呼吸系统。

Bailliere's clinical neurology Pub Date : 1996-10-01
U Zifko, R Chen
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引用次数: 0

摘要

神经系统疾病常导致危重病人呼吸衰竭。它们可能是开始机械通气的主要原因,也可能在以后发展为次要并发症。导致呼吸衰竭的中枢神经系统疾病包括代谢性脑病、急性中风、运动皮层和脑干呼吸中枢病变及其下行通路。guillan - barr综合征、重症多神经病变和急性四肢瘫痪肌病是更常见的呼吸衰竭的神经肌肉原因。临床观察和肺功能检查是监测呼吸功能的重要手段。呼吸电生理研究在调查和监测呼吸衰竭方面是有用的。经皮质和颈部磁刺激可评估中枢呼吸驱动,并可用于确定通气患者的预后,颈髓功能障碍。它也有助于评估断奶失败,这通常是由中枢和周围神经系统疾病的组合引起的。膈神经传导研究和横膈膜和胸壁肌肉的针肌电图对描述影响横膈膜的神经病变和肌病是有用的。重复膈神经刺激可评估神经肌肉传递缺陷。识别有呼吸衰竭风险的患者是很重要的。在发展为严重低氧血症之前,应仔细监测并开始机械通气。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The respiratory system.

Neurological disorders frequently contribute to respiratory failure in critically ill patients. They may be the primary reason for the initiation of mechanical ventilation, or may develop later as a secondary complication. Disorders of the central nervous system leading to respiratory failure include metabolic encephalopathies, acute stroke, lesions of the motor cortex and brain-stem respiratory centres, and their descending pathways. Guillan-Barré syndrome, critical illness polyneuropathy and acute quadriplegic myopathy are the more common neuromuscular causes of respiratory failure. Clinical observations and pulmonary function tests are important in monitoring respiratory function. Respiratory electrophysiological studies are useful in the investigation and monitoring of respiratory failure. Transcortical and cervical magnetic stimulation can assess the central respiratory drive, and may be useful in determining the prognosis in ventilated patients, with cervical cord dysfunction. It is also helpful in the assessment of failure to wean, which is often caused by a combination of central and peripheral nervous system disorders. Phrenic nerve conduction studies and needle electromyography of the diaphragm and chest wall muscles are useful to characterize neuropathies and myopathies affecting the diaphragm. Repetitive phrenic nerve stimulation can assess neuromuscular transmission defects. It is important to identify patients at risk of respiratory failure. They should be carefully monitored and mechanical ventilation should be initiated before the development of severe hypoxaemia.

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