I-methylene blue yokulimala kwezinzwa nobuhlungu: yiziphi izimo ezicwaningiwe?

Ingabe i-methylene blue iyakudambisa ukulimala kwezinzwa nobuhlungu? Lo mbuzo uzwakala njengombuzo owodwa, kodwa imibhalo yocwaningo iphendula imibuzo eminingana ehlukene. Udayi ojovwa ediskini yomgogodla, udayi ojovwa ngaphansi kwesikhumba esizungeze indunu, udayi ofakwa emthanjeni wegazi, nodayi ozungeziswa emlonyeni ukuze uwugeze kunegama elifanayo, kodwa kuhlola imiqondo ehlukene esebenza ngezimiso ezihlukene. Umphumela wenye indlela awusebenzi ngokuzenzakalela kwezinye.

Cabanga ngakho njengemiqondo emine enelebula elilodwa. Umqondo wokuqala ubhubhisa noma unciphisa ukuzwela kweziphetho ezincane zezinzwa ezikhulela ediskini elimele. Umqondo wesibili uqeda umuzwa noma uthulisa izinzwa zesikhumba endaweni yomjovo. Umqondo wesithathu usebenza kuwo wonke umzimba ngokuhamba kwegazi, uthinte isimiso sezinzwa. Umqondo wesine umboza indawo elimele ukuze udambise ubuhlungu kuleyo ndawo. Uma usuqonda lowo mehluko, ubufakazi buhleleka ngokushesha, bese igebe liyabonakala: isimangalo esidumile siphathelene nomqondo wesithathu othathwa njengoketshezi olugwinywayo, okuyiyona ndawo lapho ubufakazi babantu buncane kakhulu khona.

Ithebula lobufakazi ngokwesimo nangendlela yokunikeza

Leli thebula liyisifinyezo sendatshana. Umugqa ngamunye uhlanganisa isimo, indlela yokunikeza, nokungenelela kokwelapha, ngoba ukuzihlukanisa yikho okwenza izimangalo zobuhlungu zenziwe zibe nkulu ngokweqile.

Funda ikholomu yendlela yokunikeza uye phansi ngaphambi kokufunda noma yisiphi isihloko. Lonke uphawu lomphumela omuhle kubantu lusemugqeni wokusetshenziswa endaweni ethile noma enqubweni yokwelapha. Imigqa yokusetshenziswa okusebenza kuwo wonke umzimba iqukethe ucwaningo lokuqala olulodwa oluncane kakhulu namaseli angenalutho.

Ubuhlungu beqolo obusuka ediskini: ucwaningo olulodwa olunomphumela omkhulu, umzamo owodwa wokuphinda ongaphumelelanga

Indaba yokujova ngaphakathi kwediski iqala ngocwaningo lokuqala lwango-2007 olungenalo iqembu lokuqhathanisa ezigulini ezingu-24 ezinobuhlungu obuqinisekiswe ngokuhlolwa kwediski, obungaphenduli ekwelashweni okungahlinzi. Ngemva komjovo owodwa ngaphakathi kwediski we-10 mg we-methylene blue, ezingu-21 kwezingu-24 zabika ukuphela noma ukudamba okukhulu kobuhlungu phakathi nezinyanga ezicishe zibe ngu-18 zokulandelelwa. Ngaphandle kweqembu lokuqhathanisa, lowo mphumela wawungase ubonise indlela iziguli ezikhethwe ngayo, inkambo yemvelo yesimo, noma i-lidocaine enikezwe kanye nawo, ngakho wakhuthaza ucwaningo kunokuba uphendule umbuzo wokusebenza.

Kwalandela ucwaningo lwango-2010 oluqhathanisa nomuthi ongasebenzi, olufihlele iziguli nabacwaningi ukwabiwa kokwelashwa ezigulini ezingu-72, luqhathanisa i-methylene blue kanye ne-lidocaine namanzi anosawoti kanye ne-lidocaine. Ezinyangeni ezingu-24 umehluko obikiwe wawumkhulu kakhulu: ukwehla okumaphakathi kwamaphuzu obuhlungu kwakungu-52.5 kuqhathaniswa namaphuzu angu-0.7, kanti ukwaneliseka kwakungu-91.6% kuqhathaniswa no-14.3%. Umbono wokuhlela owawuhambisana nocwaningo wabuza ngokusobala ukuthi ingabe lokhu kwakuyikhambi lobuhlungu beqolo, okubonisa ukuthi lesi simangalo sasibonakala singavamile kangakanani kochwepheshe ngaleso sikhathi.

