Lung Expansion Therapy ®ß

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Lung Expansion Therapy
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
®ß√—°…å Õÿµ√“√—™µå°‘®
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ºŸâªÉ«¬∑’˵âÕß°“√°“√∫”∫—¥‡æ◊ËÕ„ÀâªÕ¥¢¬“¬µ—«
ªÕ¥ “¡“√∂¢¬“¬µ—«‡æ‘Ë¡¢÷Èπ‰¥âÕ¬à“߉√
«‘∏’°“√∫”∫—¥‡æ◊ËÕ„ÀâªÕ¥¢¬“¬µ—«‡µÁ¡„πºŸâªÉ«¬‡¥Á°
1.
2.
3.
4.
5.
6.
7.
v
Deep Breathing
Sustained Maximal Inspiration (SMI) Therapy
Manual Hyperinflation
Positive Expiratory Pressure Therapy (PEP Therapy)
Positive airway pressure system (EzPAPTM)
Intermittent positive pressure breathing (IPPB)
Continuous Positive Airway Pressure Treatments
°“√ª√–‡¡‘πº≈≈—æ∏å¢Õß°“√∫”∫—¥
Lung Expansion Therapy, ®ß√—°…å Õÿµ√“√—™µå°‘®
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§«“¡À¡“¬
°“√∫”∫—¥‡æ◊ÕË „ÀâªÕ¥¢¬“¬µ—« (Lung Expansion
Therapy) §◊Õ «‘∏°’ “√∑’∑Ë ”„ÀâªÕ¥¢¬“¬µ—«‡æ‘¡Ë ¢÷πÈ ®“°°“√
¢¬“¬µ—«µ“¡ª°µ‘ ∑”„Àâ°“ä ´ “¡“√∂‡¢â“‰ª¬—ß∂ÿß≈¡ªÕ¥
‰¥â∑«Ë— ∂÷ß “¡“√∂ªÑÕß°—π·≈–·°â‰¢¿“«–∂ÿß≈¡ªÕ¥·ø∫
(atelectasis) ·≈–∑”„Àâ°“√·≈°‡ª≈’ˬπ°ä“´¥’¢÷Èπ
ºŸâªÉ«¬∑’˵âÕß°“√°“√∫”∫—¥‡æ◊ËÕ„ÀâªÕ¥¢¬“¬µ—«
䴉ᡈ
1. ºŸªâ «É ¬∑’‰Ë ¡à “¡“√∂À“¬„®‡¢â“‰¥â≈°÷ Ê æ∫„πºŸâ
ªÉ«¬∑’Ë’ impaired consciousness, ‰¥â√—∫¬“πÕπÀ≈—∫,
°“√ºà“µ—¥∑√«ßÕ°À√◊Õ™àÕß∑âÕß à«π∫π,¡’ª≠í À“°≈â“¡‡π◊ÕÈ
ÕàÕπ·√ß, πÕπÕ¬Ÿ∫à π‡µ’¬ßπ“πÊ, ¡’欓∏‘ ¿“æ¢Õߪե
´÷Ëß∑”„ÀâªÕ¥¡’ resistance Ÿß ·≈– compliance µË”
·≈–ºŸâ∑’Ë¡’°“√∑”ß“π¢Õß°–∫—ß≈¡º‘¥ª°µ‘ ‡ªìπµâπ
2. ºŸâªÉ«¬∑’ˉ¡à¡’·√ß‰Õ æ∫‰¥â∫àÕ¬„πºŸâªÉ«¬∑’Ë¡’
impaired consciousness, ¡’ª≠í À“°≈â“¡‡π◊ÕÈ ÕàÕπ·√ß,
À≈—ß°“√ºà“µ—¥∑√«ßÕ° À√◊Õ™àÕß∑âÕß à«π∫π, ¢“¥Õ“À“√
·≈–∑“√°§≈Õ¥°àÕπ°”Àπ¥ ‡ªìπµâπ
3. ºŸªâ «É ¬∑’¡Ë ‡’ ¡À–¡“° ‡ ¡À–‡À𒬫 æ∫‰¥â∫Õà ¬
„πºŸªâ «É ¬ªÕ¥Õ—°‡ ∫, BPD, ·≈– bronchiectasis ‡ªìπµâπ
4. ºŸâªÉ«¬∑’Ë„ à chest drain
5. ºŸâªÉ«¬∑’Ë¡’¿“«–ªÕ¥·ø∫‡°‘¥¢÷Èπ·≈â«
ºŸªâ «É ¬‡À≈à“π’®È ”‡ªìπµâÕ߉¥â√∫— °“√¥Ÿ·≈·≈–∫”∫—¥
„ÀâªÕ¥¢¬“¬µ—«‡µÁ¡∑’Ë ‡æ◊ËÕªÑÕß°—πÀ√◊Õ·°â‰¢¿“«–ªÕ¥
·ø∫ «‘∏’°“√∫”∫—¥‡æ◊ËÕ„ÀâªÕ¥¢¬“¬µ—«‡µÁ¡∑’Ë¡’À≈“¬«‘∏’
·µà≈–«‘∏’¡’¢âÕ¥’ ¢âÕ‡ ’¬ §«“¡ßà“¬ §«“¡¬“° ‡«≈“·≈–
µâπ∑ÿπ∑’Ë„™â„π°“√∫”∫—¥·µ°µà“ß°—π ¥—ßπ—Èπ°“√π”¡“
ª√–¬ÿ°µå„™â®√‘ß∑“ߧ≈‘π‘°ºŸâ∫”∫—¥®–µâÕß¡’°“√æ‘®“√≥“
‡≈◊Õ°„™â ‡ΩÑ“µ‘¥µ“¡·≈–ª√–‡¡‘πº≈°“√∫”∫—¥Õ¬à“ß„°≈♥‘
æ√âÕ¡∑—Èߪ√—∫‡ª≈’ˬπ«‘∏’°“√∫”∫—¥„Àâ‡À¡“– ¡°—∫Õ“¬ÿ
√–¥—∫§«“¡ “¡“√∂ §«“¡√à«¡¡◊Õ °“√¬Õ¡√—∫ 欓∏‘ ¿“æ
¢Õß‚√§ºŸâªÉ«¬·≈–µâπ∑ÿπ„π°“√∫”∫—¥ ´÷Ëߧ«“¡√à«¡¡◊Õ
·≈–°“√¬Õ¡√—∫«‘∏’°“√∫”∫—¥¢ÕߺŸâªÉ«¬∂◊Õ‡ªìπÀ—«„®∑’Ë
®–∑”„Àâ°“√∫”∫—¥‡°‘¥º≈≈—æ∏å∑’Ë¥’
ªÕ¥ “¡“√∂¢¬“¬µ—«‡æ‘Ë¡¢÷Èπ‰¥âÕ¬à“߉√1
°“√∑”„ÀâªÕ¥¢¬“¬µ—«‡æ‘¡Ë ¢÷πÈ °Á§Õ◊ «‘∏°’ “√∑’∑Ë ”„Àâ
ªÕ¥ºŸâªÉ«¬¡’ª√‘¡“µ√‡æ‘Ë¡¢÷Èπ À√◊Õ«‘∏’°“√∑’Ë∑”„Àâ∂ÿß≈¡
ªÕ¥ (alveoli) ¢¬“¬¡“°¢÷πÈ π—πË ‡Õß ´÷ßË ‡√“ “¡“√∂∑”‰¥â
‚¥¬°“√‡æ‘Ë¡ transpulmonary pressure (Pl) gradient
´÷ßË §à“π’‰È ¥â¡“®“°§à“ alveolar pressure (Palv) ≈∫¥â«¬§à“
pleural pressure (Ppl)
Pl = Palv - Ppl
®“° Ÿµ√¥—ß°≈à“«π’®È –æ∫«à“°“√‡æ‘¡Ë transpulmonary pressure gradient “¡“√∂∑”‰¥â 2 «‘∏’§◊Õ
1. °“√∑”„Àâ intrapleural pressure µË”≈ß¡“°¢÷πÈ
´÷ßË “¡“√∂∑”‰¥â‚¥¬°“√欓¬“¡À“¬„®‡¢â“≈÷°Ê (spontaneous deep inspiration) (¿“æ∑’Ë1-A)
2. °“√∑”„Àâ intra-alveolar pressure À√◊Õ·√ß
¥—π¿“¬„π∂ÿß≈¡ Ÿß¢÷πÈ ´÷ßË “¡“√∂∑”‰¥â‚¥¬°“√∑”„À⇰‘¥
·√ߥ—π∫«°„πªÕ¥ (¿“æ∑’Ë1-B)
«‘∏°’ “√∫”∫—¥‡æ◊ÕË „ÀâªÕ¥¢¬“¬µ—«‡µÁ¡∑’®Ë ß÷ „™âÀ≈—°
¥—ß°≈à“«π’È·≈â«·µà«à“«‘∏’‰Àπ®–„™âÀ≈—°¢âÕ„¥
A
B
¿“æ∑’Ë 1 Transpulmonary pressure gradients with spontaneous inspiration (A) and positive pressure
inspiration (B)
88 New Insight in Pediatric Critical Care 2003
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«‘∏°’ “√∫”∫—¥‡æ◊ÕË „ÀâªÕ¥¢¬“¬µ—«‡µÁ¡„πºŸªâ «É ¬‡¥Á°
