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題名 | Acute Respiratory Failure as an Initial Manifestation of Motor Neuron Disease--A Case Report and Literature Review=運動神經元疾病以急性呼吸衰竭為起始表現--病例報告及文獻回顧 |
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作者 | 王國書; 楊光耀; 彭瑞鵬; | 書刊名 | 胸腔醫學 |
卷期 | 15:2 2000.06[民89.06] |
頁次 | 頁102-109 |
分類號 | 415.9413 |
關鍵詞 | 運動神經元疾病; 呼吸衰竭; 肺萎陷; 支氣管內空氣灌注; Motor neuron disease; MND; Respiratory failure; Atelectasis; Endobronchial room-air insufflation; |
語文 | 英文(English) |
中文摘要 | 呼吸衰竭通常出現在運動神經元疾病(motor neuron disease, MND)的病 程晚期;隨著疾病的進展,罹患運動神經元疾病的病患會逐漸發展出呼吸衰竭的 症狀。但是,有非常少數的病人在病程早期便出現此情況。我們報告一位以急性 呼吸衰竭來表現的病人,在病程中並有持續性的左下肺葉萎陷(atelectasis)及呼吸 器依賴,最後在住院31天後經由神經傳導及肌電圖檢查確定診斷為運動神經元 疾病。此病人接受過正壓呼吸器(positive-pressure ventilation),大潮氣容積(tidal volume),高吐氣末陽壓(PEEP),及支氣管內空氣灌注法(endobronchial room air insufflation)治療,但是情況並未改善。由於需要長期依賴呼吸器治療,最後他接 受氣管造口術並轉至慢性呼吸照護中心繼續治療。我們將就其病程、診斷、及治 療加以討論,並回顧相關的文獻報告。經由此病例,我們建議臨床醫師對於無法 解釋的急性呼吸衰竭病人應考慮運動神經元疾病的可能性,而儘早給予適當的診 斷及治療。如預防感染及早期使用非侵襲性呼吸器等,以改善生活品質及避免嚴 重的後果。 |
英文摘要 | Respiratory failure usually occurs late in the course of motor neuron disease (MND), but it can present very rarely as an initial manifestation of the disease. We report a patient with MND who presented with acute respiratory failure, recurrent atelectasis of the left lower lobe, and difficulty in weaning from the ventilator. After excluding other causes of respiratory failure, motor neuron disease was diagnosed based on the clinical manifestations and the electrophysiological study. Several therapeutic strategies were undertaken including the use of mechanical ventilation with a high tidal volume and high positive end-expiratory pressure (PEEP), and endobronchial room-air insufflation, but none of them was effective. After tracheostomy, he was transferred to a chronic respiratory care center for further management. We herein review the literature and discuss this unusual initial manifestation of motor neuron disease, as well as its management. Based on this case report, we would suggest that a patient with recurrent lung atelectasis and acute respiratory failure may be exhibiting an early presentation of motor neuron disease. |
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