I-methylene blue ye-COPD nomoya-mpilo ophansi: lokho okusekelwa ubufakazi

I-methylene blue ayiyona indlela yokwelapha eqinisekisiwe ye-COPD, i-emphysema, noma izinga eliphansi elivamile lomoya-mpilo egazini elihlobene ne-COPD. Ukusesha okwenziwe kulungiselelwa lesi sihloko akutholanga ucwaningo olulawulwayo lweziguli olubonisa ukuthi ithuthukisa ukuphelelwa umoya okubangelwa i-COPD, ivimbela ukubhebhetheka kwayo, ilungisa umonakalo we-emphysema, noma inciphisa isidingo somoya-mpilo onqunyiwe. Lokhu kusho okuthile ngobufakazi obutholakele, hhayi ukuthi kuqinisekisiwe ukuthi lonke ucwaningo olungase lube khona selukhishwe ekucatshangelweni.

Ukudideka kuqala ngenkulumo ethi “isiza ngomoya-mpilo.” Umoya-mpilo kufanele ungene emaphashini, udlulele egazini, uthwalwe yi-hemoglobin, bese ufinyelela emangqamuzaneni awusebenzisayo. Ithuluzi elibekwa esihlokweni somunwe libe selilinganisa ingxenye eyodwa yaleyo nqubo. Lezi zinyathelo zingaphazamiseka ngezizathu ezihlukene. Ukusetshenziswa kwe-methylene blue kwezokwelapha ekwelapheni ukuphazamiseka okuthile kwe-hemoglobin akuyenzi ibe ikhambi elijwayelekile lesilinganiso esiphansi somoya-mpilo.

Imibuzo emine ehlukene engemuva kwesimangalo esimayelana nomoya-mpilo

Imephu yobufakazi bendlela yomoya-mpilo. Indlela engenhla ilandela umoya-mpilo usuka emaphashini uye emangqamuzaneni. Igatsha lokulinganisa libheka igazi; aliyona enye ingxenye yokulethwa komoya-mpilo. Lo mdwebo womqondo owenzelwe lesi sihloko ufingqa umehluko ochazwe ngezansi futhi awuwona umphumela wocwaningo.

1. I-COPD ithinta ukugeleza komoya nokushintshaniswa kwamagesi emaphashini

Ku-COPD, imigudu yokuphefumula ingaba mincane futhi ivinjwe amafinyila. Ku-emphysema, ukulimala kwezindonga zezikhwama zomoya kunciphisa indawo esebenzayo yokushintshaniswa kwamagesi. Incazelo ye-NHLBI nge-COPD ichaza lezi zinkinga zesakhiwo. Ukuze umoya-mpilo uthathwe kahle, umoya ofinyelela engxenyeni yephaphu kufanele futhi uhambisane negazi eligeleza kuleyo ngxenye.

Ukushintsha amakhemikhali e-hemoglobin akukwazi ukuqinisekisa ukuthi izikhwama zomoya ezilimele seziluleme. Futhi ukuzizwa komuntu enamandla engeziwe akubonisi ukuthi ukugeleza komoya sekuthuthukile. Lezo zimangalo zidinga izilinganiso zazo, njengokuhlolwa kwe-spirometry, ukuhlolwa okujwayelekile kokuhamba, amaphuzu okuhlola izimpawu, noma ukuhlolwa kwamagesi egazi.

Umbuzo wokwelashwa futhi udlula ukugcwala komoya-mpilo egazini. Ukuphelelwa umoya kungabonisa umzamo odingekayo ukuze uphefumule, futhi abantu abane-COPD bangaba nezinye izimo ezifaka isandla ezimpawini. Inombolo eboniswa yithuluzi engase ibonakale iqinisekisa ukuthi konke kuhamba kahle ayikuchazi ukuphelelwa umoya okuqhubekayo.

Umhlahlandlela wokwelashwa we-NHLBI uchaza imithi evula imigudu yokuphefumula, imithi ethile yokunciphisa ukuvuvukala, ukuvuselelwa kokusebenza kwamaphaphu, nokwelashwa ngomoya-mpilo kwabantu abafanelekayo. Lezi zindlela zibhekana nezidingo ezihlukene. I-methylene blue ethengiswa ezitolo akufanele ithathe indawo yomoya-mpilo onqunyiwe, izifutho zokuhogela imithi, noma ukuhlolwa kokuphefumula okuya kuba kubi.

