Isihloko
I-methylene blue ne-POTS: kungani izindlela zokusebenza emithanjeni yegazi zingaqinisekisi ukwelashwa
I-methylene blue ayiyona indlela yokwelapha eqinisekisiwe ye-postural orthostatic tachycardia syndrome, noma i-POTS. Lapho kuseshwa imibhalo yocwaningo yale ndatshana, akutholakalanga ukuhlolwa komtholampilo okulawulwayo okubonisa ukuthi ithuthukisa izimpawu ze-POTS noma ikhono lokwenza imisebenzi yansuku zonke. Ucwaningo ngokushaqeka okubangelwa yi-sepsis nangemithambo yegazi esetshenziswa ekuhloleni luphendula imibuzo ehlukile.
Ukucabanga okungase kuhehe ukuthi i-POTS ihilela ukujikeleza kwegazi, i-methylene blue ingaphikisa ezinye izimpawu ezibangela ukuxega kwemithambo, ngakho-ke kufanele ithuthukise i-POTS. Isinyathelo ngasinye sidinga ukuhlolwa. Umphumela womuthi endleleni yokusebenza kwemithambo yegazi awuqinisekisi ukuthi leyo ndlela iyimbangela yezimpawu zomuntu othile, noma ukuthi ukuyishintsha kuzomsiza ame ngokukhululeka.
Okufanele kuhlukaniswe kuqala
Ukungakwazi ukubekezelela ukuba sesimweni esiqondile kusho izimpawu ezihlobene nokuba kuleso simo. I-POTS iyisimo esisodwa esichazwe ngokucacile ngaphakathi kwaleyo nkinga ebanzi. I-dysautonomia ibanzi nakakhulu, ibhekisela ekuphazamisekeni kokulawulwa kwemisebenzi yomzimba ezenzakalelayo; ayisho iphethini eyodwa yomfutho wegazi.
Incazelo ye-POTS yokuvumelana kochwepheshe be-NIH ichaza ukwanda okuqhubekayo kwesilinganiso sokushaya kwenhliziyo okungenani ngokushaya okungu-30 ngomzuzu phakathi kwemizuzu engu-10 umuntu esesimweni esiqondile, noma okungenani okungu-40 kwabaneminyaka engu-12–19, kanye nezimpawu ezingapheli lapho umuntu esesimweni esiqondile, ukuthuthuka lapho elala phansi, nokungabikho kokwehla okuqhubekayo komfutho wegazi lapho esukuma. Izimpawu kufanele zibe sezihlale okungenani izinyanga ezintathu, futhi ezinye izimbangela zokushaya kwenhliziyo ngokushesha kufanele zikhishwe. Isilinganiso sewashi sisodwa asikwazi ukuqinisekisa le nhlanganisela.
Ukwehla komfutho wegazi okuvamile lapho umuntu esukuma kunesilinganiso esihlukile esikuchazayo: incazelo yokuvumelana kwezinhlangano ezifunda ukulawulwa kwemisebenzi yomzimba ezenzakalelayo icacisa ukwehla okuqhubekayo okungenani ngo-20 mmHg womfutho we-systolic noma ngo-10 mmHg womfutho we-diastolic phakathi kwemizuzu emithathu yokuma noma yokutshekiswa umzimba ikhanda liphakeme. Ukushaqeka ngenxa yokulahleka kokuqina kwemithambo kuhilela ukulahleka okukhulu nokusheshayo kokuqina kwemithambo yegazi okusongela ukujikeleza kwegazi. Akutholwa ngokuhlolwa kokuma.
