Bach John R
Department of Physical Medicine & Rehabilitation, University Hospital, NY, USA.
J Spinal Cord Med. 2012 Mar;35(2):72-80. doi: 10.1179/2045772311Y.0000000051.
This article describes noninvasive acute and long-term management of the respiratory muscle paralysis of high spinal cord injury (SCI). This includes full-setting, continuous ventilatory support by noninvasive intermittent positive pressure ventilation (NIV) to support inspiratory muscles and mechanically assisted coughing (MAC) to support inspiratory and expiratory muscles. The NIV and MAC can also be used to extubate or decannulate 'unweanable' patients with SCI, to prevent intercurrent respiratory tract infections from developing into pneumonia and acute respiratory failure (ARF), and to eliminate tracheostomy and resort to costly electrophrenic/diaphragm pacing (EPP/DP) for most ventilator users, while permitting glossopharyngeal breathing (GPB) for security in the event of ventilator failure.
本文介绍了高颈脊髓损伤（SCI）所致呼吸肌麻痹的无创急性和长期管理方法。这包括全面设置，通过无创间歇正压通气（NIV）提供持续通气支持以辅助吸气肌，以及机械辅助咳嗽（MAC）以辅助吸气肌和呼气肌。NIV和MAC还可用于为SCI“无法脱机”的患者拔管或拔除套管，预防并发的呼吸道感染发展为肺炎和急性呼吸衰竭（ARF），并使大多数使用呼吸机的患者无需气管造口术，避免采用昂贵的膈神经/膈肌起搏（EPP/DP），同时在呼吸机故障时允许患者进行舌咽呼吸（GPB）以确保安全。
