Isihloko
I-methylene blue nesithuthwane: amamodeli okuquleka uma kuqhathaniswa nezimangalo zokwelapha abantu
Umnakekeli ofuna ulwazi nge-methylene blue nesithuthwane uthola izitatimende ezimbili ezibonakala ziphikisana. Esinye sithi i-methylene blue yehlise ukuquleka kumagundane. Esinye sithi kwabikwa isehlakalo esifana nokuquleka esigulini esanikezwa i-methylene blue. Zombili zingaba yiqiniso ngesikhathi esisodwa, ngoba ziphendula imibuzo ehlukene ezimweni ezihlukene.
Ukudideka kubangelwa ukuphatha “i-methylene blue nokuquleka” njengesimangalo esisodwa. Empeleni zimbili. Esokuqala sibuza ukuthi ingabe i-methylene blue, uma inikezwa ngaphansi kwezimo ezilawulwayo, iyazishintsha yini izilinganiso zokuquleka kumodeli yezilwane. Esesibili sibuza ukuthi ingabe ukuquleka kuke kwenzeka yini njengezehlakalo ezingafuneki kubantu abathola lo muthi ngezinye izizathu. Lesi sihloko sigcina le mibuzo emibili ihlukene, sibuyekeza lokho okwenziwa ngempela ucwaningo olubili lokuquleka olucashunwa kakhulu, futhi sisho ngokucacile lokho olungakubonisi. Ukuze uthole ulwazi oluyisisekelo, bheka ukubuka konke okubanzi kocwaningo lwe-methylene blue; ukuze uthole indlela yokuhlola ucwaningo, bheka umhlahlandlela wokufunda ucwaningo lwe-methylene blue.
Ucwaningo olubili, ngokucacile
Alukho ucwaningo lokuhlola kubantu oluhlole i-methylene blue njengokwelashwa kwesithuthwane. Ubufakazi bokuhlola buvela ocwaningweni lwezilwane. Amaphepha amabili acashunwa kakhulu womabili asebenzisa amagundane, womabili asebenzisa umthamo we-1 mg nge-kg owanikezwa ngaphakathi esiswini, futhi womabili abika uphawu lomphumela wokunciphisa ukuquleka. Kodwa izindlela ahlelwe ngazo zihlola imibono ehlukene yokwelapha, ngakho imiphumela yawo isho izinto ezihlukene.
Ucwaningo 1: ukwelapha ngemva kokuba i-status epilepticus isiqalile
Ocwaningweni lwamagundane lwango-2018 lwe-status epilepticus eqhubeka izimele, uCui nozakwabo babangela ukuquleka okuhlala isikhathi eside ngokushukumisa i-basolateral amygdala ngogesi imizuzu engu-25, base beqinisekisa umsebenzi wokuquleka oqhubekayo nge-EEG. Lokhu kubalulekile ngoba imodeli kagesi ihlukanisa ukuquleka ngokwako nobuthi bamakhemikhali bemithi ebangela ukuquleka. I-methylene blue yanikezwa imizuzu engu-5 ngemva kokuqala kwesimo sokuquleka esase siqinisekisiwe, okuyimodeli yokwelapha kunokuba kube eyokuvimbela. Ukuqoshwa kwe-EEG kwabe sekuqhubeka amahora angu-12, kwahlolwa nezicubu zobuchopho emahoreni angu-24. Umbhalo ophelele wokuhlolwa kwe-status epilepticus unikeza imininingwane yokushukumisa nokuqopha.
Phakathi namahora angu-12, amagundane ayelashiwe aba nesilinganiso sezehlakalo zokuquleka ezihlukene ezibonwe ku-EEG ezingaba ngu-29, uma kuqhathaniswa nezingaba ngu-39 ezilwaneni ezingelashiwe, okuwukwehla cishe ngamaphesenti angu-26. Isikhathi sokuquleka esihlanganisiwe sehla sisuka emizuzwini engaba ngu-62 saya emizuzwini engaba ngu-44, okuwukwehla cishe ngamaphesenti angu-29. Izilwane ezelashiwe zaphinde zabonisa ukucindezeleka kwe-oxidative okuncane (i-malondialdehyde ephansi, i-glutathione egcinwe kangcono), ukulahleka okuncane kwamangqamuzana ezinzwa ezingxenyeni ze-hippocampus i-CA1 ne-CA3, kanye nezimpawu ze-apoptosis ezashintsha ngendlela ebonisa ukuvikeleka.
