Ðe wò gbɔgbɔ me goglo akpaa? (Respiratory Depression/Hypoventilation) - Mina míaƒo nu tso esia ŋu!

Ðe nèse le ɖokuiwò me kpɔ be gbɔgbɔ le sesẽm na ye, alo abe gbɔgbɔtsixe tsi ƒowò ŋutɔŋutɔa? Ðewohĩ èse le ɖokuiwò me be yeƒe ta le ƒoƒom alo ɖeɖi te ye ŋu. Susu ɖeka si ate ŋu anɔ megbe na nusiawoe nye gbɔgbɔtsixe ƒe ɖiɖi, si nye nusi míeyɔna le atikewɔwɔ me be (Yagbɔgbɔ ƒe Blanuiléle) alo (Yagbɔgbɔ ƒe Dɔmawɔmawɔ nyuie) .

Nukae nye gbɔgbɔtsixetsixe?

Kpuie ko la, gbɔgbɔtsixe tsia ƒo ( alo ya si mebɔ o) nye ne wò gbɔgbɔ ƒe tsɔtsɔme va le blewu akpa, alo nègbɔ ya si me goglo akpa. Ne edzɔ alea la, ya ƒe asitɔtrɔ medzɔna nyuie le wò lãkusi me o. Bu eŋu kpɔ, ne míele gbɔgbɔm la, ɔksidzin si le ya nyui me la toa ya kotoku suesuesue siwo le míaƒe lãkusi me la me gena ɖe ʋua me. Azɔ hã, ya si woyɔna be carbon dioxide (CO2) , si nye gbeɖuɖɔ na míaƒe ŋutilã la, trɔna yia lãkusi me tso ʋua me eye wògbɔa ya. Esiae nye nusi míeyɔna be gas ƒe asitɔtrɔ .

Fifia, le (Hypoventilation) gome la, nusi dzɔna enye be esi mèle gbɔgbɔm nyuie o ta la, carbon dioxide (CO2) gas ma medona le ŋutilãa me o eye wòƒoa ƒu ɖe ʋua me. Míeyɔa esia be (Hypercapnia) . Menye ema ɖeɖeko o, ɣeaɖewoɣi la, ate ŋu axɔ oxygen si sɔ na lãkusiwo o. Emegbe oxygen ƒe agbɔsɔsɔ si le ʋua me dzi ɖena kpɔtɔna, si woyɔna be (Hypoxemia) . Èse egɔmea?

Nukawoe nye dzesiawo?

Ne gbɔgbɔ dzi ɖe kpɔtɔ (yagbɔgbɔ si mebɔ o) , àte ŋu akpɔ dzesiwo abe:

• Aɖuɖɔtoe kple ʋuʋudedi.
• Taɖuame.
• Ðeɖiteameŋu, alɔ̃dɔdɔ , alo kuviawɔwɔ ɣesiaɣi.
• Tɔtɔ, tɔtɔ , alo susu ƒe nɔnɔme ƒe tɔtrɔ.
• Dzi ƒe tsotso dzina ɖe edzi.
• Taɖuame.
• Gbɔgbɔ sena le eɖokui me blewu, me goglo o, alo dɔ sesẽ wɔwɔ.
• Ŋutilã, nuyi, alo asibidɛ ƒe amadede ƒe tɔtrɔ blɔ (cyanosis) . Esia nye dzesi si nu sẽ wu.

Nukae hea esia vɛ?

Nu vevi siwo gbɔ gbɔgbɔtsixetsixe tsona ate ŋu anye atike aɖewo zazã le mɔ gbegblẽ nu, nono fũu akpa , alo aha alo atike aɖewo zazã le vome. Bu nya siawo ŋu kpɔ:

• Opioids: Wogayɔa esiawo be atike muamewo . Kpɔɖeŋu aɖewoe nye morphine , tramadol, oxycodone (OxyContin®) , kple fentanyl . Ame aɖewo zãa atike siawo le mɔ gbegblẽ nu.
• Benzodiazepines ƒe atikewo:Zi geɖe la, esiawo nyea atike siwo naa ame ƒe dzi dzea eme kple alɔ̃dɔdɔtikewo. Kpɔɖeŋu aɖewoe nye lorazepam (Ativan®) , alprazolam (Xanax®) , kple diazepam (Valium®) .
• Barbiturates: Wodoa atike siawo ɣeaɖewoɣi na alɔ̃madɔmadɔ alo taɖuame .
• Atike siwo ŋu se meɖe mɔ ɖo o: Nuwo abe heroin kple gamma hydroxybutyrate (GHB) ene .
• Alɔ̃dɔdɔ ƒe atikewo: Atike siwo woŋlɔ na ame abe zolpidem (Ambien®) ene .
• Atike si naa alɔ̃dɔdɔ ame: Ate ŋu atso atike si wona wò be wòana nàdɔ alɔ̃ hafi woawɔ dɔ na wò hã gbɔ.

