Isihloko
Izimpawu ‘zokufa kwamagciwane’ nge-methylene blue: kungani incazelo ibalulekile
Ukuzizwa kabi kakhulu ngemva kokuthatha i-methylene blue akubonisi ukuthi amagciwane abangela izifo ayafa noma ukuthi ubuthi buyaphuma emzimbeni wakho. Ukuphathwa yikhanda, isicanucanu, ukukhathala, noma ukuqhaqhazela kuyinto oyibonayo noma oyizwayo. Ukukubiza ngokuthi “ukufa kwamagciwane” kwengeza imbangela isimpawu ngokwaso esingenakuyifakazela.
Uma unezimpawu ezintsha, gwema ukuthatha omunye umthamo ngokuzinqumela ngesikhathi ufuna iseluleko sezokwelapha. Izimpawu ezinzima noma eziba zimbi ngokushesha zidinga usizo oluphuthumayo. Uma unikezwe i-methylene blue endaweni yezokwelapha, yazisa ithimba elikwelaphayo ngokushesha. Ungazami ukubekezelela ukusabela ukuze uhlelo lokuthuthukisa impilo “lusebenze.”
Lokho okucatshangwa izimangalo “zokufa kwamagciwane”
Le ncazelo ngokuvamile iqukethe izimangalo ezintathu ezihlukene: kukhona ukutheleleka, i-methylene blue ikwelapha ngempumelelo, futhi ukwelashwa kubangela ukusabela kokuvuvukala. Ukuzizwa ugula ngemva kokuchayeka kuyo akufakazeli noma yisiphi salezo zinyathelo.
Lo mehluko ubalulekile ekwenzeni izinqumo. Ukuthi “Isicanucanu siqale emahoreni amabili ngemva kokuthatha lo mkhiqizo” kunikeza uchwepheshe wezokwelapha ulwazi angaluhlola. Ukuthi “Ngikhipha ubuthi” kufaka isiphetho esikhundleni salolo lwazi. Kungase futhi kwenze umuntu anganaki omunye umuthi, iphutha ekujiyeni komkhiqizo, noma ukugula okuvele kwaqala ngesikhathi esifanayo.
Angitholanga ubufakazi bocwaningo lwezokwelapha oluqhathanisa amaqembu obufakazela “iqoqo lezimpawu zokufa kwamagciwane” elingabikezelwa kubantu abasebenzisa i-methylene blue ukuze bathuthukise impilo. Lokhu akusona isimangalo sokuthi konke ukusabela okungachazeki sekucwaningiwe. Kusho ukuthi alukho uhlu lwezimpawu olusekelwe ubufakazi noma isikhathi okulindeleke ukuba zihlale ngaso esingasetshenziswa ukududuza umuntu kuleso simo. Umbuzo ohlukile wokuthi i-methylene blue iyazisusa yini izinsimbi ezisindayo noma isebenza njengendlela yokukhipha ubuthi udinga ubufakazi bokususwa kwazo, hhayi indlela umuntu azizwa ngayo ngemva kwalokho.
Lokho okuchazwa ngempela ukusabela kwe-Jarisch–Herxheimer
Leli gama linomongo othile wezokwelapha. Imihlahlandlela ye-CDC yokwelapha ugcunsula ichaza ukusabela kwe-Jarisch–Herxheimer njengokusabela okuvela ngokuzumayo okuhlobene nomkhuhlane okungaqala phakathi namahora okuqala angu-24 ngemva kokuqala ukwelashwa kogcunsula, ngokuvamile okuhambisana nokuphathwa yikhanda nobuhlungu bemisipha. Kuhlukaniswa nokungezwani ne-penicillin. Lokhu akusho ukuthi noma yimuphi umkhuhlane ngemva kwanoma iyiphi into elwa namagciwane uyilokhu kusabela okufanayo.
