Isixhobo esilungisiweyo siphucula ukulungelelanisa kwi-apnea yobuthongo obukhulu
Ukuba unobungozi bokulala obunzima , unokuba nomdla ekuhloliseni ukhetho lwezonyango. Enye into enjalo yi- hypoglossal nerve stimulator ebizwa ngokuba yi-Inspire. Yintoni ekhuthazayo? Ngubani omele acinge ukuwusebenzisa kwaye yintoni imiphumo emibi? Funda nge-inspirator ye-airway yokuphefumula kunye nokuba ingaba yonyango olufanelekileyo.
AbaPhicothi beeNdawo zokuKhuthaza
Umgqugquzeli ophefumlelweyo uyisistim esisetyenziswayo esisebenzayo esenza i-nerve ye-hypoglossal ukuqinisa imisipha yolwimi kunye nomoya ophezulu ngexesha lokulala, ukuphucula ukuhamba komoya nokunciphisa i-apnea yokulala.
Kuvunyiwe ukuba kusetyenziswe abo banomlinganiselo othobekileyo wokuphefumula ubuthongo obunzima (i- apnea-hypopnea index okanye i-AHI> 15) abangayithobeli unyango lwe- CPAP . Kuboniswe kulabo abane-index-mass mass (BMI) ngaphantsi kwe-32, ngaphandle kwabo bahluthe kakhulu.
Kukho izichaso ezincinci malunga nokusetyenziswa koPhulo oluphefumlelweyo. Ukuba ukuphazamiseka okubangela ukuba ugulo lwe-apnea lulale ngaphakathi kwempumlo, ngenxa yokugula okanye i- septum ye-nasal ekhethiweyo , ayiyi kusebenza. Ngokufanayo, ezinye i-skeletal anatomy (ezinjengomhlathi omncinci okanye omncinci ophantsi ) ingaba sisizathu sokungaqhubeki unyango. Ukuba i-toni ziyakwandiswa, utyando olujoliswe kule tyuki lunokuba lufanelekile. Iimeko ezithile ze-neuromuscular ezichaphazela ukukwazi ukugwinya okanye ukufaka isandla kwiintetho ezityhutywayo zingabakho ukungqinelana. Ukuba ama- MRIs amaninzi ayadingeka kwezinye iimeko zonyango, isixhobo asikhuselekile ukusetyenziswa kwezi zifundo.
Unyango aluvunyelwanga ukusetyenziswa kwabantwana.
Ukuchaza ukuChengela okufunekayo ukufakwa koMkhuthazo ophefumlelweyo
Ukuphefumlela kufuneka kufakwe ngexesha lotyando kunye ne-anesthesia jikelele kwindawo yokusebenza. Ukuqulunqa ukubekwa, enye inqubo ebizwa ngokuba yi-endoscopy yobuthongo obunokusetyenziswa kweziyobisi ingenziwa ukuze kuhlolwe i-anatomy yakho ye-airway kwaye ingaba ifowuni inokusebenza.
Ezinye izigulane, ezibizwa ngokuba ngabangezimpendulo, azizuzi nonyango. Oku kunokwenzeka ukuba uhambo lwenkqantosi lubonakala luwa phantsi ngokupheleleyo kumacala onke ngexesha le-endoscopy.
Emva kokuba uzimisele ukuba ngumviwa, indlebe eqeqeshiwe ngokukhethekileyo, impumlo, nomphimbo (ENT) oyingcali yenza utyando njengenkqubo yokuphulukisa. Intambo yokuvuselela ifakwe kuholele kwiimbilini ze-hypoglossal kwaye ifake enye yamasebe ayo ahlukeneyo. Isikhokelo sesibini sogqirha sibekwe eceleni kwembambo yentambo ukufumanisa ukuphefumula ukuze ulwimi lwe-muscle kunye ne-airway luvuselelwe ngexesha elifanelekileyo njengoko umoya uphelelwa kuwo. Ekugqibeleni, umgqugquzeli ngokwawo ubeka ngaphakathi kwindonga ephezulu yesifuba kwaye axhunyiwe kwiisensi . Inkqubo yonke ithatha malunga neeyure ezingama-2.
Emva kokuhlinzwa, izigulane zivame ukubuyela ekhaya ukuba azikho na iingxaki. Ininzi ayifuni ukusetyenziswa kweemithi zonyango zentlungu. Kunconywa ukuba umsebenzi okhuselayo ungagwenywa kwiiveki ezingama-2-3 emva kokuhlinzwa. Ukutya okuqhelekileyo kunokusetyenziswa ngaphandle kokulungiswa okuyimfuneko.
