Tsuboi Tomomasa, Chin Kazuo, Machida Kazuko, Ohi Motoharu
Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital.
Nihon Kokyuki Gakkai Zasshi. 2006 Mar;44(3):160-7.
To clarify whether noninvasive positive pressure ventilation (NPPV) is effective in patients with acute exacerbations of pulmonary tuberculosis sequelae (PTS), 50 PTS patients (66 episodes) without long-term domiciliary noninvasive ventilation were studied, retrospectively. The average values (SD) of their pulmonary function tests and arterial blood gases were as follows; %predicted VC = 31.4 (8.4)%, pH = 7.29 (0.06), PaCO2 = 91.8 (19.7) mmHg, and PaO2 = 64.2 (20.3) mmHg. The probability of avoiding endotracheal intubation and recovering from an acute exacerbation with NPPV (NPPV success rate) was 92% as a whole. NPPV success rates according to the causes of deterioration were as follows; 96% in 26 episodes with only a simple right heart failure, 93% in 29 episodes with airway infectious diseases, 75% in eight episodes with pneumonia and/or acute respiratory distress syndrome. Moreover, the NPPV success rate of eight episodes in coma or semicoma was 88%. Most patients were treated in respiratory wards rather than intensive care units. Out of 46 patients who recovered from an acute exacerbation, 41 finally received domiciliary NPPV. In facilities where staff are well-trained for an acute NPPV, patients with exacerbations of PTS can be treated as successfully with NPPV as patients with COPD.
为明确无创正压通气（NPPV）对肺结核后遗症（PTS）急性加重患者是否有效，我们对50例未长期居家进行无创通气的PTS患者（66例次）进行了回顾性研究。他们肺功能检查和动脉血气的平均值（标准差）如下：预计肺活量百分比（%predicted VC）=31.4（8.4）%，pH=7.29（0.06），动脉血二氧化碳分压（PaCO2）=91.8（19.7）mmHg，动脉血氧分压（PaO2）=64.2（20.3）mmHg。总体而言，使用NPPV避免气管插管并从急性加重中恢复的概率（NPPV成功率）为92%。根据病情恶化原因的NPPV成功率如下：单纯右心衰竭26例次中为96%，气道感染性疾病29例次中为93%，肺炎和/或急性呼吸窘迫综合征8例次中为75%。此外，昏迷或半昏迷状态的8例次NPPV成功率为88%。大多数患者在呼吸病房而非重症监护病房接受治疗。在46例从急性加重中康复的患者中，41例最终接受了居家NPPV。在医护人员接受过急性NPPV良好培训的机构中，PTS急性加重患者使用NPPV治疗的成功率与慢性阻塞性肺疾病（COPD）患者相同。
