Indlela i-CPAP ne-BiPAP inokuphatha ngayo i-COPD
Kuthetha ukuthini ukuba ugqirha wakho uncoma "ukungena kwevinive?" Ihluke njani oku kwi-ventilation engavumelekanga? Ziziphi iindlela ezifana ne-CPAP ne-BiPAP ezibonisiweyo kwaye ziziphi iingenelo kunye neengozi zonyango?
Yintoni iVangelvesenti?
Ukungena umoya okungenakunqwenela kungenye indlela yokungena emzimbeni (ukufakwa kwi-ventilalor) kubantu abanesifo esingapheliyo sokuphefumula okanye ukungaphumeleli kokuphefumula kwaye abanakho ukuphefumula ngokwabo ngokwabo.
Kwakhona kwaziwa ngokuba yi-Noninvasive Positive Pressure Ventilation (NIPPV,) ukungenwa kwamanzi okungenayo umoya kumnceda umntu ngokuphefumula ngokupheleleyo kwaye unceda ukugcina okwaneleyo okwenziwe nge-oxygen emzimbeni.
I-NIPPV inikezela ngenkxaso-moya kumntu nge-airways engenhla. Iyakwandisa inkqubo yokuphefumla ngokunikela umxube womoya kunye ne-oksijini evela kumvelisi okhulayo ngokusebenzisa imaski ebusweni okanye ebomvu. Ekubeni imiphunga ikhona, ngendlela egcinwe evulekileyo ngcinezelo elungileyo, kulula ukufumana i-oxygen phantsi kwe- alveoli encinci apho ukutshintshwa kwe-oxygen ne-carbon dioxide kwenzeka.
Kwimiqathango engeyiyo yeklinikhi ungayichaza i-alveoli yakho njengeebhaluni ezincinci. Ukusebenzisa inkxaso ye-ventilatory, "iibhaluni" zihlala zincinci emva kokuphefumula ukuze kube lula ukwandisa kunye nokuphefumula okulandelayo. Ngamanye amazwi, kufana nokugcwalisa ibhaluni kwaye uqaphele ukuba ungavumeli umoya wonke uphume phakathi kokuphefumula ukwenza kube lula ukuzalisa.
Indlela ukungena kweNdawo engeyiyo ingasetyenziswayo kwiCOPD
Abantu abanesifo esingapheliyo sesifo se-pulmary disease (COPD) ngamanye amaxesha bachitshiyelwa ukungena kwemvelo, njengeCPAP (ukuqhutyelwa kwengcinezelo ehamba phambili ) okanye i- BiPAP (i-bilevel positive airway pressure), ngexesha lokunciphisa ukubanceda baphefumle.
Ngokuqhelekileyo ehambelana nokuphathwa kwe-apnea yokulala , zombini i-CPAP ne-BiPAP ihambisa i-oksijeni ecinezelekileyo ngenjongo yokuzimela kumoya womntu.
Uxinzelelo luvimbela imisipha yomqala ukuba ingabikho kunye nokukhawulela ukuhamba komoya. Imishini ye-CPAP isetyenziswe kwinqanaba elilodwa lexinzelelo elisoloko lihlala kulo lonke ubusuku, kanti i-BiPAP inamanqanaba amabini oxinzelelo, enye yokwenza i-inhaling kunye enye yokuxhuma.
Ukusebenza kwe-Noninvasive Ventilation kwiCOPD
Upaphando olwenziwa ngo-2014 olupapashwe eLancet lufumene i-NIPPV yokuphucula izinga lokuphila kubantu abaneCOPD. Ukuhlalutya kwimihla ngemihla, ukufundwa kwamazwe ngamazwe kufumanise ukuba abantu abaneCOPD abafumana ukungena kwemvelo okungenayo i-hewa engenayo ingenayo ingozi engama-36 engozini yokufa.
Olunye uphando lubonisa ukuba i-NIPPV isetyenziswe ngexesha lokunciphisa kwe- COPD eyanciphisa isidingo sokungenwa kwe-endotracheal (ukungena kwamandla okungena emzimbeni,) kwaye idibaniswa nezinga eliphantsi lokungaphumeleli unyango kunye nokuhlala kancinci kwesibhedlele.
Ukongezelela, uphando lwango-2016 lubonise ukuba i-NIPPV yexesha elide linokuphumela ekuphuculweni kwegazi lokuguqula igazi (ABGs,) umsebenzi wamaphaphu, kunye nomgangatho wobomi obunxulumene nempilo. Ngokuqhelekileyo, ezi mphuculo zazibhetele kangcono kunye nokunyusa okukhulu okungenakuvusa umoya (kusetyenziswa ukunyanzeliswa okuphezulu kunokwenzeka) kunokuba ne-NIPPV ephantsi.