¡’¥—ßπ’È
1. Deep breathing
2. Sustained Maximal Inspiration (SMI)
Therapy
3. Manual Hyperinflation
4. Positive Expiratory Pressure Therapy
(PEP Therapy)
5. Positive airway pressure system
(EzPAPTM)
6. Intermittent positive pressure breathing
(IPPB)
7. Continuous Positive Airway Pressure
Treatments (CPAP)
1. Deep Breathing
Deep breathing ‡ªìπ«‘∏°’ “√¢¬“¬ªÕ¥∑’ßË “à ¬∑’ Ë ¥ÿ
·≈– “¡“√∂∑”‰¥â‡Õßµ≈Õ¥‡«≈“∑’˵âÕß°“√‚¥¬‰¡àµâÕß
Õ“»—¬‡§√◊ÕË ß¡◊Õ„¥Ê ™à«¬ «‘∏π’ ®’È ß÷ ‡À¡“–°—∫ºŸªâ «É ¬ ‡¥Á°‚µ
∑’¡Ë §’ «“¡‡ ’¬Ë ßµàÕ°“√‡°‘¥¿“«–ªÕ¥·ø∫·≈– “¡“√∂§«∫
§ÿ¡°“√À“¬„®‰¥â¥â«¬µπ‡Õß
«‘∏’°“√§◊Õ „À⺟âªÉ«¬π—ËßÀ√◊ÕπÕπ°Á‰¥â À“¬„®‡¢â“
™â“Ê ≈÷°Ê Õ“®À“¬„®·∫∫ Diaphragmatic Breathing
Exercise À√◊Õ Abdominal Breathing Exercise °Á‰¥â
°“√À“¬„®·∫∫π’‡È ªìπ°“√À“¬„®∑’„Ë ™âæ≈—ßß“ππâÕ¬∑’ Ë ¥ÿ ·µà
‰¥âª√‘¡“≥≈¡À“¬„®‡¢â“-ÕÕ°®“°ªÕ¥¡“°∑’Ë ÿ¥ «‘∏’°“√
§◊Õ «“ß¡◊Õ¢â“ßÀπ÷Ëß∑“∫∫πÀπâ“Õ° ¡◊ÕÕ’°¢â“ß«“ß∫π
Àπâ“∑âÕß ºàÕπ§≈“¬°≈â“¡‡π◊ÕÈ Àπâ“∑âÕß Ÿ¥≈¡À“¬„® ‡¢â“
≈÷°Ê ∑“ß®¡Ÿ°®π°√–∑—Ëß√Ÿâ ÷°«à“¡◊Õ∑’Ë«“ß∫πÀπâ“∑âÕ߬°
¢÷πÈ à«π¡◊Õ∑’«Ë “ß∫πÀπâ“Õ°¡’°“√‡§≈◊ÕË π¢÷πÈ πâÕ¬¡“° π—∫
1-2-3 ‡æ◊ÕË °—°≈¡À“¬„®‰«â °— æ—°‡æ◊ÕË „Àâ¡’ collateral ventilation (®“°ª√– ∫°“√≥å¢ÕߺŸ‡â ¢’¬π¡—°®–æ∫«à“ °“√Ωñ°
À“¬„®„π√–¬–·√°Ê ºŸâªÉ«¬¡—°®–À“¬„®‡¢â“≈÷°Ê ‰¡à‰¥â
∑—π∑’ ®–µâÕß·π–π”„À⺟âªÉ«¬À“¬„® ∫“¬Ê ·≈–ºàÕπ
§≈“¬°àÕπ ·≈â«®÷ߧàÕ¬Ê ‡æ‘Ë¡§«“¡≈÷°„π°“√À“¬„®¢÷Èπ
‡√◊ÕË ¬Ê ®π°√–∑—ßË À“¬„®‰¥â≈°÷ µ“¡µâÕß°“√) °àÕπÀ“¬„®
ÕÕ°„ÀâÀÕà ª“°„π≈—°…≥–‡À¡◊Õπº‘«ª“°À√◊Õ‡ªìπ√Ÿªµ—« O
æ√âÕ¡°—∫§àÕ¬Ê ºàÕπ≈¡À“¬„®ÕÕ°∑“ߪ“° (pursed lips)
欓¬“¡§«∫§ÿ¡„Àâ≈¡À“¬„®ÕÕ°π“π‡ªìπ 3 ‡∑à“¢Õß
√–¬–‡«≈“À“¬„®‡¢â“ „π¢≥–À“¬„®ÕÕ°„À⇰√Áß°≈â“¡‡π◊ÕÈ
Àπâ“∑âÕ߇≈Á°πâÕ¬·≈–„Àâ ß— ‡°µ«à“¡◊Õ∑’«Ë “ßÀπâ“∑âÕߧàÕ¬Ê
‡§≈◊ËÕπ≈ß à«π¡◊Õ∑’Ë«“ß∫πÀπâ“Õ°¡’°“√‡§≈◊ËÕπ≈ßπâÕ¬
¡“° „Àâ∑”«‘∏’¥—ß°≈à“«π’ȵ‘¥µàÕ°—π 8-10 §√—Èß∑ÿ°™—Ë«‚¡ß
„π™à«ß‡«≈“µ◊Ëπ2,3
2. Sustained Maximal Inspiration (SMI) Therapy
Sustained Maximal Inspiration Therapy «‘∏’
°“√∫”∫—¥∑’Ë欓¬“¡‡æ‘Ë¡ alveolar distending pressure ‚¥¬„™âÀ≈—°„π°“√∑”„Àâ pleural pressure ‡ªìπ
negative ¡“°·≈–π“π∑’ Ë ¥ÿ ´÷ßË “¡“√∂∑”‰¥â‚¥¬°“√„Àâ
ºŸªâ «É ¬À“¬„®‡¢â“Õ¬à“ß™â“Ê ®π√Ÿ â °÷ «à“À“¬„®‡¢â“≈÷°®π ÿ¥
‡µÁ¡∑’·Ë ≈â« °≈à“«§◊Õ„ÀâÀ“¬„®‡¢â“Õ¬à“ß™â“Ê (spontaneous
slow inspiration) ®“°√–¥—∫ functional residual
capacity (FRC) ®π∂÷ß√–¥—∫ total lung capacity (TLC)
·≈⫧ߧâ“ß°“√À“¬„®‡¢â“®π ÿ¥ (breath hold) „π¢≥–∑’Ë
glottis ¬—߇ªî¥Õ¬Ÿ„à Àâπ“π∑’ Ë ¥ÿ ‡∑à“∑’®Ë –∑”‰¥âÀ√◊Õª√–¡“≥
3-5 «‘π“∑’4 °“√§ß§â“ß°“√À“¬„®‡¢â“®π ÿ¥„Àâπ“π∑’Ë ÿ¥
„π≈—°…≥–¥—ß°≈à“«π’∂È Õ◊ ‡ªìπÀ—«„® ”§—≠¢Õß°“√∑” Sustained Maximal Inspiration therapy ‡π◊ËÕß®“°°“√
„À⺟âªÉ«¬À“¬„®‡Õß„π≈—°…≥–¥—ß°≈à“«π’È∑”‰¥â¬“°‚¥¬
‡©æ“–„πºŸªâ «É ¬‡¥Á° ®÷߉¥â¡°’ “√º≈‘µ‡§√◊ÕË ß¡◊Õ‡æ◊ÕË ™à«¬„π
°“√∑” Sustained Maximal Inspiration ‡§√◊ËÕß¡◊Õ
¥—ß°≈à“«π’¡È µ’ «— · ¥ß∑’∫Ë ßà ∫Õ°∂÷ß√–¥—∫§«“¡ “¡“√∂À√◊Õ
§«“¡æ¬“¬“¡¢ÕߺŸªâ «É ¬‡æ◊ÕË ∑”„À⺪Ÿâ «É ¬ “¡“√∂ª√–‡¡‘π
µπ‡Õß·≈–æ—≤π“°“√À“¬„®„À⥢’ π÷È ‡√◊ÕË ¬Ê ‡ªìπ°“√ √â“ß
·√ß®Ÿß„® ·≈–„Àâ°”≈—ß„® (incentive) ·°àºªŸâ «É ¬ ‡§√◊ÕË ß¡◊Õ
¥—ß°≈à“«π’È®÷ß¡’™◊ËÕ«à“ Incentive spirometer5
Incentive spirometer À√◊Õ sustained maximal
inspiration therapy ∑’Ë¢“¬∑âÕßµ≈“¥¡’ 2 ™π‘¥ §◊Õ
1) Volume-oriented device ™π‘¥ Incentive
Lung Expansion Therapy, ®ß√—°…å Õÿµ√“√—™µå°‘®
89
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spirometer ∑’Ë¡’ visual feedback ™π‘¥ inspired
volume ‰¥â·°à Voldyne model (¿“æ∑’Ë 2)
2) Flow-oriented device ‡ªìπ Incentive
spirometer ∑’Ë¡’ visual feedback ‡ªìπ™π‘¥ inspired
flow µ—«Õ¬à“߉¥â·°à Triflo (¿“æ∑’Ë 3), Uniflow ·≈–
