Indlela i-CPAP ne-BiPAP engayiphatha ngayo i-COPD
Kusho ukuthini uma udokotela wakho encoma "umoya wokuphuza umoya ongenayo?" Lokhu kuhluke kanjani ekungeneni kwe-ventilation? Iziphi izindlela ezifana ne-CPAP ne-BiPAP ezikhonjisiwe nokuthi ziyini izinzuzo nezingozi zokwelapha?
Kuyini Ukuphumula Okungapheli?
Ukuphuza umoya okungahambi kahle kuyindlela engcono yokuphuza umoya (ukufakwa endaweni ephuthumayo) kubantu abanezinkinga zokuphefumula okungapheli noma ukwehluleka ukuphefumula futhi abakwazi ukuphefumula ngokwabo ngokwanele.
Eyaziwa nangokuthi i-Non-invasive Positive Pressure Ventilation (i-NIPPV,) umoya ongenawo umoya ongenamandla usiza umuntu ekuphefumuleni ngokugcwele futhi kusize ukugcina okwanele okwenziwe nge-oxygen emzimbeni.
I-NIPPV inikeza ukwesekwa kwe-ventilatory kumuntu ngokusebenzisa imimoya engenhla. Ithuthukisa inqubo yokuphefumula ngokuhlinzeka ingxube yomoya kanye ne-oksijeni evela ku-generator yokugeleza ngokusebenzisa imaski ebuso ebusweni noma ebusweni. Ngenxa yokuthi amaphaphu, ngandlela-thile, avulekile ngokucindezeleka okuhle, kulula ukuthola umoya-mpilo ungene e- alveoli encane lapho ukushintshaniswa kwe-oxygen ne-carbon dioxide kwenzeka khona.
Emibhalweni engekho emitholampilo ungayifaka isithombe sakho sama-alveoli njengama-balloon amancane. Ukusebenzisa le support for ventilatory, "amabhaluni" ahlala kancane kancane ngemva kokuphefumula ukuze kube lula ukwandisa ngokuphefumula okulandelayo. Ngamanye amazwi, kufana nokugcwalisa ibhaluni futhi uqaphele ukuba ungavumeli umoya wonke uphume phakathi kokuphefumula ukwenza kube lula ukugcwalisa.
Indlela Ukungena Ngaphandle Kwemvelo Kuyasetshenziswa Ku-COPD
Abantu abanesifo esingenasifo se-pulmonary chronic obstructive (COPD) ngezinye izikhathi babikezwa umoya ongenawo umoya, njenge- CPAP (ukucindezela okuqhubekayo komoya ohamba phambili) noma i- BiPAP (i-bilevel positive airway pressure), ngesikhathi sokuqeda amandla ukubasiza baphefumule.
Ngokujwayelekile ehambisana nokuphathwa kwe-apnea yokulala , kokubili i-CPAP ne-BiPAP inikeza umoya-mpilo ocindezelekile ngokusebenzisa umcibisholo womgomo kumoya womuntu.
Ucindezelo luvimbela imisipha yomphimbo ukuba iwile futhi inqande ukugeleza komoya. Imishini ye-CPAP isethelwe ezingeni elilodwa lokucindezela elihlala njalo kulo lonke ubusuku, kuyilapho i-BiPAP inezinhlangothi ezimbili ezingcindezi, enye yokuvula futhi enye yokukhipha.
Ukuphumelela kokungenwa kwemvelo okungaphelele ku-COPD
Iphepha lokucwaninga le-2014 elishicilelwe eLancet lathola ama-NIPPV amanani okusinda ngcono kubantu abaneCOPD. Ucwaningo lwamazwe amaningi olwenziwa minyaka yonke, lwathola ukuthi abantu abaneCOPD abathola umoya ongenawo umoya ongenawo umoya babenengozi engaphansi kwamaphesenti angu-36 okufa.
Ezinye izifundo zibonisa ukuthi i-NIPPV esetshenziswe ngesikhathi sokukhushulwa okunamandla kwe- COPD kunciphisa isidingo sokungenwa kwe-endotracheal (ukungena kwe-mechanical invasive), futhi kuhlotshaniswa nesilinganiso esincane sokuhluleka kokwelapha kanye nokuhlala okufishane esibhedlela.
Ngaphezu kwalokho, isifundo se-2016 sitholile ukuthi i-NIPPV yesikhathi eside singabangela ukuthuthukiswa kokuphazamiseka kwegazi (ABGs), umsebenzi wamaphaphu, kanye nekhwalithi yokuphila ehlobene nempilo. Ngokuvamile, lezi zithuthukisiwe zazingcono kakhulu nge-ventilation ephezulu engenamandla (esebenzisa ukucindezela okukhulu okuphefumulela) kunokuba ne-NIPPV ephansi kakhulu.
