Uketshezi lwe-methylene blue lokuhlambulula umlomo lwe-mucositis: imiphumela yocwaningo lwezokwelapha

I-mucositis ebangelwa ukwelashwa komdlavuza yisimo esithile. I-chemotherapy noma ukwelashwa kokulungiselela ukufakelwa kwamaseli kulimaza ulwelwesi lomlomo, kwakheke izilonda, bese iziphetho zemizwa eziveziwe zenza ukudla, ukugwinya nokukhuluma kube buhlungu. Ngokwesilinganiso se-WHO se-mucositis esichazwe eziqondisweni zokunakekelwa okusekelayo, ibanga 2 lisavumela ukudla okuqinile, kuyilapho ibanga 3 linciphisa isiguli ukuba sithathe uketshezi kuphela. Ukulawula ubuhlungu nokuphola kwezicubu kuyimiphumela ehlukene. Uketshezi lokuhlambulula umlomo lungathuthukisa okokuqala ngaphandle kokushintsha okwesibili.

Lowo mehluko uyisisekelo sokuqonda ukuhlolwa kubantu okungcono kakhulu okutholakalayo koketshezi lwe-methylene blue lokuhlambulula umlomo kulokhu kusetshenziswa: ucwaningo lwesigaba 2 lwango-2022 olwalwabela ababambiqhaza ngokungahleliwe e-MD Anderson, olwashicilelwa ku-BMC Medicine njengocwaningo lobuhlungu be-mucositis obungalawuleki. Aluzange luhlole i-methylene blue ezilondeni zomlomo ngokujwayelekile, ekuthelelekeni komphimbo, ekuthelelekeni komlomo yisikhunta, noma ekusetshenzisweni kwansuku zonke koketshezi lokuhlambulula umlomo. Lwahlola uketshezi olulodwa olwakhiwe ngendlela ethile, olwasetshenziswa ngendlela eyodwa, ngenxa yobuhlungu obungasabeli ekwelashweni.

Lokho okw ahlolwa ucwaningo

Indlela yocwaningo ilula: ukwengeza uketshezi lokuhlambulula umlomo olusebenza endaweni oluthintana nayo ekunakekelweni okuvamile, ukulugcina luthinta izicubu ezibuhlungu, ukulukhafulela ngaphandle, ukuphinda ngokohlelo, bese kukalwa ubuhlungu nokusebenza komlomo emahoreni angu-48.

Abantu abadala ababene-mucositis ebuhlungu naphezu kokunakekelwa okuvamile babelwa ngokungahleliwe ekwelashweni okuvamile kuphela (n = 16) noma ekwelashweni okuvamile kanye ne-methylene blue engu-0.025% (n = 15), engu-0.05% (n = 14), noma engu-0.1% (n = 15). Kubabambiqhaza abangu-69, abangu-60 baqeda ukwelashwa. Umbiko ogcwele wocwaningo uthi ulwazi ngokugxila koketshezi lwalufihliwe ohlangothini olulodwa, kodwa iqembu lokuqhathanisa alitholanga uketshezi oluluhlaza okwesibhakabhaka lokuhlambulula umlomo, ngakho uma kuqhathaniswa nokunakekelwa okuvamile kwakungenakwenzeka ngempela ukufihla ukuthi ubani uthola luphi uhlobo lokwelashwa. Kwakungekho qembu elalithola i-placebo, okuyinto ababhali abayibala njengomkhawulo.

Ababambiqhaza babethinteke kakhulu. Kulabo abaqeda ukwelashwa, abangu-72% babefakelwe amaseli ayisiqalo, kanti abanye babethole i-chemotherapy esebenza emzimbeni wonke noma ukwelashwa kwe-CAR-T. Lapho bengena ocwaningweni, abangu-90% babene-mucositis yebanga 3 le-WHO kanti abangu-10% babenebanga 2; inani eliphakathi nendawo lezinsuku ababese bevele benobuhlungu ngazo lalingu-6. Iphepha alihlukanisi ukuxilongwa komdlavuza ngezinhlobo zawo, ngakho alikwazi ukusekela izimangalo eziqondene nohlobo oluthile lomdlavuza.

Isiguli ngasinye sathola ibhodlela elingu-100 mL elalilungiswe ngokuhlanganisa izithako ekhemisi locwaningo: ukuthatha u-6 kuya ku-10 mL, ukulugcina ezindaweni ezibuhlungu imizuzu engu-5 ngokulunyakazisa emlonyeni nangokugubha umphimbo, ukulukhafulela ngaphandle ngaphandle kokulugwinya, ukulinda ngaphambi kokuhlambulula umlomo noma ukudla, nokuphinda njalo emahoreni angu-6 izinsuku ezingaba ngu-2. Okunye ukunakekelwa kwaqhubeka futhi kwakungahlanganisa ukuhlanzeka komlomo, uketshezi lwe-lidocaine lokuhlambulula umlomo, ingxube ebizwa nge-magic mouthwash equkethe i-nystatin, amalungiselelo e-diphenhydramine ne-antacid, nama-opioid asebenza emzimbeni wonke.

