Department of Internal Medicine, National Organization Yakumo Hospital, Hokkaido, Japan.
Am J Phys Med Rehabil. 2012 Oct;91(10):831-5. doi: 10.1097/PHM.0b013e31825f1414.
There have been few reports of ventilator-induced lung injury associated with noninvasive ventilation (NIV), but many with invasive mechanical ventilation. The purpose of this study was to detect subclinical NIV-associated lung injury by monitoring Krebs von den Lungen glycoprotein plasma levels.
Forty-one Duchenne muscular dystrophy patients were divided into three categories: group 1, asymptomatic and not using ventilators; group 2, NIV use less than 24 hrs/day at full ventilatory support settings; and group 3, continuous NIV dependence. Plasma Krebs von den Lungen glycoprotein level was measured by electrochemical luminescent immunoassay using Krebs von den Lungen glycoprotein antibodies. One-way analysis of variance, followed by the Tukey-Kramer test, was used as appropriate to compare intergroup differences.
Extent of ventilator dependence correlated with age (P < 0.05). Intergroup plasma Krebs von den Lungen glycoprotein levels were not significantly different.
NIV used at volumes and pressures of full (invasive) ventilatory support may not induce the alveolar septal barrier injury commonly seen with invasive mechanical ventilation.
有很少的报告表明与无创通气（NIV）相关的呼吸机诱导性肺损伤，但与有创机械通气相关的报告很多。本研究的目的是通过监测肺表面活性物质蛋白 D 血浆水平来检测亚临床的 NIV 相关肺损伤。
41 例杜氏肌营养不良症患者分为三组：组 1，无症状且未使用呼吸机；组 2，每天使用 NIV 时间少于 24 小时，采用全通气支持设置；组 3，持续依赖 NIV。使用肺表面活性物质蛋白 D 抗体通过电化学发光免疫分析法测量血浆肺表面活性物质蛋白 D 水平。适当采用单因素方差分析，然后是 Tukey-Kramer 检验，以比较组间差异。
呼吸机依赖程度与年龄相关（P < 0.05）。组间血浆肺表面活性物质蛋白 D 水平无显著差异。
在与有创机械通气相同的容积和压力下使用 NIV 可能不会引起与有创机械通气常见的肺泡隔损伤。
