A fannin likitancin zamani, maganin rigakafi ya tabbatar da zama ɗaya daga cikin ci gaba mai mahimmanci, yana rage yawan faruwa da yawan mace-mace masu alaƙa da ƙwayoyin cuta. Iyawarsu na canza sakamakon asibiti na cututtukan ƙwayoyin cuta ya tsawaita tsawon rayuwar marasa lafiya marasa adadi. Magungunan rigakafi suna da mahimmanci a cikin hadaddun hanyoyin likita, gami da tiyata, sanyawa, dashewa, da chemotherapy. Duk da haka, bayyanar cututtukan ƙwayoyin cuta masu jure wa ƙwayoyin cuta ya kasance damuwa mai girma, yana rage tasirin waɗannan magungunan a kan lokaci. An ƙididdige misalan juriya na ƙwayoyin cuta a cikin kowane nau'in maganin rigakafi yayin da maye gurbi ya faru. Matsin zaɓin da magungunan kashe ƙwayoyin cuta ke yi ya ba da gudummawa wajen haɓaka nau'ikan juriya, wanda ke haifar da babban ƙalubale ga lafiyar duniya.
Don magance matsalar juriya na ƙwayoyin cuta, yana da mahimmanci don aiwatar da ingantattun tsare-tsare na rigakafin kamuwa da cuta waɗanda ke dakile yaduwar ƙwayoyin cuta masu juriya, tare da rage amfani da ƙwayoyin cuta. Bugu da ƙari, akwai buƙatar matsa lamba don madadin hanyoyin magani. Hyperbaric Oxygen Therapy (HBOT) ya fito ne a matsayin tsari mai ban sha'awa a cikin wannan mahallin, wanda ya haɗa da numfashi na 100% oxygen a takamaiman matakan matsa lamba na wani lokaci. An sanya shi a matsayin ko dai na farko ko ƙarin magani don cututtuka, HBOT na iya ba da sabon bege wajen magance cututtuka masu saurin kamuwa da ƙwayoyin cuta.
Ana ƙara amfani da wannan maganin azaman magani na farko ko madadin ga yanayi daban-daban, gami da kumburi, guba na carbon monoxide, raunuka na yau da kullun, cututtukan ischemic, da cututtuka. Aikace-aikacen asibiti na HBOT a cikin maganin kamuwa da cuta suna da zurfi, suna ba da fa'idodi masu mahimmanci ga marasa lafiya.
Aikace-aikacen asibiti na Hyperbaric Oxygen Therapy a cikin Kamuwa da cuta
Shaidu na yanzu suna goyan bayan aikace-aikacen HBOT, duka a matsayin tsayayyen magani da haɗin gwiwa, suna ba da fa'idodi masu mahimmanci ga marasa lafiya da suka kamu da cutar. A lokacin HBOT, hawan jini na iskar oxygen na jini zai iya tashi zuwa 2000 mmHg, kuma sakamakon daɗaɗɗen matsa lamba na naman oxygen zai iya haɓaka matakan oxygen na nama zuwa 500 mmHg. Irin waɗannan tasirin suna da mahimmanci musamman don haɓaka warkar da martanin kumburi da rushewar microcirculatory da aka lura a cikin mahalli na ischemic, da kuma kula da ciwo na yanki.
HBOT kuma na iya tasiri yanayin da suka dogara ga tsarin rigakafi. Bincike ya nuna cewa HBOT na iya kawar da cututtuka na autoimmune da maganin rigakafi da ke haifar da antigen, yana taimakawa wajen kula da juriya ta hanyar rage yaduwar lymphocytes da leukocytes yayin da ke daidaita martanin rigakafi. Har ila yau, HBOTyana goyan bayan warakaa cikin cututtukan fata na yau da kullun ta hanyar ƙarfafa angiogenesis, muhimmin tsari don ingantaccen farfadowa. Wannan farfadowa kuma yana ƙarfafa samuwar collagen matrix, wani muhimmin lokaci a warkar da rauni.
Dole ne a ba da kulawa ta musamman ga wasu cututtuka, musamman zurfi da wuya a magance cututtuka irin su necrotizing fasciitis, osteomyelitis, cututtuka na nama mai laushi, da kuma endocarditis mai cututtuka. Ɗaya daga cikin aikace-aikacen asibiti na yau da kullum na HBOT shine don cututtuka masu laushi na fata da osteomyelitis da ke hade da ƙananan matakan oxygen wanda sau da yawa ke haifar da anaerobic ko ƙwayoyin cuta.
