神经肌肉疾病患者的中枢呼吸驱动。

Servei de Medicina Intensiva, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain.

Respir Care. 2013 Mar;58(3):450-7. doi: 10.4187/respcare.01873.

BACKGROUND

The contribution of the central respiratory drive in the hypercapnic respiratory failure of neuromuscular diseases (NMD) is controversial.

OBJECTIVE

To compare the CO2 response and the duration of weaning of mechanical ventilation between a group of NMD patients and a group of quadriplegic patients due to ICU-acquired weakness (ICU-AW).

METHODS

We prospectively studied 16 subjects with NMD and 26 subjects with ICU-AW ready for weaning, using the method of the re-inhalation of expired air. We measured the hypercapnic drive response, defined as the ratio of change in airway occlusion pressure 0.1 second after the start of inspiration (ΔP0.1) to the change in Paco2 (ΔPaco2), and the hypercapnic ventilatory response, defined as the ratio of the change in minute ventilation (ΔVe) to ΔPaco2. We considered a value of ≤ 0.19 cm H2O/mm Hg as reduced hypercapnic drive response.

RESULTS

Hypercapnic drive response (ΔP0.1/ΔPaco2 = 0.14 ± 0.08 cm H2O/mm Hg vs 0.37 ± 0.27 cm H2O/mm Hg, P = .002) and hypercapnic ventilatory response (ΔVe/ΔPaco2 = 0.21 ± 0.19 L/min/mm Hg vs 0.44 ± 0.40 L/min/mm Hg, P = .02) were lower in the NMD than in the ICU-AW subjects. Duration of weaning values, according to the Kaplan-Meier curves, were similar in both groups (Log-rank = 0.03, P = .96). Eleven NMD (69%) and 9 ICU-AW (35%) subjects had hypercapnic drive response ≤ 0.19 cm H2O/mm Hg. The duration of weaning was longer in subjects with hypercapnic drive response ≤ 0.19 cm H2O/mm Hg (log-rank = 15.4, P < .001).

CONCLUSIONS

Subjects with acute hypercapnic respiratory failure due to NMD had reduced hypercapnic drive response, compared to ICU-AW subjects. The duration of weaning was longer in subjects with reduced hypercapnic drive response.

背景

中枢呼吸驱动在神经肌肉疾病（NMD）所致高碳酸血症性呼吸衰竭中的作用存在争议。

目的

比较一组 NMD 患者和一组因 ICU 获得性肌无力（ICU-AW）而准备撤机的四肢瘫痪患者的 CO2 反应和机械通气撤机时间。

方法

我们前瞻性研究了 16 例 NMD 患者和 26 例准备撤机的 ICU-AW 患者，使用重复呼吸法测量高碳酸血症驱动反应，定义为吸气开始后 0.1 秒气道阻断压变化（ΔP0.1）与 Paco2 变化（ΔPaco2）的比值；测量高碳酸血症通气反应，定义为分钟通气量（ΔVe）与ΔPaco2 的比值。我们认为≤0.19 cm H2O/mm Hg 为低碳酸血症驱动反应。

结果

与 ICU-AW 患者相比，NMD 患者的高碳酸血症驱动反应（ΔP0.1/ΔPaco2=0.14±0.08 cm H2O/mm Hg 比 0.37±0.27 cm H2O/mm Hg，P=0.002）和高碳酸血症通气反应（ΔVe/ΔPaco2=0.21±0.19 L/min/mm Hg 比 0.44±0.40 L/min/mm Hg，P=0.02）均较低。根据 Kaplan-Meier 曲线，两组患者的撤机时间值相似（对数秩检验=0.03，P=0.96）。11 例 NMD（69%）和 9 例 ICU-AW（35%）患者的高碳酸血症驱动反应≤0.19 cm H2O/mm Hg。高碳酸血症驱动反应≤0.19 cm H2O/mm Hg 的患者撤机时间较长（对数秩检验=15.4，P<0.001）。