Kimura T, Sekino H, Shimada K, Tsuda Z, Hirai M, Chin K, Ohi M, Kuno K
Department of Pulmonary Medicine, Shiga Prefectural Medical Center.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Feb;30(2):358-62.
We applied nocturnal ventilation (NV) with nasal intermittent positive pressure ventilation with custom molded mask (NIPPV-C Mclermott, 1989), as well as NV with tracheostomy intermittent positive pressure ventilation (TIPPV) to a male patient with limb-girdle muscular dystrophy who had developed chronic respiratory failure at the age of 47. NV with both methods successfully corrected nocturnal hypoxemia, improved daytime arterial blood gas values, and achieved a stable clinical course without marked deterioration for four years. Daytime PaO2 higher than 60 Torr and PaCO2 lower than 70 Torr while breathing room air were maintained with both methods, whereas PaO2 was lower than 50 Torr and PaCO2 higher than 70 Torr before the implementation of NV. TIPPV was safely suspended repeatedly for as long as two weeks, maintaining daytime PaO2 higher than 50 Torr. NIPPV-C was also repeatedly suspended for two weeks. Occasionally PaO2 dropped as low as 40 Torr after periods without NV; however, it was restored to higher than 60 Torr after one or two nights' NIPPV-C. These facts suggest that NV had a restorative effect on respiratory muscle fatigue in the present case. While on NIPPV-C, nighttime SaO2 was higher than 90% for 94% of the total time, and between 80% and 90% for the remaining 6% of the time. Desaturation for short periods was thought to be due to oral air leakage, which made the method slightly less effective than TIPPV. However, the overall clinical effectiveness of NIPPV-C was comparable to that of TIPPV.(ABSTRACT TRUNCATED AT 250 WORDS)
我们对一名47岁出现慢性呼吸衰竭的肢带型肌营养不良男性患者，应用了带有定制塑形面罩的鼻间歇正压通气夜间通气（NV，NIPPV - C，Mclermott，1989）以及气管切开间歇正压通气夜间通气（TIPPV）。两种方法的NV均成功纠正了夜间低氧血症，改善了日间动脉血气值，并实现了四年稳定的临床病程，无明显恶化。两种方法均维持了日间呼吸室内空气时PaO₂高于60 Torr且PaCO₂低于70 Torr，而在实施NV前，PaO₂低于50 Torr且PaCO₂高于70 Torr。TIPPV可安全地反复暂停长达两周，维持日间PaO₂高于50 Torr。NIPPV - C也可反复暂停两周。偶尔在无NV期后PaO₂会降至低至40 Torr；然而，经过一两个晚上的NIPPV - C后可恢复至高于60 Torr。这些事实表明，在本病例中NV对呼吸肌疲劳有恢复作用。使用NIPPV - C时，夜间SaO₂在总时间的94%高于90%，其余6%在80%至90%之间。短时间的氧饱和度下降被认为是由于口腔漏气，这使得该方法比TIPPV稍低效。然而，NIPPV - C的总体临床效果与TIPPV相当。（摘要截断于250字）
