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伴呼吸衰竭的肥胖低通气综合征患者的呼吸中枢反应性 被引量:5

Chemo-responsiveness in patients with obesity hypoventilation syndrome and respiratory failure
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摘要 目的探讨伴呼吸衰竭的肥胖低通气综合征(OHS)患者的呼吸中枢反应性。方法选择2009年1月至2011年12月住院的伴呼吸衰竭的重度肥胖(平均体质指数34.3±2.68,均I〉30ks/m2)14例,行肺功能检查、多导睡眠图监测和自主过度通气试验前后脉搏血氧饱和度(SpO:)测定、动脉血气分析及呼吸中枢低氧反应性(AVE/ASp02)、高CO:反应性(AVE/APaCO2)测定。其中的10例患者经1周的双水平气道正压通气(BiPAP)治疗后行动脉血气分析。结果14例患者均符合Ⅱ型呼吸衰竭的诊断,睡眠呼吸监测发现睡眠呼吸暂停低通气指数(AHI)为(66.6.4±30.1)次/h。FEV,/FVC的预计值均〉70%,不存在明显的阻塞性通气功能障碍。自主过度通气后Pa02和PaCO:均显著改善[(52.5±7.6)比(81.3±11.1)mmHg(1mmHg=0.133kPa)和(50.4±5.3)比(43.2.4±1.9)mmHg,均P=0.001],Ⅱ型呼吸衰竭均逆转。呼吸中枢AVE/ASp02和AVE/APaC02绝对值均显著低于正常人群水平[(一0.11±0.08)比(-0.38.4±0.04)L·min^-1·%Sp02^-1和0.31(0.18,0.66)比1.20(0.82,1.50)L·min^-1·mmHg^-1,均P〈0.001)]。10例患者在应用BiPAP呼吸机治疗1周后,体重无明显改变,睡眠呼吸紊乱趋于正常;日间PaCO2随治疗显著降低、PaO:明显升高,8例患者白天高CO2的患者的PaCO2恢复到正常水平。结论OHS患者存在睡眠呼吸紊乱及呼吸中枢反应性降低,导致的呼吸衰竭属于“不愿呼吸”类型,自主过度通气试验后呼吸衰竭好转,有助于明确诊断,无创通气可以改善夜间呼吸紊乱和白天的血气异常。 Objective To the evaluate chemo-responsiveness in patients with obesity hypoventilation syndrome (OHS) and respiratory failure (RF). Methods A total of 14 OHS and RF patients with a mean body mass index (BMI) of (34. 3 ± 2. 68 ) kg/m^2 hospitalized between January 2009 to December 2011 were recruited. Lung function test (LFT), polysomnograghy (PSG), arterial blood gases (ABG) before and after voluntary hyperventilation maneuver and respiratory responses to hypoxia (AVE/ ASpO2 ) and hypercapnia ( AVE/APaCO2 ) were measured. Ten of them received bi-level positive airway pressure (BiPAP) for 1 week and pre and post-treatment ABG were compared. Results All of them fulfilled the criteria of type Ⅱ respiratory failure. PSG sleep study indicated a mean sleep apnea hypopnea index of (66. 6± 30. 1 ) times/h and LFT revealed a predicted FEV1/FVC% over 70% , excluding chronic obstruction pulmonary disease. Voluntary hyperventilation maneuver induced significant improvements in PaO2(52.5±7.6vs81.3±ll. 1 mmHg (1 mmHg=0.133 kPa, P=0. O01) andPaCO2(50.4±5.3 vs 43.2± 1.9 mmHg, P = O. 001 ). RF was reversed in all patients. As compared with normal controls, all patients had decreased AVE/ASpOz ( ( - 0. 11 ± 0.08 ) vs ( - 0. 38 ± 0.04 ) L·min^- l . % SpO2 -1, p 〈 0. 001 ) and AVE/APaCOz (0. 31 (0. 18, 0. 66 ) vs 1.20 (0. 82, 1.50) L · min^-l . mmHg^-1, P 〈 0. 001 ). One-week BiPAP therapy induced significant improvement of sleep disordered breathing and daytime ABGs without any change of BMI in 10 patients. And PaCO2 was normalized in 8/10 patients. Conclusions OHS patients have sleep disordered breathing and depressed chemo-responsiveness. Voluntary hyperventilation maneuver may reverse the "unwilling breathing" type of RF. Non-invasive ventilation treatment may improve nocturnal sleep apnea and daytime ABG abnormality.
作者 王慧玲 王晶玉 李静 董霄松 安培 赵龙 胡彦峰 张雪丽 韩芳 Wang Huiling , Wang Jingyu ,Li Jing, Dong Xiaosong, An Pei , Zhao Long, Hu Yanfeng, Zhang Xueli, Han Fang. * Departments of Respiratory & Critical Care Medicine, Central Municipal Hospital, Handan 056001, China;#Departments of Respiratory & Critical Care Medicine, Binzhou Medical College, Binzhou 256603, China Wang Huiling and Wang Jingyu contributed equally to the article Corresponding author: Han Fang, Departments of Respiratory & Critical Care Medicine, Peking University People's Hospital, Bering 100044, China, Email : hanfangl @ hotmaiL com
出处 《中华医学杂志》 CAS CSCD 北大核心 2014年第46期3633-3636,共4页 National Medical Journal of China
基金 国家国际科技合作专项(2014DFA31500),国家科技支撑计划(2012BAl05800)
关键词 肥胖低通气综合征 呼吸功能不全 睡眠呼吸暂停 呼吸调节 自主过度通气试验 Obesity hypoventilation syndrome Respiratory insufficiency Sleep apnea Respiratory regulation Voluntary hyperventilation
作者简介 韩芳,100044,Email:hanfangl@hotmail.com
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