1. Ciwon Kafar Ciwon Suga
Ƙafa mai ciwon sukariUlser cuta ce mai rikitarwa a tsakanin masu ciwon sukari, wanda ke shafar kusan kashi 25% na wannan al'umma. Kwayoyin cututtuka suna tasowa akai-akai a cikin waɗannan maƙarƙashiya (ƙididdige kashi 40% -80% na lokuta) kuma yana haifar da karuwar cututtuka da mace-mace. Cututtukan ƙafar masu ciwon sukari (DFIs) yawanci sun ƙunshi cututtukan ƙwayoyin cuta da yawa tare da nau'ikan cututtukan ƙwayoyin cuta na anaerobic da aka gano. Abubuwa daban-daban, ciki har da lahani na aikin fibroblast, batutuwan samar da collagen, hanyoyin rigakafi na salula, da aikin phagocyte, na iya hana warkar da raunuka a cikin masu ciwon sukari. Yawancin karatu sun gano rashin iskar oxygenation na fata a matsayin babban haɗari mai haɗari ga yankewa masu alaƙa da DFIs.
A matsayin ɗaya daga cikin zaɓuɓɓukan halin yanzu don maganin DFI, An ba da rahoton HBOT don haɓaka ƙimar warkarwa don ciwon ƙafar ƙafar masu ciwon sukari, daga baya ya rage buƙatar yankewa da kuma rikitarwa na tiyata. Ba wai kawai yana rage larura don ingantattun hanyoyin samar da albarkatu ba, kamar su aikin fida da gyaran fata, amma kuma yana gabatar da ƙananan farashi da ƙarancin illa idan aka kwatanta da zaɓuɓɓukan tiyata. Nazarin Chen et al. ya nuna cewa fiye da zaman 10 na HBOT ya haifar da haɓakar 78.3% a cikin raunin raunin raunuka a cikin masu ciwon sukari.
2. Necrotizing Soft Tissue Cututtuka
Necrotizing taushi nama cututtuka (NSTIs) sau da yawa polymicrobial, yawanci tasowa daga hade aerobic da anaerobic kwayoyin pathogens kuma yawanci hade da gas samar. Yayin da NSTIs ba su da yawa, suna gabatar da adadin mace-mace saboda saurin ci gaba da suke yi. Daidaitaccen ganewar asali da dacewa da magani shine mabuɗin don samun sakamako mai kyau, kuma an ba da shawarar HBOT azaman hanyar haɗin gwiwa don sarrafa NSTIs. Ko da yake akwai sauran gardama game da amfani da HBOT a cikin NSTIs saboda rashin binciken da ake iya sarrafawa,shaidun sun nuna cewa ana iya danganta shi da ingantacciyar ƙimar rayuwa da adana gabobin jiki a cikin marasa lafiya na NSTI.. Wani bincike na baya-bayan nan ya nuna raguwa mai yawa a cikin yawan mace-mace tsakanin marasa lafiya na NSTI da ke karbar HBOT.
1.3 Cututtukan Site na tiyata
Ana iya rarraba SSIs dangane da wurin jikin mutum na kamuwa da cuta kuma yana iya tasowa daga ƙwayoyin cuta daban-daban, gami da ƙwayoyin cuta na aerobic da anaerobic. Duk da ci gaba a matakan sarrafa kamuwa da cuta, kamar dabarun hana haifuwa, amfani da maganin rigakafin rigakafi, da haɓakawa a ayyukan fiɗa, SSIs sun kasance mai rikitarwa.
Ɗaya daga cikin mahimman bita ya bincika ingancin HBOT don hana SSI mai zurfi a cikin aikin tiyata na scoliosis neuromuscular. HBOT na farko na iya rage yawan SSIs da sauƙaƙe warkar da rauni. Wannan maganin ba tare da lalata ba yana haifar da yanayi inda matakan iskar oxygen a cikin ƙwayoyin raunuka ke daɗaɗɗa, wanda aka danganta da aikin kashe ƙwayoyin cuta na ƙwayoyin cuta. Bugu da ƙari, yana magance raguwar jini da matakan oxygen waɗanda ke ba da gudummawa ga haɓakar SSIs. Bayan sauran dabarun sarrafa kamuwa da cuta, an ba da shawarar HBOT musamman don gurɓataccen aikin tiyata mai tsabta kamar hanyoyin launi.