Xa kuVunyelwa ukungena kweNdawo engeyiyo
Kubantu abaneCOPD abafumana ukungaphumeleli kokuphefumula ngenxa yokuphulukiswa kwe-COPD, ukungena kwe-ventilation engenziwayo kungasetyenziselwa indawo yokugcina i-inotation in patients.
Ugqirha wakho unokuncoma i-NIPPV kuwe ukuba unomlinganiselo ophezulu kwi- dyspnea (uvakalelo lokuphefumula okufutshane), i-tachypnea (isantya sokuphefumula ngokukhawuleza,) kunye ne-hypercarbia (inqanaba eliphezulu le-carbon dioxide egazini,) kunye ne-pH ephakathi kwe-7.25 no 7.35.
Abantu akufanele baphathwe nge-NIPPV endaweni ye-air ventical if they are physically unstable ngenxa ye-hypotension ( uxinzelelo lwegazi oluphantsi ), i- sepsis (isifo esinamandla esiphezulu esingasenza ukuba tshatywe,) i- hypoxia (ukungabikho kwe-oksijini kwimizimba yomzimba wakho ,) okanye esinye isifo esisongela ubomi, sinesimo sengqondo esibi kakhulu, okanye sijamelana nezikhalazo ezigqithisileyo ezibabeka emngciphekweni ophezulu wokufuna.
Ngokungafani nokuphuphuma umoya, okufuna ukubekwa kweliso kwiyunithi yokunyamekela kakhulu, ukungenwa kwamanzi okungenakuvakala kungenziwa rhoqo kwiwadi yesibhedlele jikelele, kunika abasebenzi baqeqeshwe ngokufanelekileyo ekusebenziseni kwabo.
CPAP neBiPAP
Bobabini i-CPAP ne-BiPAP ihambisa i-oksijeni exinzelelweyo nge-mask, nangona i-CPAP isetyenziswe kwisilinganiselo esisodwa xa i-BiPAP inezicwangciso ezimbini, enye yokuphefumlelwa kunye nokuphela kwexesha.
I-BiPAP isetyenziswe kaninzi kubantu abaneCOPD kuba kulula ukukhupha ngokuchasene nengcinezelo ephantsi. I-BiPAP ibuye ivumele ukulungiswa ngexesha.
Ngaphantsi
Ukungena kwemvelo kungabonakali kuwo wonke umntu kwaye akusoloko kuphumelele. Ugqirha wakho kuphela onokumisela ukuba ungumviwa wokungenwa kwamanzi.
Oko kwathiwa, uphando lubonakalisa isidingo esincitshisiweyo sokungena kwi-endotracheal intubation kunye nokuphucula izinga lokusindisa abantu abaneCOPD abaviwa be-NIPPV bayakhuthaza kakhulu. Ukongezelela, xa ukhangela ixesha elide lokusebenzisa umoya ongenawo uvalo kunye neCOPD, utshintsho olunjengokuphucuka kwegazi kunye nomsebenzi wamaphaphu, kunye nomgangatho wobomi obulungele ukugqitywa nje, ngokukodwa ngokuphuma kwe-NIPPV.
Ewe, ukuphuphuma umoya okungenasiphelo kumyinge owodwa ekuphuculeni umgangatho wobomi kunye nokusinda kwiCOPD enzima. Qinisekisa ukuba uzifundise kwiingcebiso ezongezelelweyo zokugcina umsebenzi wamaphaphu kunye necandelo III COPD .
> Imithombo
Altintas, N. Ukuhlaziywa: Ukungabikho kompembelelo wokuPhepha okuPhezulu okuNcinci ngenxa yokuPhelelwa koMphefumlo wokuHlola ngenxa yeCOPD. COPD . 2016. 13 (1): 1110-21.
> Kasper, uDennis, Anthony Fauci, uStephen Hauser, uDan Longo, noJameson. Iinqununu zeHarrison zeMithi yoPhakathi. ENew York: iMacGraw-Hill Education, 2015. Phrinta.
> Kohnlein, T., Windisch, W., Kohler, D. et al. Ukunyanzeliswa kweengcinezelo ezingenayo i-Impressable Positive Ventilation kwiNyango yeSifo esiPhezulu esingavimbayo esiPhezulu esiPhezulu esiPhezulu: I-Prospective, Multicentre, i-Randomized, i-Controlal Trial Trial. Lancet. Amachiza okuphefumula . 2014. 2 (9): 698-705.
> Windisch, W., Storre, J., noT. Kohnlein. Ukuhlwaya kweNtsholongwane engabonakaliyo yokunyanzelisa i-COPD. Iingcaphephe zoLwazi lweMpilo yokuPhepha . 2015. 9 (3): 295-308.