2. I-methemoglobinemia iyisifo segazi esihlukile

Ngokuvamile i-hemoglobin ithwala umoya-mpilo isebenzisa insimbi esesimweni se-ferrous. I-methemoglobin iqukethe insimbi esesimweni se-ferric ngenxa ye-oxidation, engakwazi ukubopha umoya-mpilo ngendlela evamile. Uma i-methemoglobin iningi ngokwanele, ingaphazamisa ukulethwa komoya-mpilo ngisho nalapho umoya-mpilo ufinyelela emaphashini.

Ulwazi lwase-US lokunquma i-ProvayBlue efakwa emthanjeni lubalula i-methemoglobinemia etholakala kamuva ekuphileni njengesimo esetshenziselwa ukusilapha. I-methylene blue ibamba iqhaza ekuguquleni i-methemoglobin ibuye ibe yi-hemoglobin esebenzayo ngenqubo ye-reduction. Lokhu kuqondiswe enjongweni ethile yamakhemikhali omzimba, hhayi ukwelashwa okuvamile komonakalo wamaphaphu ongapheli. Incazelo yokwelashwa kwe-methemoglobinemia ichaza lowo mehluko kabanzi.

Umuntu angaba nazo zombili lezi zifo. Umbiko wesiguli wango-2025 ohilela ukuchayeka ku-phenazopyridine ne-COPD wachaza indoda eneminyaka engu-67 eyayine-methemoglobin engu-14.5%. Ngemva kwe-methylene blue, izinga elibikiwe lehla laba ngu-9.5%. Yaphinde yanikezwa i-ascorbic acid, umoya-mpilo, imithi evula imigudu yokuphefumula, nama-steroid. Kwakuyisiguli esisodwa esinesifo segazi esihlobene nomuthi kanye ne-COPD ngesikhathi esifanayo, ngaphandle kweqembu lokuqhathanisa. Lokhu akuqinisekisi ukuthi i-methylene blue yelapha i-COPD yayo eyisisekelo noma ukuthi yayingathatha indawo yezinye izindlela zokwelapha.

Lo mehluko uthinta ukuhlolwa. Ingcindezi yomoya-mpilo ekuhlolweni kwamagesi egazi, evame ukubizwa ngokuthi i-PaO₂, ilinganisa umoya-mpilo oncibilike egazini. Ngokwayo, ayilinganisi ukuthi ingakanani i-hemoglobin engasebenzi kahle. Ukuhlolwa kwe-co-oximetry elabhorethri kungalinganisa izinhlobo ze-hemoglobin, kuhlanganise ne-methemoglobin. Odokotela bahumusha leyo miphumela kanye nezimpawu, izinto isiguli esichayeke kuzo, nomoya-mpilo esiwunikezwayo.

3. Ukuhlola ngama-mitochondria akuqinisekisi inzuzo ku-COPD

Ama-mitochondria asebenzisa umoya-mpilo ngesikhathi sokukhiqizwa kwamandla emangqamuzaneni. Abacwaningi bahlole i-methylene blue njengenye indlela yokuthwala ama-electron. Ngokwesibonelo, ucwaningo lokuhlola ukudluliselwa kwama-electron kuma-mitochondria lwabika ukwanda kokusetshenziswa komoya-mpilo emangqamuzaneni ezinzwa akhuliswe elabhorethri futhi lwahlola amamodeli ezilwane ezimo ezithinta isimiso sezinzwa. Le miphumela yayingeyona eyeziguli ze-COPD.

Ukwanda kokusetshenziswa komoya-mpilo kusho ukuthi amangqamuzana asebenzise umoya-mpilo omningi ngaphansi kwezimo zokuhlola. Akusho ukuthi iphaphu elilimele lithathe umoya-mpilo omningi, ukuthi ukugcwala komoya-mpilo egazini kwenyukile, noma ukuthi umoya-mpilo owengeziwe awusadingeki. Indlela ehlongozwayo yokusebenza ezigabeni ezilandelayo isadinga ukuhlolwa ezigulini eqenjini labantu okuthiwa bazozuza kuyo.

Imiphumela yokusesha idinga omunye umehluko: i-methylene blue ingase ivele ephepheni locwaningo njengodayi. Ocwaningweni lwango-2020 lokufaka uketshezi emaphashini amagundane, abacwaningi bayisebenzisela ukuhlola ukuthi uketshezi olufakiwe lufinyelele kuphi. Ukwelashwa kwe-emphysema okwakuhlolwa kwakuyi-all-trans-retinoic acid. Ukufunda kuphela amagama athi “methylene blue,” “amagundane,” kanye “ne-emphysema” kungaguqula ngephutha ukuhlolwa kwendlela yokufaka into kube isimangalo sokwelapha.

