He aha te pokanga whakaiti rōrahi pūkahukahu? Te Whāinga, te Hātepe & Ngā Hua

Ko te pokanga whakaiti rōrahi pūkahukahu (LVRS) he tikanga e tango ana i ngā wāhanga kua pakaru o ō pūkahukahu hei āwhina i te kiko hauora e toe ana kia pai ake te mahi. Whakaarohia me te mea e hanga ana i te wāhi mō tō kiko pūkahukahu pai kia whānui ake, kia pai ake te mahi mā te tango i ngā wāhanga kāore e āwhina ana i a koe ki te hā.

Ko tēnei pokanga te mea nui i hangaia mō ngā tāngata e tino kaha ana te emphysema, he āhuatanga e pakaru ai ngā pūpūhau hau i ō pūkahukahu, ka mau ai te hau. Ina tangohia e ngā tākuta pokanga ēnei wāhi kua pakaru, ka taea e tō diaphragm te neke noa ake, ā, ka taea e tō kiko pūkahukahu e toe ana te mahi i tana mahi i te pai ake.

He aha te pokanga whakaiti rōrahi pūkahukahu?

Ko te pokanga whakaiti rōrahi pūkahukahu e uru ana ki te tango i te 20-30% o tō kiko pūkahukahu kua tino pakaru mai i ngā pūkahukahu e rua. Ko te whāinga kia pai ake tō kaha ki te hā me te kounga o te ora mā te tuku i tō kiko pūkahukahu hauora kia whānui tika.

I te wā o te tikanga, ka tautohu ngā tākuta pokanga i ngā wāhi o ō pūkahukahu kua tino kaha te pakaru e te emphysema. Ko ēnei wāhanga te nuinga ka rite ki ngā pōro kua ngaro te hau e kore e taea te whakawhiti i te hāora me te hauhā. Mā te tango i ēnei wāhi kāore e mahi ana, ka āwhina te pokanga i ō uaua pouaka me te diaphragm kia pai ake te mahi.

Ka taea te mahi i te tikanga mā te whakamahi i ngā momo tikanga rerekē, tae atu ki te pokanga tuwhera tuku iho, ki ngā huarahi iti nei te whakaeke. Māu e whiriwhiri e tō tākuta pokanga te tikanga pai rawa atu i runga i tō āhuatanga pūkahukahu me te āhua hauora katoa.

He aha te take i mahia ai te pokanga whakaiti rōrahi pūkahukahu?

E tūtohu ana tēnei pokanga mō ngā tāngata e tino kaha ana te emphysema e raru tonu ana ki te hā ahakoa te rongoā pai rawa atu. Ko te whāinga tuatahi kia pai ake tō kounga o te ora me te kaha ki te hā i te wā kāore anō ētahi atu rongoā i whai hua.

He tūpono pea koe he kaitono mō te LVRS mēnā he emphysema tō tōpū o runga, kei reira te kino e arotahi ana ki ngā wāhanga o runga o ō pūkahukahu. Ko tēnei momo tauira kino ka pai ake te urupare ki te pokanga i ētahi atu momo emphysema.

Ka āwhina te pokanga ki te whakaiti i tō pōkaikaha, ki te whakanui i tō kaha ki te whakakorikori tinana, me te whakanui pea i te roa o tō oranga. He tokomaha ngā tūroro e kite ana ka taea e rātou te hoki ki ngā mahi kāore i taea e rātou i mua, pēnei i te haere i ngā tawhiti roa ake, i te piki rānei i ngā arawhata.

He aha te tikanga mō te pokanga whakaiti i te rōrahi o te pūkahukahu?

Ko te tikanga, e 3-4 hāora te roa o te pokanga, ā, ka mahia i raro i te rongoā whānui. Ka whakamahi tō rōpū pokanga i tētahi o ngā huarahi maha i runga i tō āhuatanga motuhake me te hiahia o te tākuta pokanga.

Anei te mea e pā ana i te nuinga o te wā i te wā o te tikanga:

1. Ka whiwhi koe i te rongoā whānui kia noho pai koe, kia kore koe e mōhio
2. Ka hanga e te tākuta pokanga ngā tapahi kia uru atu ki ō pūkahukahu (mā ngā tapahi kīhōro iti, he tapahi pouaka nui rānei)
3. Mā te whakamahi i ngā taputapu motuhake, ka tautuhia e rātou te kiko pūkahukahu kua tino kino
4. Ka tangohia mā te āta te wāhanga kua kino mā te whakamahi i ngā taputapu tūhono
5. Ka tirohia te toenga o te kiko pūkahukahu hauora mō ngā rerenga hau
6. Ka whakatakotoria ngā ngongo pouaka hei āwhina i te rerenga wai me te hau
7. Ka katia ngā tapahi ki ngā tūhono, ki ngā tūhono rānei

Ka rerekē pea te tikanga motuhake e whakamahia ana. Ko ētahi tākuta pokanga e whakamahi ana i te pokanga thoracoscopic āwhina-ataata (VATS), e whakamahi ana i ngā tapahi iti ake me te kāmera iti. Ko ētahi atu ka whakamahi pea i te sternotomy waenga, e uru ana ki te whakatuwhera i te pouaka mā te wheua uma.

