Shichinohe Y, Omote T, Arakawa J, Takahashi H, Ujike Y, Namiki A
Division of Anesthesiology, Emergency and Critical Care Medical Center, Asahikawa Red Cross Hospital.
Masui. 1995 Sep;44(9):1246-9.
A 68-year-old man with severe dyspnea was admitted as an emergency case. He had no past history of any respiratory or neuromuscular diseases. Immediately after insufflation of oxygen, respiratory arrest occurred. The blood gas analysis showed hypoxemia and severe hypercapnia (PaO2; 32 mmHg, PaCO2; 127 mmHg). We diagnosed as CO2 narcosis, and he was treated with a respirator in the ICU. He showed nonflaccid bilateral diaphragmatic paralysis and muscle atrophy of the upper extremities. As the EMG showed giant spikes of neurogenic pattern, he was diagnosed as ALS. Weaning from the respirator failed because of his respiratory muscle fatigue. He was given rehabilitation during the day time and ventilatory support with the respirator during the night. We conclude that if we meet with an emergency patient with CO2 narcosis without any pulmonary disorder, we have to suspect neuromuscular diseases, e.q. ALS. In some of such cases, mechanical ventilation supports social rehabilitation.
一名68岁重度呼吸困难男性作为急诊病例入院。他既往无任何呼吸或神经肌肉疾病史。吸氧后立即发生呼吸骤停。血气分析显示低氧血症和严重高碳酸血症（动脉血氧分压；32 mmHg，动脉血二氧化碳分压；127 mmHg）。我们诊断为二氧化碳麻醉，他在重症监护病房接受呼吸机治疗。他表现为双侧膈肌非弛缓性麻痹和上肢肌肉萎缩。由于肌电图显示神经源性模式的巨大棘波，他被诊断为肌萎缩侧索硬化症。因呼吸肌疲劳，脱机失败。他白天接受康复治疗，夜间使用呼吸机进行通气支持。我们得出结论，如果遇到无任何肺部疾病的二氧化碳麻醉急诊患者，我们必须怀疑神经肌肉疾病，例如肌萎缩侧索硬化症。在某些此类病例中，机械通气有助于社会康复。
