通过肺功能测试预测肌萎缩侧索硬化症患者的夜间通气量。

IF 1.2 Q4 RESPIRATORY SYSTEM
Pneumologie Pub Date : 2024-09-01 Epub Date: 2024-07-30 DOI:10.1055/a-2349-0936
Friederike Tress, Eva Luecke, Sabine Stegemann-Koniszewski, Anke Lux, Abhinav Singla, Jens Schreiber
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引用次数: 0

摘要

背景:肌萎缩性脊髓侧索硬化症(ALS)由于呼吸肌逐渐衰弱,预后很差。无创通气(NIV)可以提高患者的生存率和生活质量。无创通气的适应症是基于肺功能测试(PFT)和多导睡眠图(PSG)以及二氧化碳饱和度(tCO2)。虽然通过 ALS 清醒时的 PFT 预测夜间通气情况是可取的,但适合进行可靠预测的参数仍然难以确定:我们回顾性分析了 42 名 ALS 患者(27 名男性,15 名女性,年龄 69 ± 12.1 岁)的 PFT(肺活量测定、体液描记术、弥散容量、呼吸肌测试)和血气分析、PSG 和 tCO2 得出的参数,并对白天清醒参数和夜间睡眠参数进行了斯皮尔曼相关性分析。没有出现阻塞性通气障碍。我们没有观察到任何单一的日间 PFT 参数与夜间 pCO2 之间存在明显的相关性。但是,PIF/PEF、MEF50/MIF50、DLCO/VA 和 FEV1/FVC 与夜间 pCO2 之间存在明显的相关性。FEV1/FVC 和 Krogh 因子(DLCOc/VA)高度正常表明存在夜间高碳酸血症。此外,清醒时高碳酸血症、碳酸氢盐浓度和碱过量均与夜间高碳酸血症呈正相关:结论:清醒时的肺活量不能很好地预测夜间通气。吸气参数以及 FEV1/FVC 和 DLCO/VA 的比率表现最佳,应纳入解释中。我们的分析证实了 ALS 患者吸气肌无力的相关性。PSG 和 tCO2 仍是评估夜间通气的黄金标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prediction of nocturnal ventilation by pulmonary function testing in patients with amyotrophic lateral sclerosis.

Background: In amyotrophic lateral sclerosis (ALS) prognosis is poor due to progressive weakening of the respiratory muscles. Survival and quality of life can be improved by noninvasive ventilation (NIV), which is initially applied while sleeping. The indication for NIV is based on pulmonary function testing (PFT) and polysomnography (PSG) with capnography (tCO2). While it is desirable to predict nocturnal ventilation by waking PFT in ALS, the parameters suited for reliable predictions remain elusive.

Methods: We retrospectively analyzed parameters derived from PFT (spirometry, body plethysmography, diffusion capacity, respiratory muscle testing) and blood gas analysis, PSG and tCO2 in 42 patients with ALS (27 men, 15 women, age 69 ± 12.1 years) and performed Spearman's correlation analysis of daytime waking parameters and nighttime sleep parameters.

Results: 28 patients (66.7%) showed restrictive impairment of ventilation and 15 patients (48.3%) showed insufficiency of the respiratory musculature. There was no obstructive impairment of ventilation. We did not observe any significant correlations between any single daytime PFT parameter with nocturnal pCO2. However, there were significant correlations between the ratios PIF/PEF, MEF50/MIF50, DLCO/VA as well as FEV1/FVC and nocturnal pCO2. Highly normal FEV1/FVC and Krogh-Factor (DLCOc/VA) indicated nocturnal hypercapnia. Furthermore, waking hypercapnia, concentrations of bicarbonate and base excess were each positively correlated with nocturnal hypercapnia.

Conclusions: Waking PFT is not a good predictor of nocturnal ventilation. Inspiratory parameters as well as the ratios FEV1/FVC and DLCO/VA performed best and should be included in the interpretation. Our analyses confirm the relevance of inspiratory muscle weakness in ALS. PSG and tCO2 remain the gold standard for the assessment of nocturnal ventilation.

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来源期刊
Pneumologie
Pneumologie RESPIRATORY SYSTEM-
CiteScore
1.80
自引率
16.70%
发文量
416
期刊介绍: Organ der Deutschen Gesellschaft für Pneumologie DGP Organ des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose DZK Organ des Bundesverbandes der Pneumologen BdP Fachärzte für Lungen- und Bronchialheilkunde, Pneumologen und Allergologen
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