Bach J R
Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, University Hospital, Newark.
Paraplegia. 1993 Jul;31(7):430-8. doi: 10.1038/sc.1993.72.
Eight traumatic spinal cord injured (SCI) individuals are described. Four tetraplegic patients who were weaned from initial ventilator use despite severe restrictive pulmonary syndromes experienced multiple pulmonary complications, episodes of acute respiratory failure, and 3 of the 4 required long term ventilatory support within 2 years of initial weaning. Three other SCI individuals developed chronic late-onset ventilatory failure 17, 25, and 29 years postinjury. One other tetraplegic patient was mechanically ventilated for 8.2 years post-injury despite complete recovery of autonomous ventilatory function years earlier. Of the 6 patients requiring long term ventilatory support, 4 were managed by noninvasive techniques of intermittent positive pressure ventilation (IPPV), one by negative pressure body ventilators, and one by tracheostomy IPPV. At least one and possibly as many as 5 patients were spared bronchoscopy and/or pulmonary complications by using mechanical insufflation-exsufflation (MI-E). We conclude that patients who are weaned despite having significant restrictive pulmonary syndromes are at risk for ventilatory decompensation weeks to decades after weaning. Ongoing clinical assessment, evaluation of respiratory muscle function and, at times, nocturnal blood gas analyses are warranted in the follow up of traumatic SCI individuals.
本文描述了8例创伤性脊髓损伤（SCI）患者。4例四肢瘫痪患者，尽管患有严重的限制性肺综合征，但在停用初始呼吸机后，仍出现了多种肺部并发症、急性呼吸衰竭发作，其中4例中有3例在初次脱机后2年内需要长期通气支持。另外3例SCI患者在受伤后17、25和29年出现慢性迟发性通气衰竭。另1例四肢瘫痪患者尽管多年前自主通气功能已完全恢复，但受伤后仍接受了8.2年的机械通气。在6例需要长期通气支持的患者中，4例采用无创间歇性正压通气（IPPV）技术治疗，1例采用负压体通气机治疗，1例采用气管切开IPPV治疗。通过使用机械吹气-呼气（MI-E），至少1例患者可能多达5例患者避免了支气管镜检查和/或肺部并发症。我们得出结论，尽管有明显的限制性肺综合征但仍脱机的患者在脱机后数周至数十年有通气失代偿的风险。在创伤性SCI患者的随访中，需要进行持续的临床评估、呼吸肌功能评估，有时还需要进行夜间血气分析。
