Tagami Muneyoshi, Kimura Fumiharu, Nakajima Hideto, Ishida Shimon, Fujiwara Shinya, Doi Yoshimitsu, Hosokawa Takafumi, Yamane Kazushi, Unoda Kiichi, Hirose Takahiko, Tani Hiroki, Ota Shin, Ito Takumi, Sugino Masakazu, Shinoda Keiichi, Hanafusa Toshiaki
Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan.
J Neurol Sci. 2014 Sep 15;344(1-2):158-64. doi: 10.1016/j.jns.2014.06.047. Epub 2014 Jul 1.
To evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosis patients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010.
Data for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation.
Tracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007).
Tracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.
评估肌萎缩侧索硬化症患者行气管切开术及有创通气选择的相关因素，并确定1990年至2010年日本一家机构内患者气管切开术后的生存时间。
获取160例患者直至死亡或气管切开术的生存时间数据。52例患者（33%）接受了气管切开术/机械通气。
与未接受通气支持的对照组（32个月；p<0.001）相比，气管切开术和有创通气延长了中位生存时间（74个月），无创通气（48个月）也有同样效果。1999年后，65岁以上患者行气管切开术/机械通气的比例（27%）较早年（10%）显著增加（p=0.002）。Cox比例模型证实，年龄≤65岁有利于气管切开术后的长期生存。在单因素逻辑回归分析中，与决定行气管切开术相关的因素包括年龄≤65岁、更多使用无创通气、有配偶、从疾病发作到诊断/气管切开术的间隔时间和速度以及运动功能的保留。在多因素逻辑回归分析中，年龄、从疾病发作到气管切开术的时间较短以及有配偶与决定行气管切开术独立相关。Kaplan-Meier曲线显示，气管切开术后在家居住的患者比住院患者生存时间更长（p=0.007）。
气管切开术和有创通气在日本经常使用。多种因素影响患者进行这些手术的决定。本研究确定了与决策过程及气管切开术后生存相关的因素。
