肥胖通气低下综合征呼吸中枢反应性的改变与二氧化碳潴留相关作用

目的 观察肥胖通气低下综合征患者呼吸中枢反应性的改变与二氧化碳（ＣＯ２）潴留的相关作用。方法 测定了５例白天动脉血二氧化碳分压（ＰａＣＯ２）〉４５ｍｍＨｇ的睡眠呼吸暂停综合征（ＳＡＳ）患者呼吸中枢柢氧反应性（△Ｐ０．１／△ＳａＯ２ｗ、△Ｖｅ／△ＳａＯ２）及高ＣＯ２反应性（△Ｐ０．１／△ＰａＣＯ２、△Ｖｅ／△ＰａＣＯ２）,并选择５例年龄、性别、身高、体重、呼吸暂停病程及睡眠呼吸率乱指数（ＡＨＩ）相近

The role of breathing control disorder in the development of carbon dioxide retention in patients with obesity hypoventilation syndrome

OBJECTIVE: To define the role of breathing control in the pathogenesis of carbon dioxide (CO(2)) retention in patients with obesity hypoventilation syndrome. METHODS: 10 obese obstructive sleep apnea syndrome (OSAS) patients were studied. They were separated according to their waking arterial partial pressure of CO(2) (PaCO(2)), 5 being eucapnic and 5 hypercapnic. Both groups had similar body mass index, apnea hypopnea index and normal lung function. The hypoxic (Delta P(0.1)/Delta SaO(2), Delta V(E)/Delta SaO(2)) and the hypercapnic response (Delta P(0.1)/Delta PaCO(2), Delta V(E)/Delta PaCO(2)) were tested before and during continuous positive airway pressure (CPAP) treatment (at 2, 4, 6 weeks). RESULTS: Compared with the eucapnic patients, all the hypercapnic patients had lower Delta P(0.1)/Delta SaO(2) (-0.04 +/- 0.02) cmH(2)O% vs (-0.14 +/- 0.03) cmH(2)O%], Delta V(E)/Delta SaO(2) (-0.17 +/- 0.04) L x min(-1)% vs (-0.34 +/- 0.04) L x min(-1)%], Delta P(0.1)/Delta PaCO(2) (0.23 +/- 0.1) cmH(2)O/mm Hg vs (0.49 +/- 0.1) cmH(2)O/mm Hg], Delta V(E)/Delta PaCO(2) (1.32 +/- 0.7) L x min(-1) x mm Hg(-1) vs (2.18 +/- 0.81) L x min(-1) x mm Hg(-1)] and the Delta P(0.1)/Delta SaO(2), Delta V(E)/Delta SaO(2) were also lower than the normal value. After treatment with CPAP, the hypercapnic and the hypoxic response of the hypercapnic patients increased gradually, at about 4 approximately 6 week, both of them increased to the normal range, PaCO(2) showed a complete return to eucapnia, their weight were unchanged. CONCLUSION: The depressed breathing control play an important role in the development of CO(2) retention in OSAS patients, and the disorder in breathing control may be secondary to hypoxia, hypercapnia and sleep disorder related to the OSAS.