Mu rwego rw'ubuvuzi bwa kijyambere, antibiyotike yerekanye ko ari imwe mu majyambere akomeye, igabanya cyane umubare w'abapfa ndetse n'impfu ziterwa na virusi. Ubushobozi bwabo bwo guhindura ibyavuye mu mavuriro yanduye ya bagiteri byongereye igihe cyo kubaho kw’abarwayi batabarika. Antibiyotike ningirakamaro mubikorwa byubuvuzi bigoye, harimo kubagwa, gushyirwaho, guterwa, hamwe na chimiotherapie. Ariko kandi, kuba indwara ya antibiyotike irwanya antibiyotike yagiye itera impungenge, bigabanya ingaruka z’ibi biyobyabwenge mu gihe runaka. Ingero zo kurwanya antibiyotike zanditswe mu byiciro byose bya antibiyotike uko ihinduka rya mikorobe riba. Umuvuduko wo guhitamo ukoreshwa n’imiti igabanya ubukana bwa mikorobe wagize uruhare mu kuzamuka kw’imiti idashobora kwihanganira, bikaba ikibazo gikomeye ku buzima bw’isi.
Kugira ngo turwanye ikibazo cy’ingutu cyo kurwanya mikorobe, ni ngombwa gushyira mu bikorwa politiki nziza yo kurwanya indwara igabanya ikwirakwizwa ry’indwara ziterwa na virusi, hamwe no kugabanya ikoreshwa rya antibiyotike. Byongeye kandi, harakenewe cyane ubundi buryo bwo kuvura. Ubuvuzi bwa Hyperbaric Oxygene (HBOT) bwagaragaye nkuburyo butanga ibyiringiro muriki gice, birimo guhumeka ogisijeni 100% kurwego rwumuvuduko runaka mugihe runaka. HBOT ihagaze nkubuvuzi bwibanze cyangwa bwuzuzanya bwanduye, HBOT irashobora gutanga ibyiringiro bishya byo kuvura indwara zikaze ziterwa na antibiyotike irwanya antibiyotike.
Ubu buvuzi buragenda bukoreshwa nk'ubuvuzi bw'ibanze cyangwa ubundi buryo bwo kuvura ibintu bitandukanye, birimo gutwika, uburozi bwa monoxyde de carbone, ibikomere bidakira, indwara ziterwa na isheki, n'indwara. Ubuvuzi bwa HBOT mukuvura indwara bwimbitse, butanga inyungu zingirakamaro kubarwayi.
Ubuvuzi bwa Hyperbaric Oxygene ivura indwara
Ibimenyetso biriho bishyigikira byimazeyo ikoreshwa rya HBOT, haba nk'ubuvuzi bwihariye kandi bufatika, bugaragaza inyungu zikomeye ku barwayi banduye. Mugihe cya HBOT, umuvuduko wa ogisijeni wamaraso wa arterial urashobora kugera kuri mmHg 2000, kandi umuvuduko ukabije wumuvuduko ukabije wa ogisijeni-tissue urashobora kuzamura urugero rwa ogisijeni ya tissue kugera kuri 500 mmHg. Ingaruka nkizo zifite agaciro cyane mugutezimbere gukira ibisubizo byokongoka hamwe nihungabana rya microcirculatory biboneka mubidukikije, ndetse no mugucunga syndrome.
HBOT irashobora kandi kugira ingaruka kumiterere ishingiye kumubiri. Ubushakashatsi bwerekana ko HBOT ishobora guhagarika syndromes ya autoimmune hamwe na immunite iterwa na antigen, bigafasha gukomeza kwihanganira ibihingwa bigabanya umuvuduko wa lymphocytes na leukocytes mugihe uhindura ibisubizo byubudahangarwa. Byongeye kandi, HBOTishyigikira gukiramu bisebe byuruhu bidakira mukangura angiogenez, inzira ikomeye yo gukira neza. Ubu buvuzi kandi butera inkunga ya matagisi ya kolagen, icyiciro cyingenzi mugukiza ibikomere.
