Haas Carl F, Loik Paul S, Gay Steven E
Critical Care Support Services, University of Michigan Hospitals and Health Centers, UH B1-H245, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5024, USA.
Respir Care. 2007 Oct;52(10):1362-81; discussion 1381.
Respiratory compromise is the leading cause of morbidity and mortality in patients with neuromuscular and neurologic disease, and in elderly patients, who have a reduced pulmonary reserve from deterioration of the respiratory system associated with the normal aging process. Although the otherwise healthy older patient is normally asymptomatic, their pulmonary reserve is further compromised during stressful situations such as surgery, pneumonia, or exacerbation of a comorbid condition. The inability to effectively remove retained secretions and prevent aspiration contribute to this compromise. Although no secretion-management therapies are identified as having specific application to the elderly, clinicians must be attentive and understand the needs of the elderly to prevent the development of respiratory compromise. Patients with neuromuscular disease often can not generate an effective cough to mobilize and evacuate secretions. Respiratory muscle training, manual cough assistance, mechanical cough assistance, high-frequency chest wall compression, and intrapulmonary percussive ventilation have each been suggested as having potential benefit in this population. Although strong evidence supporting the benefit of these therapies is lacking, clinicians must be guided as to whether there is a pathophysiologic rationale for applying the therapy, whether adverse effects are associated with the therapy, the cost of therapy, and whether the patient prefers a given therapy.
呼吸功能不全是神经肌肉和神经系统疾病患者以及老年患者发病和死亡的主要原因，老年患者由于与正常衰老过程相关的呼吸系统恶化，肺储备功能下降。虽然原本健康的老年患者通常无症状，但在手术、肺炎或合并症加重等应激情况下，他们的肺储备功能会进一步受损。无法有效清除潴留的分泌物和预防误吸导致了这种功能不全。虽然没有确定哪种分泌物管理疗法专门适用于老年人，但临床医生必须予以关注并了解老年人的需求，以防止呼吸功能不全的发生。神经肌肉疾病患者通常无法产生有效的咳嗽来排出分泌物。呼吸肌训练、手动咳嗽辅助、机械咳嗽辅助、高频胸壁按压和肺内叩击通气都被认为可能对这一人群有益。尽管缺乏支持这些疗法益处的有力证据，但临床医生在应用这些疗法时必须考虑其病理生理依据、是否存在不良反应、治疗成本以及患者是否倾向于某种特定疗法。
