Imijovo Ye-Methylene Blue Nokufakwa Ngomthambo Nge-IV

Amabhodlelana amabili anoketshezi oluluhlaza okwesibhakabhaka ngokujulile angabukeka efana phezu kwetafula. Elilodwa liqukethe umjovo ongenamagciwane owenzelwe imithambo yegazi. Elinye liqukethe umkhiqizo onikezwa ngomlomo ngesidonsi samaconsi, udayi waselabhorethri, noma umkhiqizo wethangi lezinhlanzi okungafanele neze ungene emthanjeni. Umbala awukutsheli lutho. Ukwakheka komkhiqizo kukutshela konke.

Lona ngumqondo oyinhloko walesi sihloko: ukuba yikhemikhali efanayo akufani nokufaneleka ukujovwa. Isixazululo singaqukatha i-methylene blue yangempela enobumsulwa obuphezulu ngokwekhemikhali kodwa singakufanelekeli ukujovwa, ngoba imijovo kufanele futhi ingabi namagciwane, ibe nobuthi obuncane obuvela kumagciwane, ibe nezinhlayiyana ezilawulwayo, futhi ifakwe esitsheni esifanele. Gcina lowo mehluko engqondweni, bese konke okunye kulo mhlahlandlela kuzoqondakala.

Umjovo ongenamagciwane ogunyaziwe

Umkhiqizo okuyiwona okubhekiselwa kuwo yi-ProvayBlue, umjovo we-methylene blue otholakala ngencwadi kadokotela, ogunyaziwe ukwelapha i-methemoglobinemia etholakala kamuva ekuphileni kubantu abadala nasezinganeni. Ukujiya kwawo kungu-5 mg/mL (0.5%), okubalwe ngokusekelwe ku-methylene blue trihydrate, futhi unikezwa njengo-10 mg ku-2 mL no-50 mg ku-10 mL kuma-ampoule noma amabhodlelana omthamo owodwa. Isithako esisodwa kuphela esingasebenzi njengomuthi ngaManzi Okujova, kanti i-pH yesixazululo ingu-3.0 kuya ku-4.5, njengoba kuchazwe kulebula yamanje ye-ProvayBlue ku-DailyMed.

Imikhiqizo eminingana elingana nayo kodwa engabizi ngegama lomkhiqizo manje ibhekisela kulowo mkhiqizo, ngakho i-ProvayBlue yigama lomkhiqizo kunokuba kube yiwona kuphela umjovo ogunyaziwe. Nasi isixwayiso: ikhasi lomkhiqizo ku-DailyMed alifakazeli ngokwalo ukuthi ugunyazwe yi-FDA. Okungenani umjovo owodwa we-methylene blue ongu-1% othengiswayo usho kulebula yawo ukuthi i-FDA ayikawutholi uphephile futhi usebenza ngempumelelo. Hlola isimo sokugunyazwa kanye namagama athi awunamagciwane futhi ungowomthamo owodwa, kunokucabanga ukuthi noma yiliphi ibhodlelana eliluhlaza okwesibhakabhaka liyafaneleka.

Ukunikezwa kwemithamo ngaphansi kwelebula egunyaziwe kunemingcele eqondile. Abantu abadala nezingane banikezwa u-1 mg/kg emthanjeni phakathi kwemizuzu engu-5 kuya ku-30, okulingana no-0.2 mL/kg wesixazululo esingu-5 mg/mL. Uma i-methemoglobin ihlala ingaphezu kuka-30% noma izimpawu ziqhubeka, kunganikezwa omunye umthamo owodwa ongu-1 mg/kg ngemva kwehora. Uma imithamo emibili ingayixazululi inkinga, ilebula ikhomba ezinye izindlela zokungenelela kunokunikeza enye i-methylene blue. Iziguli ezinokuphazamiseka kokusebenza kwezinso okumaphakathi noma okukhulu zinikezwa umthamo owodwa kuphela ongu-1 mg/kg, ngoba ukuchayeka komzimba emuthini kukhuphuka kakhulu njengoba ukusebenza kwezinso kwehla.

Indlela yokunikeza nayo inemithetho yayo. Umkhiqizo owokusetshenziswa emthanjeni kuphela futhi akufanele unikezwe ngaphansi kwesikhumba. Isixazululo sine-osmotic pressure ephansi kunegazi, ngakho singahlanjululwa ku-50 mL we-dextrose engu-5% ukuze kuncishiswe ubuhlungu endaweni lapho sinikezwa khona, ikakhulukazi ezinganeni, futhi isixazululo esihlanjululiwe kufanele sisetshenziswe ngokushesha. Akufanele sihlanjululwe ngezixazululo ze-sodium chloride, ngoba i-chloride inciphisa ukuncibilika kwe-methylene blue. Hlola isitsha ngasinye, sebenzisa okuqukethwe yi-ampoule noma ibhodlelana lomthamo owodwa kanye kuphela, bese ulahla okusele. Sigcinwa ezingeni lokushisa lasekamelweni, sivikelwe ekukhanyeni, ngaphandle kokufakwa esiqandisini noma ukuqandiswa.

