Kuyini ukwelashwa komoya-mpilo, izinhlobo eziyinhloko nokuthi kwenzelwe ini

-Delile

• Izinhlobo eziyinhloko zokwelashwa komoya-mpilo
• 1. Izinhlelo zokugeleza okuphansi
• 2. Izinhlelo zokugeleza okuphezulu
• 3. Ukungenisa umoya okungangenisi umoya
• Yenzelwe ini
• Ukunakekela lapho usebenzisa ekhaya

Ukwelashwa kwe-oksijeni kuqukethe ukuphatha i-oxygen eningi kunaleyo etholakala endaweni ejwayelekile futhi ihlose ukuqinisekisa ukuphefumula kwezicubu zomzimba. Ezinye izimo zingaholela ekwehliseni ukunikezwa komoya-mpilo emaphashini nasezicutshini, njengoba kwenzeka ezifweni ezingalapheki ze-pulmonary disease, ezaziwa nge-COPD, isifo somoya, i-apnea yokulala kanye ne-pneumonia ngakho-ke, kulezi zimo, ukwelashwa kwe-oxygen kungadingeka.

Le ndlela yokwelashwa ikhonjiswa ngudokotela ojwayelekile noma i-pulmonologist ngemuva kokuqinisekisa izinga eliphansi lomoya-mpilo egazini, ngokwenza amagesi egazi emithanjeni, nokuhlolwa kwegazi okuqoqwe emthanjeni wesihlakala, kanye ne-pulse oximetry, okwenziwa ngokubheka ukugcwaliswa komoya-mpilo futhi kufanele kube ngaphezu kwama-90%. Thola kabanzi mayelana nokuthi kwenziwa kanjani i-pulse oximetry.

Uhlobo lokwelashwa komoya-mpilo luxhomeke ebangeni lokucindezeleka kokuphefumula komuntu kanye nezimpawu ze-hypoxia, futhi kunganconywa ukusebenzisa ipayipi lamakhala, isifihla-buso sobuso noma iVenturi. Kwezinye izimo, i-CPAP ingakhonjiswa ukwenza lula ukungena komoya-mpilo ezindleleni zomoya.

Izinhlobo eziyinhloko zokwelashwa komoya-mpilo

Kunezinhlobo ezahlukahlukene zokwelashwa komoya-mpilo ezihlukaniswa ngokuya kokukhishwa komoya-mpilo okukhishwayo, futhi udokotela uzoncoma uhlobo ngokuya ngezidingo zomuntu, kanye nezinga lokucindezeleka kokuphefumula futhi uma umuntu ekhombisa izimpawu ze-hypoxia, njenge purplish umlomo neminwe, izithukuthuku ezibandayo nokudideka kwengqondo. Ngakho-ke, izinhlobo eziyinhloko zokwelashwa komoya-mpilo kungaba:

1. Izinhlelo zokugeleza okuphansi

Lolu hlobo lokwelashwa komoya-mpilo luyanconywa kubantu abangadingi inani elikhulu lomoya-mpilo futhi ngalezi zinhlelo kungenzeka ukuthi banikeze i-oksijini ezindleleni zomoya ngokugeleza okungafika kumalitha ayi-8 ngomzuzu noma nge-FiO2, ebizwa ngengxenyenamba yokuphefumlelwa umoya-mpilo, kusuka kuma-60%. Lokhu kusho ukuthi emoyeni ophelele lowo muntu azowudonsa, ama-60% azoba yi-oxygen.

Amadivayisi asetshenziswe kakhulu kulolu hlobo yilawa:

• Ipayipi le-Nasal: kuyishubhu lepulasitiki elinamaphiko omoya amabili okufanele abekwe emakhaleni futhi, ngokwesilinganiso, anikezela nge-oxygen ngamalitha ama-2 ngomzuzu;
• I-Nasal cannula noma i-catheter ye-eyeglass: yenziwe njengebhubhu elincane elincanyana elinemigodi emibili ekugcineni kwayo futhi ifakwa emgodini wamakhala ibanga elilingana nobude obuphakathi kwekhala nendlebe futhi iyakwazi ukuletha umoya-mpilo ongafika kumalitha ayi-8 ngomzuzu;
• Imaski yobuso: inesifihla-buso sepulasitiki okufanele sibekwe phezu komlomo nangamakhala futhi sisebenze ukuhlinzeka nge-oksijeni ekugelezeni okuphezulu kunama-catheters nama-cannulas acinene, ngaphezu kokusebenzela abantu abaphefumula kakhulu ngomlomo, ngokwesibonelo;
• Imaski enedamu: imaski enesikhwama esifuthwayo esinamathiselwe futhi sikwazi ukugcina kuze kube ilitha elilodwa lomoya-mpilo. Kunezinhlobo zamaski ezinamachibi, abizwa ngokuthi ama-non-rebreathing mask, ane-valve evimbela umuntu ekuphefumuleni isikhutha;
• Imaski ye-Tracheostomy: ilingana nohlobo lwesifihla-moya somoya-mpilo ngokukhethekile kubantu abane-tracheostomy, eyi-cannula efakwe ku-trachea yokuphefumula.

Ngaphezu kwalokho, ukuze umoya-mpilo ungenwe ngamaphaphu kahle, kubalulekile ukuthi lowo muntu angabi nazithiyo noma uketshezi emakhaleni, futhi futhi, ukugwema ukomisa i-airway mucosa, kuyadingeka ukusebenzisa i-humidification lapho ukugeleza komoya-mpilo kungaphezu kwamalitha ama-4 ngomzuzu.

