Isihloko
I-methylene blue nomfutho wegazi: izindlela esebenza ngazo, ukusetshenziswa ekwelapheni, nezingozi
I-methylene blue ingawunyusa umfutho wegazi, ikakhulukazi lapho inikezwa ngomthambo wegazi ezigulini ezinemithambo yegazi evuleke ngokweqile. Lo mphumela usiza ukuchaza ukuthi kungani icwaningwa ezinhlotsheni ezithile zokushaqeka komzimba. Awufakazeli ukuthi i-methylene blue iwukwelashwa komfutho wegazi ophansi ovamile, futhi ayikafakazelwa njengokwelashwa komfutho wegazi ophezulu.
Kumuntu ocabanga ukusebenzisa umkhiqizo othathwa ngomlomo, umbuzo owusizo uqonde kakhudlwana: yibuphi ubufakazi obubikezela umphumela walo mkhiqizo olungiselelwe ngale ndlela, othathwa ngale ndlela, kumuntu onalo mlando wezempilo? Izifundo zasesibhedlela ezingezansi azikunikezi lokho kubikezela.
Kungani kubalulekile ukumelana kwemithambo nokugeleza kwegazi
Imithambo ethwala igazi lisuka enhliziyweni iqukethe imisipha ebushelelezi eshintsha ububanzi bayo bangaphakathi. Ukuxega kunweba indawo igazi eligeleza kuyo; ukufinyela kuyayinciphisa. Kuwo wonke umjikelezo wegazi, lokhu kunomthelela ekumelaneni kwemithambo nokugeleza kwegazi emzimbeni. Umfutho wegazi uncike futhi enanini legazi elimpontshwa yinhliziyo, ngakho ukushintsha lokhu kumelana akuwunqumi wonke umphumela.
Enye indlela yokuxega iqala nge-nitric oxide, noma i-NO. Ivuselela i-soluble guanylate cyclase, efushaniswa ngokuthi i-sGC, ekhiqiza isithunywa sangaphakathi kwamaseli esibizwa nge-cyclic GMP, noma i-cGMP. Izimpawu ezibangelwa yilokhu zikhuthaza ukuxega kwemisipha ebushelelezi.
I-methylene blue ingaphazamisa le ndlela. Nokho, ukuyibiza ngesivimbi esikhetha i-sGC kuphela kwenza indlela esebenza ngayo emzimbeni ibonakale ilula ngokweqile. Ocwaningweni lokuhlola lukaMayer nozakwabo ngokwakheka kwe-nitric oxide, ukuxega kwemithambo ehlukanisiwe nezimpawu kumaseli olwelwesi lwangaphakathi lwemithambo kwathinteka kalula yi-methylene blue kunemiphumela eyadalwa ukuvuselela i-sGC ngokuqondile. Lokhu okutholakele kwabonisa ukuthi yayithinta nokwakheka kwe-NO ezigabeni zangaphambili zale ndlela. Ukuhlola okunjengalokhu kuchaza indlela okungenzeka isebenze ngayo emithanjeni; akutsheli umuntu ukuthi umfutho wegazi awulinganisa ekhaya uzoshintsha kangakanani.
Isithombe sekhava sibonisa lobu budlelwano obenziwe lula phakathi kwezinga lokufinyela kwemithambo nokumelana kwayo nokugeleza kwegazi. Imidwebo yemithambo iyizibonelo zokuchaza umqondo, hhayi izinguquko ezilinganisiwe esigulini noma ekuhlolweni kwemiphumela yemithamo ehlukene.
Lokho ubufakazi bezifundo zokwelapha obakuhlola ngempela
I-vasoplegia isho ukwehla okukhulu kwezinga lokufinyela kwemithambo, ngokuvamile okuxoxwa ngakho ezimweni ezifana nokuhlinzwa okukhulu kwenhliziyo noma ukugula okubucayi. Isiguli singaba nomfutho ophansi yize inhliziyo impompa igazi ngenani elivamile noma eliphezulu, ngoba ukumelana kwemithambo nokugeleza kwegazi kwehlile. Lokhu kwehlukile kumfutho ophansi obangelwa ngokuyinhloko ukulahleka kwegazi noma ukungampompi kahle kwenhliziyo.
Ithebula lihlukanisa ukwelashwa ngemva kokuba i-vasoplegia isiqalile, ukuvimbela ezigulini ezikhethiwe ezihlinzwayo, nokwelashwa okwengeziwe kokushaqeka okubangelwa yi-sepsis. I-IV isho ukunikeza ngomthambo wegazi. Lokhu yindlela umkhiqizo owanikezwa ngayo ezifundweni, hhayi imiyalelo yokuwunikeza.