Ukuphumelela kokuPhucula nokuVavanywa kokuPhononongwa
Ukuphefumlela ukukhuthazwa kwe-airway kuyindlela yokwenza imodare ye-apnea yokuphazamiseka ngokukhawuleza xa i-CPAP inganyamezelwanga.
Ucwaningo luye lwabonisa ukuba kwiinyanga ezili-12 kunciphisa i-AHI ukusuka kwii-29.3 ukuya kwi-9.0 iziganeko ngeyure, ngokwemyinge, emele ukunciphisa ama-68%. Kufuneka kuphawulwe ukuba i-AHI eseleyo ihlala ibonisa ukuphefumula komzimba. Oku kungaphucula njengoko unyango lulungisiwe kwaye abaviwa abafanelekileyo bachongwa. Amanani kwi- Epworth sleep sleep scale kusuka 11 ukuya ku-6 unyango, ebonisa ukunciphisa ubuthongo bemini. Xa isicatshulwa sivaliwe, i-apnea yokulala ibuyele kakhulu.
Kukho iingxaki ezimbalwa ekubekwa kweso sixhobo soFupheko. Phantse i-25% yezigulane zikhalazo ngeentlungu ezinzima.
Phantse i-1/3 yezigulane zikhalaza ngolwimi okanye lukhuni, kodwa oko kwakubonakala kusombulula ngexesha. Phantse i-1% yintsholongwane yesikhumba okanye ukucasula (cellulitis) ukusuka ekutyunjweni kwaye enye i-1% kufuneka ibe nelinye uphando ukuze lilungise ukufakwa kwezixhobo.
Emva kokuba utyando lugqityiwe, izigulane zibuye zize zibone udokotela ogqirha ukuze ahlole i-post-operative kwiintsuku ezingama-7-10. Isixhobo sivuliwe kwinyanga e-1. Kunconywa ukuba ube nesifundo sokulala esisekuhlaleni kwiinyanga ezi-2 ukuvavanya ukusebenza kwayo kwaye uhlengahlengise izicwangciso.
Emva kokuba kufakwe, umgqugquzeli ophefumlelweyo angasebenza ngaphambi kokuba alele. Ngokuqhelekileyo ukulibaziseka kwemizuzu engama-30 ngaphambi kokuqalisa. Ukuba uvuka ebusuku, ifowuni inokumiswa. Ngokuqhelekileyo kusetyenziswa ukucima emva kweeyure eziyi-8.
Iindleko zonyango zingakanani? Isixhobo sokuphefumlela ngoku sithengela i-$ 30,000 ukuya kwii-40,000 zamawaka, ukuquka iindleko ezinxulumene nokuhlinzwa, kwaye ukutshintshwa kwebhetri kunokuhlawula enye i-$ 17,000. Ezi ndleko zingabhekiswa yi-inshurensi.
Ukuba unomdla wokufunda okungakumbi nge-inspirator yokuphefumula ephezulu njengendlela yokwenza unyango kuwe, qha ga mshelana nomboneleli ukuba uxoxe ngale ndlela. Iingcali zokulala nazo zinokunika iinkcukacha malunga nokunyanga okunye, kuquka nokusetyenziswa kakuhle kwe-CPAP, izixhobo zomlomo kunye nezinye iindlela zokwelapha.
> Imithombo:
> Decker, MJ. "Ukuxhaswa kombane kunye nokuphefumula ngexesha lokulala." UJ Appl Physiol . 1993 Sep; 75 (3): 1053-1061.
> "Uphefumle Ukhuthazo Oluphezulu Lomoya."
> Kezirian, EJ et al . "I-Hypoglossal Nerve Stimulation Iphucula i-Apnea yokulala." J Sleep Res . 2014; 23: 77-83.
> Safiruddin, F et al . "Impembelelo yokuThuthukiswa koMoya oPhezulu oKhuselekileyo wokuThuthuka kwe-Apnea yokulala kwi-Airway Ubukhulu." I-Eur Respir J. 2014 Sept.
> Strohl, KP et al . "I-Physiologic Basis ye-Arthritis ye-Apnea yokulala." Ngaba i-Rev Respir Dis . 1986 Oct; 134 (4): 791-802.
> Strollo, PJ kunye l. "Ukunyuka kwe-Air-stroke stimulation for the Prevention of Apnea Sleep." N Eng J Med . 2014; 370: 139-149.