Izimangalo ezingavamile zidinga ukuphindwa kocwaningo, futhi ukuphindwa akuzange kusekele umphumela. Ucwaningo lwe-IMBI lwakamuva olwenziwa ezikhungweni eziningi lwahlola i-methylene blue efakwa ngaphakathi kwediski ezikhungweni ezahlukene futhi aluzange luqinisekise umphumela kaPeng. Amaqembu eziguli amancane azimele angenamaqembu okuqhathanisa ngokuvamile abika amazinga okuphendula aphansi noma anciphayo. Isifinyezo esithembekile siwubufakazi obungavumelani: impumelelo eyodwa ephawulekayo esikhungweni esisodwa uma iqhathaniswa nokuphindwa okungaphumelelanga ezikhungweni eziningi. Lokho akumisi ukwelashwa okuqinisekisiwe, futhi akusho lutho ngokugwinya i-methylene blue, engalokothi ingene ediskini ngezinga lokugxila elifanayo. Ukubuka kwethu konke ubufakazi bobuhlungu obungapheli kubeka le mpikiswano eceleni kokunye ukungenelela kwezinqubo zokwelapha.

Umjovo ozungeze indunu: izimpawu zangempela zomphumela, ububanzi obuncane

I-methylene blue efakwa ngaphakathi kwesikhumba ekwelapheni ukulunywa kwendunu okungaphenduli ekwelashweni inomlando omude kakhulu wochungechunge lweziguli, oqala ngo-1990 uqhubeke ngamaqembu eziguli ezingu-25, 30, 49, no-103. Amazinga okuphendula abonakala ephakeme, ngokuvamile iningi lingenazo izimpawu ngemva komjovo owodwa noma emibili, kodwa lonke uchungechunge alunalo iqembu lokuqhathanisa. Ukulunywa okwenza isiguli siye enqubweni ehlasela umzimba kungashintshashintsha, kanti imijovo ngokwayo ingaba nemiphumela ngenxa yokulindela usizo, ngakho amazinga okudamba angenawo amaqembu okuqhathanisa awakwazi ukuqinisekisa ukusebenza.

Ubufakazi obuqinile bokuqhathanisa butholakala esihlokweni esihlobene sobuhlungu ngemva kokuhlinzwa. Izivivinyo ezimbili ezinokwabiwa okungahleliwe ze-methylene blue efakwa ngaphakathi kwesikhumba esizungeze indunu ngesikhathi sokuhlinzwa kokususwa kwama-hemorrhoid zathola amaphuzu obuhlungu aphansi nokusetshenziswa okuncane kwemithi eyengeziwe yokudambisa ubuhlungu ezinsukwini 1 kuya ku-3 ocwaningweni lweziguli ezingu-67 nasezinsukwini 1 kuya ku-7 ocwaningweni lweziguli ezingu-97. Lokho kuwubufakazi bangempela bokudambisa ubuhlungu enqubweni, emthamo, nasesontweni okuchaziwe. Akubona ubufakazi bokulimala kwezinzwa okungapheli, futhi inqubo yokusebenza okuxoxwa ngayo iwukunciphisa ukuzwela kwezinzwa endaweni yesilonda, into iconsi eligwinywayo elingakwazi ukuyenza ngendlela efanayo. Imininingwane yokuthi i-methylene blue isebenza kanjani ezinzwaneni nakuma-mitochondria ichaza ukuthi kungani ukusebenza kwamakhemikhali endaweni ethile kuhlala kuleyo ndawo.

Ukusetshenziswa okusebenza kuwo wonke umzimba kobuhlungu bezinzwa: ucwaningo lokuqala olulodwa oluncane kakhulu

Ngokuqondene nesimangalo esibaluleke kakhulu kubathengi abaningi, sokuthi i-methylene blue esebenza kuwo wonke umzimba idambisa ubuhlungu bezinzwa, wonke umlando wocwaningo lwabantu oluneqembu lokuqhathanisa ubonakala uyilolu kuphela cwaningo lokuqala lwango-2015 ezigulini ezingu-10 ezinobuhlungu bezinzwa obungapheli, obungaphenduli ekwelashweni, nobunezimbangela ezihlukahlukene. I-methylene blue efakwa emthanjeni wegazi engu-2 mg/kg yehlisa amaphuzu obuhlungu ngaphezu kweqembu elithole umthamo ophansi kakhulu ngosuku lokwelashwa nangosuku olulandelayo, inzuzo yacishe yaphela phakathi nezinsuku ezimbalwa. Iziguli ezintathu zabonisa ukuncipha kobuhlungu obubangelwa ukuthintwa obekungafanele kube buhlungu.

