Idivaysi ehlonyelwe ithuthukisa ukulinganisela ekuphefumuleni okukhulu kokulala
Uma une- apnea yokuvimbela ukulala , ungase ube nesithakazelo ekuhloleni izinketho zokwelashwa. Enye indlela enjalo yi- stimulator ye-hypoglossal nerve okuthiwa i-Inspire. Kuyini Inspire? Ubani okufanele acabange ukuyisebenzisa nokuthi yimiphi imiphumela emibi? Funda nge-inspirator ephezulu yokuphefumula futhi ngabe kungaba yindlela yokwelapha efanele.
Izicelo zokubekwa okuphefumulelwe
I-Inspire stimulator iyisetshenziswa esakhiwe ngokuhlinzekwa esenza ukuthi inzwa ye-hypoglossal isebenze ukuqinisa imisipha yolimi kanye nomoya ophezulu ngesikhathi sokulala, ukuthuthukisa ukugeleza komoya nokunciphisa i-apnea yokulala.
Kuvunyelwe ukusetshenziswa kwalabo abanesifo esibucayi sokuphuza ukulala (i- apnea-hypopnea index noma i-AHI> 15) engavumelani ne- CPAP therapy. Kuboniswe kulabo abane-body mass mass (BMI) ngaphansi kuka-32, ngaphandle kwalabo abanokukhuluphala ngokweqile.
Kunokuphikisana okuncane okuhlobene nokusetshenziswa kwe-Inspire therapy. Uma ukuvinjelwa okuholela ekwenzeni i-apnea yokulala kuyenzeka ngaphakathi ekhaleni, ngenxa ye-allergies noma i- septum yangasese ephukile , ngeke kusebenze. Ngokufanayo, ezinye izici ze-skeletal (njengezinsizwa ezincane noma ezihlaziye phansi ) zingase zibe yisizathu sokungaqhubeki ukwelashwa. Uma ama-tonsils ekhulisiwe, ukuhlinzekwa okubhekiswe kulezi zicubu kungaba ngcono nakakhulu. Izimo ezithile ze-neuromuscular ezithinta ikhono lokugwinya noma ukufaka isandla enkulumweni enhle zingase zibe yi-contraindication. Uma i- MRIs ejwayelekile idingwa kwezinye izimo zezokwelapha, idivayisi ayiphephile ukusebenzisa lezi zifundo.
Ukwelashwa akuvunyelwe ukusetshenziswa ezinganeni.
Ukuchaza Ukuhlinzwa Okudingekayo Ukubekwa Kokugqugquzela Okukhuthazayo
Ukuphefumulela kumele kufakwe ngesikhathi sokuhlinzwa nge-anesthesia ejwayelekile ekamelweni lokusebenza. Ukulungiselela ukubekwa, enye inqubo ebizwa ngokuthi i-endoscopy yokulala nezidakamizwa ingenziwa ukuze ihlolwe indlela yakho yokuhamba emoyeni futhi ngabe idivayisi ingase iphumelele.
Ezinye iziguli, ezibizwa ngokuthi abangewona abaphendulayo, azizuzi ukwelashwa. Lokhu kungenzeka uma ukuhamba kwezindiza kubonakala sengathi kwehla ngokuphelele kuzo zonke izinhlangothi ngesikhathi senqubo ye-endoscopy.
Uma usuzimisele ukuba ngumfundi, indlebe eqeqeshiwe ngokukhethekile, impumulo, nomphimbo (ENT) isenza ukuhlinzekwa njengendlela yokuphulukisa iziguli. Ithebula lokugqugquzela libekwe eliholele emgodini we-hypoglossal bese lihlanganisa elinye lamagatsha alo okuhlukanisa. Ukuholwa kwesibili okubekwe eceleni kufakwe eceleni komgqa wokubamba ukuze kutholakale ukuphefumula ukuze ulimi lwe-muscle kanye ne-airway luvuselelwe ngesikhathi esifanele njengoba umoya udonsela ngaphakathi. Ekugcineni, i-stimulator ngokwayo ifakwe ngaphakathi kwesigodlo esiphezulu esifubeni futhi ixhunywe kumaseli . Yonke inqubo ithatha cishe amahora amabili.
Ngemuva kokuhlinzwa, iziguli zivame ukubuyela ekhaya uma zingekho izinkinga. Iningi alidingi ukusetshenziswa kwezidakamizwa zobuhlungu bezinambuzane. Kunconywa ukuthi umsebenzi okhuthele ugwenywe amasonto amabili ngemuva kokuhlinzwa. Ukudla okuvamile kungadliwa ngaphandle kokushintshwa okudingekayo.
