Uke wazama imithi ehlukahlukene ukuze unciphise izimpawu zakho zeCOPD futhi akukho okubonakala sengathi kusebenza? Uma ukwelashwa okujwayelekile kwe- COPD kwehlulekile wena futhi uqhubeka nokulwela ukuphefumula, ukwelashwa okwelashwa kwe-COPD kungaba yinto okufanele uxoxisane nomhlinzeki wakho wokunakekela oyinhloko.
Izinhlobo Zokungenelela Okuhlinzekwayo
Kunezinhlobo ezintathu zezinqubo zokuhlinzwa ezingase zikhethwe ngesiguli se- COPD esiphezulu , esinezibonakaliso ezinzima.
Bullectomy
Ama-bullae akhuliswa (izindawo ezingaphezu kuka-1 cm) zomoya ngaphakathi kwamapayipi ngokuvamile ngezinga eliphansi ukuya ku-COPD. Ziwumphumela wokuvimbela ngaphakathi kwe-tubon bronchiole noma i-bronchus. I-bullae enkulu idala ukucindezela okukhulu phezu kwesisekelo, izicubu zamaphaphu enempilo ezenza lokho kuyanciphisa ukugeleza kwegazi kanye ne-oksijeni emaphashini. Lokhu kubangela ukuwohloka kokuphefumula.
Uma i-bullae isuswe ngenqubo yokuhlinzwa ebizwa ngokuthi i- bullectomy , ama-sacs emoyeni enempilo emaphashini angakwazi ukukhula nokuphefumula kuzoba lula.
Ovame ukhetho lwe-bullectomy kuhlanganisa lezo ziguli ezihlushwa i- dyspnea enamandla , i- hemoptysis noma izifo eziphindaphindiwe ze-bullae. Udokotela wakho anganikeza izivivinyo ezilandelayo njengendlela yokuhlola umsebenzi wakho wamaphaphu ngaphambi kokuhlinzwa:
- I-x-ray yesifuba
- I-Chest CT
- Ukuhlolwa kokusebenza kwamapulmonary
- I-Ventilation / perfusion (VQ) iskena
- I-Angiography yamaphaphu (kwezinye iziguli)
Izinto ezingase ziphikisana ne-bullectomy zihlanganisa:
- Ukuba khona kwama-bullae amaningi, amancane
- I- emphysema ethuthukile emaphashini angasondelene nawo
- Hypercapnia
- Cor pulmonale
- Uma i- FEV1 ingaphansi kuka-40% okubikezelwe noma i-500 ml
Nakuba le nqubo ingenzeka, i-bullectomy ayitholakali eyenziwa, njengengxenyana encane kakhulu yeziguli ezine-emphysema ene-giant bullae.
Ngokusho kweChest , ingozi yokufa ngesikhathi noma ngemuva kokuhlinzwa kuthiwa ngu-0-22% kumacala ashicilelwe. Ezinye izinkinga zihlanganisa ukuvuza kwe-air eside, ukutheleleka kwamaphaphu nokuhluleka kokuphefumula .
Ukwelashwa Kwe-Volume Lung (LVRS)
I-LVRS ihilela ukukhipha cishe ama-30% wezicubu zamaphaphu ezigulayo ukuze amathishu enemaphapha enempilo angasebenza ngokuphumelelayo. Kuyindlela eyenza abantu abane-emphysema enamandla baphefumule kangcono ukuze bakwazi ukuletha ukuphila okukhiqizayo.
Iziguli ezizozuza kakhulu kule nqubo yilabo abane-emphysema enamandla ema-lungs angaphezulu emaphashini, abayisengozini esincane sokuhlinzwa futhi abangazange baphendule kahle ekuvuselelweni kwamapulangwe ngaphambi kokuhlinzwa. Impumelelo ye-LVRS ihlobene ngqo nokukhethwa ngokucophelela kweziguli ezihlangabezana nalezi zinqubo.
Ucwaningo olunzulu luphetha ngokuthi labo abane-emphysema enamandla e-lobes engenhla yamaphaphu kanye nengozi ephansi yokuhlinzwa, kodwa abangaphenduli ekuvuselelweni ngaphambi kokuhlinzwa, bayozuza kakhulu ku-LVRS. Ucwaningo lubonise nokuthi iziguli ezisengozini enkulu yokuhlinzwa kanye nalabo abane-emphysema kwezinye izingxenye zamaphaphu bazoba nenzuzo encane futhi bangalimazwa (izifundo ze-NETT).
Ukuze kucatshangelwe i-LVRS, iziguli kufanele zifeze lokhu okulandelayo:
- Ukuba nomlando we-emphysema
- Ukubhema izinyanga ezine ngaphambi nangaphakathi kwenqubo yokuhlola
- Ayinayo i-LVRS yangaphambilini
- Akuzange kube ne-artery coronary yangaphambili noma ezinye izimo zenhliziyo
Ukwengeza, isiguli kumele sitholwe ukwelashwa kwepulmonary kokubili ngaphambi nangemva kokuhlinzwa.
