Non-invasive ventilation in motor neuron disease: an update of current UK practice
Non-invasive ventilation in motor neuron disease: an update of current UK practice
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DOI：
10.1136/jnnp-2011-300480
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发表时间：
2012-04-01
影响因子：
11
通讯作者：
Bourke, Stephen C.
中科院分区：
文献类型：
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作者：
O'Neill, Catherine L.;Williams, Tim L.;Bourke, Stephen C.
在运动神经元疾病（MND）中，呼吸肌无力导致大量发病率，死亡通常是由于呼吸衰竭。无创通气（NIV）可改善症状、生活质量和生存率，但以往的调查显示，很少有MND患者接受无创通气。方法采用邮寄调查的方法，对英国神经内科会诊医师在MND中的临床应用情况进行调查。该调查结果与2000年的一项类似调查结果进行了比较。结果在12个月的时间里，612例患者转诊为NIV，其中444例成功建立治疗，成功率为72.5%。38%的受访神经科医师在就诊时评估呼吸功能，20%常规监测呼吸功能；32%依赖症状作为NIV转诊的唯一标准，43%使用症状和生理损伤的组合。接受调查的神经科医生中，75%的患者在临终前接受过专科姑息治疗服务，69%的患者在早期接受过姑息治疗服务。与2000年相比，转诊和目前使用NIV的患者数量显著增加（分别为2.6倍和3.4倍）。成功建立无NIV的比例也有所增加，这表明在这一具有挑战性的患者群体中更适当地选择和/或改进使用无NIV的方法。然而，监测呼吸功能是不理想的，有时在终末期前不适当地使用不受控制的氧气。
Background In motor neurone disease (MND), respiratory muscle weakness causes substantial morbidity, and death is usually due to respiratory failure. Non-invasive ventilation (NIV) improves symptoms, quality of life and survival, but previous surveys showed that few patients with MND received NIV.Methods A postal survey was conducted of the clinical application of NIV in MND among consultant neurologists in the UK. The results were compared with those of a similar survey done in 2000.Findings Over 12 months, 612 patients were referred for NIV of whom 444 were successfully established on treatment (72.5% success rate). 38% of responding neurologists assessed respiratory function at presentation and 20% routinely monitored respiratory function; 32% relied on symptoms as the only criterion for NIV referral and 43% used a combination of symptoms and physiological impairment. 75% of responding neurologists accessed specialist palliative care services for their patients towards the end of life and 69% at an earlier stage.Interpretation Compared with 2000, there has been a marked increase in the number of patients referred for, and currently using, NIV (2.6 and 3.4-fold, respectively). The proportion successfully established on NIV has also increased, suggesting more appropriate selection and/or improvement in the methods of using NIV in this challenging group of patients. However, monitoring of respiratory function is suboptimal and uncontrolled oxygen is sometimes used inappropriately before the terminal phase.