SEVERE HYPERCAPNIA AFTER LOW-FLOW OXYGEN-THERAPY IN PATIENTS WITH NEUROMUSCULAR DISEASE AND DIAPHRAGMATIC DYSFUNCTION
SEVERE HYPERCAPNIA AFTER LOW-FLOW OXYGEN-THERAPY IN PATIENTS WITH NEUROMUSCULAR DISEASE AND DIAPHRAGMATIC DYSFUNCTION
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DOI：
10.4065/70.4.327
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发表时间：
1995-04-01
影响因子：
8.9
通讯作者：
EDMONDS, LC
中科院分区：
文献类型：
--
作者：
GAY, PC;EDMONDS, LC
目的：提高对神经肌肉疾病患者低流量吸氧可能加重高碳酸血症的认识。设计：回顾118例连续5年行膈神经传导检查的成年神经肌肉疾病患者的病历，分析8例低流量吸氧前后动脉血气检查患者的肺功能数据。材料和方法：8例神经肌肉疾病和横隔膜功能障碍患者(多发性肌炎3例，肌萎缩侧索硬化症或非特异性运动神经元病3例，炎性运动神经病和慢性脊髓灰质炎各1例)，分析低流量补充氧疗(0·5~2·L/min)后动脉血二氧化碳分压(PACE(2))的反应，并用线性分析寻找呼吸变量与氧疗后PACE反应的相关性。结果：总体研究组低流量氧疗后平均PACE增加2 8.2+/-2 3.3Torr；在5名患者中，增加了27Torr或更多，4名随后接受夜间辅助呼吸治疗的患者能够在白天补充氧气，而不是那么严重的高碳酸血症。统计分析未能揭示氧疗后心率加快的数值与任何呼吸变量的具体相关性。结论：对于有神经肌肉疾病和横隔功能障碍的患者，即使是低流量的补充氧也应谨慎使用，应强烈考虑将辅助呼吸机作为初始干预措施。
Objective: To increase the general awareness of the possible exacerbation of hypercapnia by the administration of low-flow oxygen in patients with neuromuscular disorders.Design: We retrospectively reviewed the medical records of 118 consecutive adult patients with a diagnosis of neuromuscular disease who underwent phrenic nerve conduction studies during a 5-year period, and we analyzed pulmonary function data for 8 patients who underwent arterial blood gas studies before and after the administration of low-flow oxygen.Material and Methods: In the eight patients with neuromuscular disease and diaphragmatic dysfunction (three with polymyositis, three with amyotrophic lateral sclerosis or nonspecific motor neuron disease, and one each with inflammatory motor neuropathy and chronic poliomyelitis), we analyzed the response of the arterial carbon dioxide tension (Pace(2)) after low-flow supplemental oxygen therapy (0.5 to 2 L/min), Linear analysis was used to attempt to find correlations between respiratory variables and the Pace, response after oxygen therapy.Results: For the overall study group, the mean Pace, increased 28.2 +/- 23.3 torr after low-flow oxygen treatment; in five patients, it increased by 27 torr or more, Four patients who were subsequently treated with nocturnal assisted ventilation were able to use supplemental oxygen during the day with less severe hypercapnia. Statistical analysis failed to reveal specific correlations between increased Pace, values after oxygen therapy and any respiratory variables.Conclusion: In patients with neuromuscular disease and diaphragmatic dysfunction, even low-flow supplemental oxygen should be administered with caution, and assisted ventilation should be strongly considered as an initial intervention.