Ukuphumelela Kokuphefumula Nokudingekayo Ukulandela Ukuhlola
Ukugqugquzela ukukhuthazwa kwe-airway kuyindlela yokwelapha ephumelela kakhulu yokuphefumula okunamandla okuvimbela ukulala lapho i-CPAP ingavumi.
Ucwaningo luye lwabonisa ukuthi ezinyangeni ezingu-12 kunciphisa i-AHI kusuka kumicimbi engu-29.3 kuya ku-9.0 ngehora, ngokwesilinganiso, emele ukunciphisa okungu-68%. Kumele kuqashelwe ukuthi i-AHI esalayo isalokhu ibonisa ukuphefumula okuncane kokulala. Lokhu kungathuthuka njengoba ukwelashwa kulungiselelwe futhi kubonakala ukuthi abafanelekile bayabonakala. Izibalo zokulala kwe- Epworth zikhuphuke kusukela ku-11 ukuya ku-6 zelashwa, zikhomba ukunciphisa ukulala kwelanga. Uma idivayisi ivaliwe, i-apnea yokulala ngokuvamile ibuya.
Kunezinkinga ezimbalwa ekubekeni kwe-Inspire device. Cishe iziguli ezingu-25% zikhononda ngobuhlungu obukhulu kakhulu.
Cishe 1/3 yeziguli zikhononda ngolimi olungathandeki noma ukuhlukunyezwa, kepha lokhu kubonakala kuxazulula ngesikhathi. Cishe kube ngu-1% ukutheleleka kwesikhumba noma ukucasuka (cellulitis) kusuka ekuhlinzekeni futhi enye i-1% kwadingeka ibe nokunye ukuhlinzwa ukulungisa ukufakwa kwedivayisi.
Ngemuva kokuhlinzwa sekuphelile, iziguli zibuyela emuva ukubona udokotela ohlinzayo ngenkokhelo yokuthunyelwe ngemuva kwezinsuku ezingu-7-10. Idivayisi ivaliwe ngenyanga eyi-1. Kunconywa ukuthi ube nesifundo sokulala phakathi nendawo ezinyangeni ezingu-2 ukuze uhlole ukusebenza kwayo futhi ulungise izilungiselelo.
Uma sekubekiwe, i-Inspire stimulator ingasetshenziswa ngaphambi kokulala. Ngokuvamile kubambezeleka kwemizuzu engu-30 ngaphambi kokuqala kokuvuselela. Uma uvuka ebusuku, idivayisi ingamiswa okwesikhashana. Kuvame ukusethwa ukuvala emva kwamahora angu-8.
Kubiza malini? I-Device Inspire njengamanje idinga cishe amaRandi angu-30,000 kuya ku-$ 40,000 ukufaka, kufaka phakathi izindleko ezihlobene nokuhlinzwa, futhi ukushintshwa kwebhethri kungadala enye imali engu-R17,000. Lezi zindleko zingase zibekwe ngumshuwalense.
Uma unesithakazelo ekufundeni okwengeziwe nge-Inspirator ephezulu ye-airway stimulator njengendlela yokwelashwa kwakho, xhumana nomhlinzeki eduze kwakho ukuze uxoxe ngalolu khetho. Abachwepheshe bokulala banganikeza ulwazi mayelana nemithi ehlukile, kuhlanganise nokusetshenziswa okusebenzayo kwe-CPAP, izinto zokusebenza zomlomo, nezinye izindlela zokwelashwa.
> Imithombo:
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> "Ukugqugquzela Ukukhuthazwa Komoya Ophezulu."
> Kezirian, EJ et al . "I-Hypoglossal Nerve Stimulation Ukuthuthukisa Ukuvimbela I-Apnea Yokulala." J Sleep Res . 2014; 23: 77-83.
> Safiruddin, F et al . "Umphumela Wokukhuthazwa Kwe-Airway Ukuvimbela Ukuvimbela Ukulala Nge-Apnea Nge-Airway Ubukhulu." I-Eur Respir J. 2014 Sep.
> Strohl, KP no-al . "I-Physiologic Basis of Therapy ye-Sleep Apnea." Ingabe i-Rev Respir Dis . 1986 Oct; 134 (4): 791-802.
> Strollo, PJ kanye l. "Ukukhushulwa Kwangaphandle Kwezokuvimbela Ukuvimbela Ukulala I-Apnea." N Eng J Med . 2014; 370: 139-149.