Me pēhea te whakarite mō tō pokanga whakaiti i te rōrahi o te pūkahukahu?

Ko te whakarite mō te LVRS e hāngai ana ki ngā wiki maha o te arotake me te whakakaha kia mōhio ai koe he hauora koe mō te pokanga. Ka mahi tō rōpū hauora i te taha tata ki a koe ki te whakanui i tō āhuatanga i mua i te tikanga.

Ko ō whakaritenga pea ka uru ki ēnei mahi nui:

1. He hōtaka whakahou i te pūkahukahu hei whakakaha i ō uaua manawa
2. Ngā whakamātautau whānui mō te mahi o te pūkahukahu me ngā rangahau whakaahua
3. Te arotake i te ngākau kia mōhio ai ka taea e tō ngākau te whakahaere i te pokanga
4. Te arotake kai me te whakapai ake i tō taumaha
5. Te mahi toto katoa me ētahi atu whakamātautau rongoā
6. Te whakamutu i te kai paipa mēnā kei te kai paipa tonu koe (he mea tino nui)
7. Ngā whakarerekētanga rongoā e ai ki te tohutohu a tō tākuta

Me whakamutu hoki e koe ētahi rongoā i mua i te pokanga, me whakarite hoki he āwhina i te kāinga i te wā o tō whakaora. Ko te nuinga o ngā tūroro e noho ana i te 6-8 wiki i roto i te whakahou i te pūkahukahu i mua i te pokanga kia whakanui i ō rātou kaha me te kaha manawa.

Me pēhea te pānui i ngā hua o tō pokanga whakaiti rōrahi pūkahukahu?

Ko te angitu i muri i te LVRS ka inea e ngā whakapainga i roto i tō kaha manawa, te kaha ki te whakakorikori tinana, me te kounga o te oranga whānui, kaua ko ngā tau noa iho i runga i te whakamātautau. Ka aroturukihia e ō tākuta ētahi tohu matua hei aromatawai i te pai o te mahi o te pokanga mōu.

Koinei ngā huarahi matua ka arotakehia e tō rōpū rongoā ō hua:

• Te rōrahi whakawhāiti i te manawa (FEV1) - e ine ana i te nui o te hau ka taea e koe te pupuhi i roto i te hēkona kotahi
• Te whakamātautau hikoi e ono meneti - e aroturuki ana i te tawhiti ka taea e koe te hikoi i roto i ngā meneti e ono
• Ngā pātai mō te kounga o te oranga mō ngā mahi o ia rā
• Ngā taumata whakawhānui hāora i te wā okioki me te mahi
• Ngā hihi-X o te pouaka me ngā karapa CT hei kite i te whakawhānui o te pūkahukahu
• Ngā whakamātautau hau toto ā-ārai hei tirotiro i ngā taumata hāora me te hauhā

Ko te nuinga o ngā tūroro ka kite i ngā whakapainga i roto i te 3-6 marama i muri i te pokanga. Ka mōhio pea koe ka taea e koe te hikoi atu me te kore e hā, te piki i ngā arawhata mā te māmā ake, te whai wāhi rānei ki ngā mahi kāore i taea e koe i mua i te pokanga.

He aha te putanga pai rawa atu mō te pokanga whakaiti rōrahi pūkahukahu?

Ko ngā hua pai ka puta i roto i ngā tūroro e pā ana ki te emphysema o te pūkahukahu o runga me te iti o te kaha ki te whakakorikori tinana i mua i te pokanga. Ko ēnei tāngata te nuinga ka kite i ngā whakapainga nui ki te manawa, te kaha ki te whakakorikori tinana, me te kounga o te oranga.

Ko ngā kaitono pai te nuinga ka kite i te whakapainga 15-20% i roto i ā rātou whakamātautau mahi pūkahukahu, ā, ka taea te hikoi 50-100 putu atu i roto i te whakamātautau hikoi e ono meneti. He maha ngā tūroro ka pūrongo hoki i te iti o te manawa poto i ngā mahi o ia rā pērā i te horoi, te tunu kai, te mahi whare māmā rānei.