Hagomba kwitabwaho cyane cyane indwara zimwe na zimwe, cyane cyane indwara zimbitse kandi zigoye kuvura nka nekrotizing fasciitis, osteomyelitis, indwara zidakira zidakira, na endocarditis yanduye. Bumwe mu buryo bukoreshwa cyane mu mavuriro ya HBOT ni ubwandu bwuruhu rworoshye uruhu na osteomyelitis bifitanye isano na ogisijeni nkeya ikunze guterwa na bagiteri ya anaerobic cyangwa irwanya.
1. Indwara ya Diyabete Yanduye
Ikirenge cya diyabeteibisebe ni ingorane zigaragara mu barwayi ba diyabete, yibasira abaturage bagera kuri 25%. Indwara zikunze kugaragara muri ibyo bisebe (bingana na 40% -80% by'imanza) kandi bigatuma indwara n’impfu byiyongera. Indwara ya diyabete yanduye (DFIs) ubusanzwe igizwe n'indwara ya polymicrobial hamwe na bagiteri zitandukanye za anaerobic bagiteri zamenyekanye. Impamvu zitandukanye, zirimo inenge ya fibroblast, ibibazo bya kolagen, imikorere yumubiri wa selile, hamwe na fagocyte, birashobora kubuza gukira ibikomere kubarwayi ba diyabete. Ubushakashatsi bwinshi bwerekanye ko okisijeni y’uruhu yangiritse nkimpamvu ikomeye yo gutemwa bijyanye na DFIs.
Nka bumwe muburyo bugezweho bwo kuvura DFIHBOT yavuzwe ko izamura cyane igipimo cyo gukira ibisebe by’ibirenge bya diyabete, nyuma bikagabanya gukenera gucibwa no gutabara bigoye. Ntabwo igabanya gusa ibikenewe muburyo bukoreshwa cyane, nko kubaga flap no kubaga uruhu, ariko kandi birerekana ibiciro biri hasi ningaruka nkeya ugereranije nuburyo bwo kubaga. Ubushakashatsi bwakozwe na Chen n'abandi. yerekanye ko amasomo arenga 10 ya HBOT yatumye iterambere rya 78.3% ryiyongera ku bipimo byo gukira ibikomere ku barwayi ba diyabete.
2. Necrotizing Yanduye Yoroheje
Indwara ya Necrotizing yanduye (NSTIs) ikunze kuba polymicrobial, mubisanzwe ituruka ku guhuza imiti ya bagiteri yo mu kirere na anaerobic kandi akenshi iba ifitanye isano no kubyara gaze. Mugihe NSTI ari gake cyane, irerekana umubare munini wimpfu bitewe niterambere ryabo ryihuse. Gusuzuma mugihe gikwiye kandi gikwiye ni urufunguzo rwo kugera ku musaruro ushimishije, kandi HBOT yasabwe nkuburyo bufatika bwo gucunga NSTI. Nubwo hakiri impaka zijyanye no gukoresha HBOT muri NSTIs kubera kubura ubushakashatsi buteganijwe,ibimenyetso byerekana ko bishobora guhuzwa no kuzamura imibereho no kubungabunga ingingo ku barwayi ba NSTI. Ubushakashatsi bwakozwe bwerekanye ko igabanuka ry’imfu z’abarwayi ba NSTI bakira HBOT.
1.3 Indwara zo kubaga
SSIs irashobora gushyirwa mubice hashingiwe ku kibanza cyanduye kandi gishobora guturuka kuri virusi zitandukanye, harimo na bacteri zo mu kirere na anaerobic. Nubwo hari intambwe imaze guterwa mu ngamba zo kurwanya indwara, nk'ubuhanga bwo kuboneza urubyaro, gukoresha antibiyotike ya prophylactique, hamwe no kongera imbaraga mu bikorwa byo kubaga, SSIs ikomeje kuba ingorabahizi.
