Tone Kazuya, Kiryu Ikumi, Yoshida Masahiro, Tsuboi Kazuto, Takagi Masamichi, Kuwano Kazuyoshi
Department of Respiratory Medicine, Kashiwa Hospital, Chiba, Japan; Department of Internal Medicine, Respiratory Division, Jikei University School of Medicine, Tokyo, Japan.
Department of Respiratory Medicine, Kashiwa Hospital, Chiba, Japan.
Respir Investig. 2014 May;52(3):203-8. doi: 10.1016/j.resinv.2013.11.001. Epub 2014 Jan 18.
An elderly woman diagnosed with multiple myeloma (MM) in 2007 had improved with chemotherapy. She had severe kyphosis and a diaphragmatic hernia (DH), but no respiratory symptoms. In 2011, because of thoracic deformity and emaciation, we advised her to continue the previously prescribed domiciliary noninvasive positive pressure ventilation (NPPV) therapy for chronic type II respiratory failure. However, she refused to continue NPPV. She was later admitted for deterioration in respiratory status and carbon dioxide (CO2) narcosis. We believed her low adherence to domiciliary NPPV caused CO2 narcosis; hence, we advised her to continue domiciliary NPPV and she complied. In May 2012, the now 79-year-old patient was admitted for acute exacerbation of chronic respiratory failure and CO2 narcosis. Chest imaging suggested that DH had caused a deterioration of her status. She underwent laparoscopic diaphragmatic hernia repair. Operative findings revealed a retrosternal hernia sac, and she was diagnosed as having a Morgagni hernia (MH). Her respiratory status subsequently improved. We hypothesize that NPPV increased intra-abdominal pressure, thereby worsening the MH and exacerbating respiratory failure. We believe that clinicians should be cautious when prescribing NPPV for MH patients.
一位2007年被诊断为多发性骨髓瘤（MM）的老年女性经化疗后病情有所改善。她有严重的脊柱后凸和膈疝（DH），但无呼吸症状。2011年，由于胸廓畸形和消瘦，我们建议她继续之前开具的用于慢性II型呼吸衰竭的家庭无创正压通气（NPPV）治疗。然而，她拒绝继续进行NPPV治疗。后来她因呼吸状况恶化和二氧化碳（CO2）麻醉而入院。我们认为她对家庭NPPV的低依从性导致了CO2麻醉；因此，我们建议她继续家庭NPPV治疗，她照做了。2012年5月，这位79岁的患者因慢性呼吸衰竭急性加重和CO2麻醉入院。胸部影像学检查提示DH导致了她病情的恶化。她接受了腹腔镜膈疝修补术。手术结果显示为胸骨后疝囊，她被诊断为有莫尔加尼疝（MH）。随后她的呼吸状况有所改善。我们推测NPPV增加了腹内压，从而使MH恶化并加重了呼吸衰竭。我们认为临床医生在为MH患者开具NPPV时应谨慎。