Iziguli eziyishumi ezinezimo ezihlukahlukene nezinsuku ezimbili zokudamba ziyisizathu sokuqhubeka nocwaningo, hhayi isisekelo sokwelashwa. Umuntu oyedwa kuphela obambe iqhaza wayenobuhlungu bezinzwa ngemva kwe-herpes zoster, ngakho lolu akulona nocwaningo lwaleso simo. Alukho ucwaningo lwabantu oluhlangabezana nemibandela lwe-methylene blue esebenza kuwo wonke umzimba olutholakele ngokulimala kwezinzwa ezingaphandle kobuchopho nomgogodla ngenxa yesifo sikashukela, ubuhlungu benzwa ye-trigeminal, noma isifo sobuhlungu obuyinkimbinkimbi besifunda somzimba. Izifundo zobuhlungu bezinzwa ngemva kwe-herpes zoster ezisebenzisa indawo eseceleni komgogodla, ngezinye izikhathi ezivezwa izinjini zokusesha, zahlanganisa i-methylene blue nomuthi obulala umuzwa endaweni ethile emgogodleni; lokho kuyingxenye yomqondo wenqubo yokwelapha, hhayi owokusebenza kuwo wonke umzimba.

Ukugeza umlomo, izilonda, namalunga: ubufakazi bendawo ethile obungenakubolekwa

Izimpawu ezisele zomphumela kubantu zonke zingezokusetshenziswa endaweni ethile. Ucwaningo lwango-2022 lwesigaba 2 olunokwabiwa okungahleliwe lwathola ukuthi isixazululo se-methylene blue sokugeza umlomo emazingeni amathathu okugxila sehlisa ubuhlungu bokuvuvukala kolwelwesi lomlomo obubangelwa ukwelashwa komdlavuza ngaphezu kokunakekelwa okuvamile ngosuku 2. Isixazululo sokugeza simboza ulwelwesi olulimele bese siyakhafuwa. Ukusicaphuna njengobufakazi bamaconsi agwinywayo kudidanisa ukuthinta indawo ethile nokunikeza umthamo osebenza kuwo wonke umzimba.

Ngokufanayo, ukumboza izicubu ezihlinzwayo nge-methylene blue exutshwe ukuze ibe buthakathaka ngesikhathi sokususwa kwediski yeqolo eliphansi kwehlisa amaphuzu obuhlungu beqolo ocwaningweni lweziguli ezingu-115 olufihle ukwabiwa kokwelashwa emaqenjini amathathu abandakanyekayo, kanti ucwaningo lomjovo emalungeni amancane omgogodla lwabika amaphuzu aphansi obuhlungu nokungakwazi ukwenza imisebenzi ezinyangeni ezingu-3 nezingu-6. Umphumela ngamunye uboshelwe endaweni lapho umuthi ufakwe khona. Akukho nowodwa osebenza njengobufakazi bomkhiqizo ophuzwa ngomlomo.

Okuboniswa yizilwane, nalapho inqubo yokusebenza ingaba nemiphumela ephikisanayo

Amamodeli obuhlungu bezinzwa kumagundane anikeza isisekelo sokuthi inqubo yokusebenza ingenzeka, esicashunwa kakhulu. I-methylene blue efakwa endaweni yoketshezi oluzungeze umgogodla yavimba ukuzwela ngokweqile ebuhlungwini bokushisa okwakusukhona cishe amahora angu-4 ngemva kokuboshwa kwenzwa ye-sciatic ocwaningweni lwasekuqaleni lwango-1992, okuhambisana negalelo lendlela ye-nitric oxide eya ku-cGMP emgogodleni. Ucwaningo lwakamuva lokulimala ngenxa yokucindezelwa okuqhubekayo lwathola ukuthi i-methylene blue iyodwa yayinciphisa ukusabela ebuhlungwini futhi ikwazi ukuvimbela ukwanda kokuzwela ebuhlungwini okubangelwa yi-sildenafil, okuphinde kwakhomba ukudluliselwa kwezimpawu nge-nitric oxide. Ucwaningo lwango-2021 lwengeza inqubo yesibili yokusebenza, ukucindezelwa okuqondile kokuthumela kwezimpawu zezinzwa okufana nemiphumela emigudwini ye-sodium, nokucindezelwa okuhlala isikhathi eside kune-lidocaine ohlelweni olwahlolwa.