Umphumela oyinhloko owawukalwa owashicilelwa wawuwushintsho ebuhlungwini esikalini esinamaphuzu angu-11 (u-0 uma kungekho buhlungu, u-10 uma ubuhlungu bubukhulu kakhulu), kusukela ekuqaleni kuya osukwini 2. Ukusebenza komlomo kwasebenzisa isilinganiso sobunzima esisuka ku-0 kuya ku-6, esihlanganisa ukudla, ukugwinya nokukhuluma; ngakunye kwalokhu kwakukalwa njengokungenziwa, okunzima, noma okungenakwenzeka. Ibanga le-WHO laqoshwa kuphela lapho kubhaliswa ababambiqhaza, alizange lilandelwe ngezikhathi ezilandelanayo.

Isifinyezo sendlela yocwaningo nemiphumela

Leli thebula ligcina imiqondo emithathu ihlukene: ubuhlungu, ukusebenza komlomo nemiphumela emibi. Ukuphola, ukuphela kokutheleleka nokuncipha kwesidingo sama-opioid akuzange kufakazelwe lapha.

Umbuzo	Okwakalwa	Umphumela ngosuku 2
Ingabe ubuhlungu bancipha?	Ushintsho esilinganisweni sobuhlungu, kusukela ekuqaleni kuya osukwini 2	Ukuncipha okuyisilinganiso esingu-1.69 ngokunakekelwa okuvamile uma kuqhathaniswa no-5.20, 4.54, no-5.15 ngoketshezi lokuhlambulula umlomo olungu-0.025%, 0.05%, no-0.1%. Izilinganiso eziphakathi nendawo ngosuku 2: 5.5 uma kuqhathaniswa no-3, 2, no-2.
Ingabe ukudla, ukugwinya nokukhuluma kwathuthuka?	Ubunzima bokusebenza komlomo, 0 kuya ku-6	Ukuncipha okuyisilinganiso esingu-0.81 ngokunakekelwa okuvamile uma kuqhathaniswa no-2.47, 2.79, no-2.87 ngoketshezi olunamazinga amathathu okugxila. Izilinganiso eziphakathi nendawo ngosuku 2: 4 uma kuqhathaniswa no-2, 1, no-2.
Kwenzeka ngokushesha kangakanani, futhi kwahlala isikhathi esingakanani?	Isikhathi esabikwa yiziguli	Phakathi kwabangu-44 abaqeda ukwelashwa ngoketshezi lokuhlambulula umlomo, abangu-77% bezwa ukukhululeka okukhulu kakhulu emizuzwini embalwa ngemva kokuhlambulula kokuqala. Ubuhlungu baphinda bavela kwabangu-57%, ikakhulukazi phakathi kwamahora angu-4 no-8, kodwa bungasabi bukhulu njengakuqala. Cishe abangu-59% bacela uketshezi olwengeziwe ngemva kosuku 2.
Ingabe izilonda zaphola ngokushesha?	Ibanga le-WHO ngokuhamba kwesikhathi	Alikalwanga ngemva kokubhaliswa. Ababhali bathi isikhathi sokuphola sidinga olunye ucwaningo.
Ingabe ukusetshenziswa kwama-opioid kwehla?	Amanani ansuku zonke alingana ne-morphine	Akunakuchazwa ngendlela ethembekile. Inani eliphakathi nendawo ekuqaleni lalingaba ngu-114 mg ngosuku, kodwa imithamo eyayiqondiswe ku-mucositis yayingakwazi ukuhlukaniswa naleyo yezinye izizathu zobuhlungu.
Yimiphi imiphumela eyingozi eyavela?	Izehlakalo ezimbi kuze kube yizinsuku ezingu-30	Ukushisa komlomo okwesikhashana ekusetshenzisweni kokuqala (izehlakalo ezingu-5 emiphumeleni enemininingwane; isifinyezo sithi ezingu-8, umehluko ongakaxazululwa), okuhlanganisa isiguli esisodwa esahoxa. Ukungcoliswa okwesikhashana ngombala oluhlaza okwesibhakabhaka kwaphela ngokuhlanzeka komlomo noma ngokudla. Azikho izehlakalo ezimbi ezibucayi futhi akukho kungcoliswa kombala okuhlala njalo ezinsukwini ezingu-30.

