Mills Bryan, Bach John R, Zhao Caixia, Saporito Lou, Sabharwal Sanjeev
Department of Orthopedics, University of Medicine and Dentistry of New Jersey (UMDNJ), New Jersey Medical School, Newark, NJ 07103, USA.
J Pediatr Orthop. 2013 Jul-Aug;33(5):488-93. doi: 10.1097/BPO.0b013e318287058f.
Noninvasive intermittent positive pressure ventilatory assistance/support (NIV) can permit long-term survival for patients with no autonomous ability to breathe. Its role was explored in the perioperative management of children with flaccid neuromuscular scoliosis.
Vital capacity (VC), peak cough flow, and the extent of ventilator dependence were documented before and after surgical correction of scoliosis for children with Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA) with VCs as low as 2%. All patients and their caretakers were trained in NIV and mechanically assisted coughing preoperatively. Postoperatively, all were extubated using a specific protocol irrespective of their extent of ventilator dependence.
Thirty-four children (16 DMD, 18 SMA) underwent posterior spinal arthrodesis for scoliosis at 11.7 (range, 6.6 to 16.6 y) years of age. The Cobb angle decreased from a mean 66 (range, 20 to 135 degrees) to 16 (range, 10 to 51 degrees) degrees. Fifteen patients (5 DMD, 10 SMA) had preoperative VC<40% of normal. All were extubated successfully by postoperative day 3 despite 14 failing preextubation and postextubation spontaneous breathing trials and requiring continuous NIV for up to 21 days after extubation. None had postoperative respiratory complications or required reintubation or readmission for pulmonary issues for at least 6 months postoperatively.
Noninvasive positive pressure ventilator support is an alternative to invasive airway intubation in the perioperative management of children with flaccid neuromuscular scoliosis.
Level IV-case series.
无创间歇性正压通气辅助/支持（NIV）可使无自主呼吸能力的患者长期存活。本研究探讨了其在弛缓性神经肌肉型脊柱侧弯患儿围手术期管理中的作用。
记录了杜氏肌营养不良（DMD）和脊髓性肌萎缩（SMA）且肺活量低至正常2%的脊柱侧弯患儿在脊柱侧弯手术矫正前后的肺活量（VC）、最大咳嗽流量及呼吸机依赖程度。所有患者及其护理人员在术前均接受了NIV和机械辅助咳嗽训练。术后，无论其呼吸机依赖程度如何，均按照特定方案进行拔管。
34例患儿（16例DMD，18例SMA）在11.7岁（范围6.6至16.6岁）接受了脊柱后路融合术治疗脊柱侧弯。Cobb角从平均66°（范围20至135°）降至16°（范围10至51°）。15例患者（5例DMD，10例SMA）术前VC<正常的40%。尽管14例患者在拔管前和拔管后的自主呼吸试验失败，且拔管后需要持续NIV长达21天，但所有患者均在术后第3天成功拔管。术后至少6个月内，无一例发生呼吸并发症，也无需因肺部问题再次插管或再次入院。
在弛缓性神经肌肉型脊柱侧弯患儿的围手术期管理中，无创正压通气支持是有创气道插管的一种替代方法。
IV级——病例系列。