Isuzuma rimwe ryingenzi ryakoze ubushakashatsi ku mikorere ya HBOT mu gukumira SSI zimbitse mu kubaga neuromuscular scoliose. Mbere yo gutangira HBOT irashobora kugabanya cyane indwara ya SSIs kandi ikorohereza gukira ibikomere. Ubu buryo budahwitse butera ibidukikije aho urugero rwa ogisijeni mu ngingo z’ibikomere ruzamutse, ibyo bikaba bifitanye isano n’igikorwa cyo kwica okiside irwanya virusi. Byongeye kandi, ikemura ibibazo byamaraso yagabanutse na ogisijeni bigira uruhare mu iterambere rya SSIs. Usibye izindi ngamba zo kurwanya ubwandu, HBOT yasabwe cyane cyane kubagwa byanduye neza nkuburyo bwo gukorora.
1.4
Gutwika ni ibikomere biterwa n'ubushyuhe bukabije, amashanyarazi, imiti, cyangwa imirasire kandi birashobora gutera indwara nyinshi nimpfu. HBOT ni ingirakamaro mu kuvura ibicanwa mu kongera urugero rwa ogisijeni mu ngingo zangiritse. Mugihe inyamaswa nubuvuzi zitanga ibisubizo bivanze bijyanyeimikorere ya HBOT mukuvura gutwika, ubushakashatsi bwakozwe n’abarwayi 125 batwitse bwerekanye ko HBOT itagize ingaruka zikomeye ku mibare y’impfu cyangwa ku mubare wabazwe ariko byagabanije igihe cyo gukira (iminsi 19.7 ugereranije n’iminsi 43.8). Kwinjiza HBOT hamwe nubuyobozi bwuzuye bushobora gutwika neza sepsis kubarwayi batwitse, biganisha ku gihe gito cyo gukira no kugabanya ibisabwa byamazi. Nyamara, ubushakashatsi bwimbitse burakenewe kugirango hemezwe uruhare rwa HBOT mugucunga umuriro mwinshi.
1.5 Osteomyelitis
Osteomyelitis ni infection yamagufa cyangwa igufwa ryamagufwa akenshi riterwa na bagiteri. Kuvura osteomyelitis birashobora kuba ingorabahizi bitewe nuko amaraso atagabanijwe neza kumagufa no kwinjira kwa antibiyotike muke. Indwara ya osteomyelitis idakira irangwa na virusi zidakira, gutwika byoroheje, no gukora amagufwa ya nerotic. Osteomyelitis yangiritse bivuga kwandura amagufwa adakira akomeza cyangwa agaruka nubwo bivurwa neza.
HBOT yerekanwe kunoza cyane urugero rwa ogisijeni mumitsi yanduye. Ubushakashatsi bwinshi bwakozwe hamwe nubushakashatsi bwerekana ko HBOT yongerera imbaraga abarwayi ba osteomyelitis. Bigaragara ko bikora muburyo butandukanye, harimo kongera ibikorwa bya metabolike, guhagarika indwara ziterwa na bagiteri, kongera ingaruka za antibiyotike, kugabanya umuriro, no guteza imbere gukirainzira. Nyuma ya HBOT, 60% kugeza 85% byabarwayi barwaye osteomyelitis idakira, yanga kwerekana ibimenyetso byo guhagarika ubwandu.
1.6 Indwara yibihumyo
Ku isi hose, abantu barenga miliyoni eshatu barwara indwara zidakira cyangwa zitera indwara, bigatuma abantu barenga 600.000 bapfa buri mwaka. Ibyavuye mu kuvura indwara zandurira mu bihumyo akenshi bibangamiwe bitewe n’impamvu zahinduwe z’ubudahangarwa bw'umubiri, indwara ziterwa, hamwe na virusi itera virusi. HBOT ihinduka uburyo bwiza bwo kuvura indwara zanduye bitewe numutekano wacyo hamwe na kamere idatera. Ubushakashatsi bwerekana ko HBOT ishobora kurwanya indwara ziterwa na fungal nka Aspergillus na Mycobacterium igituntu.
HBOT iteza imbere antifungal muguhagarika biofilm ya Aspergillus, hamwe nubushobozi bwiyongereye bugaragara mumirongo idafite genes ya superoxide (SOD). Imiterere ya hypoxic mugihe cyanduye fungal itera imbogamizi mugutanga imiti igabanya ubukana, bigatuma urugero rwa ogisijeni rwiyongera kuri HBOT rushobora kugira uruhare runini, nubwo ubushakashatsi buremewe.