Tsɔ kpe ɖe atike kple atike siawo ŋu la, dɔléle kple nɔnɔme bubuwo hã ate ŋu ana ya nagbɔdzɔ :

• Lolo akpa: Woyɔa esia be Obesity Hypoventilation Syndrome (OHS) . Efia be gbɔgbɔ va sesẽna le lolo akpa ta.
• Nɔnɔme siwo nana gbɔgbɔtsixe tsia ame ƒo: Le kpɔɖeŋu me, aklãdɔ si xea mɔ na ame si nɔa anyi didi (COPD) kple gbɔgbɔtsixetsixe si xea mɔ na alɔ̃dɔdɔ .
• Nɔnɔme siwo ɖea gbɔgbɔtsixetsixe dzi kpɔtɔna: Le kpɔɖeŋu me , ʋusɔgbɔdɔ kple ʋumenugbagbeviɣidɔ .
• Nɔnɔme siwo gblẽa nu le akɔta, lãmekawo, alo lãmekawo dzi ɖuɖu ŋu: Kpɔɖeŋu aɖewoe nye lãmekawo ƒe dɔmawɔmawɔ nyuie, lãmekawo alo aklã ƒe dɔmawɔmawɔ nyuie, multiple sclerosis (MS) , kple amyotrophic lateral sclerosis (ALS) .
• Tɔtrɔ siwo vaa akɔta alo akɔta ƒe nɔnɔme me: Nɔnɔmewo abe scoliosis ( akɔta ƒe ƒoƒo), ankylosing spondylitis, kple flail chest .
• Aɖi alo aɖi: Nuwo abe tetanus , ciguatera ƒe aɖi, kple botulism .

Nu kawoe dzia afɔkua ɖe edzi?

Afɔku si le gbɔgbɔtsixetsixe me ate ŋu adzi ɖe edzi le susu siwo gbɔna ta:

• Atikewo abe opioid alo benzodiazepines ene zazã le mɔ gbegblẽ nu .
• Ne wowɔ dɔ na wò nyitsɔ laa (le atike si wua alɔ̃dɔdɔ ta).
• Ne lãkusi, lãmeka, kple lãmeka (ahɔhɔ̃ kple aklã) ƒe dɔléle aɖewo li, abe alesi míedzro eme le etame ene.

Kuxi kawoe esia ate ŋu ahe vɛ?

Carbon dioxide si le wò ʋu meNe CO2 ƒe agbɔsɔsɔ va sɔ gbɔ akpa la, ate ŋu ahe kuxi siwo me afɔku le, siwo ate ŋu ade ame ƒe agbe afɔku me gɔ̃ hã vɛ. Kpɔe ɖa:

• Yagbɔgbɔ me Acidosis: Esia fia be wò ʋu me acid sɔ gbɔ wu alesi wòle be wòanɔ.
• Yagbɔgbɔ ƒe Dɔmawɔmawɔ nyuie: Esiae nye esime wò ŋutilã ƒe lãkusiwo mekpɔa ya si sɔ o.
• Dzi ƒe Dɔléle: Dzi ƒe tɔtrɔ kpata.
• Coma.
• Aklã ƒe Ʋusɔgbɔdɔ: Ʋuka siwo do ƒome kple aklã ƒe nyaƒoɖeamenu dzina ɖe edzi.

Aleke nèwɔna dea dzesi esia?

Be ɖɔkta nanya gbɔgbɔtsixetsixe , abia wò gbã tso wò dzesiwo, wò atikewɔwɔ ŋutinya, kple atike ɖesiaɖe si nèzãna ŋu. Emegbe, woate ŋu abia be woawɔ ʋudodokpɔ tɔxɛwo atsɔ adzidze carbon dioxide (CO2) ƒe agbɔsɔsɔ si le wò ʋu me. Woate ŋu aɖe gbe be woawɔ dodokpɔ bubuwo hã be woanya nusi tututu gbɔ ya si mebɔ o la tso .

Dodokpɔ ka ƒomevie wowɔna?