1.4 Konewa
Konewa raunuka ne da matsanancin zafi, wutar lantarki, sinadarai, ko radiation ke haifarwa kuma suna iya haifar da cututtuka masu yawa da adadin mace-mace. HBOT yana da amfani wajen magance konewa ta hanyar ƙara matakan iskar oxygen a cikin ƙwayoyin da suka lalace. Yayin da dabbobi da nazarin asibiti ke ba da sakamako gauraye dangane datasirin HBOT a cikin maganin kuna, Binciken da ya shafi 125 masu fama da ƙonawa ya nuna cewa HBOT bai nuna wani tasiri mai mahimmanci akan yawan mace-mace ko yawan aikin tiyata da aka yi ba amma ya rage yawan lokacin warkarwa (kwanaki 19.7 idan aka kwatanta da kwanakin 43.8). Haɗa HBOT tare da ingantaccen sarrafa ƙonawa zai iya sarrafa sepsis yadda yakamata a cikin masu ƙonawa, yana haifar da gajeriyar lokutan waraka da rage buƙatun ruwa. Koyaya, ana buƙatar ƙarin ƙarin bincike mai yiwuwa don tabbatar da rawar da HBOT ke takawa wajen sarrafa ƙonawa mai yawa.
1.5 Osteomyelitis
Osteomyelitis cuta ce ta kasusuwa ko kasusuwan kasusuwa sau da yawa ta hanyar ƙwayoyin cuta. Yin maganin osteomyelitis na iya zama ƙalubale saboda ƙarancin ƙarancin jini ga ƙasusuwa da ƙarancin shigar maganin rigakafi a cikin bargo. Ciwon osteomyelitis na yau da kullum yana da alamun cututtuka masu tsayi, kumburi mai laushi, da samuwar nama na necrotic. Refractory osteomyelitis yana nufin cututtukan ƙashi na yau da kullun waɗanda ke ci gaba ko sake dawowa duk da maganin da ya dace.
An nuna HBOT don inganta matakan iskar oxygen a cikin ƙwayoyin ƙasusuwan da suka kamu da cutar. Yawancin jerin shari'o'i da nazarin haɗin gwiwar sun nuna cewa HBOT yana haɓaka sakamakon asibiti ga marasa lafiya na osteomyelitis. Ya bayyana yana aiki ta hanyoyi daban-daban, ciki har da haɓaka ayyukan rayuwa, danne ƙwayoyin cuta, haɓaka tasirin ƙwayoyin cuta, rage kumburi, da haɓaka warkarwa.matakai. Bayan-HBOT, 60% zuwa 85% na marasa lafiya tare da na kullum, refractory osteomyelitis nuna alamun kamuwa da cuta.
1.6 Ciwon Fungal
A duk duniya, sama da mutane miliyan uku suna fama da cututtukan fungal na yau da kullun, wanda ke haifar da mutuwar sama da 600,000 kowace shekara. Sakamakon jiyya na cututtukan fungal galibi ana yin la'akari da su saboda dalilai kamar canjin yanayin rigakafi, cututtukan da ke ƙasa, da halayen ƙwayoyin cuta na ƙwayoyin cuta. HBOT yana zama zaɓi na warkewa mai ban sha'awa a cikin cututtukan fungal mai tsanani saboda amincin sa da yanayin rashin cin zarafi. Nazarin ya nuna cewa HBOT na iya yin tasiri a kan cututtukan fungal irin su Aspergillus da Mycobacterium tarin fuka.
HBOT yana haɓaka tasirin antifungal ta hanyar hana haɓakar biofilm na Aspergillus, tare da haɓaka ingantaccen aiki da aka lura a cikin nau'ikan da ba su da superoxide dismutase (SOD). Yanayin hypoxic yayin kamuwa da cututtukan fungal yana haifar da ƙalubale ga isar da magungunan antifungal, yin haɓakar matakan iskar oxygen daga HBOT mai yuwuwar shiga tsakani mai fa'ida, kodayake ƙarin bincike yana da garantin.
