Ukuhamba Ngaphansi Kwensikazi Ukuphatha Ukwehla Kwe-Apnea Uma i-CPAP ihluleka
Kulabo abangakwazi ukubekezelela ukucindezela okuqhubekayo kwe-airway (CPAP) ukuze baphathe i- obnetive obnetive apnea (OSA) , yiziphi izinketho zokuhlinzwa ezikhona? Kunezindlela ezimbalwa zokwelashwa, kodwa zingase zibe nokusebenza okulinganiselwe futhi kungase kungabi yilowo nalowo. Buyekeza ezinye zalezi zinketho nokuthi ngabe kungenzeka yini kuwe.
Uvulopalatopharyngoplasty (UPPP)
Lokhu kuye kwaba yindlela ejwayelekile yokuhlinza ukwelapha kubantu abane-OSA abanobumnene nabalinganiselwe abangakwazi ukubekezelela i-CPAP noma olunye ukuphathwa kwezokwelapha.
I-UPPP iyisuswe sokukhishwa kwezicubu ezingaphezu kwendiza engenhla, kufaka phakathi emlonyeni emlonyeni ophansi futhi emqaleni.
I-UPPP ihilela ukukhipha izicubu ezivela kumathoni , ukuvula , nokulula okunamandla (ophahleni lomlomo). Lezi zicubu zingase zivimbe umoya, futhi zithemba ukuthi ukususa kuzo kuzosusa le nkinga.
Kunezinkinga ezihlukahlukene ezingenzeka ngenqubo. Njenganoma iyiphi inqubo yokuhlinza, kunezingozi zobuhlungu, ukuphuma kwegazi nokutheleleka. Ngaphezu kwalokho, kungase kube nezinguquko ekhulwini, ukugxilwa kwe- pharynx (okuthiwa i-stenosis), ukuzwa komzimba wangaphandle emqaleni, noma ingozi yokuntuleka kwe-velopharyngeal (ukuphindwa kabusha kokudla, uketshezi noma amathe emmpeni lapho ukugwinya). Kungase kube nezinkinga zokubekezelela i-CPAP uma kudingekile ngemuva kwenqubo.
Ngeshwa, abantu abadala kuphela abangu-50% abaphathwa nge-UPPP banquma imicimbi yabo ye- apnea ne-hypopnea ngesigamu noma ngaphezulu.
Lezi zithuthukisi zingase zinciphise ngokuhamba kwesikhathi, ikakhulukazi ngokuzuza isisindo nokuguga. Kucatshangelwa ukwelashwa kwemigqa yesibili, emva kokwelapha kwe-CPAP, futhi kulabo abanokuvinjelwa kwezicubu zabo. Ngenxa yobuhlungu kanye nenzuzo enganiselwe, kancane kancane ayifuni njengesisombululo esiqondile.
Okunye ukuhlinza okubandakanya i- palate elithambile nakho kungenziwa, kufaka phakathi ukufakwa kwezinto eziqinisiwe ezibizwa ngokuthi insika yenkambiso.
Ukufakelwa kwe-Pacemaker yolimi olubizwa ngokuthi i-Inspire Nerve Stimulator
Inketho entsha yokwelashwa ebonakala sengathi iyathembisa ukufakwa kwe-pacemaker ngolimi olubizwa ngokuthi i- Inspire nerve stimulator . Isebenza emndenini we- hypoglossal futhi iyancipha ukuwa kwe-airway ngokuthola izinsimu zomlimi kanye nomoya ophezulu. Kukhonjiswe kulabo abahlulekile ukwelashwa kwe-CPAP ngokuba khona kokulinganisela ukuya ku-apnea enkulu yokulala (ene-AHI eyisisekelo engama-20 noma ngaphezulu). I-endoscopy yokulala yenziwa ukuze ihlolwe ukuthi ubani ongathola inzuzo.
I-Tracheostomy njenge-Option Last Resort Option
I-Tracheostomy iyinkimbinkimbi yokuhlinzeka ngaphambili kwe-windpipe ( trachea ), ngokubekwa kwe-tube yepulasitiki ukugcina lokhu kuvulekile, futhi isebenza kakhulu ekuphatheni i-OSA. Iqeda ukuvinjelwa kwe-airway engenhla, okuyinto imbangela eyinhloko yesifo. Lokhu kwakuyisisekelo esilandelayo sokwelashwa ekuphefumuleni okukhulu okulele ngaphambi kokusungulwa kwe-CPAP ukwelashwa ngo-1981.
Ngenxa yobuningi bayo obuningi, nokusebenza kwe-CPAP, akuvamile ukusetshenziselwa isikhathi eside.
Ngokuvamile igcinwe kulabo abanezinkinga ezisongela ukuphila ezifana ne-cor pulmonale, i-arrhythmias, noma i-hypoxemia enamandla (amazinga aphansi e-oksijeni) angeke alawulwe ngolunye ukwelashwa.
Ingabe Zikhona Ezinye Izinketho Zokuhlinza Ngolimi, UJaw, NeNose?
Kuye ngokuthi imbangela ye-apnea, ukuthuthukiswa kwe-genioglossus (ulimi), i-hyoid (chin bone) i-myotomy ngokumiswa, nokuthuthuka kwe- maxillomandibular (umhlathi) kungenziwa. Yonke yalezi zinqubo zilungisa ukukhubazeka kwamathambo okuhlobene nesikhumba namathambo asekela ulimi kanye nomhlathi omncane, futhi angeke kwenziwe ngaphandle kokungabikho kwalezi ziphutha.
Njengoba ukusebenza kuhluka, futhi ukuqina kwenqubo kungase kube phezulu, lezi zindlela zokuhlinzwa zenziwa kancane kancane.
Ukuhlinzeka ngokuhlinzwa kwangasese kungenziwa futhi ukulungisa i- septum yama-nasal ephukile , kodwa lokhu kuthuthukiswa ekuphumeni komoya ngaphakathi ekhaleni kungase kunganele ukuxazulula i-apnea yokulala.
Uma unesifiso sokukhetha ukwelapha okuhlinzekwayo okungasiza ekuthuthukiseni i-apnea yokulala, khuluma ngophethiloli wakho wokulala bese ucabangela ukudluliselwa kudokotela ohlinzayo ukuze kuhlolwe okwengeziwe izingozi nezinzuzo ezingase zibe khona kuwe.
Imithombo:
Cooper, DH et al. Umqulu we-Washington we-Medical Therapeutics. Edition 32. ULippincott Williams & Wilkins. p. 260.
Sher, AE et al. "Ukuphumelela kokuguqulwa kokuhlinzwa kwe-airway engenhla kubantu abadala abane-obstructive sleep apnea syndrome" Ukulala. 1996; 19: 156-177.
Li, KK et al. "Imiphumela yesikhathi eside yokuhlinzwa okuqhubekayo kwe-maxillomandibular." Ukulala Nokuphuza. 2000; 4: 137-139.