Cliniflo ´÷Ëß Uniflow ·≈– Cliniflo ‡ªìπ™π‘¥ low-flow
Incentive spirometer ®÷߇À¡“– ”À√—∫ºŸªâ «É ¬‡¥Á°‡≈Á°·≈–
ºŸâ∑’Ë¡’·√ßÀ“¬„®πâÕ¬
¿“æ∑’Ë 3 Flow-oriented incentive spirometer : Triflo
¿“æ∑’Ë 2 Volume-oriented incentive spirometer °. ‡ªìπ
°“√‡≈◊ÕË πµ—«∫àß™’√È –¥—∫ inspiratory goal ∑’µË Õâ ß°“√
„À⺪⟠«É ¬∑”„Àâ∂ß÷ ¢. √Ÿª· ¥ß°“√∑’ºË ªâŸ «É ¬æ¬“¬“¡
Ÿ¥≈¡À“¬„®‡¢â“‡æ◊ËÕ„Àâ≈Ÿ°≈Õ¬‡≈◊ËÕπ∂÷ß√–¥—∫∑’˵—Èß
‰«â‡æ◊ÕË „À≥â inspiratory goal ∑’µË Õâ ß°“√ (§—¥≈Õ°
®“° Pierce N.B. L Mechanical ventilation and
intensive respiratory care, WB Saunders Company 1995 )
À≈—°°“√„™â Incentive spirometer ∑—Èß 2 ™π‘¥
§≈⓬°—π ®÷ߢհ≈à“«‡©æ“–√“¬≈–‡Õ’¬¥«‘∏’°“√„™â floworiented devices ™π‘¥ Triflo ‡∑à“π—πÈ À≈—°°“√„™â Triflo
‰¡à„™à‡æ’¬ß·µà°√–µÿπâ „À⺪Ÿâ «É ¬ “¡“√∂ Ÿ¥À“¬„®‡¢â“·√ßÊ
®π≈Ÿ°ªîߪÕß≈Õ¬¢÷Èπ·≈–µ°≈ß∑—π∑’‡∑à“π—Èπ ·µà∑’Ë ”§—≠
§◊ÕµâÕß„Àâ≈°Ÿ ªîߪÕß≈Õ¬¢÷πÈ Ÿß ÿ¥·≈–≈Õ¬§â“ßπ“π∑’ Ë ¥ÿ
(¿“æ∑’Ë 3) ‡æ◊ËÕ„À≥âª√‘¡“µ√≈¡‡¢â“ªÕ¥‡µÁ¡∑’Ë §◊ÕµâÕß
‡πâπ°“√ √â“ß flow „Àâ‰¥â Ÿß ÿ¥Õ¬à“ßµàÕ‡π◊ËÕ߇ªìπ√–¬–
‡«≈“π“π∑’Ë ÿ¥ ∑—Èßπ’ȇπ◊ËÕß®“° volume = flow x time
πÕ°®“°π’°È “√µ—ßÈ ‡ªÑ“À¡“¬∑’®Ë –„À⺪Ÿâ «É ¬∑”„π√–¬–·√°Ê
‰¡à§«√µ—ßÈ ‡ªÑ“À¡“¬ Ÿß‡°‘π‰ª®πºŸªâ «É ¬∑”‰¡à‰¥â ‡æ√“–®–
∑”„À⺪Ÿâ «É ¬À¡¥°”≈—ß„®§«√µ—ßÈ ‡ªÑ“À¡“¬µË”ʇ∑à“∑’ºË ªŸâ «É ¬
“¡“√∂∑”‰¥âÕ¬à“ß ∫“¬Ê ∑—Èßπ’ȇæ◊ËÕ„À⺟âªÉ«¬‡°‘¥°“√
‡√’¬π√Ÿâ·≈–¡’°”≈—ß„®∑’Ë®–∑”µàÕ ‡¡◊ËÕºŸâªÉ«¬∑”‰¥â·≈â«®÷ß
§àÕ¬Ê ª√—∫‡æ‘Ë¡¢÷ÈπÕ¬à“ß™â“Ê ®π‰¥â‡ªÑ“À¡“¬∑’˵âÕß°“√
§◊Õ‡∑à“∑’˧«“¡ “¡“√∂¢ÕߺŸâªÉ«¬®–∑”‰¥â‡µÁ¡∑’Ë‚¥¬‰¡à
µâÕß„™â·√ß¡“°À√◊Õ∑”‰¥â‡∑à“°—∫°àÕπºà“µ—¥ À√◊Õ„À≥â
∂÷ß§à“ predicted inspiratory capacity3 ¢ÕߺŸâªÉ«¬
°“√„™â Incentive spirometer ¡—°„À⺪Ÿâ «É ¬À“¬„®
‡¢â“ºà“π∑“ß mouthpiece ”À√—∫ºŸâªÉ«¬∑’ˬ—ßµâÕß°“√
ÕÕ°´‘‡®π “¡“√∂„ÀâÕÕ°´‘‡®π∑“ß nasal cannula
¢≥–„™â Incentive spirometer ·≈–„π°√≥’∑’˺ŸâªÉ«¬¡’∑àÕ
‡®“–§Õ “¡“√∂ª√–¬ÿ°µåÕªÿ °√≥åµÕà °—∫ Incentive spirometer ·≈–∑àÕ‡®“–§Õ‡æ◊ËÕ„À⺟âªÉ«¬À“¬„®ºà“π∑“ß∑àÕ
‡®“–§Õ¥—ß¿“æ∑’Ë 4
90 New Insight in Pediatric Critical Care 2003
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¿“æ∑’Ë 4 °“√„™â Incentive spirometer ºà“π∑“ß∑àÕ‡®“–§Õ
„π°√≥’‡¥Á°‡≈Á°Ê ¡—°®–‰¡à “¡“√∂∑” Sustained
Maximal Inspiration ‰¥â °“√°√–µÿâπ„À⇥Á°∑”‰¥â‡æ’¬ß
°“√ Ÿ¥≈¡À“¬„®‡¢â“‡æ◊ÕË ¥÷ß„Àâ≈°Ÿ ªîߪÕß≈Õ¬¢÷πÈ °Á∂Õ◊ «à“
‰¥âª√–‚¬™πå ‡æ√“–Õ¬à“ßπâÕ¬°Á‡ªìπ°“√°√–µÿπâ „À⇥Á°‰¥â¡’
°“√À“¬„®≈÷°Ê ∫â“ߥ’°«à“‰¡à‰¥â„À⇥Á°∑”Õ–‰√‡≈¬
¢—ÈπµÕπ°“√„™â Incentive spirometer4
§«“¡ ”‡√Á®¢Õß°“√„™â Incentive spirometer Õ¬Ÿà
∑’˧«“¡ “¡“√∂„π°“√Õ∏‘∫“¬ºŸâªÉ«¬ ∫‘¥“¡“√¥“ ·≈–
ºŸ¥â ·Ÿ ≈‡ÀÁ𧫓¡ ”§—≠·≈– “¡“√∂ªØ‘∫µ— µ‘ “¡‰¥â∂°Ÿ µâÕß
·≈–‡§√àߧ√—¥ °“√„™â Incentive spirometer ‡æ◊ËÕ°“√
¢¬“¬ªÕ¥®–‡πâπ„Àâ„™â Incentive spirometer ∫àÕ¬Ê §◊Õ
„Àâ∑”µ‘¥µàÕ°—πª√–¡“≥ 10 §√—Èß∑ÿ° 1-2 ™—Ë«‚¡ß „π™à«ß
‡«≈“µ◊Ëπ ‚¥¬¡’√“¬≈–‡Õ’¬¥¢—ÈπµÕπ°“√„™â ¥—ßπ’È
1. Õ∏‘∫“¬„À⺪Ÿâ «É ¬·≈–ºŸ¥â ·Ÿ ≈‡ÀÁ𧫓¡ ”§—≠¢Õß
°“√¢¬“¬ªÕ¥‚¥¬°“√„™â Incentive spirometer
2. µ—È߇ªÑ“À¡“¬¢Õß volume/flow ∑’Ë®–„À⺟âªÉ«¬
∑”„À≥â
3. „À⺟âªÉ«¬Õ¬Ÿà„π∑à“π—Ëß À√◊Õ semi-Flowerûs
position
4. ÕπÀ√◊ՙ૬ºŸâªÉ«¬ª√–§Õß (splint) ·º≈
ºà“µ—¥ (∂â“¡’·º≈ºà“µ—¥)
5. ·π–π”«‘∏’°“√„™â Incentive spirometer µ“¡
¢—ÈπµÕπ¥—ßπ’È
5.1 «“ß Incentive spirometer ∫πæ◊Èπ√“∫
À√◊Õ∂◊Õ Incentive spirometer „Àâµ—Èßµ√ß
5.2 À“¬„®ÕÕ°µ“¡ª°µ‘
5.3 „™â√‘¡Ω望°Õ¡ mountpiece „Àâ π‘∑
5.4 À“¬„®‡¢â“™â“Ê ≈÷°Ê ®π∂÷ßµ—«∫àß™’È∑’˵—Èß
‡ªÑ“À¡“¬‰«â
5.5 §ß§â“ß°“√À“¬„®‡¢â“π’µÈ Õà ‰ª‡√◊ÕË ¬Ê ª√–
¡“≥ 3-5 «‘π“∑’ À√◊Õ‡∑à“∑’Ë®–§ß§â“߉¥â
5.6 ¥÷ß mountpiece ÕÕ°®“°ª“° ·≈–
À“¬„®ÕÕ°µ“¡ª°µ‘
5.7 À“¬„®µ“¡ª°µ‘Õ¬à“ߺàÕπ§≈“¬À≈“¬Ê
§√—Èß
5.8 ∑”´È”µ“¡¢—ÈπµÕπ∑’Ë 5.1 - 5.7 ª√–¡“≥