Imikhawulo icacile. Kwahlaziywa ukuquleka ezilwaneni ezingaba ngu-12 eqenjini ngalinye, kwahlolwa umthamo owodwa kuphela ngakho alikho ijika elibonisa ukuhlobana komthamo nempendulo, ukulandelela kwathatha amahora kunokuba kube izinyanga, futhi akuzange kuqhathaniswe nomuthi ojwayelekile wokulawula ukuquleka. Umphumela usekela uphawu lomphumela wesikhashana wokunciphisa ukuquleka nokuvikela amangqamuzana ezinzwa kumodeli eyodwa ye-status epilepticus kumagundane. Awubonisi ukuthi i-methylene blue ivimbela isithuthwane esingamahlalakhona, futhi awusho lutho ngemithamo noma ukuphepha kubantu abanesithuthwane.
Ucwaningo 2: ukwelapha kusengaphambili ngaphambi kokuquleka ngakunye okubangelwayo
Ocwaningweni lwamagundane lwango-2026 lwe-kindling ebangelwa yi-pentylenetetrazole, uJing nozakwabo basebenzisa isikhathi esiphambene. Amagundane anikezwa ngokuphindaphindiwe into ebangela ukuquleka (35 mg nge-kg ye-pentylenetetrazole, njalo ngosuku lwesibili, izikhathi ezingu-15), kanti i-methylene blue yanikezwa imizuzu engu-30 ngaphambi kokunikezwa ngakunye. Lokhu ukuhlelwa okufana nokuvimbela: kuhlola ukuthi ingabe ukunikeza imithamo yokuvimbela ngokuphindaphindiwe kuyaphazamisa yini ukukhula kwesimo sokuthambekela ekuqulekeni esibangelwa yi-kindling, hhayi ukuthi ingabe umuthi umisa ukuquleka okuqhubekayo noma welapha isithuthwane esesikhona.
Ukuquleka okubonisa i-kindling egcwele kwavela kumaphesenti angu-30 amagundane ayelashwe kusengaphambili, uma kuqhathaniswa namaphesenti angaba ngu-85 alawo ayengelashiwe. Lona umehluko omkhulu oqondile, onenani le-P elibikiwe elingu-0.0078. Ukwelapha kusengaphambili kwaphinde kwabambezela ukuqala kokuquleka kwe-tonic-clonic okusakazeka emzimbeni wonke futhi kwanciphisa isikhathi sakho lapho sekwenzekile. I-EEG, ukusinda kwamangqamuzana e-hippocampus, izimpawu zokucindezeleka kwe-oxidative, kanye nezilinganiso zenkumbulo emzileni oyindida wamanzi konke kwabonisa imiphumela engcono eqenjini elalelashiwe.
Lokhu kuhlelwa kunemikhawulo yako. Umuthi wawukhona ngaphambi kwakho konke ukuhlolwa kokubangela ukuquleka, ngakho ukuhlola akukwazi ukuhlukanisa ukucindezelwa kokuquleka nokuphazamiseka kokukhula kwe-kindling. Nalapha kwasetshenziswa umthamo owodwa kuphela, amaqembu amancane okwahlolwa kuwo izicubu nokuziphatha ayenezilwane ezimbalwa, i-kindling iveza ingxenye kodwa hhayi konke kokusebenza kwesithuthwane kubantu, futhi amaphepha amabili anababhali abafanayo (uCui noLuo bavela kuwo womabili), ngakho awaphindi ucwaningo ngokuzimela ngokuphelele. Umphumela usekela ukukhula okuncane kwe-kindling ngaphansi kokunikezwa kwemithamo yokuvimbela ngokuphindaphindiwe kumagundane. Awusunguli i-methylene blue njengokwelashwa kwanoma ubani osenesithuthwane.