Woate ŋu awɔ dodokpɔ siwo gbɔna atsɔ adi nusi gbɔ gbɔgbɔtsixetsixe tsona:

• Ʋukawo me Ʋu Dodokpɔ: Esia léa ŋku ɖe oxygen, carbon dioxide, kple acid agbɔsɔsɔme si le ʋua me ŋu.
• Aklã ƒe Dɔwɔwɔ Dodokpɔwo: Esiawo nye dodokpɔ siwo léa ŋku ɖe alesi wò aklã le dɔ wɔm nyuie ŋu.
• Pulse Oximetry: Mɔ̃ si dzidzea oxygen agbɔsɔsɔme si le wò ʋu me to nu sue aɖe si wotsɔ blaa wò asibidɛ ŋu me. Ðewohĩ èkpɔ esia kpɔ.
• Ʋudodokpɔ: Ʋudodokpɔ bubu geɖewo li siwo ate ŋu akpe ɖe ame ŋu wòanya dɔléle sia alo nusiwo gbɔ wòtso. Kpɔɖeŋu aɖewoe nye Ʋu Xexlẽme Blibo (CBC) , Basic Metabolic Panel (BMP) , Toxicology Screen (be woatsɔ alé ŋku ɖe nusiwo le abe atikewo ene ŋu), Carbon Dioxide (CO2) ʋudodokpɔ, kple Thyroid Function Tests.
• Nɔnɔmetatawo ɖeɖe: Ðɔkta ate ŋu abia be woawɔ wò akɔta ƒe X-ray, woawɔ wò akɔta alo ta ƒe CT scan (Computed Tomography scans) atsɔ adi nɔnɔme bubu siwo gbɔ wòtso.
• Alɔ̃dɔdɔ Ŋuti Nusɔsrɔ̃ / Polysomnography: Dodokpɔ sia kpena ɖe ame ŋu wòdea dzesi nɔnɔmewo abe alɔ̃dɔdɔ ƒe gbɔgbɔtsixetsixe kple lolo akpa ƒe yagbɔgbɔ ƒe dɔléle ene .

Aleke wowɔa atike nɛ?

Gbɔgbɔtsixe dada nɔ te ɖe nusi gbɔ dɔlélea tso kple alesi gbegbe nɔnɔmea nu sẽe dzi. Lãmesẽdɔwɔlawo ate ŋu ana atikewo wò abe:

• Yaƒoƒo si Mexɔa Nu O: Esia bia be nàzã mɔ̃ aɖe si akpe ɖe ŋuwò nàgbɔ ya to ametakpɔnu si sɔ ɖe wò mo dzi. Le kpɔɖeŋu me, mɔ̃ si nye Continuous Positive Airway Pressure (CPAP) alo mɔ̃ si nye Bilevel Positive Airway Pressure (BiPAP®) mɔ̃. Ðewohĩ èse nusiawo ŋu nya kpɔ.
• Atike Siwo Doa Yagbɔgbɔ: Ɣeaɖewoɣi la, ne atikeawo nono fũ alo atike aɖe ƒe nugbegblẽ le ame ŋu gbɔe nɔnɔme sia tso la, woate ŋu ana atike siwo naa gbɔgbɔtsixe tsia lãme na ame. Le kpɔɖeŋu me, ne opioids gbɔe nɔnɔme sia tso la, woate ŋu aɖe eƒe ŋusẽkpɔɖeamedzi dzi akpɔtɔ to atike si woyɔna be Naloxone/Narcan® nana me.
• Oxygen Dɔdamɔnu: Woate ŋu ana oxygen ne ehiã.
• Mɔ̃ɖaŋununya ƒe Yaƒoƒo: Ne nɔnɔmea nu sẽ ŋutɔ la, ahiã be woana ame aɖe ƒe dzi nadze eme, atsɔe ade mɔ̃ me, eye woana mɔ̃ aɖe nagbɔ ya.

Nɔnɔme ka ƒomevie woate ŋu akpɔ mɔ na le etsɔme? (Nukpɔsusu) .

Gbɔgbɔtsixe ƒe ŋgɔdonya nɔ te ɖe nusi gbɔ wòtso dzi. Nudzɔdzɔ kpata aɖe, abe opioid zazã fũ ene, ate ŋu awu ame ne womedae kaba o. Gake ne alɔ̃madɔmadɔ, alɔ̃madɔmadɔ si xea mɔ na lolo akpa ( OHS ) , alo dɔléle bubu siwo nɔa anyi ɣeyiɣi didi gbɔe nɔnɔmea tso la, ahiã be woayi edzi adae eye wòanyo ɖe edzi vivivi.