Abubuwan Antimicrobial na HBOT
Yanayin hyperoxic wanda HBOT ya kirkira yana fara sauye-sauyen ilimin lissafi da na biochemical waɗanda ke haɓaka kaddarorin ƙwayoyin cuta, yana mai da shi ingantaccen magani na kamuwa da cuta. HBOT yana nuna sakamako mai ban mamaki game da ƙwayoyin cuta na aerobic da galibin ƙwayoyin cuta anaerobic ta hanyar hanyoyin kamar ayyukan ƙwayoyin cuta kai tsaye, haɓaka martanin rigakafi, da tasirin daidaitawa tare da takamaiman magungunan ƙwayoyin cuta.
2.1 Kai tsaye Tasirin Kwayoyin cuta na HBOT
Tasirin ƙwayoyin cuta kai tsaye na HBOT yana da alaƙa da haɓakar nau'in oxygen mai amsawa (ROS), waɗanda suka haɗa da anions superoxide, hydrogen peroxide, radicals hydroxyl, da ions hydroxyl-duk waɗanda ke tasowa yayin metabolism na salula.
Haɗin kai tsakanin O₂ da sassan salula yana da mahimmanci don fahimtar yadda ROS ke samuwa a cikin sel. A karkashin wasu yanayi da ake magana a kai a matsayin danniya na oxidative, ma'auni tsakanin samuwar ROS da lalacewarsa yana rushewa, yana haifar da matakan ROS masu girma a cikin sel. Samar da superoxide (O₂⁻) yana haɓaka ta superoxide dismutase, wanda daga baya ya canza O₂⁻ zuwa hydrogen peroxide (H₂O₂). Wannan juzu'i yana ƙara haɓaka ta hanyar Fenton, wanda ke oxidizes Fe²⁺ don samar da radicals hydroxyl (·OH) da Fe³⁺, don haka yana ƙaddamar da tsarin sake fasalin tsarin ROS da lalacewar salula.
Tasirin guba na ROS ya yi niyya ga sassan salula masu mahimmanci kamar DNA, RNA, sunadarai, da lipids. Musamman ma, DNA shine babban makasudin cytotoxicity na H₂O₂, saboda yana rushe sifofin deoxyribose kuma yana lalata tushen abubuwan haɗin gwiwa. Lalacewar jiki da ROS ta haifar ya kai ga tsarin helix na DNA, wanda zai iya haifar da peroxidation na lipid peroxidation ta ROS. Wannan yana nuna mummunan sakamako na haɓakar matakan ROS a cikin tsarin ilimin halitta.
Ayyukan Antimicrobial na ROS
ROS yana taka muhimmiyar rawa wajen hana ci gaban ƙananan ƙwayoyin cuta, kamar yadda aka nuna ta hanyar HBOT-induced ROS ƙarni. Tasirin mai guba na ROS kai tsaye yana kai hari ga sassan salula kamar DNA, sunadarai, da lipids. Yawancin nau'ikan oxygen masu aiki na iya lalata lipids kai tsaye, wanda ke haifar da peroxidation na lipid. Wannan tsari yana lalata amincin membranes tantanin halitta kuma, saboda haka, ayyukan masu karɓa da sunadarai masu alaƙa da membrane.
Bugu da ƙari kuma, sunadaran, waɗanda kuma su ne maƙasudin maƙasudin ƙwayoyin ƙwayoyin cuta na ROS, suna fuskantar takamaiman gyare-gyare na oxidative a wasu ragowar amino acid kamar cysteine, methionine, tyrosine, phenylalanine, da tryptophan. Misali, an nuna HBOT don haifar da sauye-sauyen iskar oxygen a cikin sunadaran sunadarai da yawa a cikin E. coli, gami da elongation factor G da DnaK, don haka yana shafar ayyukan salularsu.
Haɓaka rigakafi ta hanyar HBOT
Abubuwan anti-mai kumburi na HBOTan rubuta su, suna tabbatar da mahimmanci don rage lalacewar nama da kuma hana ci gaban kamuwa da cuta. HBOT yana tasiri sosai ga maganganun cytokines da sauran masu sarrafa kumburi, suna tasiri ga amsawar rigakafi. Daban-daban na tsarin gwaji sun lura da canje-canje daban-daban a cikin maganganun kwayoyin halitta da kuma tsararrun furotin bayan HBOT, wanda ko dai ya daidaita ko rage abubuwan girma da cytokines.