Imiti igabanya ubukana bwa HBOT
Ibidukikije bya hyperoxic byakozwe na HBOT bitangiza impinduka zifata umubiri na biohimiki zitera antibacterial, bigatuma iba imiti ifatika yanduye. HBOT yerekana ingaruka zidasanzwe zirwanya bagiteri zo mu kirere na bagiteri yiganjemo anaerobic hakoreshejwe uburyo nk'ibikorwa bya bagiteri itaziguye, kongera imbaraga z'umubiri, hamwe n'ingaruka ziterwa na mikorobe yihariye.
2.1 Ingaruka zitaziguye za Antibacterial ya HBOT
Ingaruka ya antibacterial itaziguye ya HBOT ahanini iterwa no kubyara amoko ya ogisijeni ikora (ROS), arimo anion ya superoxide, hydrogène peroxide, hydroxyl radicals, na hydroxyl ion - ibyo byose bivuka mugihe cya metabolism selile.
Imikoranire hagati ya O₂ nibice bigize selile ningirakamaro mugusobanukirwa uburyo ROS ikora muri selile. Mubihe bimwe na bimwe byitwa guhagarika umutima, uburinganire hagati yimikorere ya ROS no kwangirika kwayo burahungabana, biganisha ku ntera ya ROS mu ngirabuzimafatizo. Umusaruro wa superoxide (O₂⁻) uterwa na superoxide disutase, hanyuma igahindura O₂⁻ muri hydrogen peroxide (H₂O₂). Ihinduka ryongerewe imbaraga na reaction ya Fenton, itera Fe²⁺ kubyara hydroxyl radicals (· OH) na Fe³⁺, bityo igatangiza redox ikurikirana ikurikirana ROS no kwangirika kwa selile.
Ingaruka z'ubumara bwa ROS yibasira ibice byingenzi bigize selile nka ADN, RNA, proteyine, na lipide. Ikigaragara ni uko ADN ari intego y'ibanze ya cytotoxicity ya H₂O₂, kuko ihungabanya imiterere ya deoxyribose kandi ikangiza ibyingenzi. Ibyangiritse ku mubiri byatewe na ROS bigera no kuri helix imiterere ya ADN, birashoboka ko biterwa na lipide peroxidation yatewe na ROS. Ibi bishimangira ingaruka mbi ziterwa na ROS murwego rwo hejuru mubinyabuzima.
Ibikorwa bya mikorobe ya ROS
ROS igira uruhare runini mukubuza mikorobe, nkuko bigaragazwa na HBOT iterwa na ROS. Ingaruka z'ubumara bwa ROS yibasira ibice bigize selile nka ADN, proteyine, na lipide. Ubwinshi bwubwoko bwa ogisijeni ikora burashobora kwangiza lipide, biganisha kuri lipide peroxidation. Ubu buryo bubangamira ubusugire bwibice bigize selile, bityo, imikorere yimikorere ya reseptor na proteyine.
Byongeye kandi, poroteyine, nazo zikaba ari intego zikomeye za ROS, zihinduka mu buryo bwihariye bwa okiside ku bisigazwa bitandukanye bya aside amine nka sisitemu, methionine, tirozine, fenylalanine, na tripitofani. Kurugero, HBOT yerekanwe gutera impinduka za okiside muri poroteyine nyinshi muri E. coli, harimo no kurambura G na DnaK, bityo bikagira ingaruka kumikorere ya selile.
Kongera ubudahangarwa binyuze muri HBOT
Kurwanya inflammatory ya HBOTByanditswe, byerekana ko ari ngombwa kugabanya ibyangiritse no guhagarika ubwandu. HBOT igira ingaruka zikomeye kumagambo ya cytokine hamwe nubundi buryo bugenzura ibintu, bigira ingaruka kumubiri. Sisitemu zitandukanye zubushakashatsi zagaragaje impinduka zinyuranye mumagambo ya gene hamwe na proteine nyuma ya HBOT, igenga cyangwa igabanya ibintu bikura na cytokine.
