Smith I E, Laroche C M, Jamieson S A, Shneerson J M
Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, England.
Chest. 1996 Oct;110(4):1105-10. doi: 10.1378/chest.110.4.1105.
To investigate the relationship of thoracic kyphosis following tuberculosis to the development of ventilatory failure and to assess the efficacy on nocturnal noninvasive ventilatory support.
Retrospective consecutive case series with crossover from a phase without noninvasive ventilatory support to a phase with this treatment.
The Respiratory Support and Sleep Centre, Papworth, Hospital, Cambridge, England.
Seven patients with thoracic kyphosis following tuberculous osteomyelitis which had been contracted by the age of 4 years were studied. Their mean age was 53 (SD 7.1) years and the mean angle of kyphosis was 113.60. All patients were in ventilatory failure.
The patients were treated with nocturnal noninvasive ventilation with either an individually constructed cuirass shell and a negative pressure pump or nasal intermittent positive pressure ventilation using a volume preset ventilator.
Each patient underwent an initial clinical assessment along with radiologic studies of the spine, pulmonary function tests, daytime arterial blood gas tensions, and overnight recordings of arterial saturation, and transcutaneous carbon dioxide tension. They were reassessed in detail at a mean of 5 years after starting ventilatory support. Symptoms, vital capacity, daytime carbon dioxide tension, and overnight oximetry had all improved following treatment. Temporary withdrawal of ventilatory support led to severe sleep fragmentation in four patients and the appearance of central apneas and hypopneas in the other three. Six of the 7 patients were alive at a mean of 5.7 years after starting nocturnal ventilation.
These results show that ventilatory failure may develop, after an interval of many years, in patients with a severe thoracic kyphosis due to tuberculosis in childhood. Noninvasive nocturnal ventilatory support can control the symptoms of ventilatory failure, improve the physiologic abnormalities, and is associated with prolonged survival.
探讨结核后胸椎后凸与呼吸衰竭发生之间的关系，并评估夜间无创通气支持的疗效。
回顾性连续病例系列研究，从无创通气支持阶段过渡到该治疗阶段。
英国剑桥帕普沃思医院呼吸支持与睡眠中心。
研究了7例4岁前患结核性骨髓炎后出现胸椎后凸的患者。他们的平均年龄为53（标准差7.1）岁，平均后凸角度为113.60°。所有患者均有呼吸衰竭。
患者接受夜间无创通气治疗，使用个体化定制的胸甲外壳和负压泵，或使用预设容量通气机进行鼻间歇正压通气。
每位患者均接受了初始临床评估，包括脊柱影像学检查、肺功能测试、日间动脉血气分析以及夜间动脉血氧饱和度和经皮二氧化碳分压记录。在开始通气支持平均5年后对他们进行了详细复查。治疗后症状、肺活量、日间二氧化碳分压和夜间血氧饱和度均有所改善。4例患者暂时停用通气支持导致严重睡眠片段化，另外3例出现中枢性呼吸暂停和呼吸浅慢。7例患者中有6例在开始夜间通气平均5.7年后仍存活。
这些结果表明，儿童期患结核导致严重胸椎后凸的患者，多年后可能会发生呼吸衰竭。无创夜间通气支持可控制呼吸衰竭症状，改善生理异常，并延长生存期。