Abafundi abafuna ulwazi oluyisisekelo ngalokho okwenziwa yile molekhuli lapho isifinyelele egazini bangaqala ngokufunda indlela i-methylene blue esebenza ngayo emzimbeni, lapho isayensi yokusebenza komuthi ihlukaniswa khona nemibuzo yokwakheka komkhiqizo echazwe lapha.

Ukufakwa ngomthambo okungaphandle kokusetshenziswa okugunyaziwe kusebenzisa i-molekhuli efanayo ngaphansi kwemithetho ehlukene

Ngaphandle kwe-methemoglobinemia, ngezinye izikhathi odokotela banikeza i-methylene blue emthanjeni ezimweni ezifana ne-vasoplegia ngemva kokuhlinzwa kwenhliziyo noma ukushaqeka komzimba okubangelwa yi-sepsis, lapho imiphumela yayo ekuqineni kwemithambo yegazi icwaningwa khona. Lezi zinqubo ngokuvamile zibandakanya imithamo ehlukene, ukufakwa ngomthambo okuqhubekayo, noma ukunikezwa okuphindaphindiwe okungahambisani nohlelo olugunyaziwe lwemithamo emibili. Lokho kuzenza zibe ukusetshenziswa okungaphandle kwalokho okugunyaziwe kulebula: umkhiqizo womuthi ungaba ngumjovo ogunyaziwe, kodwa uhlelo lokunikeza ngokwalo alulona olugunyazwe yi-FDA. Ubufakazi bokuqala bezivivinyo nge-vasoplegia nokushaqeka komzimba okubangelwa yi-sepsis bubonisa ukuthi kungani abacwaningi benentshisekelo, nokuthi kungani ukunikezwa kwemithamo kusaphenywa kunokuba kube yinto esinqunyiwe.

Izixazululo zokufakwa ngomthambo ezihlanganiswa ekhemisi zengeza omunye umehluko. Umuthi ohlanganisiwe ungahluka ngokujiya kokugcina, uketshezi lokuhlanjululwa, isitsha, izithako ezingasebenzi njengomuthi, nesikhathi sokugcina ongase usetshenziswe ngaso. Imithi ehlanganisiwe, njengeqembu lemikhiqizo, ayigunyazwa yi-FDA ngokuphepha noma ukusebenza ngempumelelo, njengoba i-FDA ichaza emibuzweni nasezimpendulweni zayo ngokuhlanganiswa kwemithi. Kungakhathaliseki ukuthi isirinji inomuthi onegama lomkhiqizo, ongenalo igama lomkhiqizo, noma ohlanganisiwe, i-molekhuli inezingozi ezifanayo ezichazwe kulebula egunyaziwe, kuhlanganise nokusebenzisana nemithi ethinta i-serotonin, ingozi yokubhujiswa kwamangqamuzana abomvu egazi, nokuzwela ekukhanyeni, okuchazwa ezigabeni ezilandelayo.

Kungani izinga lobumsulwa lilodwa lingakwenzi uketshezi lufaneleke ukujovwa

Yilapho ukudideka okuningi kwenzeka khona. Isixazululo esithengiswa esitolo singakhangisa ukuthi sine-methylene blue yezinga le-USP, sibonise umphumela wokuhlolwa kobumsulwa ongaphezu kuka-98%, kodwa singafaneleki ukujovwa. Izinga lekhemikhali lichaza impushana: ukuhlonzwa kwayo, isilinganiso sobumsulwa, ukungcola kwezinhlanganisela ze-organic, izincibilikisi ezisele, izinsimbi, nokuhlolwa okufanayo. Umkhiqizo wokujova kufanele uphumelele kulokho kuhlolwa kanye nezimfuneko ezengeziwe zemikhiqizo enikezwa ngaphandle komgudu wokugaya ukudla, ezingafakwa ezingeni lobumsulwa lilodwa.

Umugqa ngamunye uvimbela inkinga ehlukile. Uketshezi olunamagciwane lungabangela ukutheleleka egazini. Ubuthi bangaphakathi obuvela kumagciwane afile abususwa ukuhlunga okulula futhi bungabangela umkhuhlane omkhulu noma ukushaqeka komzimba. Izinhlayiyana nezinto eziphuma esixazululweni zakhe izinhlayiya zingabambeka emithanjeni emincane. Isitsha esingafanele singadedela izinto zaso zingene oketshezini noma sehluleke ukuhlala sivaliwe. Akukho kulawa maphutha okushintsha umbala oluhlaza okwesibhakabhaka noma inombolo yomphumela wokuhlolwa kobumsulwa, okuyisona sizathu esenza ukuhlola ngokubuka nephesenti lobumsulwa kungakwazi ukufakazela ukuthi umkhiqizo ufanele imithambo yegazi. Ukuze uthole isithombe esiphelele salokho okuhlanganiswa ukuhlolwa okuphelele kobumsulwa, bheka indlela okuqinisekiswa ngayo izinga le-USP.