Imininingwane yakamuva ewusizo ivela ekuhlaziyweni kwesibili kwango-2025 kocwaningo logcunsula olwahlukanisa abahlanganyeli ngamaqembu ngokungahleliwe. Abacwaningi bahlola abantu abadala abangu-249 abanogcunsula olusesigabeni sokuqala ngemva kokwelashwa kwabo kokuqala nge-benzathine penicillin G ejovwe emsipheni. Abangamashumi amahlanu nesishiyagalolunye, noma u-23.7%, babika izimpawu ezihambisana nalokhu kusabela. Isikhathi esimaphakathi sokuqala kwezimpawu sasingamahora angu-4.9, kanti isikhathi esimaphakathi sokuhlala kwezimpawu sasingamahora angu-12.8. Izimpawu zaqoqwa kusetshenziswa uhlu lokuhlola olufanayo kubo bonke, kunokuba ziqinisekiswe ngokuhlolwa okukodwa kwaselabhorethri okuxilongayo.
Lezo zibalo zichaza ukutheleleka okuthile, ukwelashwa okuthile, neqembu labantu elithile elacwaningwa. Azisona isikhathi okufanele asilinde umuntu ozizwa egula ngemva kokuthatha i-methylene blue ngomlomo. Ngisho nalapho umongo wokutheleleka nokwelashwa ufaneleka, uchwepheshe wezokwelapha kufanele acabangele ezinye izincazelo ezingaba khona. Igama lilodwa alifakazeli ukuthi kuphephile ukuhlala ekhaya.
Ithebula lokuhlukanisa: okuphawulwayo, incazelo, nesinyathelo esilandelayo
Leli thebula lihlukanisa okungabikwa kulokho okusadinga ukuhlolwa. Liyithuluzi lokusiza ingxoxo, hhayi uhlelo lokunikeza amaphuzu okuxilonga.
| Okuphawulayo | Lokho elingakufakazeli | Okufanele kuhlolwe |
|---|---|---|
| Ukuphathwa yikhanda, isicanucanu, noma isifo sohudo ngemva kokuchayeka | Ukuthi amagciwane abulewe noma ubuthi bukhishwe | Umkhiqizo, inani, isikhathi, izimpawu ezihambisana nakho, nezinye izimbangela ezingaba khona |
| Ukujuluka, ukuyaluza, umkhuhlane, noma ukuqhaqhazela, ikakhulukazi uma kuvela ndawonye | Isigaba esifiselekayo sokujwayela | Ubuthi be-serotonin obungaba khona noma okunye ukugula okuvela ngokuzumayo; funa ukuhlolwa ngokuphuthumayo |
| Ubuthakathaka obusha, ukuphelelwa umoya, amehlo aphuzi, noma umchamo omnyama | Ukuthi umzimba ukhipha ubuthi | Ukuntuleka kwegazi noma esinye isifo okungaba khona; thola ukuhlolwa kwezokwelapha ngokushesha, ngokuphuthumayo uma kubi kakhulu |
| Ukuqubuka okuhambisana nokuvuvukala kobuso noma komphimbo, ukuphefumula okunomsindo, noma ukuwa | Ukusabela kwe-“Herx” okungenabungozi | Ukusabela okukhulu kokungezwani nomuthi okungaba khona; shayela abezimo eziphuthumayo |
| Umkhuhlane nobuhlungu ngemva kokwelashwa kogcunsula oluxilongiwe ngaphansi kokuqondisa kochwepheshe wezokwelapha | Ubufakazi bokuthi zonke izimpawu ezilandela kamuva zinembangela efanayo | Ithimba elikwelaphayo lingahlola ukusabela kwe-Jarisch–Herxheimer okungaba khona kanye nokungezwani nomuthi nezinye izimbangela |
Umugqa wokuqala uhlanganisa izimpawu ezibalwe phakathi kwemiphumela engemihle olwazini lokunikeza umuthi lwe-PROVAYBLUE. Lolo lwazi luphathelene nokwelashwa nge-methemoglobinemia etholakala kamuva, kusetshenziswa umuthi onikezwa ngomyalelo kadokotela emthanjeni. Amazinga okuvela kwalezo zehlakalo akufanele asetshenziswe emikhiqizweni ephuzwa ngomlomo ethengelwa ukuzisebenzisa, kodwa izingozi zayo ezibhaliwe akufanele ziqanjwe kabusha ngokuthi “ukukhipha ubuthi.” Luphinde luxwayise ngesimo esibi se-serotonin syndrome, ukusabela okukhulu kokungezwani nomuthi, nokuntuleka kwegazi okubangelwa ukubhujiswa kwamangqamuzana abomvu egazi, okuhlanganisa ingozi ekhethekile kubantu abanokuntuleka kwe-G6PD. Ukuntuleka kwegazi kungase kuvele kuphela ngemva kosuku noma ngaphezulu ngemva kokwelashwa.