A lokacin tsarin HBOT, ƙara yawan matakan O₂ yana haifar da kewayon martani na salon salula, kamar su hana sakin masu shiga tsakani da haɓaka lymphocyte da neutrophil apoptosis. Gabaɗaya, waɗannan ayyukan suna haɓaka hanyoyin rigakafin ƙwayoyin cuta na tsarin rigakafi, ta yadda za su sauƙaƙe warkar da cututtuka.
Bugu da ƙari kuma, nazarin ya nuna cewa ƙara yawan matakan O₂ a lokacin HBOT na iya rage maganganun cytokines masu kumburi, ciki har da interferon-gamma (IFN-γ), interleukin-1 (IL-1), da kuma interleukin-6 (IL-6). Waɗannan canje-canjen kuma sun haɗa da rage girman rabon CD4: CD8 T da daidaita sauran masu karɓa masu narkewa, a ƙarshe suna haɓaka matakan interleukin-10 (IL-10), wanda ke da mahimmanci don magance kumburi da haɓaka warkarwa.
Ayyukan antimicrobial na HBOT suna haɗuwa tare da hadaddun hanyoyin nazarin halittu. Dukansu superoxide da matsananciyar matsa lamba an ba da rahoton cewa ba su da alaƙa da haɓaka ayyukan ƙwayoyin cuta na HBOT da neutrophil apoptosis. Bayan HBOT, alamar haɓakawa a cikin matakan oxygen yana haɓaka ƙarfin ƙwayoyin cuta na neutrophils, muhimmin sashi na amsawar rigakafi. Bugu da ƙari kuma, HBOT yana hana mannewar neutrophil, wanda ke yin sulhu ta hanyar hulɗar β-integrins akan neutrophils tare da kwayoyin adhesion na intercellular (ICAM) akan ƙwayoyin endothelial. HBOT yana hana aikin neutrophil β-2 integrin (Mac-1, CD11b / CD18) ta hanyar nitric oxide (NO), yana ba da gudummawa ga ƙaura na neutrophils zuwa wurin kamuwa da cuta.
Madaidaicin sake fasalin cytoskeleton ya zama dole don neutrophils don phagocytize pathogens yadda ya kamata. An nuna S-nitrosylation na actin don tayar da actin polymerization, mai yiwuwa sauƙaƙe aikin phagocytic na neutrophils bayan HBOT kafin magani. Bugu da ƙari, HBOT yana haɓaka apoptosis a cikin layin ƙwayoyin T na mutum ta hanyar hanyoyin mitochondrial, tare da haɓaka mutuwar lymphocyte bayan HBOT da aka ruwaito. Kashe caspase-9-ba tare da tasirin caspase-8 ba-ya nuna tasirin immunomodulatory na HBOT.
Tasirin Haɗin kai na HBOT tare da Ma'aikatan Antimicrobial
A cikin aikace-aikacen asibiti, ana yawan amfani da HBOT tare da maganin rigakafi don magance cututtuka yadda ya kamata. Halin hyperoxic da aka samu a lokacin HBOT na iya rinjayar ingancin wasu magungunan ƙwayoyin cuta. Bincike ya nuna cewa takamaiman magungunan ƙwayoyin cuta, irin su β-lactams, fluoroquinolones, da aminoglycosides, ba wai kawai suna aiki ta hanyar ingantattun hanyoyin ba amma har ma sun dogara da wani yanki akan metabolism na aerobic na ƙwayoyin cuta. Sabili da haka, kasancewar iskar oxygen da halaye na rayuwa na ƙwayoyin cuta suna da mahimmanci yayin kimanta tasirin maganin rigakafi.
Muhimmiyar shaida ta nuna cewa ƙananan matakan oxygen na iya ƙara juriya na Pseudomonas aeruginosa zuwa piperacillin / tazobactam da kuma cewa ƙananan yanayin oxygen yana ba da gudummawa ga ƙarar juriya na Enterobacter cloacae zuwa azithromycin. Sabanin haka, wasu yanayi na hypoxic na iya haɓaka ƙwarewar ƙwayoyin cuta zuwa maganin rigakafi na tetracycline. HBOT yana aiki azaman hanyar warkewa mai yuwuwa ta hanyar haifar da metabolism na aerobic da reoxygenating hypoxic kamuwa da kyallen takarda, sa'an nan ƙara ji na pathogens zuwa maganin rigakafi.