10 §√—Èß ∑ÿ° 1 -2 ™—Ë«‚¡ß™à«ß‡«≈“µ◊Ëπ
5.9 µ‘¥µ“¡/ª√–‡¡‘π/„Àâ°”≈—ß„®·≈–„À⧔·π–
𔇪ìπ√–¬–Ê
5.10 ∫—π∑÷°§«“¡√à«¡¡◊Õ¢ÕߺŸâªÉ«¬·≈–º≈
°“√∫”∫—¥„π‡Õ° “√∑“ß°“√·æ∑¬å
¢âÕ∫àß™’È„π°“√„™â Incentive spirometer
1. ‡æ◊ÕË ªÑÕß°—π°“√‡°‘¥¿“«–ªÕ¥·ø∫„πºŸªâ «É ¬∑’Ë
¡’§«“¡‡ ’Ë¬ß ‡™àπ ºŸâªÉ«¬∑’輈ҵ—¥∫√‘‡«≥∑√«ßÕ° À√◊Õ
™àÕß∑âÕß à«π∫π
2. ºŸâªÉ«¬∑’Ë¡’¿“«–ªÕ¥·ø∫
3. „™â‡ªìπ‡§√◊ÕË ß¡◊Õ„π°“√µ‘¥µ“¡ ¡√√∂¿“æªÕ¥
À≈—ßºà“µ—¥ ¡’°“√»÷°…“æ∫«à“¡’ good correlation √–À«à“ß
Incentive spirometer performance °—∫ vital capacity ∑’Ë«—¥‚¥¬„™â spirometry6
4. „™â√à«¡°—∫°“√„Àâ chest physical therapy
‡æ◊Ëՙ૬°√–µÿâπ°“√‰Õ
5. „™âª√–‡¡‘𧫓¡ “¡“√∂„π°“√ Ÿ¥≈¡À“¬„®
‡¢â“∑“ߪ“°¢ÕߺŸªâ «É ¬‡¥Á°°àÕπ°“√µ—¥ ‘π„®„™â¬“ª√–‡¿∑
dry powder inhaler
Lung Expansion Therapy, ®ß√—°…å Õÿµ√“√—™µå°‘®
91
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¢âÕ®”°—¥„π°“√„™â Incentive spirometer
«‘∏’°“√∑” Manual hyperinflation8
‡π◊ËÕß®“°º≈≈—æ∏å¢Õß Sustained Maximal Inspiration therapy ¢÷ÈπÕ¬Ÿà°—∫欓∏‘ √’√«‘∑¬“·≈–§«“¡
√à«¡¡◊Õ¢ÕߺŸâªÉ«¬ ¥—ßπ—Èπ®÷߉¡à “¡“√∂„™â„πºŸâªÉ«¬∑’ˉ¡à
√Ÿ â °÷ µ—«,‰¡à„À⧫“¡√à«¡¡◊ÕÀ√◊Õ‰¡à “¡“√∂∑”µ“¡§”·π–π”
‰¥â, ¡’¿“«–À“¬„®≈”∫“° ·≈–„πºŸªâ «É ¬∑’‰Ë ¡à “¡“√∂À“¬„®
‰¥â≈°÷ æÕ§◊Õ¡’ vital capacity πâÕ¬°«à“ 10 ¡≈./°°. À√◊Õ¡’
inspiratory capacity πâÕ¬°«à“ 1/3 ¢Õß§à“ predicted1,3,7
«‘∏’°“√∑” Manual hyperinflation ‡æ◊Ëՙ૬„Àâ
‡ ¡À–∑’ËÕÿ¥µ—πÕ¬Ÿà„πÀ≈Õ¥≈¡ª≈“¬ÊÀ≈ÿ¥ÕÕ°·≈–™à«¬
‡ªî¥ªÕ¥ à«π∑’·Ë ø∫ (reinflate areas of lung collapse)
¡’«‘∏’°“√¥—ßπ’ȧ◊Õ
1. ‡ªî¥ gas supply ºà“π∑“ß ambu bag À√◊Õ
manual reservior bag ‡¥Á°‡≈Á°„Àâ„™â bag ¢π“¥ 500
´’´’ ‡¥Á°‚µ„Àâ„™â bag ¢π“¥ 1000 ´’´’
2. ∫’∫≈¡À“¬„®‡¢â“Õ¬à“ß™â“Ê „π√–¥—∫ª√–¡“≥
tidal volume 3-4 §√—ßÈ ‚¥¬™à«ß ÿ¥¢Õß°“√∫’∫≈¡À“¬„®
‡¢â“·µà≈–§√—ßÈ „Àâ∫∫’ ambu bag À√◊Õ manual reservior
bag §â“߉«â —°æ—° (short inspiratory hold) ‡æ◊ËÕ‡æ‘Ë¡
ª√‘¡“µ√ªÕ¥ ·≈–¡’‡«≈“„Àâ≈¡ “¡“√∂·∑√°‡¢â“∑“ß
collateral pathway µ“¡¥â«¬°“√∫’∫≈¡À“¬„®‡¢â“„π
√–¥—∫¡“°°«à“ tidal volume (large volume breath)
§◊Õ∫’∫¥â«¬§«“¡¥—π∑’¡Ë “°°«à“§«“¡¥—πÀ“¬„®‡¢â“∑’ºË ªŸâ «É ¬
‰¥â√∫— ®“°‡§√◊ÕË ß™à«¬À“¬„® (ventilator inspiratory pressure) ª√–¡“≥√âÕ¬≈– 20 Õ’° 1 §√—Èß
3. ª≈àÕ¬ ambu bag À√◊Õ manual reservior
bag Õ¬à“ß√«¥‡√Á«‡æ◊ËÕ„Àâ≈¡À“¬„®ÕÕ°æÿàßÕÕ°¡“®“°
ªÕ¥Õ¬à“߇√Á« (fast expiratory flow rate) ‚¥¬™à«ßª≈àÕ¬
ambu bag À√◊Õ manual reservior bag Õ“®∑”°“√
—πË –‡∑◊Õπ√à«¡¥â«¬ °“√ª≈àÕ¬ ambu bag À√◊Õ manual
reservior bag Õ¬à“ß√«¥‡√Á«‡™◊ÕË «à“®–™à«¬„À⇠¡À–‰À≈
‡¢â“ ŸàÀ≈Õ¥≈¡„À≠à ·≈–‡ªìπ«‘∏’°“√°√–µÿâπ°“√‰Õ
4. ¥Ÿ¥‡ ¡À–∑“ß∑àÕÀ≈Õ¥≈¡§Õ
∑”´È”µ“¡¢—ÈπµÕπ∑’Ë 1-4 ®π°√–∑—Ëß “¡“√∂
√–∫“¬‡ ¡À–‰¥âµ“¡∑’˵âÕß°“√ °“√·°â‰¢À√◊ÕªÑÕß°—π
°“√‡°‘¥¿“«– hypoxia ‡π◊ÕË ß®“°°“√¥Ÿ¥‡ ¡À–„πºŸªâ «É ¬
∑’ËÕ¬Ÿà„π¿“«–«‘°ƒµ®–µâÕß„Àâ hyperinflation √à«¡°—∫
hyperoxygenation ‡æ◊Ëՙ૬„π‡√◊ËÕß ventilation ·≈–
oxygenation „π°√≥’ºŸâªÉ«¬∑’Ë¡’ lung compliance µË”
·≈–µâÕß„™â‡§√◊ËÕߙ૬À“¬„® √à«¡°—∫°“√„™â PEEP „π
√–¥—∫ Ÿß‡°‘π 6 ´¡.πÈ”8 °“√™à«¬°“√À“¬„®¥â«¬°“√„™â
ambu bag §«√µàÕÀ—« PEEP ¥â«¬ ·≈–µ—ßÈ √–¥—∫ PEEP
Õ—πµ√“¬®“°°“√„™â Incentive spirometer
°“√„™â Incentive spirometer ¡’º≈¢â“߇§’¬ßπâÕ¬
¡“° º≈¢â“߇§’¬ß∑’ÕË “®‡°‘¥¢÷πÈ ‰¥â·°à syncope, hypoxia
(æ∫„π°√≥’∑’˺ŸâªÉ«¬∑’ˉ¥â√—∫ÕÕ°´‘‡®π ·µà¢“¥ÕÕ°´‘‡®π
¢≥–„™â), hyperventilation, respiratory alkalosis,
pulmonary barotrauma (emphysematous lung),
exacerbation of bronchospasm, fatigue ·≈–‡°‘¥
§«“¡‰¡à ÿ¢ ∫“¬‡π◊ËÕß®“° inadequate pain control
∑”„À⇰‘¥Õ“°“√ª«¥·º≈ºà“µ—¥ ‡ªìπµâπ1, 3,7
3. Manual hyperinflation
‡ªìπ«‘∏’°“√¢¬“¬ªÕ¥‡æ◊ËÕ„ÀâªÕ¥¢¬“¬µ—«‡µÁ¡∑’Ë
¥â«¬°“√„™â gas supply µàÕ°—∫ ambu bag À√◊Õ manual
