Takami Hirofumi
Neurology Clinic Namba.
Gan To Kagaku Ryoho. 2006 Dec;33 Suppl 2:246-7.
In home respiratory management, an important issue to consider is for patients at home with neuromuscular diseases. Under the current condition, however, a technical support is not offered sufficiently. In evaluating the effect of respiratory physical therapy, we have found significant differences in both between peak cough flow (PCF) and assisted peak cough flow (a-PCF) and between vital capacity (VC) and maximum inspiratory capacity (MIC) for patients with spontaneous ventilation and those with non-invasive positive pressure ventilation (NPPV). Since in neuromuscular diseases, it is not rare that the patients fall into acute respiratory insufficiency due to the difficulty of sputum expectoration, the respiratory physical therapy to strengthen the ability of coughing is considered useful. In the case of rapidly worsening amyotrophic lateral sclerosis (ALS), the effect of this therapy lasts only briefly, but it is considered necessary to popularize this technique, because neuromuscular diseases require a different approach in respiratory physical therapy, compared to other pulmonary diseases such as chronic obstructive pulmonary diseases.
在家中进行呼吸管理时，需要考虑的一个重要问题是针对患有神经肌肉疾病的居家患者。然而，在当前情况下，技术支持并未得到充分提供。在评估呼吸物理治疗的效果时，我们发现对于自主通气患者和无创正压通气（NPPV）患者，其峰值咳嗽流量（PCF）与辅助峰值咳嗽流量（a-PCF）之间以及肺活量（VC）与最大吸气量（MIC）之间均存在显著差异。由于在神经肌肉疾病中，患者因咳痰困难而陷入急性呼吸功能不全的情况并不少见，因此增强咳嗽能力的呼吸物理治疗被认为是有用的。对于快速进展的肌萎缩侧索硬化症（ALS），这种治疗的效果仅能持续很短时间，但仍认为有必要推广这项技术，因为与慢性阻塞性肺疾病等其他肺部疾病相比，神经肌肉疾病在呼吸物理治疗方面需要不同的方法。