Ðe woate ŋu axe mɔ ɖe enua?

Mɔ nyuitɔ si dzi nàto axe mɔ ɖe gbɔgbɔtsixetsixe nue nye be nàno wò atikewo abe alesi wogblɔe ene pɛpɛpɛ eye nàkpɔ atikewɔwɔ me nɔnɔme ɖesiaɖe si gbɔ wòtso gbɔ. Kpɔ egbɔ be yebia wò ɖɔkta alo atikewɔla hafi nàno atike eve alo esi wu nenema, vevietɔ opioid kple benzodiazepines, siwo ɖea wò susu ƒe dɔwɔwɔ dzi kpɔtɔna alo nana nèdɔa alɔ̃. Azɔ hã , nya nu gbegblẽ siwo ate ŋu ado tso eme ne wozã atike siawo kpe ɖe aha ŋu.

"Atike nye xɔlɔ̃ ne wozãe nyuie, gake enye futɔ ne wozãe vodadatɔe."

Ɣekaɣie wòle be makpɔ ɖɔkta?

Ƒo nu kple wò ɖɔkta le nɔnɔme siawo me:

• Ne nyabiase alo ɖikeke aɖe le ŋuwò le atikewɔwɔ ƒe nɔnɔme aɖe si le ŋuwò ŋu.
• Ne nyabiase alo ɖikeke le ŋuwò le atike aɖe si ɖɔkta ŋlɔ na wò ŋu.
• Ne gbɔgbɔtsixetsixe ƒe dzesiwo le ŋuwò, vevietɔ ne atikewɔwɔ me nɔnɔme bubu siwo nana wò afɔkua dzina ɖe edzi.

Ɣekaɣie wòle be nàyi Atikewɔwɔ Kpata ƒe Dɔwɔƒe (ETU) ?

Ne dzesi sesẽ siawo dometɔ aɖe le ŋuwò la , yi xɔ si me wokpɔa dɔnɔwo gbɔ kpata le si te ɖe ŋuwò enumake:

• Ne alɔ̃madɔmadɔ le ŋuwò la .
• Ne susu ƒe nɔnɔme trɔ eye tɔtɔ le ame ŋu .
• Ne èse le ɖokuiwò me be alɔ̃ le ye wum ale gbegbe be màte ŋu anɔ ŋudzɔ o.
• Ne wò susu tɔtɔ le afisi nèle kple ɣeyiɣi si nèle ŋu.
• Ne èse vɔvɔ̃ alo ɖikeke si mebɔ o (paranoia) .
• Ne ŋutigbalẽ, ɖa, alo nuyiwo trɔ zu blɔ.

Nya kawoe wòle be nàbia ɖɔktaa?

Ate ŋu aɖe vi be nàbia wò ɖɔkta nya siawo abe esiawo ene:

• "Nukatae esia dzɔ ɖe dzinye?"
• "Nukae wòle be mawɔ be nane si le abe esia ene nagadzɔ le etsɔme o?"
• "Atikewɔwɔ ƒe tiatia kawoe le asinye?"

Mlɔeba la, nusiwo dzi wòle be woaɖo ŋkui (Take-Home Message) .

Yagbɔgbɔ ƒe blanuiléle nye nɔnɔme sesẽ aɖe si me ya si woyɔna be carbon dioxide (CO2) ƒoa ƒu ɖe wò ʋu me. Gake woate ŋu axe mɔ ɖe enu zi geɖe. Ne èle atike siwo ate ŋu ana gbɔgbɔtsixe natsi ame nu la zãm la, ƒo nu kple wò ɖɔkta be nàka ɖe edzi be yele wo zãm nyuie eye wòle dedie. Ne atikewɔwɔ me dɔléle bubu aɖe le ŋuwò si ate ŋu ahe nɔnɔme sia vɛ la, bia wò ɖɔkta tso afɔ siwo nàte ŋu aɖe atsɔ aɖe wò afɔkua dzi akpɔtɔ ŋu. Ate ŋu aƒo nu tso wò dzimaɖitsitsiwo ŋu na wò eye wòawɔ ɖoɖo aɖe si dzi nàto akpɔ wò nɔnɔmea kple atikewo gbɔ dedie. Wò lãmesẽ dzi kpɔkpɔe nye nu vevitɔ kekeake.

` Yagbɔgbɔ ƒe blanuiléle, yaƒoƒo ƒe agbɔsɔsɔ si mede ame dzi o, gbɔgbɔtsixetsixe, carbon dioxide, oxygen, lãkusidɔ, atike muamewo zazã