reservior bag ‡æ◊ËÕ∫’∫Õ“°“»®“° ambu bag À√◊Õ
manual reservior bag ‡¢â“ªÕ¥ºŸªâ «É ¬„π√–¥—∫¡“°°«à“
tidal volume ª°µ‘ (ª√–¡“≥√âÕ¬≈– 150 ¢Õß tidal
volume ª°µ‘)3 ‡æ◊ÕË „À⺪Ÿâ «É ¬‰¥â√∫— ≈¡À“¬„®‡¢â“ªÕ¥Õ¬à“ß
‡µÁ¡∑’Ë
¢âÕ∫àß™’È„π°“√∑” Manual hyperinflation8,9
1. ‡æ◊ËÕªÑÕß°—π°“√‡°‘¥¿“«–ªÕ¥·ø∫·≈–¿“«–
¢“¥ÕÕ°´‘‡®π∑’ËÕ“®‡°‘¥®“°°“√¥Ÿ¥‡ ¡À–∑“ß∑àÕ
À≈Õ¥≈¡§Õ (endotracheal suctioning)
2. ™à«¬‡ªî¥ªÕ¥ à«π∑’Ë·ø∫ (reinflate areas of
lung collapse) ‡π◊ËÕß®“°¡’‡ ¡À–Õÿ¥µ—πÕ¬Ÿà„πÀ≈Õ¥≈¡
à«πª≈“¬Ê „πºŸâªÉ«¬∑’Ë„ à∑àÕÀ≈Õ¥≈¡§Õ
92 New Insight in Pediatric Critical Care 2003
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„Àâ‡∑à“°—∫∑’˺ŸâªÉ«¬‰¥â√—∫®“°‡§√◊ËÕߙ૬À“¬„®
„π¢≥–∑” manual hyperinflation ®–µâÕßµ‘¥µ“¡
ª√–‡¡‘πºŸâªÉ«¬Õ¬à“ß„°≈♑¥‡π◊ËÕß®“°‡ ’ˬߵàÕ°“√‡°‘¥
barotrauma, pneumothorax, §«“¡¥—π„π ¡Õ߇æ‘Ë¡
¢÷Èπ·≈– cardiac output ≈¥≈ß ‡ªìπµâπ ®÷ߧ«√√–«—ß„π
ºŸâªÉ«¬∑’Ë¡’¿“«–µàÕ‰ªπ’È ‰¥â·°à preterm neonates, hypervolemia, low cardiac output, raised intracranial
pressure, emphysematous bullae, multiple cysts,
undrained pneumothorax
4. Positive expiratory pressure (PEP) therapy
‡ªìπ«‘∏°’ “√¢¬“¬ªÕ¥¥â«¬°“√∑”„À⇰‘¥§«“¡¥—π
∫«°‡æ◊ËÕ‡æ‘Ë¡ alveolar pressure „π™à«ßÀ“¬„®ÕÕ°
§«“¡¥—π∫«°∑’˧â“ßÕ¬Ÿà„π™à«ßÀ“¬„®ÕÕ°·µà≈–§√—Èß®–
§àÕ¬Ê ‡ªî¥∑àÕ∑“߇¥‘πÀ“¬„®·≈–∂ÿß≈¡‡≈Á°Ê ∑’·Ë ø∫À√◊Õ
¡’‡ ¡À–Õÿ¥°—πÈ Õ¬Ÿà∑”„Àâ∑Õà ∑“߇¥‘πÀ“¬„®·≈–∂ÿß≈¡¢¬“¬
‡ ¡À–√–∫“¬ÕÕ°‰¥â
PEP-therapy ∑’Ë¡—°„™â„πºŸâªÉ«¬‡¥Á°¡’ 2 «‘∏’§◊Õ
1. Blow bottle ‡ªìπ°“√‡ªÉ“πÈ”¢â“¡¢«¥Àπ÷Ë߉ª
¬—ßÕ’°¢«¥Àπ÷Ëß∑’Ë¡’ “¬¬“ßµàÕ∂÷ß°—π (¿“æ∑’Ë 5) À√◊Õ‡ªÉ“
≈Ÿ°‚ªÉß À≈—°°“√ ”§—≠¢Õß«‘∏’π’ȧ◊Õ °àÕπ‡ªÉ“®–µâÕß„Àâ
ºŸâªÉ«¬À“¬‡¢â“≈÷°Ê ®π ÿ¥°àÕπ ·≈â«®÷ß„Àâ§àÕ¬Ê À“¬„®
ÕÕ°‚¥¬°“√‡ªÉ“¢«¥À√◊Õ≈Ÿ°‚ªÉß®π ÿ¥°“√À“¬„®ÕÕ°ª°µ‘
(∑’ËFRC)Õÿª°√≥å‡À≈à“π’®È –∑”Àπâ“∑’‡Ë ªìπµ—«µâ“π(resistance)
°“√À“¬„®ÕÕ°∑”„À⇰‘¥§«“¡¥—π„π™à«ßÀ“¬„®ÕÕ°·≈–
√–¬–‡«≈“À“¬„®ÕÕ°π“π¢÷πÈ °“√‡ªÉ“π’‰È ¡à§«√°√–µÿπâ „Àâ
‡°‘¥ forced expiration À√◊Õ„À⇪ɓ≈¡ÕÕ°¡“°‡°‘π°“√
À“¬„®ÕÕ°ª°µ‘À√◊Õ®πÀ¡¥≈¡ ‡æ√“–Õ“®∑”„Àâ∂ÿß≈¡
·ø∫≈ß ·≈–ºŸâªÉ«¬®–‡Àπ◊ËÕ¬‰¥âßà“¬
2. PEP-mask therapy ‰¥â¡’°“√‡ πÕ·π«§‘¥
¢Õß PEP-mask therapy „πª√–‡∑» Denmark µ—Èß·µà
ª≈“¬ªï §.».1970 ·≈–¡’√“¬ß“π°“√„™âÕ¬à“ß°«â“ߢ«“ß
„πªï §.».199110 Õÿª°√≥åπ’È “¡“√∂∑”„À⇰‘¥§«“¡¥—π
∫«°„π™à«ßÀ“¬„®ÕÕ° ·≈–∑”„Àâ√–¬–‡«≈“„π°“√À“¬„®
ÕÕ°π“π¢÷Èπ ´÷Ëß¡’ª√–‚¬™πå™à«¬‡ªî¥∑àÕ∑“߇¥‘πÀ“¬„®
·≈–∂ÿß≈¡∑’·Ë ø∫À√◊Õ¡’‡ ¡À–Õÿ¥°—πÈ Õ¬Ÿà ∑”„Àâ∑Õà ∑“߇¥‘π
À“¬„®·≈–∂ÿß≈¡¢¬“¬ ‡ ¡À–√–∫“¬ÕÕ°‰¥â mechanism
¢Õß PEP-mask ®÷ßπà“®–™à«¬„π‡√◊ËÕߥ—ßµàÕ‰ªπ’È §◊Õ
improved homogeneity of ventilation, improved gas
exchange ·≈– improved airway clearance11
°“√ª√–°Õ∫ PEP-mask “¡“√∂∑”‰¥â‡Õß ‚¥¬
„™âÕÿª°√≥åµà“ßÊ µàÕ‰ªπ’È §◊Õ (¿“æ∑’Ë 6)
1. Àπâ“°“°∑’Ë„™â™à«¬À“¬„® (soft mask) ¢π“¥
∑’ˇÀ¡“–°—∫Àπ⓺ŸâªÉ«¬
2. One-way valve ”À√—∫‡ªìπ∑“ßÀ“¬„®‡¢â“
3. Expiratory resistance ‡æ◊ËÕ„À⇰‘¥·√ßµâ“π
¢≥–À“¬„®ÕÕ° „Àâ„™â slip joint ¢Õß endotrachel tube
‚¥¬‡≈◊Õ°¢π“¥∑’∑Ë ”„À⇥Á°À“¬„® ∫“¬ ‰¡àÕ¥÷ Õ—¥¡“° ‚¥¬
ª°µ‘®–„™â slip joint No. 2.5 -3.5
4. T-Piece
5. Manometer ”À√—∫«—¥§«“¡¥—π
MANOMETER
ONE WAY VALVE
IN
pep mask
FACE MASK
OUT
¿“æ∑’Ë 5 Blow bottle
¿“æ∑’Ë 6 °“√ª√–¬ÿ°µå PEP mask
Lung Expansion Therapy, ®ß√—°…å Õÿµ√“√—™µå°‘®
93
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«‘∏’°“√„™â PEP-mask ‡æ◊ËÕªÕ¥¢¬“¬µ—«
1. „À⺟âªÉ«¬§√Õ∫ PEP-mask §≈ÿ¡∫√‘‡«≥®¡Ÿ°
·≈–ª“°„Àâ π‘∑„π∑à“π—Ëß
2. À“¬„®‡¢â“-ÕÕ°Õ¬à“ß ∫“¬Ê µ“¡ª°µ‘ºà“π
∑“ß PEP-mask „Àâ√–¬–‡«≈“„π™à«ßÀ“¬„®ÕÕ°π“π°«à“
À“¬„®‡¢â“ª√–¡“≥ 2-3 ‡∑à“10
3. ‡≈◊Õ°¢π“¥ slip joint ∑’Ë “¡“√∂∑”„À⇰‘¥
§«“¡¥—π∫«°„π™à«ßÀ“¬„®ÕÕ°µ“¡∑’˵âÕß°“√ ®“°°“√
