Bach J R, Rajaraman R, Ballanger F, Tzeng A C, Ishikawa Y, Kulessa R, Bansal T
Department of Physical Medicine and Rehabilitation, UMDNJ-The New Jersey Medical School, University Hospital, Newark 07103, USA.
Am J Phys Med Rehabil. 1998 Jan-Feb;77(1):8-19. doi: 10.1097/00002060-199801000-00003.
The purpose of this study was to determine rates of pneumonia and hospitalization for patients receiving oxygen therapy, patients having indwelling tracheostomy tubes, and those using tracheostomy or noninvasive methods of home mechanical ventilation. Six hundred eighty-four users of assisted ventilation for 13,751 patient-years or 19.8 years per patient were surveyed by mail and twice by telephone over a span of four years. Pneumonia and hospitalization rates were significantly higher for ventilator users with chronic obstructive pulmonary disease or with neuromuscular ventilatory insufficiency and gastrostomy tubes than for ventilator users with neuromuscular ventilatory insufficiency without gastrostomy tubes. Of the latter group, more than 90% of the pneumonias and hospitalizations were triggered by otherwise benign intercurrent upper respiratory tract infections. Oxygen therapy was associated with a significantly (P < 0.001) higher rate of pneumonias and hospitalizations than that seen for untreated patients after initial episodes of respiratory distress or during the use of either tracheostomy intermittent positive pressure ventilation or noninvasive ventilatory assistance methods. The lowest pneumonia and hospitalization rates (P < 0.001) were by full-time, noninvasive intermittent positive pressure ventilation users. We conclude that oxygen therapy is not an effective substitute for assisted ventilation for patients with primarily ventilatory insufficiency. Noninvasive ventilatory aids can be used effectively for up to full-time ventilatory support for patients with neuromuscular conditions whose bulbar muscle function is adequate to avert the need for gastrostomy tube placement.
本研究的目的是确定接受氧疗的患者、留置气管造口管的患者以及使用气管造口术或家庭机械通气非侵入性方法的患者的肺炎发病率和住院率。在四年时间里，通过邮件对684名辅助通气使用者进行了调查，这些使用者共涉及13751患者年，即每位患者平均19.8年，并通过电话进行了两次随访。患有慢性阻塞性肺疾病或神经肌肉通气不足且有胃造口管的通气使用者的肺炎发病率和住院率显著高于没有胃造口管的神经肌肉通气不足的通气使用者。在后一组中，超过90%的肺炎和住院是由原本良性的并发上呼吸道感染引发的。与初次呼吸窘迫发作后未经治疗的患者相比，或与使用气管造口间歇性正压通气或非侵入性通气辅助方法期间的患者相比，氧疗与显著更高（P<0.001）的肺炎发病率和住院率相关。全职使用非侵入性间歇性正压通气的使用者的肺炎和住院率最低（P<0.001）。我们得出结论，对于主要存在通气不足的患者，氧疗并非辅助通气的有效替代方法。对于球部肌肉功能足以避免放置胃造口管的神经肌肉疾病患者，非侵入性通气辅助设备可有效地用于提供高达全职的通气支持。