| Indlela yokunikeza nesimo sokwelashwa | Abantu abacwaningiwe nokuqhathaniswa | Okwalinganiswa noma okwatholakala | Lokho umphumela ongeke ukufakazele |
|---|---|---|---|
| I-methylene blue ye-IV ngemva kokuhlinzwa kwenhliziyo | ULevin nozakwabo, 2004: iziguli ezingama-56 ezazine-vasoplegia ngemva kokuhlinzwa zabelwa ngokungahleliwe ukuthola i-methylene blue noma umuthi-mbumbulu | I-vasoplegia yahlala ngaphansi kwamahora ayisithupha kuzo zonke iziguli ezelashwa; eziyisishiyagalombili eqenjini lokuqhathanisa zaqhubeka zithintekile ngemva kwamahora angama-48. Ukufa kwaba ngu-0/28 uma kuqhathaniswa no-6/28. | Ucwaningo oluncane lokuhlinzwa oluqondene nesimo esithile alukwazi ukufakazela inzuzo yokusinda evamile noma ukwelashwa komfutho wegazi ophansi ezigulini ezingalaliswanga esibhedlela. |
| I-methylene blue ye-IV ngaphambi kokuhlinzwa kokudlulisela ukugeleza kwegazi kwenye indlela emithanjeni yenhliziyo | UOzal nozakwabo, 2005: iziguli ezikhethiwe eziyi-100 ezisengozini enkulu; isixazululo esingu-1% esanikezwa ngokufakwa kancane emthanjeni ngaphambi kokuhlinzwa uma kuqhathaniswa nokunganikezwa i-methylene blue | I-vasoplegia yavela ezigulini ezingu-0/50 uma kuqhathaniswa nezingu-13/50. Lokhu kwakuwukuvimbela ngesikhathi esihlobene nokuhlinzwa, hhayi ukwelapha umfutho ophansi ohlala isikhathi eside. | Okutholakele akukuniki isizathu sokuyisebenzisa ngomlomo ukuvimbela, futhi akuvezi ukuthi ubani ongazuza ngaphandle kwalesi simo sokuhlinzwa. |
| I-methylene blue ye-IV eyengezwe ekunakekelweni kokushaqeka okubangelwa yi-sepsis | UIbarra-Estrada nozakwabo, 2023: abantu abadala abangama-91 abafakwe ekuhlaziyweni; ukufakwa emthanjeni amahora ayisithupha ngosuku imithamo emithathu uma kuqhathaniswa nomuthi-mbumbulu we-sodium chloride ofanayo | Isikhathi esimaphakathi nendawo sokuyeka imithi eqinisa imithambo sanyusa umfutho wegazi saba amahora angama-69 uma kuqhathaniswa nangama-94. Izinga lokufa nobude besikhathi sokusizwa ukuphefumula ngomshini kwakufana. | Ukuyeka imithi eqinisa imithambo ngaphambi kwesikhathi akubona ubufakazi bokusinda okuthuthukisiwe noma bokunyuka komfutho wegazi okungabikezelwa kubantu abaphilile. |
| Umuthi we-IV ogunyaziwe wokwelapha i-methemoglobinemia etholakele | Ulwazi lokunikeza i-PROVAYBLUE; ukwelapha i-hemoglobin engajwayelekile, hhayi ucwaningo lomfutho wegazi | Umfutho wegazi ophezulu uphakathi kwemiphumela emibi ebikiwe ngemikhiqizo yesigaba se-methylene blue. | Ukubhalwa komphumela omubi ohlwini akulinganiseli amathuba noma ubukhulu bokunyuka komfutho ngomkhiqizo othengiselwa abathengi othathwa ngomlomo. |
| Ukusetshenziswa ngomlomo ngabathengi ngenxa yomfutho wegazi ophezulu noma ophansi | Alutholakalanga ucwaningo lokwelapha olunokuqhathaniswa olusebenza ngokuqondile kulesi simo ezincwadini zocwaningo eziseshiwe ukuze kubhalwe lesi sihloko | Izifundo ze-IV ezingenhla azinikezi izinga lomfutho eliqinisekisiwe okufanele kuhloswe ngalo noma uhlelo lokusetshenziswa ngomlomo. | Ukungatholakali kocwaningo akubona ubufakazi bokuphepha noma ubufakazi bokuthi noma yikuphi ukuthathwa ngomlomo kushintsha umfutho. |
Ocwaningweni lokushaqeka okubangelwa yi-sepsis, womabili amaqembu athola ukunakekelwa okujulile, okuhlanganisa i-norepinephrine, i-hydrocortisone, ne-vasopressin lapho kudingeka. Ukwelashwa kwaqala phakathi kwamahora angama-24 ngemva kokuqala i-norepinephrine. Abelaphi bashintsha imithi eqinisa imithambo ukuze bafinyelele ezingeni lomfutho elihlosiwe; umbuzo oyinhloko wawuwukuthi iziguli ziyayidinga yini leyo mithi isikhathi esifushane. Iziguli ezazinezici eziningana ezibalulekile ezandisa ingozi, kuhlanganise ukusetshenziswa kwakamuva kwe-SSRI nomlando wokushoda kwe-G6PD, azifakwanga. Lezi zinqumo zokwakheka kocwaningo zibalulekile lapho kuhlaziywa kokubili inzuzo nokuphepha.
Ukubuyekezwa okubanzi kwezifundo zokwelapha ze-vasoplegia nokushaqeka okubangelwa yi-sepsis kuhlola ubufakazi bokunakekelwa kweziguli ezigula kakhulu ngokuningiliziwe.