Ngokufanayo, ingxoxo yeziguli nge-methylene blue kanye nokukhanya okubomvu iveza umbuzo abantu abafuna uphendulwe. Ayinikezi ubufakazi obulawulwayo bokuthi lokhu kuhlanganiswa kuthuthukisa i-COPD.

4. Isilinganiso somoya-mpilo singashintsha ngaphandle kokuba iphaphu lishintshe

I-pulse oximeter evamile isebenzisa ukukhanya ukulinganisa ukugcwala komoya-mpilo egazini, okubikwa njenge-SpO₂. Ayilinganisi ngokuqondile umzamo wokuphefumula, i-carbon dioxide, noma ukukhiqizwa kwamandla emangqamuzaneni. Umhlahlandlela we-FDA nge-pulse oximeter uphawula ukuthi ukujikeleza kwegazi, umbala wesikhumba, izinga lokushisa kwesikhumba, nezinye izinto zingathinta ukunemba.

I-methylene blue ngokwayo ingaphazamisa lokhu kulinganisa okusebenzisa ukukhanya. Ulwazi lwayo lokunquma umuthi luxwayisa ngokuthi igazi eliqukethe lo dayi lingaveza isilinganiso sokugcwala komoya-mpilo esingaphansi kwesangempela, ikakhulukazi ngesikhathi noma ngokushesha ngemva kokufakwa emthanjeni. Luncoma isampula yegazi lomthambo othwala igazi lisuka enhliziyweni, ihlolwe ngenye indlela uma kudingeka kuhlolwe ukugcwala komoya-mpilo kuleso simo.

Leso sixwayiso asiqinisekisi umphumela ongabikezelwa kuwo wonke umkhiqizo ophuzwa ngomlomo othengiswa ezitolo. Futhi asisho ukuthi isilinganiso esisha esiphansi singanakwa ngokuphephile kuthiwe siwukuphazamiseka okubangelwa udayi. Izinkinga zangempela zomoya-mpilo nokuphazamiseka kokulinganisa kungaba khona ngesikhathi esifanayo. Tshela ithimba elikwelaphayo ngokusetshenziswa kwe-methylene blue ukuze likhethe futhi lihumushe ukuhlolwa ngendlela efanele. Umhlahlandlela nge-methylene blue nezilinganiso zamathuluzi aqapha umoya-mpilo uchaza inkinga yokulinganisa ngokwehlukile.

Ukwenyuka okubonakala ngemva kokuthatha umkhiqizo nakho kunzima ukukuhumusha. Ukuphumula ngemva kokwenza umsebenzi, ukushintsha indlela yokunikezwa komoya-mpilo, ukufudumeza isandla esibandayo, noma ukushintsha indawo yenzwa kungashintsha ukuqhathanisa. Isilinganiso sasekhaya sangaphambi nangemva kokuthatha umkhiqizo asikwazi ukuhlukanisa umphumela womuthi kwezinye izinto.

Okufanele ukwenze lapho ukuphefumula kuya kuba kubi

Landela uhlelo lomoya-mpilo nolokubhebhetheka kwesifo olunikezwe ithimba lakho elinakekela ukuphefumula. Funa ukuhlolwa ngokushesha uma kuba nokwehla okungalindelekile nokuqhubekayo ngaphansi kwezinga lakho eliqondiwe noma uma izimpawu ziba zimbi kakhulu ngokuphawulekayo. Ungashintshi ukwelashwa kwakho ukuze kuhambisane nohlelo lwe-methylene blue olutholakala ku-inthanethi.

Umhlahlandlela we-NHLBI ngezimpawu zesimo esiphuthumayo weluleka ngokufuna usizo oluphuthumayo uma kunzima ukuthola umoya noma ukukhuluma, izindebe ziluhlaza okwesibhakabhaka noma zimpunga, ukuphaphama kunciphile, noma izimpawu zingasabeli ekwelashweni okunconyiwe. Shayela inombolo yezimo eziphuthumayo yendawo yakini kunokulinda ukuze uhlole isengezo.

I-methylene blue nayo inezingozi ezifanele ukucatshangelwa: ulwazi lwayo lokunquma umuthi luxwayisa ngobuthi obuyingozi be-serotonin uma isetshenziswa nemithi ethile, kanye nokubhujiswa okukhulu kwamangqamuzana abomvu egazi lapho kunokuntuleka kwe-G6PD. Letha uhlu oluphelele lwemithi nemikhiqizo lapho uyobonana nodokotela. Umbuzo owusizo uqondile: yini echaza inkinga yokuphefumula, yalinganiswa kanjani, futhi iyiphi indlela yokwelapha enobufakazi baleso sifo esitholakele?