Mugihe cya HBOT, kwiyongera kwa O₂ bitera ibisubizo bitandukanye bya selile, nko guhagarika irekurwa ryabunzi batera inflammatory no guteza imbere lymphocyte na neutrophil apoptose. Hamwe na hamwe, ibyo bikorwa byongera sisitemu yumubiri uburyo bwo kurwanya mikorobe, bityo bikorohereza gukira indwara.
Byongeye kandi, ubushakashatsi bwerekana ko kwiyongera kwa O₂ mugihe cya HBOT bishobora kugabanya imvugo ya cytokine itera inflammatory, harimo interferon-gamma (IFN-γ), interleukin-1 (IL-1), na interleukin-6 (IL-6). Izi mpinduka zirimo kandi kugabanya igipimo cya CD4: CD8 T no guhindura izindi reseptor zishonga, amaherezo ikazamura urwego rwa interleukin-10 (IL-10), rukaba ari ingenzi cyane mukurwanya umuriro no guteza imbere gukira.
Ibikorwa birwanya mikorobe ya HBOT byahujwe nuburyo bukomeye bwibinyabuzima. Byombi byavuzwe na superoxide hamwe n’umuvuduko mwinshi byazamuye mu buryo budasubirwaho ibikorwa bya antibacterial biterwa na HBOT na apoptose ya neutrophil. Gukurikira HBOT, kuzamuka kurwego rwa ogisijeni byongera ubushobozi bwa bagiteri yica neutrophile, igice cyingenzi mubisubizo byubudahangarwa bw'umubiri. Byongeye kandi, HBOT irwanya neutrophil adhesion, igahuzwa n’imikoranire ya β-integin kuri neutrophile hamwe na molekile zifata ingirabuzimafatizo (ICAM) kuri selile endothelia. HBOT ibuza ibikorwa bya neutrophil β-2 integrin (Mac-1, CD11b / CD18) ikoresheje inzira ya nitric oxyde (OYA), igira uruhare mu kwimuka kwa neutrophile aho yanduye.
Guhindura neza neza cytoskeleton birakenewe kugirango neutrophile ikore neza fagocytize virusi. S-nitrosylation ya actin byagaragaye ko itera polimerisiyumu, ishobora koroshya ibikorwa bya fagocyitike ya neutrophile nyuma ya HBOT mbere yo kuvurwa. Byongeye kandi, HBOT iteza apoptose mumirongo ya T yumuntu binyuze mumihanda ya mitochondrial, hamwe na lymphocyte yihuta nyuma yurupfu rwa HBOT. Guhagarika caspase-9 - bitagize ingaruka kuri caspase-8 - byagaragaje ingaruka zubudahangarwa bwa HBOT.
Ingaruka za Synergistic Ingaruka za HBOT hamwe na mikorobe yica mikorobe
Mubikorwa byubuvuzi, HBOT ikoreshwa kenshi hamwe na antibiotique kugirango irwanye indwara neza. Imiterere ya hyperoxic yagezweho mugihe cya HBOT irashobora guhindura imikorere ya antibiotique zimwe na zimwe. Ubushakashatsi bwerekana ko imiti yihariye ya bagiteri, nka β-lactam, fluoroquinolone, na aminoglycoside, idakora gusa mu buryo bwihariye ahubwo inashingira ku gice cya metabolisme ya aerobic metabolism. Kubwibyo, kuba hari ogisijeni nibiranga metabolike biranga virusi ni ingenzi mugihe dusuzumye ingaruka zo kuvura antibiyotike.
Ibimenyetso bifatika byagaragaje ko urugero rwa ogisijeni nkeya rushobora kongera imbaraga za Pseudomonas aeruginosa kuri piperacillin / tazobactam kandi ko ibidukikije bya ogisijeni nabyo bigira uruhare mu kongera imbaraga za Enterobacter cloacae na azithromycine. Ku rundi ruhande, ibintu bimwe na bimwe bya hypoxique bishobora kongera ubukana bwa antibiyotike ya tetracycline. HBOT ikora nk'uburyo bufatika bwo kuvura butera metabolisme yo mu kirere no kongera kwanduza hypoxic tissue yanduye, hanyuma bikongera ubukana bwa virusi itera antibiyotike.