Uma kuqhathaniswa nokunakekelwa okuvamile, ukuncipha kobuhlungu kwafinyelela emkhawulweni ovamile wamazinga okugxila angu-0.025% no-0.1%, kodwa kwaba semngceleni ku-0.05% (P = .0506). Amazinga amathathu okugxila koketshezi lokuhlambulula umlomo awazange ahluke komunye nomunye, ngakho ucwaningo alukhombi izinga lokugxila elifanele kakhulu.

Lokho lolu cwaningo olungazange lukuhlole

Umfundi ubona umphumela omuhle wobuhlungu bese ewusebenzisa nakomunye umqondo osondelene nawo. Ukunwetshwa ngakunye okungezansi kudinga ucwaningo lwakho.

Okokuqala, ukwelashwa kokutheleleka. Ucwaningo lwakala ubuhlungu nokusebenza komlomo ku-mucositis ehlobene ne-chemotherapy. Aluzange luhlole ukutheleleka komlomo ngamagciwane, isikhunta noma amavayirasi, ungqimba olunamathela emazinyweni, ukuvuvukala kwezinsini, noma ukugcina umoya ophuma emlonyeni unuka kahle nsuku zonke. Ukusetshenziswa ngesikhathi esifanayo kwengxube equkethe i-nystatin akuguquli uketshezi locwaningo lokuhlambulula umlomo lube umuthi wokulwa nesikhunta. Isifinyezo sethu esihlukanisa izilonda zomlomo ezivamile ne-mucositis yomdlavuza sigcina lezi zizathu zokusetshenziswa zihlukene.

Okwesibili, ukusetshenziswa okuvamile koketshezi lwe-methylene blue lokuhlambulula umlomo. Ababambiqhaza babene-mucositis yebanga 2 kuya ku-3 engasabeli ekwelashweni futhi babenakekelwa ochwepheshe bomdlavuza. Amavolontiya aphilile, izilonda zomlomo ezivamile nobuhlungu bomphimbo akuzange kufundwe. Lowo mkhawulo uphinde uchazwe esiqondisweni sethu sezimangalo ezimayelana nomlomo nomphimbo.

Okwesithathu, ukuphola kolwelwesi. Ngaphandle kokukalwa kwebanga ngezikhathi ezilandelanayo noma ukukalwa kwezilonda, isilinganiso esiphansi sobuhlungu asikwazi ukufakazela ukuthi izicubu zavaleka ngokushesha. Ababhali bakusho ngokucacile lokhu.

Okwesine, i-methylene blue egwinyiwe. Iziguli zazikhafulela uketshezi ngaphandle. Ukumuncwa kwalo emzimbeni wonke, ukusebenzisana nemithi nobuthi bukadayi ogwinyiwe kwakungesikho okwahlolwa. Ukukhafulela ngaphandle kunokugwinya kuyingxenye yokwelashwa okwahlolwa, hhayi imininingwane engabalulekile.

Kungani uketshezi oluthengiswa ezitolo lungeke lusetshenziswe esikhundleni salo

Uketshezi olwakhelwe ucwaningo nebhodlela elithengiswa esitolo kungaba nombala ofanayo kodwa kuhluke kukho konke okunquma umphumela nobungozi: izinga lokugxila, umthamo woketshezi, isikhathi sokuthintana nezicubu, izithako ezisizayo, ikhwalithi ephathelene namagciwane nemiyalelo. Lolu cwaningo lwasebenzisa uketshezi oluhlanganiswe ekhemisi olunamazinga okugxila acishe abe ngu-0.25 kuya ku-1 mg ku-mL ngayinye, ukuthintana nezicubu okulinganiselwe emizuzwini engu-5, nokusetshenziswa njalo emahoreni angu-6. Umkhiqizo othengiswa esitolo onezinga lokugxila elihlukile, ohlanjululwa emlonyeni isikhashana, noma onomyalelo wokugwinywa awuphindi noma iyiphi yalezo zimo.

Amabhodlela ocwaningo ayevela ekhemisi locwaningo. I-methylene blue ethengiswa ezitolo iyehluka ngokwezinga nangokuhlolwa, futhi amaphutha ezingeni lokugxila emlonyeni onezilonda awawona amancane. Ukuqhathanisa kudinga izinga lokugxila eliqondile, uhlu oluphelele lwezithako nesitifiketi esihlanganisa uketshezi oluqediwe, hhayi isithako esingakalungiswa kuphela. Incazelo yethu yokuhlolwa koketshezi oluqediwe ichaza lowo mbhalo.

