Soudon P, Steens M, Toussaint M
Inkendaal Rehabilitation Hospital, Acute Neurorespiratory Rehabilitation Unit, Centre for Mechanical Ventilation and Neuromuscular Centre VUB - Inkendaal, Brussels, Belgium.
Chron Respir Dis. 2008;5(2):87-93. doi: 10.1177/1479972308088715.
The aim of this study was to compare morbidity and causes of death in a series of 42 Duchenne patients receiving full-time mechanical ventilation either by tracheostomy (TR, n = 16 or by noninvasive methods (noninvasive ventilation [NIV], n = 26). At inclusion for a 5-year observation period (2002-2006), TR and NIV patients were 32.7 and 27 years old, respectively. A program of follow-up with similar ventilation devices, techniques of respiratory physiotherapy, and drugs was applied to all the patients [TR + NIV]. Ages and respiratory characteristics at death and causes of death were comparable between groups. Morbidity was worse in TR compared with NIV patients; mucus hypersecretion and tracheal injuries were more frequent, whereas loss of weight and need for gastric feeding appeared less frequent in the TR group. Because noninvasive techniques avoid the severe complications associated with TR with comparable mortality, the authors support the use of noninvasive interfaces as default choice when assisted ventilation is required for daytime use.
本研究旨在比较42例接受全时机械通气的杜氏肌营养不良患者的发病率和死亡原因，这些患者分别采用气管切开术（TR组，n = 16）或无创方法（无创通气[NIV]组，n = 26）。在纳入进行5年观察期（2002 - 2006年）时，TR组和NIV组患者的年龄分别为32.7岁和27岁。对所有患者[TR + NIV]采用了使用类似通气设备、呼吸物理治疗技术和药物的随访方案。两组在死亡时的年龄、呼吸特征及死亡原因具有可比性。与NIV组患者相比，TR组患者的发病率更高；黏液分泌过多和气管损伤更为常见，而TR组体重减轻和需要胃饲的情况则较少见。由于无创技术在死亡率相当的情况下可避免与气管切开术相关的严重并发症，作者支持在白天需要辅助通气时将无创接口作为默认选择。
