Splaingard M L, Frates R C, Jefferson L S, Rosen C L, Harrison G M
Arch Phys Med Rehabil. 1985 Apr;66(4):239-42. doi: 10.1016/0003-9993(85)90157-1.
Twenty years of experience using negative pressure devices (NPD) at home to ventilate 40 patients with neuromuscular disease is presented. The purpose of the study was to determine the costs, complications, and clinical outcome of this form of respiratory support, and to ascertain the reasons for failure to institute effective negative pressure ventilation (NPV) in nine patients. Emerson tank respirators, used mainly to rest respiratory muscles at night, and intermittent positive pressure breathing machines were used by 98% of patients at an average equipment cost of +2,700 annually. Patients in whom NPV was initiated on an elective rather than emergent basis saved an average of +12,000 during their initial hospitalization. Life table analysis shows a five-year survival of 76%, and a 10-year survival of 61%. Complications were minor and occurred at an average rate of less than one per year per patient at home on NPV. Failure to achieve satisfactory NPV in nine patients was associated with age (six patients were younger than 3 years of age), or severe thoracocervical scoliosis, which prevented proper fitting of the NPD. For reasons of safety, economy, and quality of life, NPV at home is the preferred treatment for patients having neuromuscular disease who need respiratory assistance.
本文介绍了在家中使用负压设备（NPD）为40例神经肌肉疾病患者进行通气治疗20年的经验。该研究的目的是确定这种呼吸支持方式的成本、并发症和临床结果，并查明9例患者未能进行有效负压通气（NPV）的原因。98%的患者使用主要用于夜间使呼吸肌休息的艾默生水箱呼吸器和间歇正压呼吸机，平均每年设备成本为2700英镑。择期而非急诊开始NPV治疗的患者在首次住院期间平均节省12000英镑。生命表分析显示，五年生存率为76%，十年生存率为61%。并发症较轻，在家中接受NPV治疗的患者平均每年发生率低于每人1次。9例患者未能实现满意的NPV与年龄（6例患者年龄小于3岁）或严重的胸颈段脊柱侧弯有关，这妨碍了NPD的正确安装。出于安全、经济和生活质量的考虑，对于需要呼吸辅助的神经肌肉疾病患者，在家中进行NPV是首选治疗方法。