Mu bushakashatsi bwibanze, guhuza HBOT - gutangwa kabiri kumunsi mumasaha 8 kuri 280 kPa - hamwe na tobramycine (20 mg / kg / kumunsi) byagabanije cyane imitwaro ya bagiteri muri Staphylococcus aureus yanduye endocarditis. Ibi birerekana ubushobozi bwa HBOT nkubuvuzi bufasha. Iperereza ryakozwe ryerekanye ko munsi ya 37 ° C na 3 ya ATA y’amasaha 5, HBOT yongereye cyane ingaruka za imipenem kurwanya macrophage yanduye Pseudomonas aeruginosa. Byongeye kandi, uburyo bwa HBOT hamwe na cephazoline bwagaragaye ko bugira ingaruka nziza mukuvura Staphylococcus aureus osteomyelitis mubyitegererezo by'inyamaswa ugereranije na cephazolin yonyine.
HBOT kandi yongera cyane ibikorwa bya bagiteri yica ciprofloxacin irwanya biofilm ya Pseudomonas aeruginosa, cyane cyane nyuma yiminota 90 yo guhura. Uku kwiyongera guterwa no gushiraho ubwoko bwa ogisijeni ya endogenous reaction (ROS) kandi bugaragaza ibyiyumvo byiyongera muri mutoxidase-ifite inenge.
Mu ngero za pleurite yatewe na methicilline irwanya Staphylococcus aureus (MRSA), ingaruka zifatika za vancomycine, teicoplanin, na linezolide na HBOT zerekanye imbaraga ziyongera kuri MRSA. Metronidazole, antibiyotike ikoreshwa cyane mu kuvura indwara zikomeye za anaerobic na polymicrobial nko kwandura ibirenge bya diyabete (DFIs) ndetse no kubaga aho babaga (SSIs), byagaragaje imbaraga za mikorobe mu bihe bya anaerobic. Inyigisho z'ejo hazaza ziremewe gushakisha ingaruka ziterwa na antibacterial ya HBOT hamwe na metronidazole haba muri vivo ndetse no muri vitro.
Imiti igabanya ubukana bwa HBOT kuri Bagiteri Zirwanya
Hamwe nubwihindurize no gukwirakwira kwingutu, antibiyotike gakondo akenshi itakaza imbaraga mugihe runaka. Byongeye kandi, HBOT irashobora kwerekana ko ari ngombwa mu kuvura no gukumira indwara ziterwa na virusi zanduza imiti myinshi, bikaba ingamba zikomeye iyo imiti ya antibiyotike yananiwe. Ubushakashatsi bwinshi bwerekanye ingaruka zikomeye za bagiteri ziterwa na HBOT kuri bagiteri zirwanya indwara. Kurugero, iminota 90 HBOT isomo kuri 2 ATM yagabanije cyane iterambere rya MRSA. Byongeye kandi, mubyitegererezo, HBOT yazamuye antibacterial ingaruka za antibiyotike zitandukanye zanduza MRSA. Raporo zemeje ko HBOT igira akamaro mu kuvura osteomyelitis iterwa na OXA-48 itanga umusonga wa Klebsiella pneumoniae bitabaye ngombwa ko antibiyotike ziyongera.
Muri make, hyperbaric ogisijene ivura yerekana uburyo butandukanye bwo kurwanya indwara, byongera ubudahangarwa bw'umubiri ndetse binongerera imbaraga imiti igabanya ubukana. Hamwe nubushakashatsi bwuzuye niterambere, bifite ubushobozi bwo kugabanya ingaruka ziterwa na antibiyotike, bitanga ibyiringiro kurugamba rukomeje kurwanya indwara ziterwa na bagiteri.
Igihe cyo kohereza: Gashyantare-28-2025