Ngaba uye wazama iintlobo zamachiza ukunciphisa iimpawu zakho zeCOPD kwaye akukho nto ibonakala isebenza? Ukuba umgangatho osetyenziswayo weCOPD ukwenzekile kwaye uqhubeke ulwa nomoya wokuphefumla, unyango olukhuselweyo lweCOPD lube yinto ekufuneka uxoxe ngayo nomboneleli wakho oyintloko.
Iintlobo zoLungiso lokuPhepha
Kukho iintlobo ezintathu zenkqubo yokuqapha ezinokuthi zikhethwe ngumguli ngesigxina sokugqibela seCOPD, ophethwe yimpawu ezinzima.
Bullectomy
I-bullae ikhulisiwe (ngaphezulu kwe-1 cm) izikhala zomoya ngaphakathi kwemiphunga edlalwa ngamanye amaxesha kwi-COPD. Ziyiphumo lokukhupha phakathi kwe-bronchiole tubes okanye i-bronchus. I-bullae enkulu idala ukunyanzeliswa okukhulu kwi-underlying, izifo zamaphaphu ezempilo eziye zinciphisa ukuhamba kwegazi kunye ne-oksijini emiphakeni. Oku kubangela ukunyuka kokuphefumula.
Emva kokuba i-bullae isuswe yindlela yokucoca ebizwa ngokuba yi- bullectomy , i-sac air air enempilo kwimiphunga iyakwandisa nokuphefumla iya kuba lula.
Umviwa oqhelekileyo we-bullectomy uquka ezo zigulane ezinobunzima be- dyspnea, i- hemoptysis okanye i-bullae yezifo eziphindaphindiweyo. Ugqirha wakho unokuyalela ezi zilandelayo mvavanyo njengendlela yokuhlola umsebenzi wakho wemiphunga ngaphambi kokuhlinzwa:
- I-xst ray
- ICape CT
- ImiSebenzi yovavanyo
- Ukuphuza umoya / ukucoca (VQ) ukutshintshwa
- I-Angiography yemiphunga (kwezinye izigulane)
Izinto ezichasene nokuba ne-bullectomy ziquka:
- Ubuninzi be-bullae encinane
- I- emphysema ephakamileyo kwi-lung ne-bulls esondeleyo
- Hypercapnia
- Cor pulmonon
- Xa i- FEV1 ingaphantsi kwe-40% echazwe okanye 500 ml
Nangona le nkqubo inokwenzeka, i-bullectomy ayinakwenziwa ngokungaqhelekanga, njengengxenyana encinane kakhulu yezigulane ezine-emphysema zinomthi omkhulu.
Ngokutsho kweChest , umngcipheko wokufa ngexesha okanye emva kokuhlinzwa, ngu-0-22% kwiimeko ezipapashiweyo. Ezinye iingxaki ziquka ukuvuza kwexesha elide, ukusuleleka kumaphaphu kunye nokungaphumeleli kokuphefumula .
Ukuvuthwa kweVoluction Surgery (LVRS)
I-LVRS ibandakanya ukususa malunga ne-30% yeethambo eziphazamisayo zemiphunga ukuze izicubu zemiphunga eziphilileyo zisebenze ngokufanelekileyo. Yinkqubo inceda abantu abane-emphysema enamandla ukuphefumula kangcono ukuze bakwazi ukukholisa ubomi obunemveliso.
Izigulane eziza kuxhamla kakhulu kule nkqubo zizo zi-emphysema ezinzulu kwi-lobes ephezulu yemiphunga, eyingozi enkulu yokuhlinzwa kwaye abangazange baphendule kakuhle ukulungiswa kwempompo ngaphambi kokuhlinzwa. Impumelelo ye-LVRS ihambelana ngqo nokukhethwa ngokuthe ngqo kwezigulane ezihlangabezana nale miqathango.
Ucwaningo olukhulu luphelile ukuba abo abane-emphysema enamandla kwi-lobes ephezulu yomphunga kunye nomngcipheko ophantsi wokuhlinzwa, kodwa abangaphenduliyo ekubuyiselweni ngaphambi kokuhlinzwa, baya kuzuza kakhulu kwi-LVRS. Uphononongo luye lwabonisa ukuba izigulane ezisengozini enkulu yokuhlinzwa kwaye abo abane-emphysema kwezinye iindawo zomphunga baya kuba neenzuzo ezincinci kwaye banokwenzakala (izifundo ze-NETT).
Ukuqwalaselwa nge-LVRS, izigulane kufuneka zizalise iikhrayitheriya ezilandelayo:
- Ukuba nomlando we-emphysema
- Ukubhema kweenyanga ezine ngaphambi kokuya kwenkqubo yonke yovavanyo
- Ayinayo iLVRS yangaphambili
- Ukungazange ube ne-coronary artery bypass okanye iimeko ezithile zeentliziyo
Ukongeza, isigulane kufuneka sithobele unyango lwepulmonary kokubili nangaphambi kokuhlinzwa.
