Birnkrant David J, Petelenz Kasia M, Ferguson Roy D, Martin James E, Gordon Gregory J
Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Pediatr Pulmonol. 2006 Nov;41(11):1077-81. doi: 10.1002/ppul.20497.
Severe muscular dystrophy (MD) has historically led to death in early adulthood, due to mainly cardiopulmonary complications. However, with newer methods of cardiac and respiratory management, survival has improved, and patients with MD are more frequently undergoing procedures requiring deep sedation or anesthesia. Respiratory management of these patients during procedures is challenging; safe and effective options for respiratory support are needed. In this report, we describe our experience using the laryngeal mask airway (LMA) to provide respiratory support during deep sedation or anesthesia for eight patients with severe MD during the following medical procedures: eight percutaneous endoscopic gastrostomy (PEG) placements, three lithotripsies, and placement of an implantable cardioverter-defibrillator. We also review the benefits and risks of the LMA in the context of other respiratory support options for people with MD, and the integral role of non-invasive positive pressure ventilation (NPPV) during induction of and recovery from deep sedation or general anesthesia.
严重肌肉萎缩症（MD）在历史上通常会导致患者在成年早期死亡，主要原因是心肺并发症。然而，随着心脏和呼吸管理新方法的出现，患者生存率有所提高，MD患者接受需要深度镇静或麻醉的手术也更为频繁。在手术过程中对这些患者进行呼吸管理具有挑战性；因此需要安全有效的呼吸支持方案。在本报告中，我们描述了在以下医疗手术中，使用喉罩气道（LMA）为8例严重MD患者在深度镇静或麻醉期间提供呼吸支持的经验：8例经皮内镜下胃造口术（PEG）置入、3例碎石术以及植入式心脏复律除颤器置入。我们还在MD患者其他呼吸支持方案的背景下，回顾了LMA的益处和风险，以及无创正压通气（NPPV）在深度镇静或全身麻醉诱导和恢复过程中的重要作用。