»÷°…“„πµà“ߪ√–‡∑»·π–π”„Àℙ⧫“¡¥—π∫«°„π™à«ß
À“¬„®ÕÕ°ª√–¡“≥ 10-20 ´¡.πÈ”10 ·µà®“°ª√– ∫°“√≥å
„π§≈‘π‘°∑’Ë‚√ß欓∫“≈√“¡“∏‘∫¥’®–„™â§«“¡¥—π∫«°„π
™à«ßÀ“¬„®ÕÕ°ª√–¡“≥ 5-8 ´¡.πÈ”·µà‰¡à‡°‘π 10 ´¡.πÈ”
°Áæ∫«à“‰¥âº≈¥’
4. À“¬„®‡¢â“-ÕÕ°ºà“π∑“ß PEP-mask ª√–¡“≥
10-20 §√—ßÈ ‡πâπ„ÀâÀ“¬„®ÕÕ°µ“¡ª°µ‘‡æ◊ÕË “¡“√∂§«∫
§ÿ¡§«“¡¥—π‰¥â§ß∑’Ë
5. ‡ªî¥ mask ÕÕ° À“¬„®µ“¡ª°µ‘ ∂â“¡’‡ ¡À–
„À⺟âªÉ«¬‰Õ‡Õ“‡ ¡À–ÕÕ°
6. ªØ‘∫µ— µ‘ “¡¢âÕ 1-5 ®”π«π 4-8 §√—ßÈ ∑ÿ° 1 - 2
™—Ë«‚¡ß‡«≈“µ◊Ëπ
¿“æ∑’Ë 7 · ¥ß°“√„™â PEP-mask
®“°ª√– ∫°“√≥å „ π§≈‘ π‘ ° æ∫«à “ ∂â “ ºŸâ ªÉ « ¬¡’
‡ ¡À–¢≥–„™â PEP-mask ®–™à«¬„À⺪⟠«É ¬‰Õ‡Õ“‡ ¡À–
ÕÕ°‰¥âßà“¬¢÷Èπ ·≈– “¡“√∂„™â PEP-mask √à«¡°—∫
aerosol therapy 䴉
¢âÕ®”°—¥„π°“√„™â PEP-mask ‰¥â·°à ºŸâªÉ«¬∑’Ë¡’
‰´π— Õ—°‡ ∫, °“√µ‘¥‡™◊ÈÕ¢ÕßÀŸ à«π°≈“ß, epistaxis,
‡æ‘ßË ºà“µ—¥À√◊Õ∫“¥‡®Á∫∫√‘‡«≥„∫Àπâ“ ™àÕߪ“° ·≈–°–‚À≈°
»’√…–, active hemoptysis À√◊Õ¿“«– pneumothorax
∑’ˉ¡à‰¥â√—∫°“√·°â‰¢ ªí≠À“·∑√°´âÕπ∑’˵âÕß√–«—߇ªìπ
摇»…§◊Õ barotrauma À√◊Õ hemodynamic compromise8 ¥—ßπ—πÈ „π¢≥–„™â PEP-mask ºŸªâ «É ¬µâÕß√Ÿ â °÷ ∫“¬
·≈–‰¡à√âÕ߉ÀâÀ√◊ÕµàÕµâ“π ‡æ√“–®–∑”„Àâ·√ߥ—π∫«°„π
™à«ßÀ“¬„®ÕÕ° Ÿß¢÷Èπ ‡ ’ˬߵàÕ°“√‡°‘¥ barotrauma ∂â“
ºŸªâ «É ¬√Ÿ â °÷ ‰¡à ∫“¬ √âÕ߉Àâ·≈–µàÕµâ“π¡“° ®–µâÕ߬ÿµ°‘ “√
∫”∫—¥·≈–ª√–‡¡‘𧫓¡‡À¡“– ¡„π°“√∫”∫—¥„À¡à
5. Positive airway pressure system (EzPAPTM)
(¿“æ∑’Ë 8)
Positive Airway Pressure System: EzPAPTM
‡ªìπÕÿª°√≥å„À¡à∑’˺≈‘µ¢÷Èπ„πªï§».1999 ®ÿ¥ª√– ߧå
‡æ◊ËÕπ”¡“„™â√—°…“·≈–ªÑÕß°—π¿“«–ªÕ¥·ø∫„π ºŸâªÉ«¬
∑’ÀË “¬„®‰¥â‡Õß ‚¥¬ “¡“√∂„Àâ·√ߥ—π∫«°‡æ◊ÕË ‡æ‘¡Ë alveolar pressure ∑—Èß„π™à«ßÀ“¬„®‡¢â“·≈–À“¬„®ÕÕ°12-14
EzPAPTM ¡’§ÿ≥ ¡∫—µ‘‡ªìπ‡ ¡◊Õπ‡§√◊ËÕߢ¬“¬
Õ“°“» (air amplifier) Õ“»—¬À≈—°¢Õß coanda effect
„π°“√‡æ‘Ë¡ input flow ∑’Ë·√ߥ—π 50 Psi ¥â«¬°“√¥Ÿ¥
Õ“°“»√Õ∫Ê ‡¢â“¡“„π system ∑”„Àâ total flow ‡æ‘¡Ë ‡ªìπ
4 ‡∑à“¢Õß input flow (¿“æ∑’Ë 9) ‡™àπ ∂Ⓡªî¥ input
flow 10 ≈‘µ√/π“∑’ 50 Psi ®–¡’ out flow ‡æ‘Ë¡‡ªìπ 40
≈‘µ√/π“∑’
EzPAPTM system ª√–°Õ∫¥â«¬
1. Positive airway pressure device
°. Pressure port cap
¢. Pressure monitoring port
§. Gas inlet port
94 New Insight in Pediatric Critical Care 2003
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¢
°
§
2
ß (Àâ“¡Õÿ¥¥â“ππ’È)
Patient
1
¿“æ∑’Ë 8 Positive airway pressure system : EzPAPTM
50-60 PSI
Air (O2) input
Air from gas source
COANDA
EFFECT
Entrained ambient air
¿“æ∑’Ë 9 · ¥ß Coanda effect
ß. Ambient air inlet (¥â“π¢Õ∫‡ªìπ§≈◊Ëπ
Àâ“¡Õÿ¥¥â“ππ’È)
2. Patient interface: mouthpiece À√◊Õ soft
mask (Àπâ“°“°∑’˙૬À“¬„®) µàÕ°—∫¥â“π∑’Ë¢Õ∫‡√’¬∫
3. “¬ÕÕ°´‘‡®π‡æ◊ÕË µàÕ√–À«à“ß flow meter °—∫
gas inlet port
«‘∏’ª√—∫µ—Èß input flow ∑’ˇÀ¡“– ¡
1. µàÕÕÿª°√≥å„Àâ∂Ÿ°µâÕß
2. µàÕ pressure gauge ‡¢â“°—∫™àÕß«—¥§«“¡¥—π
(pressure monitoring port)
3. µàÕ flow meter °—∫·À≈àß®à“¬ÕÕ°´‘‡®πÀ√◊Õ
Õ“°“»∑’Ë¡’·√ߥ—π‰¡àµË”°«à“ 50-60 PSI ‡ªî¥Õ—µ√“°“√
‰À≈‡√‘Ë¡µâπ∑’Ë 5 ≈‘µ√/π“∑’ (‰¡à§«√‡ªî¥µË”°«à“ 5 ≈‘µ√/
π“∑’)
4. „À⺟âªÉ«¬Õ¬Ÿà„π∑à“π—Ëß
5. „À⺟âªÉ«¬Õ¡ mouthpiece „Àâ π‘∑ (§«√„ à
nose clip) À√◊Õ§√Õ∫ soft mask „π°√≥’‡¥Á°‡≈Á° ‚¥¬
§√Õ∫„Àâ§≈ÿ¡∫√‘‡«≥®¡Ÿ°·≈–ª“° §√Õ∫„Àâ π‘∑ Õ¬à“°¥
·πàπ®πºŸªâ «É ¬‰¡à ¢ÿ ∫“¬∂ⓧ√Õ∫∂Ÿ°µâÕß®–‰¥â¬π‘ ‡ ’¬ß≈¡
µ“¡®—ßÀ«–≈¡À“¬„®‡¢â“-ÕÕ°¢ÕߺŸâªÉ«¬
6. «—¥ airway pressure ·≈–§àÕ¬Ê ‡æ‘¡Ë airway
pressure ¥â«¬°“√§àÕ¬Ê ‡ªî¥Õ—µ√“°“√‰À≈¢ÕßÕÕ°´‘‡®π
À√◊ÕÕ“°“»‡æ‘Ë¡¢÷ÈπÕ¬à“ß™â“Ê ®π°√–∑—Ë߉¥â expiratory
airway pressure ∑’˵âÕß°“√ ª°µ‘®–„™â§«“¡¥—π„π™à«ß
À“¬„®ÕÕ°ª√–¡“≥ 5-8 ´¡.πÈ” („π¢≥–«—¥ airway
Lung Expansion Therapy, ®ß√—°…å Õÿµ√“√—™µå°‘®
95
...................................................................................
