Uma othile ebuza ukuthi yini okukuvimbela ekusebenziseni uma une- COPD , kungenzeka ukuthi ungasho i- dyspnea (ebizwa ngokuthi ukuphefumula). Ku-COPD, ukukhathala kwe-dyspnea ne-muscle yizona ezivimbela kakhulu ukuqala uhlelo lokuzivocavoca . Lokhu kuyadabukisa ngoba indlela engcono kakhulu yokuthuthukisa ukubekezela kokuzivocavoca nokunciphisa ukuphefumula ku-COPD ukuqhuba njalo.
Ngakho-ke, uyakwazi kanjani ukusebenzisa uma imisipha yakho iphela futhi awukwazi ukubamba umoya wakho?
Nakuba kufanele uhlole njalo nodokotela wakho ngaphambi kokusebenzisa noma yiziphi izindlela ezibalulwe ngezansi, amasu alandelayo angakusiza ukuba usebenzise isikhathi eside futhi unciphise ukuphefumula ngesikhathi sokuvivinya umzimba:
Ukungahambi Kokucindezela Okungenawo Okungavamile
Nakuba kungenakwenzeka, izifundo zibonise ukuthi abantu abavame ukusebenzisa njalo ukusebenzisa ingcindezi enhle yokucindezela umoya (NIPPV) bangaba nenzuzo yokuqeqeshwa kulabo abangenalo. Akukhona kuphela ukuthi i-NIPPV ivumela iziguli ze-COPD ukuthi zisebenzise isikhathi eside, kodwa zikwazi ukufinyelela umthwalo ophezulu wokusebenza ngesikhathi sokuzivocavoca ukudlula lapho zibonisa ukungasebenzi. Sethemba ukuthi intuthuko kwezobuchwepheshe bezokwelapha izoholela emoyeni okwenziwa ngokunethezeka ngesikhathi se-NIPPV, kunokuba kube nemaski enesisindo esifanele.
Ukusebenzisa i-NIPPV ebusuku kungase kube impendulo ewusizo kakhulu.
Ucwaningo lubonisa ukuthi uma kuhlanganiswa nokuvuselelwa kwe-pulmonary, iziguli ezisebenzisa i-nocturnal NIPPV zibonisa ukuthuthukiswa ekuvivinyeni kwamaminithi angu-6 , i- FEV1 , i- hyperinflation eguquguqukayo kanye negesi egazini legazi . Iziguli zingase zibone ngcono ekusebenzeni kwazo ngokomzimba, ukusebenza komphakathi, impilo yengqondo nokuqina.
Ukukhuthazwa kagesi
Iziguli ze-COPD ezinamandla okugcina imisipha nobuhlungu bemisipha zingase zizuze ekuvuseleleni kwamandla kagesi we-neuromuscular (hf-NMES). Ucwaningo lubonisa ukuthi kuthuthukisa ikhono lokuzivocavoca ngokuvumela iziguli ukuba zibekezelele izinga eliphakeme lokuzivocavoca. Kungase futhi kuthuthukise ukuphefumula.
Indlela engcono kakhulu yokusondela ku-hf-NMES ukuyisebenzisa ngaphambi kokushayiswa kwezicubu (evamile ku-COPD ephakeme) kwenzeka, nakuba kungase kuzuze iziguli ezikhutshazeke kakhulu ngokukhubaza i-dyspnea, futhi.
Ukuvuselela kagesi kungasetshenziswa ekhaya, noma njengengxenye yohlelo oluhlelekile lokuvuselelwa kwamapulmoni.
I-Oxygen Supplementation
Ucwaningo olunyathelisiwe eTrara lusikisela ukuthi oksijithali okwengezayo ngesikhathi sokuvivinya umzimba kuhlinzeka kuphela ukukhululeka okuvela e-dyspnea futhi akwenzi lutho ekuthuthukiseni ukubekezela kokuzivocavoca eCOPD. Kodwa-ke, izifundo ezalandela zibonisa ukuthi zingathuthukisa ukukhuthazela kokuzivocavoca, ukunciphisa umbono we-dyspnea nokunciphisa i-lung hyperinflation ezigulini ezinezinga elivamile le-oksijeni yegazi.
Kukhona ukucatshangelwa okuqhubekayo mayelana nokuthi iyiphi indlela yokulethwa - i- nasal cannula noma i- transtracheal - ingcono kakhulu ngesikhathi sokuvivinya umzimba. Ucwaningo olusekela ukusebenzisa indlela ye-transtracheal luphelelwe yisikhathi; Kodwa-ke, abaxhasi be-transtracheal oxygen delivery baqhubeka benenkolelo yokuthi isebenza kahle kakhulu.
Ukuvuselelwa kwePulmonary
Ukulungiswa kwamapulmonary yingxenye ebalulekile yokwelapha kwe-COPD futhi kunconywa kuzo zonke iziguli ezisezingeni eliphansi ukuya ezigabeni ezinzima ze -COPD. Ukuvuselelwa kwamapulmonary kungasiza iziguli ze- COPD :
- Thuthukisa ukubekezela kokuzivocavoca
- Ncipha ukuphefumula
- Thuthukisa izinga lokuphila
- Nciphise isikhathi sokubhedlela kanye nesibhedlela
- Nciphisa ukukhathazeka nokucindezeleka
- Thuthukisa ukusebenza kwengalo
- Thuthukisa amandla omzimba wokuphefumula (uma kuhlangene nokuvivinya umzimba jikelele)
Imithi
Kunemithi eminingi etholakalayo eye yaboniswa ekuthuthukiseni ukubekezelelana kokuzivocavoca kanye nokunciphisa ukuphefumula okubangelwa ukuzivocavoca ku-COPD.
