Gruis K L, Brown D L, Schoennemann A, Zebarah V A, Feldman E L
Department of Neurology, University of Michigan Health System, 1C327 University Hospital/0316, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0316, USA.
Muscle Nerve. 2005 Dec;32(6):808-11. doi: 10.1002/mus.20415.
Noninvasive ventilation (NIV) appears to improve survival and quality of life in patients with amyotrophic lateral sclerosis (ALS), but little is known about predictors of NIV tolerance. NIV use was assessed and clinical predictors of tolerance were investigated, using predictive modeling, in ALS patients diagnosed and followed in our clinic until death over a 4-year time period. Patients were prescribed NIV based on current practice parameters when respiratory symptoms were present or forced vital capacity was less than 50%. We prescribed NIV in 52% (72) of patients. For those prescribed NIV, information regarding tolerance was available for 50 patients, with 72% (36) tolerant to its use. Tolerance was six times more likely in limb-onset than bulbar-onset ALS patients, with a trend toward reduced tolerance in those with lower forced vital capacity at NIV initiation. Age, gender, and duration of disease were not predictors of NIV tolerance. We conclude that a majority of ALS patients who are prescribed NIV can successfully become tolerant to its use.
无创通气（NIV）似乎可提高肌萎缩侧索硬化症（ALS）患者的生存率和生活质量，但对于NIV耐受性的预测因素知之甚少。我们在4年时间里，对在本诊所诊断并随访直至死亡的ALS患者，采用预测模型评估了NIV的使用情况，并研究了耐受性的临床预测因素。当出现呼吸症状或用力肺活量小于50%时，根据当前的实践参数为患者开具NIV处方。我们为52%（72例）的患者开具了NIV。对于那些开具了NIV的患者，有50例患者提供了关于耐受性的信息，其中72%（36例）对其使用耐受。肢体起病的ALS患者耐受的可能性是延髓起病患者的6倍，在开始使用NIV时用力肺活量较低的患者中，耐受性有降低的趋势。年龄、性别和病程不是NIV耐受性的预测因素。我们得出结论，大多数开具NIV处方的ALS患者能够成功耐受其使用。
