​UNDERSTANDING HYPERBARIC OXYGEN THERAPY: SECHRIST'S COMPREHENSIVE GUIDE

I-Hyperbaric Oxygen Therapy (HBOT) iyindlela yokwelapha lapho isiguli sivalelwe ngokuphelele ekamelweni lokucindezela ukuphefumula i-100% i-oksijeni ehlanzekile (O2) ekucindezelweni okungaphezu kweyodwa emkhathini. Umoya uqukethe cishe u-21% we-oxygen, futhi cishe u-78% we-nitrogen. Ku-hyperbaric oxygen therapy (HBOT), iphesenti le-oksijini eliphefumulelwe isiguli licishe libe ngu-100%, cishe ngokuphindwe kahlanu kunasemoyeni. Ukucindezela kwe-oksijini ephefumulelwe isiguli ekamelweni le-oksijini ye-hyperbaric ngokuvamile kunezikhathi ze-1.5 (futhi kungaba izikhathi ezingaphezu kwe-3) kukhulu kunokucindezela komkhathi. I-HBOT ingaletha umoya-mpilo ophindwe cishe izikhathi ezingu-15 kunomoya ovamile.

I-Hyperoxygenation: I-HBOT incibilikisa umoya-mpilo owengeziwe ku-plasma yegazi, bese ihanjiswa ezicutshini. Ukuphefumula komoya-mpilo ohlanzekile ngomfutho ojwayelekile ophindwe kabili kuya kathathu kunikeza umoya-mpilo ohlakazekile ngokomzimba izikhathi eziyi-10-15 ezicutshini. Lokhu kungakhuphula umoya-mpilo wezicubu ezicutshini ezisengozini ukuya kumanani amakhulu kunokujwayelekile. I-Hyperoxygenation iye yaboniswa ukuze ibangele ukwakheka kwama-capillaries amasha kuma-ischemic noma amanxeba angenalutho. Ngakho-ke, kuyasiza ekwelapheni amanxeba atholwe yi-ischemic, ama-flaps nama-grafts. Kuyasiza futhi kwezinye izifo ngokuvumela umsebenzi we-white cell (leukocytic) ukuthi uqalise ukusebenza.

Umphumela Wemishini Wokucindezela Okunyukile: Noma iyiphi igesi emzimbeni izokwehla ngevolumu njengoba ingcindezi kuyo ikhula. Ngokukhuphuka kwengcindezi ephindwe kathathu, ibhamuza elivaleleke emzimbeni lincishiswa ngokuphindwe kabili kwezintathu. Ngakho-ke, ukunciphisa umthamo wegesi kuxazulula i-air embolism kanye nokugula kwe-decompression lapho ukuxilongwa kokwelashwa kwenziwa ngesikhathi esifanele.

I-Vasoconstriction: I-oksijeni enengcindezi ephezulu ibangela ukuminyana kwemithambo yegazi ezicutshini ezivamile ngaphandle kokudala i-hypoxia. Ayibangeli ukuminyana ezicutshini ebezingawutholi umoya-mpilo ngaphambilini. I-vasoconstriction inciphisa i-edema esiza ekwelapheni ukusha, ukulimala kokuchotshozwa, i-compartment syndromes nezinye izifo ze-ischemia ezibuhlungu. Ngisho noma ukugeleza kwegazi okufaka isandla edema kuncishisiwe, ukulethwa komoyampilo ezicutshini kugcinwa ngomphumela we-hyperoxygenation.

Umsebenzi Wama-Antimicrobial: I-HBOT ivimbela ukukhiqizwa kwe-alpha toxin njengoba kubonakala ezifweni ze-anaerobic ezifana ne-clostridium perfringens (i-gas gangrene). Isizathu esivame kakhulu se-gas gangrene yi-clostridium perfringens; Nokho, kunezidalwa eziningana ezikhiqiza igesi (i-aerobic ne-anaerobic) ezidinga ukuchithwa ngokuhlinzwa ekuqaleni. Iphinde ithuthukise umsebenzi wokubulala amangqamuzana amhlophe ohlinzeka nge-adjuvant enhle kakhulu ye-IV antibiotic kanye nokunakekelwa kwamanxeba wendawo.

Isenzo Esikhulu Segesi: Ukugcwala komzimba nganoma iyiphi igesi kuvame “ukugeza” amanye. Lesi senzo senzeka ngokushesha okukhulu ngaphansi kwengcindezi kunangaphansi kwezimo ezijwayelekile, futhi senza i-HBOT ibe ukwelashwa okubonisiwe kokugula kokucindezeleka.

