延髓功能障碍评分可预测肌萎缩侧索硬化症患者急性下呼吸道感染期间无创容量控制通气失败。
Bulbar impairment score predicts noninvasive volume-cycled ventilation failure during an acute lower respiratory tract infection in ALS.
作者信息
Servera Emilio, Sancho Jesús, Bañuls Pilar, Marín Julio
机构信息
Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, Spain; Universitat de Valencia, Spain.
Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, Spain.
出版信息
J Neurol Sci. 2015 Nov 15;358(1-2):87-91. doi: 10.1016/j.jns.2015.08.027. Epub 2015 Aug 21.
UNLABELLED
Amyotrophic lateral sclerosis (ALS) patients can suffer episodes of lower respiratory tract infections (LRTI) leading to an acute respiratory failure (ARF) requiring noninvasive ventilation (NIV).
AIM
To determine whether clinical or functional parameters can predict noninvasive management failure during LRTI causing ARF in ALS.
MATERIAL AND METHOD
A prospective study involving all ALS patients with ARF requiring NIV in a Respiratory Care Unit. NIV was provided with volume-cycled ventilators.
RESULTS
63 ALS patients were included (APACHE II: 14.93±3.56, Norris bulbar subscore (NBS): 18.78±9.68, ALSFRS-R: 19.90±6.98, %FVC: 40.01±18.07%, MIC: 1.62±0.74L, PCF 2.51±1.15L/s, PImax -34.90±19.44cmH2O, PEmax 51.20±28.84cmH2O). In 73.0% of patients NIV was successful in averting death or endotracheal intubation. Differences were found between the success and failure in the NBS (22.08±6.15 vs 8.66±3.39, p<0.001), ALSFRS (22.08±6.11 vs 12.71±4.39, p<0.001), PCFMI-E (3.85±0.77 vs 2.81±0.91L/s, p=0.007) and ALS onset (spinal/bulbar 33/13 vs 7/10, p=0.03). The predictor of NIV failure was the NBS (OR 0.53, 95% CI 0.31-0.92, p 0.002) with a cut-off point of 12 (S 0.93; E 0.97; PPV 0.76; NPV 0.97).
CONCLUSIONS
NBS can predict noninvasive management failure during LRTI in ALS.
未标注
肌萎缩侧索硬化症（ALS）患者可能会发生下呼吸道感染（LRTI），导致急性呼吸衰竭（ARF），需要无创通气（NIV）。
目的
确定临床或功能参数是否能预测ALS患者因LRTI导致ARF时无创治疗的失败。
材料与方法
一项前瞻性研究，纳入了呼吸护理单元中所有因ARF需要NIV的ALS患者。使用容量控制通气机进行NIV。
结果
纳入63例ALS患者（急性生理与慢性健康状况评分系统II：14.93±3.56，诺里斯延髓亚评分（NBS）：18.78±9.68，修订的ALS功能评定量表（ALSFRS-R）：19.90±6.98，用力肺活量百分比（%FVC）：40.01±18.07%，最大吸气量（MIC）：1.62±0.74L，用力肺活量（PCF）2.51±1.15L/s，最大吸气压（PImax）-34.90±19.44cmH₂O，最大呼气压（PEmax）51.20±28.84cmH₂O）。73.0%的患者NIV成功避免了死亡或气管插管。在NBS（22.08±6.15 vs 8.66±3.39，p<0.001）、ALSFRS（22.08±6.11 vs 12.71±4.39，p<）、PCFMI-E（3.85±0.77 vs 2.81±0.91L/s，p=0.007）和ALS起病类型（脊髓性/延髓性33/13 vs 7/10，p=0.03）方面，成功组与失败组存在差异。NIV失败的预测因素是NBS（比值比0.53，95%置信区间0.31-0.92，p=0.002），截断点为12（敏感度0.93；特异度0.97；阳性预测值0.76；阴性预测值0.97）。
结论
NBS可预测ALS患者LRTI期间无创治疗的失败。
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