Escarrabill J, Estopá R, Farrero E, Monasterio C, Manresa F
UFISS-Respiratòria-Servei de Pneumologia, Ciutat Sanitàrin i Universitària de Bellvitge, L'Hospitalet, Barcelona, Spain.
Respir Med. 1998 Mar;92(3):438-41. doi: 10.1016/s0954-6111(98)90288-8.
Acute respiratory insufficiency (ARI) with alveolar hypoventilation or incapacitating dyspnoea but without peripheral muscle involvement can be an early manifestation of respiratory involvement in amyotrophic lateral sclerosis (ALS). Some of these patients benefit from assisted ventilation. The object of this study was to analyse the results of long-term mechanical ventilation (LTMV) in ten patients with ALS.
A retrospective analysis of intensive care unit (ICU) or ambulant patients with ALS who underwent LTMV in a conventional hospital ward was performed. Erect and supine spirometry, blood gas analysis and pulse oximetry were performed before the start and during the course of ventilation.
Ten patients on LTMV were included. Four from the ICU were ventilated via tracheostomy, and six ambulant patients had non-invasive (nasal) ventilation. In all cases, ventilation was performed in a conventional hospital ward. The ambulant patients improved symptomatically during ventilation, confirmed by measurement of gas exchange and of SaO2 by continuous pulse oximetry. Three of the ten patients survive in long-term care--two with nasal and one with tracheostomy ventilation.
LTMV outside ICU was possible in ten patients, seven of whom returned home. Returning home is very difficult for patients dependent on a ventilator who lack family support.
急性呼吸功能不全（ARI）伴肺泡通气不足或严重呼吸困难但无外周肌肉受累，可能是肌萎缩侧索硬化症（ALS）呼吸受累的早期表现。其中一些患者受益于辅助通气。本研究的目的是分析10例ALS患者长期机械通气（LTMV）的结果。
对在常规医院病房接受LTMV的重症监护病房（ICU）或门诊ALS患者进行回顾性分析。在通气开始前和通气过程中进行直立和仰卧位肺活量测定、血气分析和脉搏血氧饱和度测定。
纳入10例接受LTMV的患者。4例来自ICU的患者通过气管切开进行通气，6例门诊患者采用无创（鼻）通气。在所有病例中，通气均在常规医院病房进行。门诊患者在通气过程中症状改善，连续脉搏血氧饱和度测定的气体交换和SaO2测量结果证实了这一点。10例患者中有3例在长期护理中存活——2例采用鼻通气，1例采用气管切开通气。
10例患者在ICU外进行LTMV是可行的，其中7例回家。对于依赖呼吸机且缺乏家庭支持的患者来说，回家非常困难。