2. Izinhlelo zokugeleza okuphezulu

Izinhlelo zokugeleza okuphezulu ziyakwazi ukuhlinzeka ngokuhlushwa okukhulu komoya-mpilo, ngaphezu kwalokhu umuntu akwazi ukukuhogela futhi kuboniswe ezimweni ezinzima kakhulu, ezimweni ze-hypoxia ezibangelwa ukwehluleka ukuphefumula, i-pulmary emphysema, i-acute lung edema noma i-pneumonia. Bona okuningi ukuthi yini i-hypoxia kanye ne-sequelae engenzeka uma ishiywe ingalashwa.

Isifihla-buso seVenturi siyindlela ejwayelekile kakhulu yalolu hlobo lokwelashwa komoya-mpilo, njengoba sinama-adaptha ahlukene akhonza ukunikela ngamazinga e-oxygen aqondile nsehlukile, ngokusho kombala. Isibonelo, i-adaptha ebomvana inikezela ngama-40% oksijini ngamanani wamalitha ayi-15 ngomzuzu. Lesi sifihla-buso sinemigodi evumela umoya ophefumulwayo ukuba uphume, oqukethe i-carbon dioxide, futhi odinga ukuthanjiswa ukuze kungabangeli ukuthi imigwaqo yomoya yome.

3. Ukungenisa umoya okungangenisi umoya

Ukuphefumula okungavumelekile, okwaziwa nangokuthi yi-NIV, kuqukethe ukwesekwa komoya okusebenzisa ingcindezi enhle ukwenza lula ukungena komoya-mpilo ezindleleni zomoya. Le ndlela ikhonjiswa yi-pulmonologist futhi ingenziwa ngumhlengikazi noma i-physiotherapist kubantu abadala abanenkinga yokuphefumula futhi abanesilinganiso sokuphefumula esingaphezu kokuphefumula okungama-25 ngomzuzu noma ukugcwaliswa komoya-mpilo ngaphansi kwama-90%.

Ngokungafani nezinye izinhlobo, le ndlela ayisetshenziswanga ukuhlinzeka nge-oksijini eyengeziwe, kepha isebenza ukwenza lula ukuphefumula ngokuvula kabusha i-alveoli yamaphaphu, ukuthuthukisa ukushintshaniswa kwegesi nokunciphisa umzamo wokuphefumula futhi kunconyelwe abantu abane-apnea yokulala futhi abanezifo eziphefumulayo.

Ngaphezu kwalokho, kunezinhlobo eziningana zamaski e-NIV ezingasetshenziswa ekhaya futhi ziyahlukahluka ngosayizi wobuso nokuzivumelanisa komuntu ngamunye, neCPAP ibe uhlobo oluvame kakhulu. Bheka okuningi mayelana nokuthi yini i-CPAP nokuthi ungayisebenzisa kanjani.

Yenzelwe ini

Ukwelashwa kwe-oxygen kunconyelwa ngudokotela ukukhulisa ukutholakala komoya-mpilo emaphashini nasezicutshini zomzimba, kunciphise imiphumela emibi ye-hypoxia, futhi kufanele kwenziwe lapho umuntu ene-oxygen saturation engaphansi kwama-90%, ingcindezi engatheni ye-oxygen, noma i-PaO2 , ngaphansi kuka-60 mmHg, noma lapho izimo ezinjenge:

• Ukwehluleka okuphefumulayo noma okungapheli;
• Isifo samaphaphu esingapheliyo;
• I-emphysema yamaphaphu;
• Ukuhlaselwa yi-asthma;
• Ubuthi be-Carbon monoxide;
• Ukuvimbela ukuphefumula kokulala;
• Ubuthi be-cyanide;
• Ukutakula ngemuva kokubulala izinzwa;
• Ukuboshwa kwenhliziyo.

Lolu hlobo lokwelashwa lukhonjiswa nasezimweni ze-acute myocardial infarction kanye ne-angina pectoris engazinzile, ngoba ukutholakala komoya-mpilo kunganciphisa izimpawu ze-hypoxia, ezibangelwa ukugeleza kwegazi okuphazamisekile, kukhuphule amazinga e-oxygen egazini futhi, ngenxa yalokho, ku i-alveoli yamaphaphu.

Ukunakekela lapho usebenzisa ekhaya

Kwezinye izimo, abantu abanesifo sokuphefumula esingapheli, njenge-COPD, badinga ukusebenzisa ukwesekwa komoya-mpilo amahora angama-24 ngosuku futhi ngenxa yalesi sizathu, ukwelashwa komoya-mpilo kungasetshenziswa ekhaya. Lokhu kwelashwa kwenziwa ekhaya nge-catheter yamakhala, efakwa emakhaleni, bese kuthi umoya-mpilo unikezwe kusuka kwisilinda, okuyisiqukathi sensimbi lapho kugcinwa khona i-oxygen futhi yimali enikezwe udokotela kuphela okufanele inikezwe.

Amasilinda omoya-mpilo enziwa atholakale ngezinhlelo ezithile ze-SUS noma angaqashwa ezinkampanini zemikhiqizo yezibhedlela zezokwelapha futhi angahanjiswa ngosizo olunamasondo futhi angayiswa ezindaweni ezahlukahlukene. Kodwa-ke, lapho usebenzisa amasilinda e-oxygen, ezinye izindlela zokuqapha ziyadingeka, njengokungabhemi ngenkathi usebenzisa i-oksijini, ukugcina isilinda ikude nanoma iliphi ilangabi futhi ivikelwe elangeni.

Futhi, umuntu osebenzisa umoya-mpilo ekhaya udinga ukufinyelela kumadivayisi we-pulse oximetry ukuhlola ukugcwala futhi esimweni somuntu okhombisa izimpawu ezifana nezindebe ezibubende neminwe, isiyezi nokuquleka, kufanele uye esibhedlela ngokushesha, ngoba ungaba nezinga eliphansi le-oxygen egazini lakho.