Ukuqhathanisa: isimo, umphumela, negebe ebufakazini
| Umbuzo | I-POTS | Ukwehla komfutho wegazi okuvamile lapho umuntu esukuma | Ukushaqeka ngenxa yokulahleka kokuqina kwemithambo |
|---|---|---|---|
| Yini ekwehlukanisayo? | Izimpawu ezingapheli lapho umuntu esesimweni esiqondile, ezinokwanda ngokweqile kwesilinganiso sokushaya kwenhliziyo, ngaphandle kokwehla okuqhubekayo kwe-BP okusetshenziselwa ukuxilonga | Ukwehla okuqhubekayo kwe-BP ngemva kokuba sesimweni esiqondile | Ukuncipha okukhulu nokusheshayo kokuqina kwemithambo yegazi, okuhambisana nokwehluleka kokujikeleza kwegazi |
| Kungani isimo somzimba sibalulekile | Ukuma kubangela ukushaya kwenhliziyo ngokushesha nezimpawu ezichaza lesi simo | Ukuma kuveza ukwehla komfutho okuchaza lesi simo | Umfutho wegazi ophansi nezinkinga zokufinyelela kwegazi ezithweni zidinga ukuhlolwa okungancikile ekumeni |
| Inzuzo enengqondo ingahlanganisani? | Ukuncipha kwesiyezi nokugquma kwenhliziyo lapho umuntu esesimweni esiqondile, ukuthuthuka kwemisebenzi yansuku zonke, nokuhlolwa ndawonye kwesilinganiso sokushaya kwenhliziyo ne-BP | Izimpawu ezimbalwa nokuwa okumbalwa, ikhono elingcono lokusebenza umuntu esesimweni esiqondile, nomfutho owamukelekayo lapho elele phansi | Ukubuyiselwa kokufinyelela kwegazi ezicutshini, ukuncipha kokwesekwa ngemithi enyusa umfutho wegazi, ukululama kwezitho nokusinda |
| Yibuphi ubufakazi be-methylene blue obutholakele? | Ingxoxo ngezindlela zokusebenza nemibiko engalawulwanga; akukho ukuhlolwa okulawulwayo kokusebenza kwayo ku-POTS | Akutholakalanga ubufakazi obulawulwayo obuqinisekisa ukwelashwa okujwayelekile kokwehla komfutho wegazi okungapheli lapho umuntu esukuma | Ukuhlolwa komtholampilo ekushaqekeni okubangelwa yi-sepsis, okuhlanganisa ucwaningo olulawulwa nge-placebo okuxoxwa ngalo ngezansi |
| Yini engakwazi ukudluliselwa kwesinye isimo? | I-BP ephakeme noma ukusabela kwemithambo okushintshile kukodwa akuqinisekisi ukuthuthuka kwezimpawu | Ukusabela egunjini labagula kakhulu (ICU) akunakuqinisekisa inzuzo noma ukuphepha ezigulini ezingalaliswanga esibhedlela | Ukusetshenziswa kwemithi enyusa umfutho wegazi isikhathi esifushane akunakuqinisekisa ukwelashwa kwezimo ezingapheli ezihlobene nokuba sesimweni esiqondile |
Lokhu kuqhathanisa kuhlukanisa imibuzo yocwaningo; akulona ishidi lokuxilonga. Landa ukuqhathaniswa kwezimo nemibuzo yengxoxo ukuze ugcine lokhu kwehlukanisa ndawonye. Kubalulekile futhi lapho kuchazwa i-methylene blue nezinguquko zomfutho wegazi.
Lokho ukuhlolwa kokushaqeka okwakuhlola ngempela
Ekuhlolweni kuka-Ibarra-Estrada nozakwabo kwango-2023 okwabela amaqembu ngokungahleliwe, abantu abadala ababenokushaqeka okubangelwa yi-sepsis bathola i-methylene blue ngomthambo noma i-placebo eyisixazululo sikasawoti, kanye nokwelashwa egunjini labagula kakhulu. Ukuhlaziywa kwakuhlanganisa iziguli ezingu-91, ezingu-45 zithola i-methylene blue nezingu-46 zithola i-placebo. Ukwelashwa kwakuhlanganisa ukufakwa ngomthambo phakathi kwezinsuku ezintathu, imiphumela ihlolwa kuze kube yizinsuku ezingu-28.
Umphumela oyinhloko kwakuyisikhathi kuze kube yilapho imithi enyusa umfutho wegazi ingayekiswa. Le yimithi esetshenziselwa ukweseka umfutho wegazi ngesikhathi sokushaqeka. Isikhathi esimaphakathi sasiy amahora angu-69 nge-methylene blue namahora angu-94 nge-placebo. Ukufa nesikhathi sokusizwa ukuphefumula ngomshini kwakufana phakathi kwamaqembu.