Okuvame ukufundiswa yilokhu:
- I-Albuterol - Esinye sezici ze-COPD ukukhawulelwa kwe-airflow. I-hyperinflation ye-Dynamic ingumphumela omkhulu wokunciphisa kwe-air ngesikhathi sokuzivocavoca ku-COPD kanye nomthelela obalulekile wokuphefumula. Ukucwaninga kubonisa ukuthi i-albuterol eyabhalisiwe, i-agonist ye-beta-short-acting i-agonist, inciphisa i-hyperinflation ehlobene nokuzivocavoca umzimba futhi ithuthukise eminye imisebenzi ebalulekile ye-ventilatory.
- I-Spiriva - Ehlanganiswe nokuvuselelwa kwe-pulmonary, i- anticholinergic bronchodilator Spiriva (tiotropium) ithuthukisa ukuvivinya umzimba, ukuphefumula, nesimo sezempilo kuqhathaniswa nokusebenzisa ukuvuselelwa kwamaphalitha yedwa.
- I-Salmeterol - i-Salmeterol, i-agonist ye-beta ende ende ende, ithuthukisa ukuphefumula ngesikhathi sokuzivocavoca kodwa akudingi ukwandisa isikhathi sokusebenza.
- I-bromide ye-ipratropium ene-Nebulized - Uma kuqhathaniswa ne-placebo, i-ipratropium bromide nebulized (i-anticholinergic) ayandisa ukuvivinya umzimba isikhathi eside, inciphisa i-dyspnea futhi iyanciphisa i-hyperinflation enamandla. Ukwengeza, ngemuva kokusebenzisa i-ipratropium bromide, iziguli ezifundweni zemitholampilo zenze ukwanda kwe-FEV1, i-FVC nomthamo wokuphefumula (umthamo womoya ongagxiliswa emva kokuphuma okuvamile).
Ukuqeqeshwa Kwesikhashana
Ngesikhathi sokuqeqeshwa kwesikhashana, isiguli siphinda ukulandelana kokuzivocavoca okuphezulu okusetshenziselwa ukuvivinya umzimba (okufundwa kakhulu ku-COPD) noma ukuphumula. Isikhathi sokuqeqesha emiphakathini ye-COPD emiphakathini emihle yokuqeqeshwa kwezinye iziguli futhi kuvame ukusetshenziswa njengengxenye yohlelo lokuvuselela i-pulmonary.
Imithombo
UBelman MJ, et.al. I-bronchodilators engabhalisiwe iyanciphisa i-hyperinflation enamandla ngesikhathi sokuzivocavoca ezigulini ezinezifo ezingavimbayo zomshoshaphansi. Am J Respir Crit Care Med1996; 153: 967-75
I-Calverley, i-PMA. Ukuphefumula ngesikhathi sokuvivinya umzimba ku-COPD: izidakamizwa zisebenza kanjani? I-Thorax 2004; 59: 455-457 i-doi: 10.1136 / thx.2004.023150.
Casaburi R., etal. Ukuthuthukisa ukuvivinya umzimba ngokuhlanganiswa kwe-tiotropium nokuvuselelwa kwamaphalenda kuziguli ezineCOPD .CHEST 2005; 127 (3): 809-817.
Napolis, uLara Maris et al. Ukuvuselelwa kwamagesi we-neuromuscular kukuthuthukisa ukuvivinya umzimba ekutheni ukubekezelelana kwezifo eziphethwe yi-chronic obstructive pulmonary izifo ezinomzimba okhululekile ongagcini kahle. Imitholampilo [ku-intanethi]. 2011, vol.66, n.3 [okushiwo ngo-2012-07-02] 401-406.
Neder, JA et. al. Ukuvuselela kwe-electrical neuromuscular electrical njengendlela entsha yokuvuselela iziguli ezikhubazekile kakhulu ezine-chronic obstructive pulmonary disease (COPD). I-Thorax 2002; 57: 4 333-337 i-doi: 10.1136 / i-thorax.57.4.333.
U-O'Donnell DE, et.al. Ama-correlate e-spirometric ekuthuthukiseni ukuvivinya umzimba emva kwe-anticholinergic therapy lapho isifo se-chronic obstructive pulmonary. Am J Respir Crit Care Med 1999; 160: 542-9.
Schönheit, uKöhnlein T. et. al. Ukuphuza umoya okungenasidingo ekuvuselelweni kwamapayipi kweziguli ze-COPD. I-Respir Med. 2009; 103 (9): 1329.
Somfay, A. et.al. Umphumela we-Dose-response of oksijeni ku-hyperinflation nokuzivocavoca ekuguleni iziguli ezingekho ze-COPD ezingenayo i-hypoxide. ERJ 1 kuJulayi 2001 vol. 18 cha. 1 77-84.
Wesmiller SW et.al. Ukubekezelelana kokuzivocavoca ngesikhathi se-nasal canal kanye ne-transtracheal oxygen delivery. Ingabe i-Rev Respir Dis. 1990 Mar; 141 (3): 789-91.