonke amanye amakhasi akule sayithi esendaweni yawo efanele. Iziqondiso zokwelapha izinhlanzi, izinyathelo zokususa umuthi emanzini ngemva kokuwufaka ethangini lezinhlanzi, amakhemikhali kadayi, nezinqubo zokufaka umbala kumasampula kuchaza amathangi, izitsha zengilazi, nezibonakhulu. Akukho kukho okuwumyalelo womuthi wenja. Umbuzo wenja uhlale uphetha ngendlela efanayo: shayela udokotela wezilwane, ulethe ilebula nezilinganiso, bese uvumela imiphumela yokuhlolwa kwegazi iqondise isinqumo.