Bach John Robert, Bianchi Carlo, Aufiero Elaine
Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen St, Newark, NJ 07103, USA.
Chest. 2004 Nov;126(5):1502-7. doi: 10.1378/chest.126.5.1502.
To explore the use of oximetry as a guide for using respiratory aids and tracheotomy in the treatment of patients with amyotrophic lateral sclerosis (ALS).
A retrospective review of all ALS patients presenting to a neuromuscular disease clinic since 1996.
Patients who were symptomatic for nocturnal hypoventilation were prescribed noninvasive ventilation (NIV). Patients with assisted cough peak flows of < 300 L/min were prescribed oximeters and access to mechanically assisted coughing (MAC) to prevent or reverse decreases in baseline pulse oximetric saturation (Spo(2)) levels of < 95%. The number of decreases in baseline Spo(2) that could be normalized by any combination of NIV and MAC and the duration of normalization were recorded. When the baseline was not or could not be normalized, the time to acute respiratory failure and tracheotomy or death were recorded.
Twenty-five patients became dependent on NIV, including 13 patients who received NIV continuously for a mean (+/- SD) period of 19.7 +/- 16.9 months, without desaturation (group 1). For another 76 patients, the daytime baseline Spo(2) level decreased to < 95% 78 times. For 41 patients, the baseline level was corrected by NIV/MAC (group 2) for a mean duration of 11.1 +/- 8.7 months before desaturation reoccurred for 27 patients. Of the latter patients, 11 underwent tracheotomy, 14 died in < 2 months, and 2 had their condition again corrected by the addition of MAC therapy. For 35 patients, the desaturation was not or could not be normalized (group 3). Thirty-three of these 35 patients required tracheotomy or died within 2 months. The only significant difference between groups 1 and 2 and group 3 was significantly poorer glottic function in the patients in group 3.
Tracheotomy or death is highly likely within 2 months of a decrease in baseline Spo(2) that cannot be corrected by NIV or MAC. The long-term use of NIV and MAC, and the avoidance of tracheotomy is dependent on glottic function rather than on inspiratory or expiratory muscle failure.
探讨血氧饱和度测定法在肌萎缩侧索硬化症（ALS）患者治疗中作为使用呼吸辅助设备和气管切开术指导的应用。
对自1996年以来到神经肌肉疾病诊所就诊的所有ALS患者进行回顾性研究。
对夜间通气不足有症状的患者给予无创通气（NIV）治疗。辅助咳嗽峰值流量<300L/分钟的患者配备血氧饱和度测定仪，并可进行机械辅助咳嗽（MAC），以防止或纠正基线脉搏血氧饱和度（Spo₂）水平降至<95%。记录通过NIV和MAC的任何组合可使基线Spo₂恢复正常的次数以及恢复正常的持续时间。当基线未恢复或无法恢复正常时，记录急性呼吸衰竭、气管切开术或死亡的时间。
25例患者依赖NIV，其中13例患者持续接受NIV治疗，平均（±标准差）时间为19.7±16.9个月，未出现血氧饱和度下降（第1组）。另外76例患者，白天基线Spo₂水平降至<95%共78次。41例患者的基线水平通过NIV/MAC得到纠正（第2组），平均持续时间为11.1±8.7个月，之后27例患者再次出现血氧饱和度下降。在后者中，11例接受了气管切开术，14例在<2个月内死亡，2例通过增加MAC治疗病情再次得到纠正。35例患者的血氧饱和度下降未恢复或无法恢复正常（第3组）。这35例患者中有33例在2个月内需要进行气管切开术或死亡。第1组和第2组与第3组之间唯一的显著差异是第3组患者的声门功能明显较差。
基线Spo₂下降且无法通过NIV或MAC纠正后，2个月内极有可能进行气管切开术或死亡。NIV和MAC的长期使用以及避免气管切开术取决于声门功能，而非吸气或呼气肌无力。