Ukunciphisa Ukulimala Okuphindaphindiwe: Ukulandela isikhawu se-ischemic, ukulimala okungaqondile kwenzeka, okuxhunyaniswa nokusebenza okungalungile kwe-leukocyte. I-HBOT ivimbela ukwenza kusebenze okunjalo. Ukunamathela kwamangqamuzana egazi amhlophe ezindongeni ze-capillary kuncishiswe ngokuphawulekayo, ngaleyo ndlela kunciphisa isenzakalo "sokungagelezi kabusha". Yingakho ukwelashwa kwe-HBOT kukhonjiswe kushevu we-carbon monoxide futhi kuthathwa njengokwelashwa okukhethwa kukho.

I-HBOT ifakazelwe ukuthi iyasebenza ezimeni eziningi zezokwelapha, futhi ngenxa yalokho i-Undersea ne-Hyperbaric Medicine Society, enye yezikhungo zocwaningo eziyinhloko, igunyaze izinkomba ezilandelayo:

1. I-Air noma i-Gas Embolism

2. I-Carbon monoxide Poisoning Ubuthi Be-Carbon monoxide Ihlanganiswe Ubuthi Be-Cyanide

3. I-Clostridal Myositis kanye ne-Myonecrosis (iGas Gangrene)

4. I-Crush Injury, I-Compartment Syndrome, nezinye I-Acute Traumatic Ischemias

5. I-Decompression Isifo

6. Ukuthuthukiswa Kokuphulukisa Emanxebani Anenkinga Ekhethiwe; Ukungasebenzi kahle kwe-Arterial; Ukuvaleka komthambo we-retinal ophakathi

7. I-anemia Enzima

8. Ithumba le-Intracranial

9. I-Necrotizing Soft Tissue Infections

10. I-Refractory Osteomyelitis

11. Ukulimala Kwemisebe Ebambezelekile (Izicubu Ezithambile neBony Necrosis)

12. I-Skin Grafts & Flaps Esengozini

13. I-Acute Thermal Burn Injury

Ngaphezu kwalokho, ukunqunywa kokufakwa kwe-Medicare kuzobuyisela e-US lezi zimo ezilandelayo:

• Amanxeba esifo sikashukela emaphethelweni aphansi ezigulini ezihlangabezana nalezi zindlela ezintathu ezilandelayo:

  • Isiguli sinesifo sikashukela sohlobo I noma uhlobo lwe-II futhi sinesilonda esiphansi esibangelwa isifo sikashukela;

  • Isiguli sinenxeba elithathwa njenge-Wagner grade III noma ngaphezulu; futhi

  • Isiguli sihlulekile inkambo eyanele yokwelashwa kwesilonda okujwayelekile.

Uma ukwelashwa kwenziwa ngaphakathi kwezinkomba ezamukelwe ezishicilelwe yi-Undersea & Hyperbaric Medicine Society futhi njengoba kubhekwa yi-Health Care Financing Administration, ukwelashwa kuvame ukubuyiselwa imali. Njengazo zonke izinsiza zezokwelapha ezinikeziwe, abanye abahlinzeki bokunakekela abazimele nabo bonke abaphethwe badinga ukugunyazwa kusengaphambili.

Ngokufanayo nazo zonke izindlela zokwelapha, i-HBOT ayisetshenziselwa izifo lapho kungekho bufakazi bomtholampilo bokuthi iyasebenza. Kube nezimangalo zokuthi i-HBOT ingasiza ngezinkinga ezifana nesikhumba esiguga noma yelule impilo evamile enempilo. Lokho akuzange kubhalwe phansi noma kwamukelwe emphakathini wezokwelapha obanzi.

Ngencazelo, i-hyperbaric oxygen therapy inikezwa isiguli ekamelweni elicindezelweyo. I-hyperbaric chamber iyinsimbi, i-aluminium noma igumbi lepulasitiki elicacile lapho umoya ungacindezelwa khona ukucindezela okukhulu kunezinga lolwandle. Ngokuyisisekelo kunezinhlobo ezimbili zamakamelo, i-monoplace kanye nezindawo eziningi.

I-Monoplace Chambers: I-monoplace chamber uhlelo oluhlalisa isiguli esisodwa ngesikhathi. Isiguli silala phansi ngohlaka olushelela ekamelweni. Ngokuvamile igumbi licindezelwa nge-oxygen engu-100%. Isiguli sithola i-oxygen engu-100% ngokuphefumula umoya-mpilo ngaphakathi kwekamelo. Imaski noma ihood ayidingeki. Amakamelo e-Monoplace anamandla okucindezelwa ku-3 ATA. Ngaphandle kokugula okuwohlokayo kanye ne-gas embolism, izivumelwano ze-UHMS zokwelashwa kwe-hyperbaric azidingi ingcindezi engaphezu kwe-3 ATA yokwelashwa. Iziguli ezigula kakhulu ezidinga okokusebenza okubanzi okusekela impilo zingelashwa endaweni eyodwa ye-Sechrist. (Abanye abakhiqizi bendawo eyodwa abanikezeli ngawo wonke amandla okusekela impilo). Iningi leziguli ze-hyperbaric ziphathwa ekamelweni le-monoplace.