Kunemininingwane eyodwa efanele ukugcinwa ngoba abathengisi bayayishiya. Imibhalo yocwaningo lwe-nitric oxide olungakafinyeleli ezivivinyweni zabantu ayivumelani yonke ngokuthi i-methylene blue isho ukudambisa ubuhlungu. Kwezinye izindlela zocwaningo, ukudluliselwa kwezimpawu nge-nitric oxide ngokwakho kudambisa ubuhlungu, bese i-methylene blue ivimba lokho kudamba. Ocwaningweni lokulimala kwezinzwa ngenxa yesifo sikashukela, i-methylene blue yavimba ukuncipha kokusabela ebuhlungwini okuhlobene ne-sildenafil futhi iyodwa yandisa ukuzwela ngokweqile ebuhlungwini. Imiphumela yezinqubo zokusebenza incike kumodeli nasendleleni yezimpawu, okuyisizathu esengeziwe sokuthi imiphumela yezilwane ingafundwa njengeseluleko semithamo.

Okungakacwaningwa, nomngcele wokuphepha

Alukho ucwaningo olunokwabiwa okungahleliwe noma uchungechunge lweziguli oluthembekile lwe-methylene blue egwinywa ngomlomo olutholakele ngobuhlungu bezinzwa obungapheli, ukulimala kwezinzwa ngenxa yesifo sikashukela, ubuhlungu benzwa ye-trigeminal, isifo sobuhlungu obuyinkimbinkimbi besifunda somzimba, noma ubuhlungu bezinzwa ngemva kwe-herpes zoster. Ucwaningo olulodwa kuphela oluqondile lobuhlungu bezinzwa olusebenzisa indlela esebenza kuwo wonke umzimba yilolu cwaningo lokuqala lweziguli ezingu-10 olusebenzisa umthambo wegazi, olunophawu lomphumela oluhlala usuku olungu-1 kuya kwezingu-2. Imiphumela yokufakwa ngaphakathi kwediski, esikhumbeni, elungeni, eceleni komgogodla, neyokugeza umlomo ayikwazi ukunwetshwa ngokwesayensi yokusebenza kwemithi iye emaconsini athengiswayo, anezinga lokugxila endaweni okuhloswe kuyo elihluke ngokuphindaphindeka okukhulu futhi angenayo indlela yokubekwa khona ngenqubo ethile.

Ukudideka kwezindlela zokunikeza nakho kuhambisana nesixwayiso sokuphepha. Izindawo zomgogodla azikwazi ukushintshaniswa: ukufakwa ngaphakathi kwediski, eceleni komgogodla, ngaphandle kolwelwesi oluqinile olumboza umgogodla, nasendaweni yoketshezi oluzungeze umgogodla kwehlukile ngokusebenza kwemithi nangobuthi bayo, futhi ubuthi obukhulu obulimaza izinzwa ngemva kokufakwa kwe-methylene blue endaweni yoketshezi oluzungeze umgogodla baholela esixwayisweni esicacile sengozi. Ngaphezu kwalokho, i-methylene blue iyasebenzisana nemithi ethinta i-serotonin futhi akufanele isetshenziswe lapho kunokushoda kwe-G6PD, ngakho noma yisiphi isiguli esinobuhlungu esicabanga ukuyisebenzisa sidinga kuqala ukubuka konke kwemiphumela engemihle nezimo ezivimbela ukusetshenziswa kwayo kanye nengxoxo nochwepheshe wezokwelapha, sisebenzisa le mibuzo okufanele ibuzwe nge-methylene blue.

Indlela yokusebenzisa lobu bufakazi

Noma ubani ohlola i-methylene blue ngobuhlungu kufanele abuze imibuzo emithathu ngomthombo ngamunye ocashuniwe. Yisiphi isimo ngokuqondile, ngoba ukululama ngemva kokususwa kwama-hemorrhoid akukhona ukulimala kwezinzwa ngenxa yesifo sikashukela. Iyiphi indlela yokunikeza ngokuqondile, ngoba ukufakwa ngaphakathi kwediski noma esikhumbeni akuwona umthamo ogwinywayo. Futhi yimuphi umphumela olinganisiwe ngasiphi isikhathi, ngoba izinsuku zokudamba okuhlobene nenqubo yokwelapha azizona izinyanga zokulawula ukulimala kwezinzwa.

Ngobufakazi obukhona njengamanje, izimpawu zokudambisa ubuhlungu kubantu nge-methylene blue zigxile ekunikezweni endaweni ethile noma enqubweni yokwelapha, ukusebenza kwayo kungavumelani kuzo zonke izimo ezisetshenziselwa zona. Ubufakazi bokusebenza kuwo wonke umzimba bugcine ocwaningweni lokuqala olulodwa oluncane kakhulu lokufakwa emthanjeni wegazi, futhi abukho ubufakazi bezokwelapha obusekela i-methylene blue ethengiswayo enikezwa ngomlomo ngobuhlungu bezinzwa noma obungapheli.