Edwards P R, Howard P
Dept of Medicine, Royal Hallamshire Hospital, Sheffield, UK.
Monaldi Arch Chest Dis. 1993;48(2):176-82.
Ventilatory failure is the commonest terminal event in many neuromuscular disorders. Increasingly, non-invasive methods of ventilation, employing both negative and positive pressure techniques, have been used, with the aim of prolonging life and reducing morbidity. The use of non-invasive ventilation is reviewed in three main groups of neurological diseases, and the degree of success assessed. It is concluded that non-invasive methods can be effective in reducing morbidity in selected patients, especially those with more slowly progressive disorders. A reduction in mortality is suggested by comparison with historical controls. The institution of ventilatory support is a major undertaking for the medical team, patient and family, and should only be initiated after a full and frank discussion of the overall prognosis, in terms of both mortality and quality of life. The patient and principal caregivers can then make an informed decision as to the desirability of home ventilation.
通气衰竭是许多神经肌肉疾病最常见的终末事件。越来越多地，采用负压和正压技术的无创通气方法已被用于延长生命和降低发病率。本文回顾了在三类主要神经系统疾病中无创通气的应用情况，并评估了其成功程度。得出的结论是，无创方法对特定患者，尤其是那些病情进展较慢的患者，可有效降低发病率。与历史对照相比提示死亡率有所降低。启动通气支持对医疗团队、患者及其家属来说是一项重大任务，并且应该仅在就死亡率和生活质量等整体预后进行充分且坦诚的讨论之后才开始。然后患者和主要护理人员可以就是否进行家庭通气做出明智的决定。