Ithebula lamamodeli nezimo: insiza yokuqala
Ithebula elingezansi liyinkomba eyinhloko yaleli khasi. Umugqa ngamunye uqala ngokucacisa isimo, bese usho indima eyadlalwa yi-methylene blue nokuthi okubonwe kungabonisani nokuthi yini okungeke kuyibonise. Ukungenelela kokuhlola nemibiko yezehlakalo ezingathandeki kubekwe emigqeni ehlukene ngamabomu.
| Isimo | Indima ye-methylene blue | Isikhathi sokunikezwa | Umphumela olinganiswayo | Okukubonisayo |
|---|---|---|---|---|
| I-status epilepticus ebangelwe ngogesi kumagundane, 2018 | Ukwelashwa kokuhlola, 1 mg/kg ngaphakathi esiswini | 5 min ngemva kokuqinisekiswa kwesimo sokuquleka; i-EEG isikhathi esingu-12 h | Inani lokuquleka ku-EEG nesikhathi sokuquleka esiphelele; izicubu ze-hippocampus ngo-24 h | Uphawu lomphumela wesikhashana wokunciphisa ukuquleka kumodeli eyodwa; hhayi ukuvimbela isithuthwane esingamahlalakhona, hhayi ukusebenza kahle kubantu |
| I-kindling ye-pentylenetetrazole ephindaphindiwe kumagundane, 2026 | Ukwelapha kusengaphambili kokuhlola, 1 mg/kg ngaphambi kokuhlolwa ngakunye kokubangela ukuquleka | 30 min ngaphambi kokunikezwa ngakunye kwezikhathi ezingu-15 zento ebangela ukuquleka | Izinga le-kindling egcwele, isikhathi ngaphambi kokuqala kokuquleka nobude bako, i-EEG, ukuziphatha okuhlobene nenkumbulo, izimpawu ezicutshini | Ukukhula okuncane kwe-kindling ngaphansi kwemithamo yokuvimbela; hhayi ukwelapha isithuthwane esesikhona |
| I-methemoglobinemia etholakele, ukusetshenziswa ngomthambo okunqunywe udokotela | Ukwelashwa okugunyaziwe kwesinye isifo | Ngesikhathi sokunakekelwa emtholampilo, ngokuvamile 1 mg/kg | Ukuqapha ukuphepha | Isehlakalo esisodwa esibucayi esifana nokuquleka eqenjini lokuhlola ukuphepha leziguli ezingu-24 ngokusho kolwazi lwamanje oluselebula lwe-methylene blue enikezwa ngomthambo; umbiko wokuhlobana ngesikhathi, hhayi izinga lokwenzeka futhi hhayi ubufakazi bembangela |
| I-serotonin syndrome lapho kusetshenziswa imithi ethinta i-serotonin | Into eyibangela ngokuvimba i-monoamine oxidase | Ngemva kokusetshenziswa ndawonye nemithi yokulwa nokucindezeleka noma imithi ehlobene nayo | Iqoqo lezimpawu ezibonakala emtholampilo, elingahlanganisa ukuquleka | Ukusebenzisana okwaziwayo okunesixwayiso esisebhokisini olwazini lokunquma umuthi; bheka i-serotonin syndrome kanye nokusebenzisana nemithi yokulwa nokucindezeleka neminye imithi ethinta i-serotonin; ukubuyekezwa okuhlelekile kwathola izehlakalo ezingu-50 ezishicilelwe, zonke zihambisana nokusetshenziswa kwemithi yokulwa nokucindezeleka ethinta i-serotonin |
| I-encephalopathy ebangelwa yi-ifosfamide | Ukwelashwa okunikezwa i-encephalopathy ngaphandle kokusetshenziswa okugunyaziwe | Ngesikhathi noma ngemva kobuthi be-ifosfamide ohlelweni lwezinzwa | Ukudideka, ukuquleka, ikhoma, ukululama | Ukuquleka lapha kulindelekile ngenxa ye-encephalopathy ngokwayo, ngakho akunakuthiwa ngokuzenzakalelayo kubangelwa yi-methylene blue; ubufakazi benzuzo ikakhulukazi buyimibiko yeziguli ngazinye, lapho kubikwa ukuthi iziguli ezingu-28 kwezingu-38 ezelashiwe zaba ngcono kokunye ukubuyekezwa kokwelashwa kwe-ifosfamide encephalopathy |
Kungani isikhathi nemiphumela elinganiswayo kunquma incazelo yocwaningo
Imininingwane emibili ithwala ingxenye enkulu yencazelo ocwaningweni lokuquleka: ukuthi umuthi wanikezwa nini, nokuthi yini eyalinganiswa.