Ingabe i-methylene blue iyawehlisa umfutho wegazi?
Isizathu sokusebenza emithanjeni esichazwe ngenhla sikhomba ekunciphiseni ukuxega ngokweqile, hhayi ekwelapheni umfutho wegazi ophezulu. Isilinganiso esiphansi ngemva kokuba umuntu ethathe i-methylene blue asikwazi, sisodwa, ukufakazela umphumela womuthi. Indlela umzimba omi noma ohlezi ngayo, ukuphumula, indlela yokulinganisa, eminye imithi, nesimo esibangele ukulinganiswa kungashintsha konke ukuqhathaniswa.
Ngokufanayo, isilinganiso esiphezulu siyinto okufanele ihlolwe, hhayi isiqinisekiso sokuthi indlela yokusebenza efiselekayo isivuselelwe. Ukwelashwa okuwusizo kwezokwelapha kudinga ubufakazi ngezimpawu, ukusebenza komzimba, imiphumela emibi, nemiphumela yokwelashwa, hhayi inombolo esesikrinini sokulinganisa kuphela.
Lo mehluko uyasebenza nasezimangalweni nge-methylene blue mayelana ne-POTS nokungakwazi ukubekezelela ukuma uqonde. Izimpawu lapho umuntu emi nezinguquko ekushayeni kwenhliziyo zidinga ubufakazi bazo bezifundo zokwelapha; abantu abanokushaqeka okubangelwa yi-vasoplegia bayiqembu locwaningo elihlukile.
Imithi esetshenziswayo iyawushintsha umbuzo
Yisa uhlu oluphelele lwemithi kumelaphi noma kusokhemisi ngaphambi kokucabanga ukusebenzisa i-methylene blue. Izimo ezintathu zidinga ukunakwa ngokwehlukana:
- Imithi ethinta i-serotonin nama-opioid. Ilebula lomkhiqizo we-IV lixwayisa nge-serotonin syndrome engabulala lapho kuhlanganiswa le mithi. Umfutho wegazi ongazinzile ungavela kanye nokuyaluza, umkhuhlane, ukujuluka, ukuthuthumela, noma ukuqina kwemisipha. Lokhu kuwukukhathazeka ngobuthi, hhayi umphumela ofiselekayo emithanjeni. Bheka umhlahlandlela wokusebenzelana kwe-methylene blue neminye imithi.
- Imithi esebenza ku-NO naku-cGMP. Ama-nitrate nezivimbi ze-PDE5 ezifana ne-sildenafil zithinta lolu hlelo lwezimpawu. Ilebula le-sildenafil lichaza indlela enweba ngayo imithambo nokusebenzelana kwayo nama-nitrate. Imicibisholo ephambene emdwebeni wendlela yokusebenza ayibonisi ukuthi i-methylene blue ingayiqeda ngokuphepha imiphumela yomunye umuthi.
- Imithi yomfutho wegazi osuvele uyibhalelwe. Isilinganiso ngemva kwe-methylene blue asisona isisekelo sokweqa, ukushintsha, noma ukwandisa ukwelashwa okubhaliwe. Bhala umkhiqizo, ukugxila kwawo, inani, indlela owuthathe ngayo, isikhathi, izilinganiso, nezimpawu ukuze lowo obhale umuthi akwazi ukuhlola okuthathiwe.
Umfutho wegazi uyingxenye eyodwa kuphela yokuhlolwa kokuphepha kukonke. Ngokwesibonelo, ilebula le-IV liyakwenqabela ukusetshenziswa lapho kukhona ukushoda kwe-G6PD ngenxa yengozi yokubola kwamangqamuzana egazi abomvu. Isilinganiso esivamile esithathwe ngebhande lokulinganisa umfutho asikwazi ukukhipha ukuthi leyo nkinga noma ukusebenzelana kwemithi kukhona.
Lapho isilinganiso sidinga ukunakwa ngokuphuthumayo
Kubantu abadala abangakhulelwe, i-American Heart Association yeluleka ukuba kuthathwe isinyathelo esiphuthumayo uma izilinganiso zingaphezu kuka-180 we-systolic kanye/noma u-120 we-diastolic. Uma kukhona ubuhlungu besifuba, ukuphelelwa umoya, ubuthakathaka, izinguquko ekuboneni, noma ubunzima bokukhuluma, shayela abezimo eziphuthumayo ngokushesha. Uma zingekho izimpawu ezintsha ezikhathazayo, phinda ukulinganisa ngemva okungenani komzuzu owodwa bese uthintana nochwepheshe wezempilo ngokushesha uma usalokhu uphezulu kangako.
Funa usizo oluphuthumayo uma umuntu ewa, enobunzima obukhulu bokuphefumula, noma kusolwa i-serotonin syndrome ngemva kokuthatha umkhiqizo, kungakhathaliseki isilinganiso sebhande lokulinganisa umfutho. Ungathathi enye i-methylene blue ukuze ulungise inombolo ephezulu noma ephansi.