Kumele kucaciswe ukuthi ngenkathi ukuhlinzekwa kwe-LVRS kuboniswe ukusiza ukuthuthukisa ikhono lokuphefumula, amandla emaphaphu, kanye nekhwalithi yonke yokuphila. Akulondolozi ukusinda.
Ukufakelwa kwe-Lung
Ukufakelwa kwama-lung kwenziwa njengendlela yokwelapha okuhlinzekwa ngezifo ezihlukahlukene zamaphaphu kuhlanganise ne-pulmonary fibrosis ne- blood pressure.
I-COPD, noma kunjalo, iyisibonakaliso esivame kakhulu sokufakelwa kwesiphuphu.
Iziguli ezingaphansi kweminyaka engama-65 ubudala ekupheleni kwesigaba se-COPD ngokungabikho kwezifo eziphawulekayo kufanele zibhekwe ukuhlolwa kokufakelwa kwamaphaphu nokudluliselwa. Ezinye izinhlelo zizocubungula iziguli ezineminyaka engaphezu kwengu-65, kepha izindlela eziqinile kufanele zihlangane ukuze zicutshungulwe.
Labo abazovuna umvuzo ophakeme kakhulu wokufakelwa kwamaphaphu kufaka iziguli ezibonisa lokhu okulandelayo:
- I-FEV1 ye-20% noma ngaphansi kwebikezelo
- Hypercapnia
- Labo abane-hypertension yamapayipi ehlobene
- Labo abanethuba lokusinda babeyoba mkhulu uma bephethe ukufakelwa kwamaphaphu kunokuba bengakwenzi
Ukwengeza kwalokho, ukhetho lokufakelwa okungaba khona kufanele lube yi-ambulatory, isisindo esifanele, futhi lukhuthazwe kakhulu ngesistimu yokweseka okwanele.
Kuyathakazelisa ukuphawula ukuthi i-bullectomy yangaphambili noma i-LVRS akuyona inkinga yokufakelwa kwe-lung. Lezi zinqubo zingasiza ekusebenzeni njengebhuloho ekufakweni kwamaphaphu kwezinye iziguli.
Ngenkathi ukufakelwa kwamaphaphu kungaphuthuli ukusinda kumagciwane e-COPD, izinzuzo ezivela ekutheni ukufakelwa kwamaphaphu kufanele zibukwe ngokwemisebenzi yokusebenza kanye nekhwalithi yokuphila.
Okubalulekile
Umthwalo wokuthi i-COPD ibeka phezu kwesiguli ingathinta kakhulu izinga labo lokuphila. Kulabo abane-COPD esiphelile engaphenduli kahle imithi, ukungenelela kokuhlinzwa kungase kube yindlela yokukhetha. Umhlinzeki wakho oyinhloko kuphela wokunakekelwa anganquma ukuthi uzokwenza yini ukhetho olufanele lolu hlobo lohlinzekwa.
Imithombo
I-American Lung Association. I-LVRS Fact Sheet. Agasti 2005.
I-American Thoracic Society, i-European Thoracic Society. 2004. Izilinganiso zokuxilongwa nokuphathwa kweziguli ezine-COPD. Inguqulo 1.2. 2005. Itholakala ku-http: //www.thoracic.org.
Huang FRCPC, Max MD, Singer, FRCPC, uLieanne G. MD. "Ukungenelela Okuhlinzekwayo kwe-COPD". Ukuguga kwe-Geriatrics. 2005; 8 (3): 40-46.
Fishman A, Martinez F, Naunheim K, Piantadosi S, Uhlakaniphile R, Ries A, et al; "I-National Emphysema Treatment Trial Research Group. Isivivinyo esingahleliwe siqhathanisa nokuhlinzekwa kwe-lung-ukunciphisa ukwelapha ngezokwelashwa kwe-emphysema eqinile". N Engl J Med 2003; 348 (21): 2059-2073.
U-Hosenpud JD, uBennett LE, uKeck BM, u-Edwards EB, u-Novick RJ. Imiphumela yokuxilongwa ekusizeni okuqhubekayo kokufakelwa kwamaphaphu ukuphela kwesigaba se-lung phase. Lancet 1998; 351 (9095): 24-27.
I-National Emphysema Treatment Trial Research Group. Iziguli ezisengozini enkulu yokufa ngemva kokuhlinzwa kwe-lung-volume-reduction. N Engl J Med 2001; 345 (15): 1075-1083.
I-Snider G. Ukunciphisa i-pneumoplasty ye-emphysema enkulu kakhulu: impikiswano yokuhlinza ukwelashwa kwe-emphysema engenabuthi. I-Chest 1996; 109 (2): 540-548.