Pérez de Llano Luis A, Golpe Rafael, Ortiz Piquer Montserrat, Veres Racamonde Alejandro, Vázquez Caruncho Manuel, Caballero Muinelos Olga, Alvarez Carro Cristina
Respiratory Division, Hospital Xeral-Calde, c/Dr. Ochoa s/n, 27004 Lugo, Spain.
Chest. 2005 Aug;128(2):587-94. doi: 10.1378/chest.128.2.587.
To assess the outcome of 54 patients with obesity-hypoventilation syndrome (OHS) who were treated with nasal intermittent positive-pressure ventilation (NIPPV).
Descriptive analysis of retrospectively collected clinical data.
From March 1995 to December 2002, OHS (defined as a body mass index [BMI] of > 30 kg/m2, a daytime Pa(CO2) of > or = 50 mm Hg, and a Pa(O2) of < 60 mm Hg in the absence of COPD) was diagnosed in 69 cases. Fifteen patients (21.7%) refused to be treated with NIPPV, and 20 patients were started on NIPPV therapy electively and 34 following an acute exacerbation. We employed daytime arterial blood gas values and overnight pulse oximetry to determine the initial NIPPV modes and settings. The outcome measures were survival, clinical status, and arterial blood gas levels.
Among the 54 study patients (18 women), the mean (+/- SD) age was 56 +/- 13 years. The mean BMI was 44 +/- 8.8 kg/m2. Sleep apnea syndrome (apnea-hypopnea index, > 5) was present in 87% of the patients. At presentation, 22 of the 54 patients had experienced an acute hypercapnic respiratory failure (pH < 7.34). None of these patients required orotracheal intubation after NIPPV treatment. Initially, 2 patients were treated with volume-preset ventilation, 49 patients used pressure-preset equipment, and 3 patients employed continuous positive airway pressure (CPAP). Forty-seven patients required supplemental oxygen. At the end of the follow-up period (mean duration, 50 months), Pa(O2) had increased by 24 mm Hg from baseline (95% confidence interval [CI], 21 to 28 mm Hg; p < 0.0001) and Pa(CO2) had decreased by 17 mm Hg (95% CI, 13 to 20 mm Hg; p < 0.0001). NIPPV therapy improved subjective sleepiness (mean Epworth sleepiness scale score decrease, 16 +/- 5 to 6 +/- 2; p < 0.001), and dyspnea decreased in all but four patients. During follow-up, three patients died (one of them due to the progression of respiratory failure). NIPPV therapy could be withdrawn in 5 patients who had achieved a sufficient weight loss, and the conditions of 16 patients could be maintained without respiratory failure by the use of simple therapy with CPAP.
NIPPV therapy is effective in the treatment of patients with OHS, providing a significant improvement in clinical status and gas exchange.
评估54例肥胖低通气综合征（OHS）患者接受鼻间歇正压通气（NIPPV）治疗的效果。
对回顾性收集的临床数据进行描述性分析。
1995年3月至2002年12月期间，69例患者被诊断为OHS（定义为体重指数[BMI]>30kg/m²、白天动脉血二氧化碳分压[Pa(CO2)]≥50mmHg且在无慢性阻塞性肺疾病[COPD]情况下动脉血氧分压[Pa(O2)]<60mmHg）。15例患者（21.7%）拒绝接受NIPPV治疗，20例患者选择性地开始NIPPV治疗，34例在急性加重后开始治疗。我们采用白天动脉血气值和夜间脉搏血氧饱和度测定来确定初始NIPPV模式和设置。观察指标为生存率、临床状况和动脉血气水平。
54例研究患者（18例女性）中，平均（±标准差）年龄为56±13岁。平均BMI为44±8.8kg/m²。87%的患者存在睡眠呼吸暂停综合征（呼吸暂停低通气指数>5）。就诊时，54例患者中有22例经历过急性高碳酸血症性呼吸衰竭（pH<7.34）。这些患者在接受NIPPV治疗后均无需气管插管。最初，2例患者采用容量预设通气，49例患者使用压力预设设备，3例患者采用持续气道正压通气（CPAP）。47例患者需要补充氧气。随访期末（平均时长50个月），Pa(O2)较基线水平升高了24mmHg（95%置信区间[CI]，21至28mmHg；p<0.0001），Pa(CO2)降低了17mmHg（95%CI，13至20mmHg；p<0.0001）。NIPPV治疗改善了主观嗜睡情况（平均爱泼沃斯嗜睡量表评分从16±5降至6±2；p<0.001），除4例患者外，所有患者的呼吸困难均有所减轻。随访期间，3例患者死亡（其中1例死于呼吸衰竭进展）。5例体重减轻足够的患者可停用NIPPV治疗，16例患者通过使用CPAP简单治疗可维持病情且无呼吸衰竭。
NIPPV治疗对OHS患者有效，可显著改善临床状况和气体交换。
