Lerman R M, Weiss M S
Paraplegia. 1987 Apr;25(2):130-5. doi: 10.1038/sc.1987.22.
Acutely high level quadriplegics may experience neuromuscular respiratory insufficiency secondary to loss of use of intercostal and abdominal muscles as well as partial involvement of the phrenic nerve. Frequently, these patients will require mechanical ventilation in the initial stages of their treatment. These patients may present difficulty with weaning off the ventilator. In addition, poor respiratory reserve increases the risk of episodic decompensation. We have instituted a progressive resistive exercise protocol (PRE) analogous to PRE commonly used in training skeletal muscle, to wean patients off the ventilator. This involves determining the patient's endurance to the development of fatigue while off the ventilator. Patients are re-evaluated weekly until they are weaned from the ventilator. Three case studies are reported in which this protocol was used. In addition to our standard respiratory therapy and physical therapy protocols, values for vital capacity and maximum inspiratory force at admission and post-weaning were recorded. After completion of the programme, none of the patients required re-intubation or subsequent mechanical ventilation. This method of diaphragm training may be useful in weaning high level quadriplegics from the ventilator.
急性高位四肢瘫痪患者可能会因肋间肌和腹肌无法使用以及膈神经部分受累而出现神经肌肉性呼吸功能不全。通常，这些患者在治疗初期需要机械通气。这些患者可能在脱机方面存在困难。此外，呼吸储备能力差会增加间歇性失代偿的风险。我们制定了一种渐进性抗阻运动方案（PRE），类似于常用于训练骨骼肌的PRE，以使患者脱机。这包括确定患者在脱机状态下对疲劳发展的耐力。每周对患者进行重新评估，直到他们脱机。报告了三个使用该方案的病例研究。除了我们的标准呼吸治疗和物理治疗方案外，还记录了入院时和脱机后的肺活量和最大吸气力值。该方案完成后，所有患者均无需再次插管或后续机械通气。这种膈肌训练方法可能有助于高位四肢瘫痪患者脱机。