I-Multiplace Chambers: Igumbi lezindawo eziningi liwuhlelo olukwazi ukuhlalisa abantu ababili noma ngaphezulu. Iziguli zingahamba noma zihanjiswe ngamasondo (zihlezi noma zilele phansi) ziye endaweni enezindawo eziningi, kuye ngosayizi. Ngokuvamile, umlindi ungaphakathi neziguli. Amakamelo acindezelwa ngomoya ocindezelwe ngohlelo oluzinikele lokunikezela. I-oxygen engu-100% ilethwa esigulini kusetshenziswa imaski noma i-hood. Ama-Multiplace chambers anamandla okucindezelwa ku-6 ATA. Izingcindezi eziphakeme zingafiswa ekwelapheni ukugula kwe-decompression kanye namacala e-air embolism.

Ngaphandle kwesifo sokuwohloka kokucindezeleka kanye ne-arterial gas embolism, ukwelashwa okuvamile kuthatha cishe amahora amabili ubude. Ukwelashwa kwenziwa ngesisekelo sesiguli esilalisiwe noma esingaphandle. Kwezinye izimo ezibucayi, ukwelashwa kungase kunikezwe njalo emahoreni ayisishiyagalombili kuya kwayishumi nambili.

Impendulo yomtholampilo yesiguli kanye nezinye izici ngokuvamile zisho inani lokwelashwa elidingekayo. Izimo eziphuthumayo, ezifana nobuthi be-carbon monoxide, i-arterial gas embolism noma isifo sokuwohloka, zingadinga kuphela ukwelashwa okukodwa noma okubili. Izilonda ezingapholi zingase zidinge ukwelashwa okungama-20 kuye kwangama-30.

Ngokuvamile, isiguli ngeke sizizwe ngendlela ehlukile. Nokho, ezingxenyeni ezithile zokwelashwa, isiguli singase sibe nomuzwa wokugcwala ezindlebeni, okufana nomuzwa ozwakala endizeni. Lokhu kuwumphumela we-eardrum esabela ekushintsheni kwengcindezi. Ngaphambi kokwelashwa, isiguli sizofundiswa izindlela ezimbalwa ezilula "zokusula" izindlebe zakhe ukuze zigweme ukungahambi kahle.

Isiguli kufanele sigqoke izingubo zikakotini ezingu-100% ngesikhathi sokwelashwa. Izinto zomuntu siqu azivunyelwe ku-hyperbaric chamber. Ukuze uthole ulwazi olwengeziwe bheka lokho okungafanele ukulethe kusixhumanisi se-hyperbaric chamber.

The most common side-effects are not serious, those include:

• Claustrophobia

• Ear popping

• Temporary myopia

• Lung problems in rare cases, the lungs have become irritated by the oxygen, and the patient develops a dry cough that is resolved once the treatment is stopped.

In extremely small number of cases, some patients have developed non-life threatening issues. Overall, HBOT is a safe procedure.

Zonke iziguli ezingase zibe ne-hyperbaric chamber kumele zibe nencwadi kadokotela oqondisayo ukuze zithole ukwelashwa kwe-hyperbaric.

Ukuze i-HBOT ikhavwe ngaphansi kohlelo lwe-Medicare e-United States, udokotela kufanele abe khona njalo phakathi nakho konke ukwelashwa.

Izinqubo zokwelashwa zisungulwa ngudokotela oya khona. Izikhathi zokwelashwa eziphephile, umthamo kanye nemikhawulo yengcindezi iye yasungulwa ukuze kutholakale umoya-mpilo we-hyperbaric futhi le mikhawulo yenza isisekelo sazo zonke izinqubo zokwelapha. Ngenkathi sithola ukwelashwa, isiguli esigula kakhulu singase sihlinzekwe ngokungenisa umoya ngemishini, ukwelashwa kwe-IV kanye nokuqapha komzimba okuhlaselayo okungavamisile.

Geza igumbi ngokohlobo lwezimo eziphathwayo futhi njengoba uqondiswa abasebenzi bezokwelapha. Geza igumbi kanye nawo wonke ama-gurney, i-stretcher kanye nezindawo zikamatilasi ngesibulali magciwane esigunyaziwe noma isobho lokuwasha izitsha.

CHOFOZA LAPHA UKUZE Uthole UHLU OLINEMINININGWANE LWEZIBONGA EZINGAFAKAZI ZEGUMBI