A cikin binciken bincike na yau da kullum, haɗin HBOT-wanda aka gudanar sau biyu a kowace rana don 8 hours a 280 kPa-tare da tobramycin (20 mg / kg / day) ya rage yawan nauyin kwayoyin cuta a cikin Staphylococcus aureus endocarditis. Wannan yana nuna yuwuwar HBOT azaman jiyya na taimako. Ƙarin bincike ya nuna cewa a ƙarƙashin 37 ° C da 3 ATA matsa lamba na 5 hours, HBOT ya inganta tasirin imipenem akan macrophage-cutar Pseudomonas aeruginosa. Bugu da ƙari, haɗin haɗin HBOT tare da cephazolin an gano ya fi tasiri wajen magance Staphylococcus aureus osteomyelitis a cikin nau'in dabba idan aka kwatanta da cephazolin kadai.
HBOT kuma yana haɓaka aikin ƙwayoyin cuta na ciprofloxacin akan Pseudomonas aeruginosa biofilms, musamman bayan mintuna 90 na fallasa. Ana danganta wannan haɓakawa ga samuwar nau'in iskar oxygen mai ƙarfi (ROS) kuma yana nuna haɓakar hankali a cikin mutantattun ƙwayoyin cuta na peroxidase.
A cikin nau'ikan pleuritis da ke haifar da methicillin-resistant Staphylococcus aureus (MRSA), tasirin haɗin gwiwar vancomycin, teicoplanin, da linezolid tare da HBOT ya nuna tasiri sosai akan MRSA. Metronidazole, maganin rigakafi da aka yi amfani da shi sosai wajen magance cututtuka masu tsanani na anaerobic da polymicrobial irin su ciwon ƙafar ƙafar ciwon sukari (DFIs) da cututtuka na wurin tiyata (SSI), ya nuna babban tasiri na maganin ƙwayoyin cuta a ƙarƙashin yanayin anaerobic. Ana ba da garantin karatu na gaba don bincika tasirin ƙwayoyin cuta na synergistic na HBOT hade tare da metronidazole a duka a cikin vivo da saitunan in vitro.
Tasirin Magungunan Kwayoyin cuta na HBOT akan ƙwayoyin cuta masu jurewa
Tare da juyin halitta da yaduwar nau'ikan juriya, maganin rigakafi na gargajiya yakan rasa ƙarfinsu na tsawon lokaci. Bugu da ƙari kuma, HBOT na iya tabbatar da mahimmanci wajen magancewa da hana cututtuka da ƙwayoyin cuta masu jure wa miyagun ƙwayoyi ke haifarwa, yin aiki a matsayin dabarun mahimmanci lokacin da magungunan ƙwayoyin cuta suka kasa. Yawancin karatu sun ba da rahoton mahimman tasirin ƙwayoyin cuta na HBOT akan ƙwayoyin cuta masu juriya na asibiti. Misali, zaman HBOT na mintuna 90 a ATM 2 ya rage girman ci gaban MRSA. Bugu da ƙari, a cikin nau'ikan rabo, HBOT ya haɓaka tasirin ƙwayoyin cuta na ƙwayoyin cuta daban-daban akan cututtukan MRSA. Rahotanni sun tabbatar da cewa HBOT yana da tasiri wajen magance osteomyelitis wanda OXA-48 ke haifar da Klebsiella pneumoniae ba tare da buƙatar wani maganin rigakafi ba.
A taƙaice, maganin oxygen na hyperbaric yana wakiltar hanya mai yawa don sarrafa kamuwa da cuta, yana haɓaka amsawar rigakafi yayin da yake haɓaka tasirin abubuwan da ke tattare da ƙwayoyin cuta. Tare da cikakken bincike da haɓakawa, yana riƙe da yuwuwar rage tasirin juriya na ƙwayoyin cuta, yana ba da bege a ci gaba da yaƙi da cututtukan ƙwayoyin cuta.
Lokacin aikawa: Fabrairu-28-2025