Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan.
Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan.
Parkinsonism Relat Disord. 2022 Apr;97:107-111. doi: 10.1016/j.parkreldis.2022.01.008. Epub 2022 Jan 14.
Tracheostomy invasive ventilation (TIV) is therapeutic intervention to prolong survival. However, few reports have addressed TIV in multiple system atrophy (MSA). This study sought to evaluate the impact of TIV on survival in MSA patients.
This retrospective cohort study examined medical records of probable or definite MSA for patients in Hyogo-Chuo National Hospital from January 2000 to September 2021 to investigate overall survival and cause of death in those with tracheostomy and TIV.
The study enrolled 12 definite and 127 probable MSA patients. Mean age at onset was 61.3 ± 9.8 years, and median survival time was 9.0 years. Tracheostomy was performed in 53 patients, 21 of whom were ventilated. Mean time from onset to tracheostomy and TIV was 7.0 ± 3.0 and 8.4 ± 4.4 years, respectively. After propensity score matching, tracheostomy showed a significant prolongation of median survival compared with no tracheostomy (10.1 vs. 7.5 years, p = 0.001) and TIV significantly prolonged survival compared with tracheostomy alone (17.8 vs. 9.2 years, p = 0.023). On Cox regression analysis, the hazard ratio for tracheostomy was 0.35 (95% confidence interval [CI] 0.17-0.68, p = 0.002) and TIV was 0.22 (95% CI 0.07-0.89, p = 0.032). In MSA with TIV, sudden death was significantly lower compared with tracheostomy alone, and infection was the most common cause of death.
Results showed that TIV prolonged survival and reduced sudden death compared with tracheostomy alone in MSA, although sudden death can never be completely prevented.
气管切开有创通气（TIV）是一种延长生存时间的治疗干预措施。然而，很少有报道涉及多系统萎缩（MSA）中的 TIV。本研究旨在评估 TIV 对 MSA 患者生存的影响。
本回顾性队列研究调查了 2000 年 1 月至 2021 年 9 月兵库中央医院 MSA 患者的病历，以研究气管切开和 TIV 患者的总体生存率和死亡原因。
研究纳入了 12 例明确和 127 例可能的 MSA 患者。发病年龄的平均值为 61.3±9.8 岁，中位生存时间为 9.0 年。53 例患者行气管切开术，其中 21 例接受通气。从发病到气管切开和 TIV 的平均时间分别为 7.0±3.0 和 8.4±4.4 年。经过倾向评分匹配后，与未行气管切开术相比，气管切开术显著延长了中位生存时间（10.1 年比 7.5 年，p=0.001），TIV 与单独气管切开术相比也显著延长了生存时间（17.8 年比 9.2 年，p=0.023）。在 Cox 回归分析中，气管切开术的风险比为 0.35（95%置信区间 0.17-0.68，p=0.002），TIV 为 0.22（95%置信区间 0.07-0.89，p=0.032）。在接受 TIV 的 MSA 患者中，与单独气管切开术相比，突然死亡的发生率明显降低，感染是最常见的死亡原因。
结果表明，与单独气管切开术相比，TIV 可延长 MSA 患者的生存时间并降低突然死亡的风险，尽管不能完全预防突然死亡。
