Vpliv uporabe izkašljevalnika in neinvazivne mehanske ventilacije na preživetje bolnikov z amiotrofično lateralno sklerozo : diplomsko delo

Pivk, Teja (author), Leonardis, Lea (mentor)

Uvod: Amiotrofična lateralna skleroza (ALS) je nevrodegenerativna bolezen, ki prizadane spodnje in zgornje motorične nevrone. Povzroči okvaro alfa motoričnih celic in s tem šibkost skeletnih, bulbarnih in/ali dihalnih mišic. Prizadetost dihalnih mišic lahko vodi v smrt zaradi dihalne odpovedi. Namen: Želeli smo ugotoviti, ali uporaba izkašljevalnika (IZK) in neinvazivne mehanske ventilacije (NIMV) pomembno podaljšata preživetje ALS bolnikov v primerjavi z uporabo samo enega od aparatov. Metode dela: Na Kliničnem inštitutu za klinično nevrofiziologijo UKC Ljubljana smo zbrali podatke 36 preminulih ALS bolnikov, ki smo jih nato razdelili v tri skupine glede na to, ali so uporabljali IZK, NIMV ali oba aparata. Zbrali smo podatke o starosti ob začetku bolezni, datumu začetka bolezni, datumu začetka uporabe vsaj enega od aparatov in datumu slabega dogodka (smrt ali invazivna mehanska ventilacija). S statističnim programom smo analizirali preživetje od začetka bolezni do slabega dogodka med skupinami in čas od začetka uporabe prvega aparata do slabega dogodka. Preverili smo, ali so starost in skupine dejavniki tveganja za slab dogodek. Na koncu smo še za vsako skupino preverili, ali sta starost in čas od začetka rabe aparatov do slabega dogodka dejavnika tveganja za slab dogodek. Rezultati: V celoti se skupine niso razlikovale v preživetju, le bolniki v skupini IZK so kasneje začeli uporabljati aparat kot ostali. Čas od začetka rabe aparatov do slabega dogodka je pomembno vplival na tveganje za smrt pri skupini, ki je uporabljala oba aparata. Razprava in zaključek: Rezultati kažejo, da uporaba obeh aparatov bistveno ne podaljša preživetja v primerjavi z uporabo samo enega od aparatov. Slabost raziskave je bil majhen vzorec. Prav tako nismo upoštevali uporabe riluzola in perkutane endoskopske gastrostome, ki pomembno vplivata na preživetje. V prihodnosti bi bilo smiselno imeti večji vzorec bolnikov in bolj strukturirano delitev po skupinah glede na prizadetost mišic (bulbarni, spinalni), različne podtipe (oblike) ALS, uporabo riluzola in perkutane endoskopske gastrostome. Smiselno bi bilo tudi upoštevati preživetje od začetka bolezni in od postavitve diagnoze za lažjo primerjavo z ostalo literaturo. Na koncu bi bilo smiselno vključiti tudi kontrolno skupino.

• Language: Slovenian
• Keywords: amiotrofična lateralna skleroza, izkašljevalnik, neinvazivna mehanska ventilacija, preživetje
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2020
• PID: 20.500.12556/RUL-113766
• COBISS.SI-ID: 5774955
• Publication date in RUL: 01.02.2020

Secondary language

• Language: English
• Title: Effect of cough assist and noninvasive mechanical ventilation use on survival of patients with amyotrophic lateral sclerosis : diploma work

Abstract

Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, which affects the lower and upper alpha motor neurons. Skeletal, bulbar and/or respiratory muscles may be impaired. Respiratory muscle damage can lead to death by respiratory failure. Purpose: The purpose of this study was to examine the effect of cough assist (CA) and noninvasive mechanical ventilation (NIMV) use on survival of ALS patients compared to using only one of the devices. Methods: The data of 36 patients were obtained at the Clinical Institute of Clinical Neurophysiology at UKC Ljubljana. The patients were devided into three groups, depending on which device/devices they used. We collected data of the patients age, when the disease started, date of the first symptomes, the date they started using at least one of the devices and the date of the bad outcome (death or invasive mechanical ventilation). Using a statistical programme, we compared the survival from the start of the disease until the bad outcome between the gropus and the time they started using the first device until the bad outcome. We analized, if age and group were a risk factor for a bad outcome. Lastly we analized, if age and the time of using the devices were a risk factor for a bad outcome for every group separately. Results: Overall, there was no significant difference in survival between the groups. We did notice, that the patients in the CA group started using the device later than in the other two groups. In the group that used both devices, time of use was a risk factor for a bad outcome. Discussion and conclusion: The results show that there is no significant difference in overall survival, no matter the device used. The disadvantage of this study was a small sample and no control group. We also didn't include the use of riluzol and percutaneous endoscopic gastrostomy. In future studies, the sample should be bigger, the patients should be devided depending on the muscle impairment (bulbar, spinal), ALS type, riluzol use and percutaneous endoscopic gastrostomy use. Both survival times (from first symptoms and date of diagnosis) should also be included, as well as a control group.

• Keywords: amyotrophic lateral sclerosis, cough assist, noninvasive mechanical ventilation, survival