Annunziata Anna, Fiorentino Giuseppe, Esquinas Antonio
UOC Malattie, Fisiopatologia e Riabilitazione dell'Apparato Respiratorio, Monaldi Hospital, Naples, Italy.
Intensive Care Unit Hospital Morales Meseguer, Murcia, Spain.
Acta Myol. 2017 Mar;36(1):33-35.
In patients with muscular dystrophies both muscle length tension relationship changes and muscle elasticity and plasticity are decreased, resulting in impaired inspiratory muscle function and decreased vital capacity. Furthermore, the loss of deep breathing further increases the risk of alveolar collapse, hypoventilation and atelectasias. In this case report, a stable improvement of vital capacity after treatment with mounthpiece ventilation (MPV), was observed, suggesting that not invasive ventilation (NIV) might help to maintai lung and chest wall compliance, prevent hypoventilation and atelectasias which in turn may slow down the development of the restrictive respiratory pattern. The improvement of vital capacity may have a positive impact on alveolar ventilation by reducing the time with SaO2 values below 90%. This case illustrates that MPV is an effective method to improve respiratory function in patients non-tolerant of nasal mask and a valid alternative option for those who need NIV support for the most part of the day. Furthermore, the use of MPV, alone or combined with other interfaces, improves the quality of life of the neuromuscular patients and promotes a greater adherence to mechanical ventilation.
在肌肉萎缩症患者中，肌肉长度 - 张力关系的改变以及肌肉弹性和可塑性均降低，导致吸气肌功能受损和肺活量下降。此外，深呼吸的丧失进一步增加了肺泡塌陷、通气不足和肺不张的风险。在本病例报告中，观察到经口咽通气（MPV）治疗后肺活量稳定改善，这表明无创通气（NIV）可能有助于维持肺和胸壁顺应性，预防通气不足和肺不张，进而可能减缓限制性呼吸模式的发展。肺活量的改善可能通过减少血氧饱和度（SaO2）值低于90%的时间，对肺泡通气产生积极影响。该病例表明，MPV是改善不耐受鼻罩患者呼吸功能的有效方法，也是那些一天中大部分时间需要NIV支持的患者的有效替代选择。此外，单独使用MPV或与其他接口联合使用，可改善神经肌肉疾病患者的生活质量，并促进对机械通气的更大依从性。