Abacwaningi baphakamisa ukuthi uketshezi lunomphumela wokudambisa ubuhlungu endaweni oluthintana nayo emicu yemizwa yobuhlungu eveziwe, mhlawumbe kuhlanganise nokudluliswa kwezimpawu zokunciphisa ukuvuvukala kuleyo ndawo. Baphawula nokuthi uketshezi aluzange luqede ukunambitha noma ukusabela kokuklinyeka njengoba umuthi ovamile wokubulala izinzwa ubungenza. Lowo mbono wenza ukukhululeka kwezimpawu kube nokwenzeka. Awufakazeli ukuthi noma yiluphi uketshezi oluluhlaza okwesibhakabhaka lusebenza kunoma yisiphi isilonda somlomo.

Umongo wokuphepha nemikhawulo

Ukubekezelelwa kwesikhashana kuleli qembu elikhethiwe akufakazeli ukuphepha ngokujwayelekile. Ucwaningo aluzange lufake abantu ababenokuntuleka kwe-glucose-6-phosphate dehydrogenase, abakhulelwe, abancelisayo, noma ababene-mucositis ehlobene nokwelashwa ngemisebe. I-methylene blue esebenza emzimbeni wonke inengozi yokusebenzisana okubucayi nemithi ethinta i-serotonin, okungadala i-serotonin syndrome, ingozi yokubhidlika kwamangqamuzana abomvu egazi lapho kune-G6PD deficiency, kanye nezixwayiso zokusetshenziswa ngesikhathi sokukhulelwa. Ukuthi bungakanani ubungozi emzimbeni wonke obusebenza eketshezini lokuhlambulula umlomo elikhafulelwa ngaphandle ngendlela efanele akukakalinganiswa kahle, ngakho ukubuyekezwa kwemithi kubalulekile.

Lindela ukushintsha kombala okwesikhashana ube luhlaza okwesibhakabhaka, bika ukushisa okuqhubeka ngemva kokusetshenziswa kokuqala, futhi ungaguquli uketshezi okufanele lukhafulelwe ngaphandle lube umthamo ogwinywayo ngaphandle kokubuyekezwa ochwepheshe bezokwelapha.

Ukulandelelwa kokusebenza kokwelashwa ekuhlaziyweni okushicilelwe kwakungamahora angu-48; ukuqashwa kokuphepha kwaqhubeka kuze kube yizinsuku ezingu-30. Inani lababambiqhaza lalincane, ezinye izindlela zokwelashwa zazihlukene, futhi eqenjini lokuqhathanisa kwakungafihliwe ukuthi ubani uthola luphi uhlobo lokwelashwa. Umphumela uyinkomba evela esigabeni 2 yokulawulwa kwezimpawu, hhayi indlela yokwelashwa esamukelwe njengejwayelekile. Isiqondiso sethu sokufunda ucwaningo lwe-methylene blue sibonisa indlela yokuhlola ukwabiwa ngokungahleliwe, ukufihlwa kolwazi ngokwelashwa, imiphumela ekalwayo nokulandelelwa ngaphambi kokuthatha isinyathelo ngenxa yocwaningo olulodwa.

Imibuzo okufanele uyiyise ethimbeni elinakekela umdlavuza

Ubuhlungu be-mucositis sebunezindlela ezimisiwe zokunakekelwa okusekelayo, futhi noma yiluphi uketshezi locwaningo lokuhlambulula umlomo kufanele kuxoxwe ngalo ngaphakathi kwalolo hlelo. Imibuzo ewusizo ihlanganisa ukuthi yiliphi ibanga le-mucositis elikhona, yiziphi izindlela ezivamile ezisetshenziswa kakade, yimiphi imithi engase isebenzisane ne-methylene blue, ukuthi isimo se-G6PD siyaziwa yini, nokuthi yimuphi umphumela ozosho impumelelo noma isidingo sokuyeka (isilinganiso sobuhlungu, ikhono lokugwinya uketshezi, noma umphumela omubi). Letha inkomba eqondile yocwaningo nemininingwane yokwakhiwa koketshezi kunesimangalo esivamile ngomkhiqizo. Uhlu lwethu lokuhlola lwezingxoxo nochwepheshe bezokwelapha lubala imininingwane yomkhiqizo neyocwaningo efanele ukuphrintwa.

Ngakho umqondo owafundwa ulinganiselwe: uketshezi oluhlanganiswe ekhemisi, olwalukhafulelwa ngaphandle futhi lusetshenziswa ngokuphindaphindiwe njalo, lwanciphisa ubuhlungu be-mucositis obungasabeli ekwelashweni futhi lwathuthukisa ukudla, ukugwinya nokukhuluma phakathi kwezinsuku ezingu-2 ekuqhathaniseni okuncane lapho ulwazi ngokwelashwa lwalungafihliwe, ngaphandle kokubonisa ukuphola okusheshayo, isidingo esincane sama-opioid, ukwelashwa kokutheleleka, noma inzuzo yokuhlambulula umlomo ngokujwayelekile.