Umthetho osebenzayo mfushane: ungalokothi ujove umkhiqizo we-methylene blue owenzelwe umlomo, ithangi lezinhlanzi, noma ilabhorethri, kungakhathaliseki ubumsulwa obushiwo ngawo. Ukujova kudinga umkhiqizo owenziwe, wahlolwa, wafakwa ilebula, futhi wanqunywa udokotela njengomjovo.

Amaphuzu okuphepha asuka kulebula egunyaziwe

Ilebula egunyaziwe igxila ezingozini okufanele zaziwe ngaphambi kwanoma yikuphi ukusetshenziswa emthanjeni. Eyokuqala yi-serotonin syndrome, enesixwayiso esifakwe ebhokisini: i-methylene blue ivimbela i-monoamine oxidase, ngakho ukuyihlanganisa nemithi yokudangala ethinta i-serotonin, ama-opioid athile, neminye imithi ehlobene kungabangela ukusabela okukhulu noma okubulalayo. Iziguli ziyatshelwa ukuthi zigweme imithi enjalo amahora angu-72 ngemva komthamo wokugcina, ngaphandle uma udokotela ebona ukuthi ukunikeza le mithi ndawonye akunakugwenywa futhi eyibhekisisa eduze.

Eyesibili ukushoda kwe-glucose-6-phosphate dehydrogenase, okuyisimo esivimbela ukusetshenziswa kwalo muthi: iziguli ezinalokhu kushoda zisengozini yokubhujiswa okukhulu kwamangqamuzana abomvu egazi, futhi umuthi ungase ungasebenzi ngoba ukusebenza kwawo kuncike endleleni ye-enzyme lezi ziguli ezingenayo. Ukungezwani okukhulu ne-methylene blue noma omunye udayi wohlobo lwe-thiazine kungesinye isimo esivimbela ukusetshenziswa kwawo.

Ezinye izexwayiso zihlanganisa ukuphazamiseka kokusebenza kwezinso okukhuphula ukuchayeka komzimba emuthini, ukulimala kombungu ngokuchayeka emuthini ngaphakathi kwesaka loketshezi elizungeze umbungu kanye nohlu lwezinto okufanele ziqashwe ezinganeni ezichayekile ezizalwa sezifinyelele isikhathi esigcwele sokukhulelwa, nokulimala okubikiwe okubangelwa ukusebenzisana komuthi nokukhanya, okudinga ukuvikelwa ekukhanyeni. Izinto ezimbili ezingavamile ekuqapheni zibalulekile ezibhedlela: umbala oluhlaza okwesibhakabhaka wehlisa ngokungamanga ukufundwa kwemishini yokukala umoya-mpilo egazini nge-pulse oximetry, ngakho kuncanyelwa ukuhlolwa kwegazi lomthambo othwala igazi lisuka enhliziyweni; futhi ungaphazamisa imishini yokuqapha ukujula kokulaliswa ngomuthi kanye nokuhlolwa komchamo okusebenzisa udayi oluhlaza okwesibhakabhaka. Eqoqweni ledatha yokuphepha labantu abadala abangu-31, ukusabela okukhulu kwenzeka cishe ku-3%, kanti ukusabela okwabonakala okungenani ku-2% kwakuhlanganisa ikhanda elibuhlungu, isicanucanu, uhudo, amazinga aphansi e-potassium ne-magnesium, ukudikiza kwemisipha, nezehlakalo ezifana nokuquleka.

Akukho kulokhu okuwukuphikisana nokusekela noma iyiphi inqubo ethile yokusetshenziswa okungaphandle kwalokho okugunyaziwe kulebula. Kuyisikhumbuzo sokuthi izingozi zihambisana ne-molekhuli, kungakhathaliseki ukuthi kubhalweni esikhwameni sokufakwa ngomthambo.

Okufanele kuqinisekiswe ngaphambi kwanoma yikuphi ukusetshenziswa nge-IV

Uma uyisiguli noma umnakekeli, qinisekisa izinto ezine nethimba elikwelaphayo: ukuthi umkhiqizo ngumjovo ongenamagciwane ogunyaziwe noma ohlanganiselwe ukusetshenziswa emthanjeni; ukuthi isizathu sokusetshenziswa nomthamo kulandela inqubo ehleliwe; ukuthi imithi ethinta i-serotonin nesimo se-G6PD kubuyekeziwe; nokuthi ukuqapha kuhlanganisa ukukalwa komoya-mpilo ngokuhlolwa kwegazi kunokuthembela ku-pulse oximetry kuphela. Uma noma ubani ephakamisa ukujova umkhiqizo wesidonsi samaconsi wasezitolo noma isixazululo saselabhorethri, kubheke njengento okufanele imiswe ngokuphelele bese ucela ukuthintana nekhemisi lesibhedlela esikhundleni salokho.

Ukwakheka komkhiqizo kungumqondo oyisisekelo, kanti ilebula iyisivumelwano. Qondanisa uketshezi nendlela olunikezwa ngayo, bese umbala oluhlaza okwesibhakabhaka uyeka ukuba ngumthombo wokudideka.