Lobu ubufakazi obuphathelene nokwelashwa okungeziwe ngesikhathi sokwehluleka kokujikeleza kwegazi okuqala ngokushesha futhi okuhlobene nokutheleleka. Abubonisi ukuthi i-methylene blue ethathwa ngomlomo inciphisa ukushaya kwenhliziyo ngokushesha lapho umuntu emile, ivimbela umuzwa wokuthi umuntu usezoquleka, noma ithuthukisa ukuya esikoleni kwabane-POTS. Iziguli, indlela yokunikezwa komuthi, ezinye izindlela zokwelashwa ezihambisana nayo, isikhathi, nomphumela oyinhloko konke kuhlukile. Ukubuyekezwa okuhlukile kokuhlolwa kwe-methylene blue ekulahlekeni kokuqina kwemithambo nasekushaqekeni okubangelwa yi-sepsis kuhlola lobo bufakazi bokunakekelwa kwabagula kakhulu esimweni sabo.
Kungani incazelo ye-nitric oxide ingaphelele
I-nitric oxide ibamba iqhaza ekuxegeni kwemithambo yegazi, okuhlanganisa ukudluliswa kwezimpawu nge-guanylate cyclase encibilikayo nange-cyclic GMP. I-methylene blue ingaphazamisa lezi zinqubo zomzimba, kodwa ukuyichaza nje njengento evimba i-nitric oxide kufihla umehluko phakathi kokuhlolwa okuhlukahlukene.
Ngokwesibonelo, ukuhlolwa kwemithambo yegazi kuka-Wolin nozakwabo kwango-1990 kwafaka i-methylene blue endaweni ethile yokujikeleza kwegazi emithanjeni emincane yezicubu zemisipha yohlaka lwamathambo eyayiveziwe emagundaneni ayelaliswe ngomuthi. Yanciphisa ukunwebeka okubangelwa yi-acetylcholine ne-nitric oxide. I-superoxide dismutase yavimbela lokho kunciphisa, okusekela indlela yokusebenza ehilela i-superoxide engaphandle kwamangqamuzana kuleso simiso sokuhlola. Lokhu kwakuwukuhlolwa kwemithambo emincane endaweni ethile, hhayi ucwaningo lokwelashwa ngomuthi othathwa ngomlomo kubantu abane-POTS. Umphumela wako awukwazi ukuqinisekisa inzuzo yokwelashwa noma ukulimala kwezinzwa kulezo ziguli.
Ukucabanga ngohlangothi lwesifo nakho akuqinisekile. Ucwaningo lwango-2005 lokusabela kwemithambo emincane ku-POTS lwaqhathanisa abahlanganyeli abangu-15 abane-POTS enokugeleza kwegazi okuphansi, abangu-17 abane-POTS enokugeleza okuvamile, nabangu-13 abaphilile ababeyiqembu lokuqhathanisa, abaneminyaka engu-14–22. Abacwaningi balinganisa ukugeleza kwegazi esikhunjeni ngesikhathi sokuhlolwa kokusabela kwemithambo ezindaweni ezithile. Abakutholile kwaphakamisa ukuthi ukukhishwa kwe-nitric oxide okuncike ekugelezeni kwakunciphile eqenjini elinokugeleza okuphansi. Abazange bahlole i-methylene blue njengendlela yokwelapha.
Lokhu okutholakele kuphikisa umqondo wokuthi yonke i-POTS imelela i-nitric oxide eyeqile okufanele icindezelwe. Akufakazeli futhi ukuthi wonke umuntu one-POTS untula i-nitric oxide. Njengoba ukubuyekezwa kwezokwelashwa kuka-Mar no-Raj kuchaza, ukulimala kwengxenye yezinzwa ezilawula imisebenzi ezenzakalelayo, umthamo ophansi wegazi elijikelezayo, nomsebenzi owandisiwe wohlelo lwe-adrenergic kungaba nomthelela ngezindlela ezihlanganayo. Umehluko phakathi kwe-NOS, i-cGMP, nokudluliswa kwezimpawu emithanjeni yegazi ubalulekile ngoba igama lendlela yokusebenza alikona ukuxilongwa okuqondene nesiguli esithile.