Ka taea e ngā painga te roa i te maha o ngā tau, ahakoa he āhuatanga haere tonu te emphysema. Ko ētahi tūroro ka mau tonu i ā rātou mahi pai mō te 5-10 tau, neke atu rānei, i te wā e kite ana ētahi atu i te hekenga haere i te wā e pakeke ana te kiko pūkahukahu e toe ana.

He aha ngā āhuatanga tūpono mō ngā hua pokanga whakaiti rōrahi pūkahukahu kino?

Ka taea e ētahi āhuatanga te whakanui i tō tūponotanga ki ngā raruraru, ki ngā hua kino rānei mai i te LVRS. Mā te māramatanga ki ēnei āhuatanga tūpono ka āwhina i tō rōpū hauora ki te whakatau mēnā he kaitono pai koe mō te tikanga.

He maha ngā āhuatanga ka nui ake te tūpono o te pokanga mō koe:

• He iti rawa te mahi pūkahukahu (FEV1 iti iho i te 20% o te tikanga)
• He mate ngākau nui, he pēhanga toto pūkahukahu rānei
• Te pōhēhē tonu, te hītori pōhēhē tata rānei
• Te kore kai nui, te iti rawa rānei o te taumaha
• Te pokanga pouaka o mua, te kiko whara nui rānei o te pouaka
• Ngā mate kaha, ngā mate rānei o te manawa tata nei
• Te pakeke (nui ake i te 75-80 tau)
• Emphysema ōrite (te kino e horahia ana puta noa i ngā pūkahukahu)

Ka āta arotakehia e tō rōpū hauora ēnei āhuatanga i te wā o tō aromatawai i mua i te pokanga. I ētahi wā, mā te whakatika i ētahi āhuatanga tūpono pērā i te kai, i te whakakaha rānei ka taea te whakapai ake i tō tūnga hei kaitono mō te tikanga.

He pai ake te pokanga whakaiti rōrahi pūkahukahu, te whakahaere rongoā rānei?

Ko te whakatau i waenga i te pokanga me te whakahaere rongoa tonu e pa ana ki to momo emphysema, nga tohu o naianei, me te ahua o to hauora. Mo nga kaitono tika, ka taea e te LVRS te whai hua nui e kore e taea e te rongoa anake.

He pai ake te pokanga mena he emphysema to ou puku o runga me nga waahi kua tino pakaru me nga kiko hauora. I enei keehi, ko te tango i nga waahi kino rawa atu ka tino pai ake te mahi o to kiko pūkahukahu e toe ana.

He pai ake pea te whakahaere rongoa mena he emphysema homogeneous koe (te kino i horahia puta noa i ou pūkahukahu) mena ranei he pai tonu to kaha ki te korikori tinana. Ma to pulmonologist koe e awhina ki te pauna i nga painga ka puta ki nga tupono o te pokanga i runga i to ahuatanga takitahi.

He aha nga raruraru ka puta i te pokanga whakaiti rōrahi pūkahukahu?

Pērā i ngā pokanga nui katoa, he tūponotanga noa me te onge te LVRS ka kōrerohia e tō rōpū hauora ki a koe. Ma te mohio ki enei raruraru ka puta ka awhina koe ki te whakatau tika mena he pai te pokanga mo koe.

Anei nga raruraru noa e tika ana kia mohio koe:

• Te turuturu hau roa mai i te mata o te pūkahukahu (ka puta i roto i te 30-50% o nga turoro)
• Pneumonia, etahi atu mate manawa ranei
• Te toto e hiahia ana kia whakawhitia te toto
• Nga manawataki ngakau koretake i te wa e ora ana
• Te rangirua rangitahi, te delirium ranei i muri i te rongoa
• Nga raruraru whakaora patunga, te mate ranei i nga waahi tapahi
• Nga toto toto i roto i nga waewae, i nga pūkahukahu ranei

Ko nga raruraru nui ake engari he iti ake te noa ka uru ki te korenga o te manawa e hiahia ana kia roa te hauora miihini, te whakaeke ngakau, te whiu, i etahi wa onge, te mate. Ko te reeti mate katoa mo te LVRS he tata ki te 2-5% i runga i te pokapū hauora me te kowhiringa turoro.

Ahea ahau ka kite i te taote i muri i te pokanga whakaiti rōrahi pūkahukahu?

Me whakapā atu koe ki tō rōpū hauora i te wā tonu mena ka pā ki a koe ētahi tohumate e pā ana i te wā o tō whakaoranga. Mā te mōhio wawe me te rongoā i ngā raruraru ka ārai i ngā raru nui ake kia kore e puta.