Kungani iphethini yezimpawu ibalulekile
Ukuphazamiseka kwesisu okukodwa akuxilongi i-serotonin syndrome. Inhlanganisela yokushintsha kwesimo sengqondo, ukwenyuka kwezinga lokushisa, ukujuluka, nokusebenza kwemisipha okungavamile ikhathaza kakhulu. I-MedlinePlus ichaza i-serotonin syndrome njengesimo esingasongela ukuphila futhi ichaza ukuthi ukuhlolwa kufaka umlando wemithi nokukhipha ezinye izimbangela ezingaba khona. Ungalindi kuze kuvele zonke izimpawu ezingaba khona ngaphambi kokufuna usizo.
Ingozi yokuhlanganisa izinto yenza ukusebenzisana kwe-methylene blue neminye imithi kubaluleke ngisho noma umuntu ebiza lokho akusebenzisile ngokuthi isengezo. Letha uhlu oluphelele lwemithi, okuhlanganisa imithi yokucindezeleka kwengqondo, imithi yezinhlungu, imikhiqizo yokukhwehlela, nezinye izengezo. Ungayeki ngokuzinqumela imithi oyinikeziwe noma uziqambele isikhathi sokulinda ukuze imithi iphume emzimbeni ngenhloso yokuqhubeka ne-methylene blue.
I-hemolysis isho ukubhujiswa kwamangqamuzana abomvu egazi. I-NHLBI ichaza ukuthi ukuntuleka kwegazi okubangelwa i-hemolysis kuqala lapho ukubhujiswa kwamangqamuzana kudlula ukukhiqizwa kwalawo awathatha indawo, futhi ukuxilonga kudinga ukuhlolwa komuntu nokuhlolwa kwegazi. Izimpawu zokuntuleka kwegazi zingahlanganisa ukuphelelwa umoya, ubuthakathaka, ukuphuzi kwesikhumba noma kwamehlo, nomchamo omnyama. Lezi akuzona izilinganiso zokukhishwa kobuthi. I-methylene blue ngokwayo ingashintsha umbala womchamo, ngakho umbala wodwa nawo awukwazi ukunquma incazelo.
Shayela abezimo eziphuthumayo uma kunobunzima bokuphefumula, ukuwa, ukudlikizela, ukudideka okukhulu, noma ukusabela okuba kubi ngokushesha. Ungazishayeleli uma unesiyezi, udidekile, noma ikhono lakho lokwenza izinto liphazamiseke ngenye indlela.
Bhala imininingwane yokuchayeka ngaphandle kokunquma ukuxilongwa
Ngezimpawu ezingesona isimo esiphuthumayo, xhumana nochwepheshe wezokwelapha noma usokhemisi ngokushesha bese usebenzisa irekhodi lezimpawu nokuchayeka ukuze ubhale imininingwane emine:
- Igama lomkhiqizo, indlela owakhiwe ngayo, ukujiya kwawo, nesithombe selebula.
- Inani nendlela osetshenziswe ngayo, izikhathi zokuchayeka, nanoma yiluphi ushintsho lwakamuva.
- Izimpawu ngolimi oluvamile, isikhathi eziqale ngaso, ubukhulu bazo, nokuthi ziyadamba noma ziba zimbi.
- Eminye imithi nezingezo, izimo zempilo ezifanele ukucatshangelwa, nanoma yimuphi umphumela wokuhlolwa kwe-G6PD owaziwayo.
Ungathathi omunye umthamo ukuze uhlole ukuthi izimpawu ziyabuya yini. Ungangezi “into ebopha ubuthi,” isikhathi ku-sauna, uhlelo lokuzila ukudla, noma inhlanganisela yezingezo ukuze ulawule ukusabela ocabanga ukuthi kungokukhipha ubuthi. Ukungenelela okwengeziwe kwenza umlando wokuchayeka ube nzima ukuwuchaza futhi akufakazeli imbangela yokuqala. Umhlahlandlela obanzi wokuphepha kwe-methylene blue uchaza imiphumela engemihle eyaziwayo nendlela yokubika ukusabela okusolwayo.