pressure ®–µâÕß„À⺪⟠«É ¬À“¬„®‡¢â“-ÕÕ°µ“¡ª°µ‘Õ¬à“ß
™â“Ê ·≈–√Ÿ â °÷ ∫“¬ „π°√≥’‡¥Á°‡≈Á°Ê §«√«—¥¢≥–∑’‡Ë ¥Á°
ß∫·≈–‰¡àµàÕµâ“π)
Airway pressure ¢≥–À“¬„®ÕÕ°®–‡ªìπ
—¥ à«π·ª√º—πµ“¡ expiratory flow rate °≈à“«§◊Õ∂â“
expiratory flow rate Ÿß airway pressure ®– Ÿßµ“¡
à«π airway pressure ¢≥–À“¬„®‡¢â“®–‡ªìπ —¥ à«π
º°º—π°—∫ inpiratory flow rate °≈à“«§◊Õ∂â“ inpiratory
flow rate Ÿß airway pressure ®–≈¥≈ß
7. ∫—π∑÷°Õ—µ√“°“√‰À≈¢ÕßÕÕ°´‘‡®πÀ√◊ÕÕ“°“»
·≈– airway pressure ∑—Èß inspiratory ·≈– expiratory
airway pressure „π°√≥’∑’ˇª≈’ˬπ flow meter ®–µâÕß
∑”°“√«—¥ airway pressure ‡æ◊ËÕÀ“ input flow „À¡à
∑ÿ°§√—Èß
∑’Ë 11 (§«√«—¥ airway pressure ‡æ◊ËÕÀ“ input flow „π
¢≥–∑’Ë„Àâ aerosol √à«¡¥â«¬) °“√„Àâ aerosol √à«¡
EzPAPTM §«√§√Õ∫ EzPAPTM 2-3 π“∑’ ≈—∫°—∫
À¬ÿ¥æ—° ∑”‡™àππ’ȇ√◊ËÕ¬‰ª®π¬“À¡¥ √–À«à“ß∫”∫—¥∂â“¡’
‡ ¡À–„Àâ‰Õ‡Õ“‡ ¡À–ÕÕ° À√◊Õ¥Ÿ¥‡ ¡À–ÕÕ°
®“°ª√– ∫°“√≥å„π§≈‘π°‘ ∑’‚Ë √ß欓∫“≈√“¡“∏‘∫¥’
‰¥âπ” EzPAPTM ¡“ª√–¬ÿ°µå°∫— ºŸªâ «É ¬‡¥Á°∑’¡Ë ª’ ≠í À“ªÕ¥
·ø∫ tracheomalacia12 æ∫«à“ EzPAP TM “¡“√∂√—°…“
¿“«–ªÕ¥·ø∫ ™à«¬≈¥ work of breathing ·≈–™à«¬
√–∫“¬‡ ¡À–‰¥â¥¢’ πÈ÷ „π°√≥’∑µË’ Õâ ß°“√π” EzPAPTM ¡“
«‘∏’°“√„™â EzPAPTM system
1. µàÕÕÿª°√≥å„Àâ∂Ÿ°µâÕß Àâ“¡Õÿ¥ ambient air
inlet ·≈– ªî¥Ω“™àÕß«—¥§«“¡¥—π
2. ‡ªî¥Õ—µ√“°“√‰À≈¢ÕßÕÕ°´‘‡®π À√◊Õ Õ“°“»
µ“¡∑’Ë°”À𥉫â
3. „À⺟âªÉ«¬Õ¬Ÿà„π∑à“π—ËßÕ¡ mouthpiece À√◊Õ
§√Õ∫ soft mask „Àâ π‘∑ ‚¥¬ —߇°µ®“°‡ ’¬ß≈¡øŸ‡É ¢â“ÕÕ°µ“¡®—ßÀ«–≈¡À“¬„®¢ÕߺŸâªÉ«¬
4. „À⺟âªÉ«¬À“¬„®‡¢â“-ÕÕ°µ“¡ª°µ‘Õ¬à“ß™â“Ê
¡Ë”‡ ¡Õ ·≈–√Ÿâ ÷° ∫“¬ À√◊ÕÀ“¬„®‚¥¬„™â°–∫—ß≈¡
„π°√≥’‡¥Á°‡≈Á°Ê 欓¬“¡°≈àÕ¡„À⇥Á° ß∫ ‰¡à√âÕ߉Àâ
À√◊ÕµàÕµâ“π¢≥–À“¬„®ºà“π EzPAPTM (¿“æ∑’Ë 10) ®“°
ª√– ∫°“√≥å°“√„™â EzPAPTM „π§≈‘π°‘ æ∫«à“‡¥Á°®–√Ÿ â °÷
∫“¬¢≥–À“¬„®ºà“π EzPAPTM ®÷ß¡—°®–‰¡àµÕà µâ“π ·µà
∂â“¢≥–∫”∫—¥‡¥Á°‰¡à ¢ÿ ∫“¬ À√◊Õ√âÕ߉Àâ·≈–µàÕµâ“π¡“°
§«√¬ÿµ‘°“√∫”∫—¥ ·≈–ª√–‡¡‘𧫓¡‡À¡“– ¡„π°“√
∫”∫—¥„À¡à
5. „ÀâÀ“¬„®ºà“π EzPAPTM §√—ßÈ ≈–ª√–¡“≥ 2-3 π“∑’
·≈â«æ—° ∑”‡™àππ’È∑ÿ° 1-2 ™—Ë«‚¡ß„π‡«≈“µ◊Ëπ
6. „π°√≥’∑’Ë„Àâ aerosol √à«¡¥â«¬„ÀâµàÕ¥—ß¿“æ
¿“æ∑’Ë 10 ¿“懥Á°¢≥–§√Õ∫ EzPAPTM
¿“æ∑’Ë 11 °“√„™â EzPAPTM √à«¡°—∫ aerosol therapy
96 New Insight in Pediatric Critical Care 2003
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„™â‡æ◊ÕË °“√√–∫“¬‡ ¡À– ·≈–™à«¬≈¥Õ“°“√‡Àπ◊ÕË ¬¢≥–
¥Ÿ¥‡ ¡À– §«√„™â EzPAPTM ∑—ßÈ „π™à«ß°àÕπ·≈–√–À«à“ß
¥Ÿ¥‡ ¡À–‡ªìπ√–¬–Ê §√—Èß≈–ª√–¡“≥ 1-2 π“∑’ ·≈–
§√Õ∫ EzPAPTM Õ’°ª√–¡“≥ 2-3 π“∑’ À≈—ß ‘Èπ ÿ¥°“√
¥Ÿ¥‡ ¡À–
¢âÕÀâ“¡ ‰¥â·°à ºŸâªÉ«¬∑’Ë¡’¿“«–À“¬„®≈⡇À≈«,
§«“¡¥—π„π°–‚À≈°»’√…– Ÿß, ‡æ‘Ëßºà“µ—¥À√◊Õ∫“¥‡®Á∫
∫√‘‡«≥„∫Àπâ“ ™àÕߪ“° ·≈–°–‚À≈°»’√…–, ºà“µ—¥À≈Õ¥
Õ“À“√, pneumothorax ∑’¬Ë ß— ‰¡à‰¥â√°— …“, ‡¬◊ÕË ·°â«ÀŸ∑–≈ÿ
À√◊Õ‚√§¢ÕßÀŸ à«π°≈“ß, ‰´π— Õ—°‡ ∫, hemodynamic
instability, epistaxis, ·≈– active hemoptysis
º≈¢â“߇§’¬ß‰¥â·°à ‡æ‘Ë¡ß“π„π°“√À“¬„®, ‡æ‘Ë¡
§«“¡¥—π„π°–‚À≈°»’√…–, cardiovascular compromise, myocardial ischemia, ≈¥ venous return,
°“√°≈◊π≈¡∑”„Àâ¡’‚Õ°“ Õ“‡®’¬π ·≈– aspiration,
claustrophobia, ‡°‘¥∫“¥·º≈∫√‘‡«≥º‘«Àπ—ß®“° mask
·≈– barotrauma
πÕ°®“°π’§È «√√–«—ß excessive pressure ¥—ßπ—πÈ
„π¢≥–∑’Ë„™â EzPAPTM µâÕß«—¥ airway pressure ‡ªìπ
√–¬–Ê ‚¥¬‡©æ“–‡¡◊ËÕºŸâªÉ«¬¡’Õ“°“√‡ª≈’ˬπ·ª≈ß∑“ß
§≈‘π‘°
6. Intermittent positive pressure breathing
(IPPB)
IPPB ‡ªìπ«‘∏°’ “√„™â§«“¡¥—π∫«°Õ—¥°ä“´‡¢â“ªÕ¥
(positive pressure ventilation) ‡ªìπ√–¬–Ê ¡—°„™â„π
ºŸâªÉ«¬∑’ˉ¡à “¡“√∂À“¬„®‡¢â“‰¥â≈÷°æÕ À√◊Õ‰¡à¡’·√ß
À“¬„® ®ÿ¥ª√– ߧå‡æ◊ÕË „ÀâªÕ¥¢¬“¬µ—«¥’¢πÈ÷ ‚¥¬‰¡à∑”„Àâ
ºŸªâ «É ¬‡Àπ◊ÕË ¬¡“°‡°‘π‰ª °“√„™â§«“¡¥—π∫«°Õ—¥°ä“´ ‡¢â“
ªÕ¥®–∑”„Àâ alveolar pressure „π™à«ßÀ“¬„®‡¢â“‡æ‘¡Ë ¢÷πÈ
∑”„Àâ∂ÿß≈¡¢¬“¬ ∑”„Àâ∂ÿß≈¡ à«π∑’Ë·ø∫‡ªî¥ÕÕ°·≈–
‡ ¡À–∂Ÿ°¢—∫ÕÕ°¡“‰¥âßà“¬
IPPB “¡“√∂∑”‰¥â‚¥¬°“√„™â¡Õ◊ À√◊Õ„™â‡§√◊ÕË ß
™à«¬À“¬„® ‚¥¬„Àâºà“π∑“ß facemask, mouth- piece,
ET-tube À√◊Õ tracheostomy tube „π°√≥’∑’˵âÕß°“√
„À⬓¢¬“¬À≈Õ¥≈¡ “¡“√∂„Àâæ√âÕ¡°—∫°“√„™â IPPB
°“√„Àâ IPPB‚¥¬„™â¡◊Õ®–„™â Ambu bag µàÕ°—∫ face
make, ET-tube À√◊Õ tracheostomy tube 欓¬“¡
∫’∫ bag „Àâ —¡æ—π∏å°—∫®—ßÀ«–À“¬„®‡¢â“ ·≈–∑√«ßÕ°
¢¬“¬µ“¡∑’˵âÕß°“√ °“√∑” IPPB ‚¥¬„™â‡§√◊ËÕߙ૬
À“¬„® π‘¬¡„™â Birdûs respirator ·≈– BiPAP ‚¥¬µ—Èß
§«“¡¥—πª√–¡“≥ 10-15 ´¡.πÈ” µ—ßÈ sensitivity ª√–¡“≥
-1 ∂÷ß -2 ´¡.πÈ” ·≈–øí߇ ’¬ß≈¡À“¬„®‡æ◊ËÕª√–‡¡‘π
«à“≈¡ “¡“√∂‡¢â“ªÕ¥„π à«π∑’Ë¡’欓∏‘ ¿“楒À√◊Õ‰¡à
¢≥–∫”∫—¥‡¥Á°®–µâÕ߉¡à°≈—ÈπÀ“¬„®À√◊Õµâ“π„π¢≥–∑’Ë
‡§√◊ÕË ß°”≈—ßÕ—¥°ä“´‡¢â“ªÕ¥ °“√∫”∫—¥·µà≈–§√—ßÈ „™â‡«≈“
