CAJ | 학술논문

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≥30kg/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(SpO2)测定、动脉血气分析及呼吸中枢低氧反应性(△VE/△SpO2)、高CO2反应性(△VE/△PaCO2)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±30.1)次/h.FEV1/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PaO2和PaCO2均显著改善[(52.5±7.6)比(81.3±11.1)mmHg(1 mmHg=0.133 kPa)和(50.4±5.3)比(43.2±1.9) mmHg,均P=0.001],Ⅱ型呼吸衰竭均逆转.呼吸中枢△VE/△SpO2和△VE/△PaCO2绝对值均显著低于正常人群水平[(-0.11±0.08)比(-0.38±0.04)L·min-1·％ SpO2-1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、PaO2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.
목적 탐토반호흡쇠갈적비반저통기종합정(OHS)환자적호흡중추반응성.방법 선택2009년1월지2011년12월주원적반호흡쇠갈적중도비반(평균체질지수34.3 ±2.68,균≥30kg/m2) 14례,행폐공능검사、다도수면도감측화자주과도통기시험전후맥박혈양포화도(SpO2)측정、동맥혈기분석급호흡중추저양반응성(△VE/△SpO2)、고CO2반응성(△VE/△PaCO2)측정.기중적10례환자경1주적쌍수평기도정압통기(BiPAP)치료후행동맥혈기분석.결과 14례환자균부합Ⅱ형호흡쇠갈적진단,수면호흡감측발현수면호흡잠정저통기지수(AHI)위(66.6±30.1)차/h.FEV1/FVC적예계치균＞70％,불존재명현적조새성통기공능장애.자주과도통기후PaO2화PaCO2균현저개선[(52.5±7.6)비(81.3±11.1)mmHg(1 mmHg=0.133 kPa)화(50.4±5.3)비(43.2±1.9) mmHg,균P=0.001],Ⅱ형호흡쇠갈균역전.호흡중추△VE/△SpO2화△VE/△PaCO2절대치균현저저우정상인군수평[(-0.11±0.08)비(-0.38±0.04)L·min-1·％ SpO2-1화0.31(0.18,0.66)비1.20(0.82,1.50)L·min-1·mmHg-1,균P＜0.001)].10례환자재응용BiPAP호흡궤치료1주후,체중무명현개변,수면호흡문란추우정상;일간PaCO2수치료현저강저、PaO2명현승고,8례환자백천고CO2적환자적PaCO2회복도정상수평.결론 OHS환자존재수면호흡문란급호흡중추반응성강저,도치적호흡쇠갈속우“불원호흡”류형,자주과도통기시험후호흡쇠갈호전,유조우명학진단,무창통기가이개선야간호흡문란화백천적혈기이상.
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/m2 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 (△VE/△SpO2) and hypercapnia (△VE/△PaCO2) 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 ±7.6 vs 81.3 ±11.1 mmHg (1 mmHg =0.133 kPa,P =0.001) and PaCO2 (50.4 ±5.3 vs 43.2 ± 1.9 mmHg,P =0.001).RF was reversed in all patients.As compared with normal controls,all patients had decreased △VE/△SpO2 ((-0.11 ± 0.08) vs (-0.38 ± 0.04) L · min-1 · ％ SpO2-1,P ＜0.001) and △VE/△PaCO2 (0.31 (0.18,0.66) vs 1.20 (0.82,1.50) L · min-1 · 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.