Ferguson G T, Benoist J
Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.
Am Rev Respir Dis. 1993 Feb;147(2):457-61. doi: 10.1164/ajrccm/147.2.457.
The effect of nasal continuous positive airway pressure (CPAP) was assessed in three patients with tracheobronchomalacia (TBM) who failed conventional medical management. Using physiologic measures of airflow and fiberoptic bronchoscopy, we evaluated expiratory airflow and airway collapse during the acute administration of nasal CPAP. FVC increased and dynamic airway collapse [slow vital capacity minus forced vital capacity (SVC--FVC)] decreased with increasing levels of CPAP. Notching associated with airway collapse was observed in the baseline spirograms of all three patients, and it disappeared with the addition of nasal CPAP. Fiberoptic bronchoscopy confirmed the severity of TBM in each patient and documented an acute improvement in expiratory airway collapse with the addition of nasal CPAP. Intermittent nasal CPAP was then added to the patients' treatment regimens, improving the course of their disease. Specific treatment outcomes varied from patient to patient, but they included improved sputum production, atelectasis, exercise tolerance, and patient symptoms plus reduced need for medical care. These findings suggest that the addition of intermittent nasal CPAP to routine medical therapy may be of benefit to patients with severe TBM unresponsive to conventional medical management.
对三名经传统药物治疗无效的气管支气管软化症（TBM）患者评估了鼻持续气道正压通气（CPAP）的效果。通过气流的生理学测量和纤维支气管镜检查，我们评估了急性给予鼻CPAP期间的呼气气流和气道塌陷情况。随着CPAP水平升高，用力肺活量（FVC）增加，动态气道塌陷[慢肺活量减去用力肺活量（SVC - FVC）]减少。在所有三名患者的基线肺量图中均观察到与气道塌陷相关的切迹，添加鼻CPAP后切迹消失。纤维支气管镜检查证实了每位患者TBM的严重程度，并记录了添加鼻CPAP后呼气气道塌陷的急性改善情况。然后将间歇性鼻CPAP添加到患者的治疗方案中，改善了他们的病程。具体的治疗结果因患者而异，但包括痰液产生、肺不张、运动耐量改善，患者症状减轻以及医疗需求减少。这些发现表明，在常规药物治疗中添加间歇性鼻CPAP可能对传统药物治疗无反应的重度TBM患者有益。