Okokuqala, isikhathi. Umuthi onikezwa ngaphambi kwakho konke ukuhlolwa kokubangela ukuquleka, njengasocwaningweni lwe-kindling, ungabonakala usebenza ngokumane unciphise isehlakalo ngasinye esibangelwayo noma ubambezele inqubo ye-kindling. Umuthi onikezwa ngemva kokuba ukuquleka sekuqalile, njengasocwaningweni lwe-status epilepticus, ubhekana nokuhlolwa okunzima kakhulu futhi okuhambisana kakhulu nokwelapha emtholampilo. Akukho kulezi zindlela zokuhlela okufana nesimo somuntu onesithuthwane esesikhona ophuza umuthi wokulawula ukuquleka nsuku zonke. Yingakho isikhathi sokunikezwa komuthi ezilwaneni singenakuguqulwa sibe iseluleko sokwelapha.
Okwesibili, imiphumela elinganiswayo. Inani lokuquleka ku-EEG phakathi namahora angu-12, izinga le-kindling, kanye nokungabi nokuquleka kubantu kuyimiphumela ehlukene. Izimpawu ezicutshini ezifana ne-glutathione noma izibalo zamangqamuzana zichaza izindlela okungenzeka umuthi usebenze ngazo, kanti ukuziphatha emzileni oyindida wamanzi kusikisela ukuhlobana nokusebenza kwamagundane. Kodwa akukho kulokhu okuwumphumela wesithuthwane olinganiswa emtholampilo. Ukutholwa komphumela omuhle ezicutshini okuhambisana nomphumela omncane omuhle ekuqulekeni kuqinisa incazelo yezinto eziphilayo; akuguquli okutholwe ekuqulekeni kube ubufakazi bokwelapha emtholampilo.
Kusho ukuthini lokhu ngezinqumo zokwelapha
Izimpawu zokunciphisa ukuquleka ezilwaneni ziyisizathu sokwenza ucwaningo olwengeziwe, hhayi isizathu sokushintsha ukunakekelwa. Akekho okufanele aqale, ayeke, noma alungise umthamo womuthi wokulawula ukuquleka onqunywe udokotela ngokusekelwe ocwaningweni lwamagundane, futhi i-methylene blue ayiyona indlela egunyaziwe yokwelapha isithuthwane kunoma yiluphi uhlobo lomuthi. Noma ubani ocabangela ukuyisebenzisa kufanele aqale axoxe nodokotela wakhe ngohlu oluphelele lwemithi yakhe, ngoba ukusebenzisana nemithi ethinta i-serotonin okuchazwe ngenhla kuyingozi ehlobene nokuquleka enobufakazi obucace kakhulu emarekhodini abantu, futhi iyagwemeka.
Isifinyezo esithembekile singena esigabeni esisodwa. Ucwaningo olubili oluncane lwamagundane, ngomthamo ofanayo we-1 mg nge-kg, lubika ukuquleka okumbalwa noma okungekho kubi kakhulu: olunye lapho umuthi unikezwa ngemva kwe-status epilepticus ebangelwe ngogesi, olunye lapho unikezwa ngaphambi kokubangelwa kokuquleka okuphindaphindiwe ngamakhemikhali. Amarekhodi okuphepha kubantu, ngokwehlukana, aqukethe izehlakalo ezifana nokuquleka, ezigxile ezimweni zokusebenzisana kwemithi nezokugula okubucayi kunokuba kube ekwelapheni isithuthwane. Akukho kulawa maqoqo obufakazi okuqinisekisa ukuthi elinye alilungile, futhi akukho okuqinisekisa i-methylene blue njengokwelashwa kwesithuthwane. Imibuzo ejwayelekile ngemiphumela engemihle nezinto okufanele kuqashelwe iqoqwe emibuzweni evame ukubuzwa ngokuphepha kwe-methylene blue.