ª√–¡“≥ 15-20 π“∑’1
¢âÕ∫àß™’È
1. „™â IPPB „πºŸâªÉ«¬∑’Ë¡’¿“«–ªÕ¥·ø∫∑’Ë„™â IS,
CPT À√◊Õ«‘∏’Õ◊ËπÊ ·≈⫉¡àª√– ∫º≈ ”‡√Á®
2. ºŸªâ «É ¬∑’‰Ë ¡à¡·’ √ßÀ“¬„®‡π◊ÕË ß®“° vital capacity πâÕ¬°«à“ 10-15 ¡≈./°°.1,15 ‡™àπ ºŸâªÉ«¬ neuromuscular disease
3. ºŸªâ «É ¬∑’¡Ë °’ “√§—ßË §â“ߢÕ߇ ¡À– ‰¡à¡·’ √߉ՇՓ
‡ ¡À–ÕÕ°·≈–‡Àπ◊ËÕ¬ßà“¬ °“√„™â IPPB ®–™à«¬„π°“√
√–∫“¬‡ ¡À–®“°ªÕ¥
®–‰¡à„™â IPPB ‡æ◊ÕË ·°â‰¢¿“«– hypoxemia, CO2
retention ·≈– acute respiratory failure ‡π◊ËÕß®“°
ºŸªâ «É ¬‡À≈à“π’®È ”‡ªìπµâÕ߉¥â√∫— °“√·°â‰¢‚¥¬„™â‡§√◊ÕË ß™à«¬
À“¬„®
¢âÕÀâ“¡ ‰¥â·°à pneumothorax ∑’¬Ë ß— ‰¡à‰¥â√°— …“,
pulmonary hemorrhage, §«“¡¥—π„π°–‚À≈° »’√…– Ÿß,
‡æ‘Ëßºà“µ—¥À√◊Õ∫“¥‡®Á∫∫√‘‡«≥„∫Àπâ“ ™àÕߪ“° ·≈–
°–‚À≈°»’√…–, ºà“µ—¥À≈Õ¥Õ“À“√, hemodynamic instability, active hemoptysis, ·≈–«—≥‚√§√–¬– active
∑’ˬ—ß¡‘‰¥â√—°…“
¿“«–·∑√°´âÕπ
1. Hyperventilation ®“°°“√∑’˺ŸâªÉ«¬À“¬„®‡√Á«
‡°‘π‰ª
Lung Expansion Therapy, ®ß√—°…å Õÿµ√“√—™µå°‘®
97
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™à«ß∑’‡Ë Àπ◊ÕË ¬À√◊ÕÀ≈—∫ ·≈– “¡“√∂„Àâ°“√√–∫“¬‡ ¡À–
„π¢≥–„™â CPAP‰¥â √–¬–‡«≈“∑’„Ë ™â CPAP ·∫∫ periodic
treatment·µà≈–§√—È߉¡à§«√πâÕ¬°«à“ 30 π“∑’ 8 à«π
§«“¡¥—π∑’„Ë ™â殑 “√≥“µ“¡æ¬“∏‘ ¿“溟ªâ «É ¬ §«√„ à NG
tube ·≈–‡ªî¥ª≈“¬ “¬‡æ◊ËÕ√–∫“¬≈¡®“°°√–‡æ“–
Õ“À“√ ·≈–≈¥§«“¡‡ ’ˬߵàÕ°“√ ”≈—°
¢âÕ∫àß™’È„π°“√„™â CPAP
¿“æ∑’Ë 12 °“√„™â IPPB √à«¡°—∫ aerosol therapy
2. Hypotension ‡π◊ËÕß®“°°“√≈¥ venous
return
3. ºŸâªÉ«¬‡°‘¥§«“¡‰¡à ÿ¢ ∫“¬, Õ“‡®’¬π·≈–¡’
gastric dilation ‡π◊ÕË ß®“°¡’§«“¡¥—π°√–∑”µàÕ°–∫—ß≈¡
·≈–Õ“®π”¡“´÷Ëß°“√‡°‘¥ ileus
4. Nosocomial infection ‡π◊ËÕß®“°¡’ bacterial
contamination ∑’ËÕÿª°√≥å∑’Ë„™â
5. Hyperoxia ‡π◊ÕË ß®“°°“√„™â oxygen ‡ªìπ gas
source
6. Pneumothorax, Pneumomediastinum ´÷Ëß
‡ªìπº≈®“°°“√„™â volume ·≈– pressure ∑’Ë Ÿß‡°‘π‰ª
7. Continuous Positive Airway Pressure
(CPAP)
CPAP ‡ªìπ«‘∏’°“√‡æ‘Ë¡ alveolar distending
pressure ‚¥¬°“√‡æ‘Ë¡ intraalveolar pressure ¥â«¬
°“√„À⧫“¡¥—π∫«°µ≈Õ¥‡«≈“∑—Èߢ≥–À“¬„®‡¢â“·≈–
À“¬„®ÕÕ° „πªí®®ÿ∫π— ¡—°„Àâ CPAP ‚¥¬„™â Noninvasive
ventilator ‡π◊ÕË ß®“°°“√„™â‰¡à¬ßÿà ¬“° “¡“√∂„Àâ‚¥¬ºà“π
∑“ß face mask, nasal mask, mouth piece, nasal
cannula À√◊Õ tracheostomy tube ‡ªìπµâπ ¡—°„™â„πºŸªâ «É ¬
∑’ Ë “¡“√∂À“¬„®‰¥â‡Õß ‡√“ “¡“√∂„Àâ CPAP ‰¥â∑ß—È ·∫∫
continuous À√◊Õ·∫∫periodic treatment §◊Õ„™â„π
1. ºŸªâ «É ¬¡’¿“«–¢“¥ÕÕ°´‘‡®π‡π◊ÕË ß®“°ªÕ¥·ø∫
2. Postextubation ·≈–¡’¬—ߧߡ’¿“«–À“¬„®
≈”∫“°√à«¡¥â«¬ °“√„™â CPAP ®–≈¥°“√ reintubation
3. „™â CPAP √–¬–À≈—ßºà“µ—¥„πºŸâªÉ«¬∑’Ë¡’ªí≠À“
restrictive lung disease ·≈–¡’°“√≈¥≈ߢÕß FRC
‰¥â·°à ºŸâ∑’Ë¡’‚§√ß √â“ߢÕß°√–¥Ÿ° —πÀ≈—ߺ‘¥ª°µ‘ ·≈–
‰¥â√—∫°“√∑” spinal fusion
º≈∑“ß √’√«‘∑¬“¢Õß CPAP8 ‰¥â·°à ‡æ‘¡Ë FRC,
improve oxygenation, ªÑÕß°—π°“√µ’∫·§∫¢Õß∑“߇¥‘π
À“¬„®„π à«π dependent part, à߇ √‘¡„Àâ¡’ collateral flow ´÷Ëß®–™à«¬„π°“√√–∫“¬‡ ¡À–, ≈¥ work of
breathing ·≈–‡æ‘Ë¡ lung compliance
¢âÕÀâ“¡„π°“√„™â CPAP1,8 ‰¥â·°à pneumothorax ∑’ˬ—߉¡à‰¥â√—°…“, multiple cysts À√◊Õ emphysematous bullae, hemodynamic instability, hypo-ventilation, nausea, §«“¡¥—π„π°–‚À≈°»’√…– Ÿß, ·≈–
∫“¥‡®Á∫∫√‘‡«≥„∫Àπâ“
¿“æ∑’Ë 13 ºŸâªÉ«¬¢≥–„ à CPAP ∑“ß tracheostomy tube
98 New Insight in Pediatric Critical Care 2003
....................................................................................
¿“«–·∑√°´âÕπ®“°°“√„™â CPAP1,17 ‰¥â·°à ‡æ‘¡Ë
ß“π„π°“√À“¬„®, barotrauma, gastric distension,
aspiration of gastric contents, ≈¥cardiac output,
hypoventilation, CO2 retention, ·º≈∫√‘‡«≥„∫Àπâ“
·≈–√Ÿâ ÷°‰¡à ÿ¢ ∫“¬
°“√ª√–‡¡‘πº≈≈—æ∏å¢Õß°“√∫”∫—¥ (Effectiveness Evaluation Methods)
º≈≈—æ∏å¢Õß°“√∫”∫—¥‡æ◊ÕË „ÀâªÕ¥¢¬“¬µ—«‡µÁ¡∑’Ë
“¡“√∂ª√–‡¡‘π‰¥â®“°
1. ‰¡à‡°‘¥¿“«–ªÕ¥·ø∫„π√“¬∑’Ë¡’¿“«–‡ ’ˬß
2. „π°√≥’∑¡’Ë ¿’ “«–ªÕ¥·ø∫ ¿“«–ªÕ¥·ø∫¥’¢π÷È
À√◊ÕÀ“¬‰ª ´÷Ëß “¡“√∂ª√–‡¡‘π‰¥â®“°Õ—µ√“°“√À“¬„®
≈¥≈ß, ‡ ’¬ßÀ“¬„®¥’¢πÈ÷ , SpO2 ‡æ‘¡Ë ¢÷πÈ ·≈–¿“æ∂à“¬√—ß ’
∑√«ßÕ°ª°µ‘ (normal chest x-ray films) ‡ªìπµâπ
3. „π√“¬∑’輈ҵ—¥®–¡’§à“ vital capacity ‡∑à“°—∫
√–¬– °àÕπºà“µ—¥ („π√“¬∑’ˉ¡à¡’°“√∑” lung resection)
4. Improved inspiratory muscle performance
„π°√≥’∑º’Ë ªŸâ «É ¬‰¥â√∫— °“√∫”∫—¥Õ¬à“߇µÁ¡∑’·Ë ≈â«¿“«–ªÕ¥
·ø∫‰¡à¥¢’ πÈ÷ ®”‡ªìπµâÕß«‘π®‘ ©—¬À“ “‡Àµÿ¿“«–ªÕ¥·ø∫
‡æ◊ËÕ„Àâ°“√√—°…“∑’Ë∂Ÿ°µâÕßµàÕ‰ª
‡Õ° “√Õâ“ßÕ‘ß
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