Kufuneka icaciswe ukuba ngelixa uvavanyo lwe-LVRS luboniswe ukunceda ukuphucula amandla okuphefumula, amandla omphunga kunye nobomi bomgangatho wonke. Akulondolozi ixesha lokusinda.
Ukufakelwa kwezityalo
Ukufakelwa kweembopho kwenziwa njengendlela yokungenelela ngoncedo lwezifo ezahlukahlukeneyo zezifo zemiphunga kuquka i-pulmonary fibrosis kunye negazi legazi.
I-COPD, nangona kunjalo, isona sibonakaliso esivame kakhulu sokufakelwa kwemiphunga.
Izigulane ezingaphantsi kweminyaka engama-65 ubudala kunye ne-COPD yokugqibela ekungabikho kwezinye izifo ezibalulekileyo kufuneka ziqwalaselwe ukuhlolwa kokuphucula umphunga nokuthunyelwa. Ezinye iinkqubo ziya kuqwalasela izigulane ezineminyaka engama-65 ubudala, kodwa iimpawu eziqinileyo kufuneka zidibeneyo ukuze ziqwalaselwe.
Abo bavuna ukufumana umvuzo ophezulu kwi-pulpment plant, kubandakanya izigulane ezibonisa oku kulandelayo:
- I-FEV1 ye-20% okanye ngaphantsi kwe-predicted
- Hypercapnia
- Abo baxinzeleleke kwi-pulmonary blood pressure
- Abo babe nethuba lokusinda laliza kuba likhulu xa bephethe ukufakelwa kwemiphunga ngaphandle kokuba bengenalo
Ukongezelela, abaviwa abanokutyala kufuneka babe yi-ambulatory, isisindo esifanelekileyo, kwaye bakhuthaze kakhulu ngeenkqubo ezifanelekileyo zokuxhasa.
Kuyathakazelisa ukuqaphela ukuba i-bullectomy yangaphambili okanye i-LVRS ayikho inkcazo yokufakelwa kwemiphunga. Ezi nkqubo zinokukunceda ekusebenzeni njengebhulorho ekutshaleni imiphunga kwezinye izigulane.
Nangona ukutshintshwa kwemiphunga akuphuculisi ukusinda kwizigulane zeCOPD, izibonelelo ezivela ekutshalweni kwemiphunga kufuneka zijongwe ngokwemiqathango yokusebenza kunye nekhwalithi yobomi.
Ngaphantsi
Umthwalo okhutshwa yiCOPD kwisigulane unokuchaphazela kakhulu umgangatho wobomi. Kwabo abaneCOPD engapheliyo engaphendulanga kakuhle kumachiza, ukungenelela ngonyango kunokukhetha. Umboneleli wakho oyintloko kuphela unokugqiba ukuba ngaba uza kuba ngumviwa ofanelekileyo kulolu hlobo lotyando.
Imithombo
I-American Lung Association. I-LVRS Fact Sheet. Agasti 2005.
I-American Thoracic Society, i-European Thoracic Society. 2004. Imigangatho yokuxilongwa nokuphathwa kwezigulane ezineCOPD. Version 1.2. 2005. Kufumaneka kwi-http: //www.thoracic.org.
I-Huang FRCPC, uMx MD, uMculi, i-FRCPC, uLianne G. MD. "Uncedo loPhando lweCOPD". Geriatrics Ukuguga. 2005; 8 (3): 40-46.
U-Fishman A, uMartinez F, uNaunheim K, uPiantadosi S, Uhlakaniphile R, uRies A, et al; I-National Emphysema Treatment Trial Research Group. Isilingo esingaqhelekanga siqhathaniswa nokutyunjwa kwamanani emiphunga kunye neyeza lonyango kwi-emphysema enamandla ". N Engl J Med 2003; 348 (21): 2059-2073.
Hosenpud JD, uBennett LE, iKeck BM, Edwards EB, uNobick RJ. Impembelelo yokuxilongwa kwi-survival benefit ye-transplantation yamaphaphu ukuphela kwesigulane sesifo somphunga. Lancet 1998; 351 (9095): 24-27.
Iqela loPhando lweZiko loPhando lwe-Emphysema. Izigulane ezisengozini enkulu yokufa emva kokuhlinzwa okunciphisa umthamo wamaphaphu. N Engl J Med 2001; 345 (15): 1075-1083.
I-Snider G. Ukunciphisa i-pneumoplasty ye-giant bullfish emphysema: impembelelo yonyango lotyando lwe-emphysema engabonakaliyo. I-Chest 1996; 109 (2): 540-548.