Waea atu ki tō tākuta i te wā tonu mēnā ka kite koe i ētahi tohu whakatūpato e whai ake nei:

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• Te pōrohe ohorere o te manawa poto, te mamae rānei i te uma
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• Te kirika i runga ake i te 100.4°F (38°C) he tohu rānei o te mate
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• Te maremare toto, te hūpē kōwhai-kākāriki rānei
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• Te whero, te pūhi, te wai rānei mai i ō tapahi
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• Te rerenga mai i te ngongo uma e pōrohe ana te nui, te huri rānei i te tae
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• Te mamae nui kāore i te whakahaerehia e ō rongoā kua whakaritea
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• Te pūhi i ō waewae, te uaua rānei ki te manawa i te takoto whakapae
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Ka whai koe i ngā whakaritenga whai-muri auau hei aroturuki i tō whakaora me te whai i tō whakapai ake. He mea nui ēnei haerenga ki te hopu i ngā raru i te wā wawe me te whakatika i tō mahere whakaora i te mea e tika ana.

Ngā pātai e pātai pinepine ana mō te pokanga whakaheke rōrahi pūkahukahu

Q.1 He pai te pokanga whakaheke rōrahi pūkahukahu mō ngā momo emphysema katoa?

Kāore, he pai rawa atu te LVRS mō ngā momo emphysema motuhake, ina koa ko te emphysema o te taha o runga o te pūkahukahu kei reira te kino e arotahi ana ki ngā wāhanga o runga o ō pūkahukahu. Mā tēnei momo tauira kino ka taea e ngā tākuta pokanga te tango i ngā wāhi kino rawa atu i te wā e tiaki ana i ngā kiko hauora ake ka taea te whānui me te pai ake te mahi.

Mēnā he emphysema homogeneous tō, kei reira te kino e horahia ana puta noa i ō pūkahukahu, kāore te pokanga i te nuinga o te wā e tūtohutia. I ēnei keehi, kāore he wāhi

Whakaarohia me te mea e hoatu ana ki ō pūkahukahu he "tīmatanga hou" mā te tango i ngā wāhi kāore i te pai te mahi. Ka taea e tēnei te whakarato i ngā tau o te manawa pai ake me te kounga o te oranga, engari me haere tonu koe i ō rongoā emphysema me te whai i te tiaki.

Q.3 E hia te roa o te whakaora i muri i te pokanga whakaiti rōrahi pūkahukahu?

Ko te whakaora tuatahi e 6-8 wiki te roa, engari ka roa te whakaora katoa i te 3-6 marama, neke atu rānei. Ka noho pea koe i te hōhipera mō te 7-14 rā, ko ngā rā tuatahi i roto i te tiaki kaha mō te aroturuki tata.

I ngā wiki tuatahi i te kāinga, ka piki haere tō taumata mahi i raro i te tirotiro hauora. Ko te nuinga o ngā tūroro ka tīmata ki te kite i ngā painga manawa i roto i te 1-3 marama, ā, ko te whakapai ake i te nuinga ka puta i te 6 marama i muri i te pokanga.

Q.4 Ka taea e au te pokanga whakaiti rōrahi pūkahukahu mēnā kei te whakamahi au i te hāora?

Ko te whakamahi i te hāora kāore e whakakore aunoa i a koe i te LVRS, engari me tino arotake. He maha ngā kaitono angitu e whakamahi ana i te hāora tāpiritanga i mua i te pokanga, ina koa i te wā e whakakorikori ana, e moe ana rānei.

Ka arotakehia e tō rōpū hauora mēnā nā ngā raruraru miihini te take o ō whakaritenga hāora ka taea e te pokanga te whakatika (pēnei i te hau kua mau) ētahi atu take rānei e kore e āwhina te pokanga. Ka taea e ētahi tūroro te whakaiti, te whakakore rānei i ō rātou hiahia hāora i muri i te pokanga angitu.

Q.5 He aha te rerekētanga i waenga i te pokanga whakaiti rōrahi pūkahukahu me te whakawhitinga pūkahukahu?

Ka mahi te LVRS me ō pūkahukahu o nāianei mā te tango i ngā wāhi kua pakaru, i te wā e whakakapi ana te whakawhitinga pūkahukahu i ō pūkahukahu katoa ki ngā pūkahukahu takoha. Ko te LVRS te tikanga e whakaarohia ana mō ngā tūroro he iti ake te mate e kāore anō kia hiahia whakawhitinga.

Ko te whakaora mai i te LVRS he poto ake, he iti ake te uaua i te whakaora whakawhitinga. Heoi, ka taea e te whakawhitinga te whakarato i ngā whakapainga nui ake mō ngā tūroro he mate pūkahukahu i te wā whakamutunga. Ka āwhina tō rōpū hauora ki te whakatau ko tēhea kōwhiringa te mea tika mō tō āhuatanga motuhake.