Uma Kunconywa Ukungena Kwemvelo Kunconywa
Kubantu abaneCOPD abahluleka ukuphefumula ngokuphefumula ngenxa ye-ECOPD eyingozi kakhulu, ukungena kwe-pressure okungenayo engavumelekile kungasetshenziswa esikhundleni sokungenwa kokugcina kokugcina kweziguli ezikhethiwe.
Udokotela wakho angancoma i-NIPPV uma unesilinganiso esincane ukuya ku- dyspnea ejulile (ukuzwa okuphefumulayo), i-tachypnea (isilinganiso esiphezulu sokuphefumula,) kanye ne-hypercarbia (izinga eliphezulu le-carbon dioxide egazini,) elinama-pH aphakathi kuka-7.25 futhi 7.35.
Abantu akufanele baphathwe nge-NIPPV esikhundleni se-ventilation mechanical uma bengenakusebenza ngokwemithi ngenxa ye-hypotension ( ukucindezela kwegazi okuphansi ,) i- sepsis (ukutheleleka okukhulu okwenziwe konke okungaholela ekushaqeni,) i- hypoxia (ukuntuleka kwe-oksijini emathanjeni omzimba wakho ,) noma ezinye izifo ezisongela ukuphila, zibe nesimo sengqondo esibucayi, noma zibhekene nezicathulo ezidlulayo ezibabeka engozini enkulu yokufuna.
Ngokungafani nokuphuza umoya okungenasidingo, okudinga ukuqapha ekamelweni lokunakekelwa okujulile, ukuphuza umoya okungavamile kungenziwa njalo esigcemeni esibhedlela jikelele, unikeze abasebenzi ukuthi baqeqeshwe ngendlela efanele ekusetshenzisweni kwayo.
I-CPAP vs. BiPAP
Kokubili i-CPAP ne-BiPAP inikeza i-oksijeni ecindezelekile nge-mask, nakuba i-CPAP isethwe ngesilinganiso esisodwa lapho i-BiPAP inezilungiselelo ezimbili, eyodwa yokuphefumlelwa kanye nokuphela kwesikhathi.
I-BiPAP isetshenziswe kaningi kubantu abane COPD ngoba kulula ukuphuma ngokumelene nengcindezi ephansi. I-BiPAP ibuye ivumele izinguquko ngesikhathi.
Okubalulekile
Ukuphuza umoya okungavumelekile akufanelekile wonke umuntu futhi akupheli ngaso sonke isikhathi. Udokotela wakho kuphela onganquma ukuthi ungumuntu obhekene ne-ventilation engavamile.
Lokho kusho ukuthi izifundo zibonisa kokubili isidingo esinciphile sokungakapheli isikhathi sokugcina kanye nezinyathelo zokuphucula ezithuthukisiwe kubantu abaneCOPD abakhethiweyo be-NIPPV bayakhuthaza kakhulu. Ngaphezu kwalokho, uma sibheka ukusetshenziswa kwesikhathi eside kwe-ventilation engavumelekile ne-COPD, izinguquko ezinjengokuthuthukiswa kwegazi nokuphazamiseka komsebenzi, kanye nekhwalithi yokuphila engcono kakhulu kusanda kuphawulwa, ikakhulukazi ngokugeleza okuphezulu kwe-NIPPV.
Yiqiniso, ukuphuza umoya okungenasidingo kuyisilinganiso esisodwa kuphela ekuthuthukiseni izinga lakho lokuphila nokuphila nge-COPD enzima. Qiniseka ukuthi uzifundele amathiphu engeziwe ukuze ugcine umsebenzi wamaphaphu nesigaba III COPD .
> Imithombo
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> Kasper, uDennis, Anthony Fauci, uStephen Hauser, uDan Longo, noJameson. Izimiso zikaHarrison zeMithi yangaphakathi. I-New York: I-McGraw-Hill Education, 2015. Phrinta.
> Kohnlein, T., Windisch, W., Kohler, D. et al. Ukucindezeleka Okungavumelekile Ukuphuza Ukuphulukiswa Kwemithi Eyingozi Yokuvimbela Izifo Eziphuthumayo: I-Prospective, Multicentre, Randomized, Controlled Clinical Trial. I-Lancet. Imithi yokuphefumula . 2014. 2 (9): 698-705.
> Windisch, W., Storre, J., noT. Kohnlein. Ukushisa Okumnyama Okungavumelekile Ukuphuza Ukucindezeleka Okuhle KwamaCOPD. Ukuhlolwa kobuchwepheshe bemithi yokuphefumula . 2015. 9 (3): 295-308.