Bach J R, Alba A S
University Hospital, New Jersey Medical School, Newark 07103.
Chest. 1990 Sep;98(3):613-9. doi: 10.1378/chest.98.3.613.
The ventilation of 25 ventilator-dependent traumatic quadriplegic patients was supported by noninvasive means of ventilatory assistance. Twenty-four of the 25 were initially managed by endotracheal intubation, and 23 of these went on to tracheostomy intermittent positive pressure ventilation before being converted to NVA. Seventeen of the 23 patients had their tracheostomies closed. This included three patients with no significant free time except with the use of glossopharyngeal breathing. Seven of the 25 patients who used NVA for at least one year with no significant free time have employed NVA for a mean of 7.4 +/- 7.4 years (1 to 22 years). Mouth IPPV was the most common form of NVA used both during the daytime and overnight. The wrap ventilators, intermittent abdominal pressure ventilator, and GPB were also employed for long-term respiratory support. It was concluded that, in general, because of their youth, intact mental status and bulbar musculature, and absence of obstructive lung disease, patients with traumatic high level spinal cord injury are candidates to benefit from these techniques.
25例依赖呼吸机的创伤性四肢瘫痪患者通过无创通气辅助手段维持通气。25例患者中有24例最初通过气管插管进行管理，其中23例在转换为无创通气之前进行了气管切开术并采用间歇性正压通气。23例患者中有17例的气管造口关闭。这包括3例除了使用咽式呼吸外没有显著自主呼吸时间的患者。25例使用无创通气至少一年且无显著自主呼吸时间的患者中，有7例平均使用无创通气7.4±7.4年（1至22年）。口部间歇性正压通气是白天和夜间最常用的无创通气形式。包裹式呼吸机、间歇性腹部压力呼吸机和咽式呼吸也用于长期呼吸支持。研究得出结论，一般来说，由于创伤性高位脊髓损伤患者年轻、精神状态和延髓肌肉组织完好且无阻塞性肺病，他们有可能从这些技术中获益。