Lokho imibiko yeziguli ephikisanayo engasitshela kona
Ingxoxo ku-Phoenix Rising ihlanganisa umbiko wokuba kubi kakhulu kwe-POTS ngesikhathi sokusebenzisa i-methylene blue. Ngakolunye uhlangothi, ingxoxo nge-POTS ku-Reddit iqukethe umbiko wokuthuthuka ngokushesha kwesilinganiso sokushaya kwenhliziyo okuthiwa kubangelwe yi-methylene blue. Le mibiko ichaza okuhlangenwe nakho nemibuzo; ayiqinisekisi imbangela yokuthuthuka noma yokuba kubi.
Imibuzo ewusizo icacile. Ingabe izimpawu zalinganiswa umuntu esesimweni somzimba esifanayo? Ingabe umfutho wegazi washintsha kanye nesilinganiso sokushaya kwenhliziyo? Ingabe imithi noma ezinye izithasiselo kwashintshwa? Ingabe umuntu wazizwa engcono okwesikhashana kuphela, noma waphinde wakwazi ukuchitha isikhathi esiwusizo esesimweni esiqondile ezinsukwini ezalandela? Umbiko ongenayo le mininingwane awukwazi ukuhlukanisa umphumela womuthi nezinguquko ezenzeka ngesikhathi esifanayo noma ukushintshashintsha okuvamile kwezimpawu.
Kubantu abane-ME/CFS futhi, ukuzizwa benamandla ngokushesha akuphenduli ukuthi umsebenzi othile waholela yini ekubeni kubi okwenzeka kamuva. I-ME/CFS, i-methylene blue, nokungaphatheki kahle ngemva kokuzikhandla ikhuluma ngalowo mphumela ohlukile. Imibiko ejabulisayo noma ethusayo ayisona isizathu esanele sokusungula uhlelo lokuzilinga ekhaya.
Yini engenza isimangalo nge-POTS sikholakale?
Ucwaningo oluwusizo lungabhalisa iziguli ezinokuxilongwa okubhalwe phansi, lucacise ukwakheka komkhiqizo nendlela yokuwunikeza, lusebenzise into ethembekile yokuqhathanisa, futhi lulinganise izimpawu nekhono lokusebenza. Isilinganiso sokushaya kwenhliziyo nomfutho wegazi kufanele kuhlolwe ndawonye. Ukulandelela kufanele kube isikhathi esanele ukuhlola inzuzo eqhubekayo nemiphumela emibi, kunokuthatha isilinganiso esisodwa esihle njengokululama. Lezi yizidingo zokuhlola isimangalo, hhayi ubufakazi bokuthi ukwelashwa kuyasebenza.
Ukuphepha kubalulekile kulesi siphakamiso uqobo. Ulwazi lwase-US lokunquma i-ProvayBlue enikezwa ngomthambo luxwayisa ngesimo se-serotonin syndrome esingabulala lapho ihlangana neminye imithi, futhi luthi akufanele isetshenziswe lapho kukhona ukuntuleka kwe-G6PD ngenxa yengozi yokushoda kwegazi okubangelwa ukubhujiswa kwamangqamuzana abomvu. Isimo evunyelwe ukuselapha yi-methemoglobinemia etholakala kamuva, hhayi i-POTS. Lelo lwazi aluqinisekisi uhlelo lokuthatha umuthi ngomlomo lwezimpawu ezihlobene nokuba sesimweni esiqondile.
Yisa isimangalo esithile, umkhiqizo, uhlu lwemithi oyithathayo manje, nomphumela ohlose ukuwuthola kuchwepheshe wezokwelapha ojwayelene nezimpawu zakho ezihlobene nokuba sesimweni esiqondile. Imibuzo okufanele uyibuze ngaphambi kokucabangela i-methylene blue isiza ukuhlela leyo ngxoxo. Umbuzo ongakaxazululwa uwukuthi ingabe iletha inzuzo efanele neqhubekayo ezigulini ezine-POTS, hhayi ukuthi ingakwazi yini ukushintsha imithambo yegazi kwesinye isimo.