CAJ | 학술논문

目的探讨需长期气管切开.机械通气治疗(TMV)的肌萎缩侧索硬化症(ALS)患者,使用无创双水平正压(BiPAP)呼吸机替代有创呼吸机进行长期家庭治疗的可行性.方法选择2002年1月至2008年3月在我院进行TMV的ALS患者16例,其中男12例,女4例,年龄25～75岁,平均59岁.在经抗感染等综合治疗后病情稳定,将BiPAP呼吸机的呼吸管道经平台呼气阀和转接管直接与气管切开导管连接(命名为"向氏"连接法),进行机械通气并持续家庭应用.观察使用有创呼吸机时、改用无创呼吸机后及出院前的动脉血气;患者出院前,必须对其家属进行尤创呼吸机应用相关知识的培训;随访患者无创呼吸机的使用情况、患者耐受情况和生存率.采用单因素方差分析进行统计学分析.结果使用无创呼吸机前及使用无创呼吸机后2 h、1 d及患者出院前的PaCO2分别为(36±10)、(42±10)、(41±10)及(42±11)mm Hg(1 mm Hg=0.133 kPa),PaO2分别为(84±11)、(80±12)、(87±14)及(86±12)mm Hg,SaO2分别为(96.7±1.3)%、(96.5±0.8)%、(96.8 ±1.2)%及(96.5±1.0)%,各时间段差异均无统计学意义(F值分别为1.21、0.59、0.97、0.41,均P>0.05);患者均无明显不适主诉,未发现有不能耐受无创呼吸机的现象,也未发生呼吸机故障等问题.截至2008年7月31日随访结束,16例患者中除1例在治疗13个月后猝死外,其余15例存活至今,使用无创呼吸机的平均时间为39个月(4～66个月).结论对于需长期TMV的ALS患者,临床情况稳定后采用无创BiPAP呼吸机连接气管切开导管进行家庭机械通气可能是一种安全有效的方法.
목적 탐토수장기기관절개.궤계통기치료(TMV)적기위축측색경화증(ALS)환자,사용무창쌍수평정압(BiPAP)호흡궤체대유창호흡궤진행장기가정치료적가행성.방법 선택2002년1월지2008년3월재아원진행TMV적ALS환자16례,기중남12례,녀4례,년령25～75세,평균59세.재경항감염등종합치료후병정은정,장BiPAP호흡궤적호흡관도경평태호기벌화전접관직접여기관절개도관련접(명명위"향씨"련접법),진행궤계통기병지속가정응용.관찰사용유창호흡궤시、개용무창호흡궤후급출원전적동맥혈기;환자출원전,필수대기가속진행우창호흡궤응용상관지식적배훈;수방환자무창호흡궤적사용정황、환자내수정황화생존솔.채용단인소방차분석진행통계학분석.결과 사용무창호흡궤전급사용무창호흡궤후2 h、1 d급환자출원전적PaCO2분별위(36±10)、(42±10)、(41±10)급(42±11)mm Hg(1 mm Hg=0.133 kPa),PaO2분별위(84±11)、(80±12)、(87±14)급(86±12)mm Hg,SaO2분별위(96.7±1.3)%、(96.5±0.8)%、(96.8 ±1.2)%급(96.5±1.0)%,각시간단차이균무통계학의의(F치분별위1.21、0.59、0.97、0.41,균P>0.05);환자균무명현불괄주소,미발현유불능내수무창호흡궤적현상,야미발생호흡궤고장등문제.절지2008년7월31일수방결속,16례환자중제1례재치료13개월후졸사외,기여15례존활지금,사용무창호흡궤적평균시간위39개월(4～66개월).결론 대우수장기TMV적ALS환자,림상정황은정후채용무창BiPAP호흡궤련접기관절개도관진행가정궤계통기가능시일충안전유효적방법.
Objective To study the feasibility of the bilevel positive airway pressure ( BiPAP) non- invasive ventilator used in home mechanical ventilation for long-term tracheostomy-mechanical ventilation (TMV) in patients with amyotrophic lateral sclerosis (ALS). Methods Sixteen patients(12 men and 4 women,mean age 59 years) with ALS were selected for this study at Respiratory Department of the Shougang Hospital, Peking University from January 2002 to March 2008. After the disease had been controlled by anti-infective therapy and comprehensive treatment,the patients received TMV,through the improved ( "Xiang's" connection) non-invasive BiPAP ventilator connected with tracheotomy tube,and on-going home mechanical ventilation ( HMV). The blood gas was evaluated during invasive ventilation and non-invasive ventilation before discharge . Family members of the patients were trained for the use of non-invasive ventilators. The use of ventilators and the patients' condition were regularly followed and the survival rate calculated. Statistical analysis was carried out by using one-way ANOVA. Results There was no statistical difference in the blood gas before the use of non-invasive ventilator,2 h and 1 d after the use of non-invasive ventilator, and before discharge, PaCO2[ (36 ± 10) ,(42 ± 11) , (41 ± 10) , (42 ± 11) mm Hg( 1 mm Hg =0.133 kPa) ] , PaO2 [(84 ±11), (81 ± 12), (87 ±14), (86 ±12) mm Hg], SaO2[(96.7 ± 1. 3 )% , (96. 5 ± 0. 8)% , (96.8±1.2)%,(96.5 ±1.0)%] respectively,( F = 1.21, 0.59, 0.97, 0. 41, respectively, all P> 0.05). All patients had no complaint of uncomfortable use, no intolerance to ventilators, and no ventilator breakdown. Fifteen patients were alive at the end of the follow-up ( July 31 ,2008). The mean time of using non-invasive ventilator was 39 months ( range 4 to 66 months). Conclusion For ALS patients who need long-term ventilation support, the use of BiPAP non-invasive ventilators is a safe and effective alternative for invasive ventilators.