Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA.
Clin Chest Med. 2010 Jun;31(2):249-70. doi: 10.1016/j.ccm.2010.03.002.
A wide variety of mechanisms can lead to the hypoventilation associated with various medical disorders, including derangements in central ventilatory control, mechanical impediments to breathing, and abnormalities in gas exchange leading to increased dead space ventilation. The pathogenesis of hypercapnia in obesity hypoventilation syndrome remains somewhat obscure, although in many patients comorbid obstructive sleep apnea appears to play an important role. Hypoventilation in neurologic or neuromuscular disorders is primarily explained by weakness of respiratory muscles, although some central nervous system diseases may affect control of breathing. In other chest wall disorders, obstructive airways disease, and cystic fibrosis, much of the pathogenesis is explained by mechanical impediments to breathing, but an element of increased dead space ventilation also often occurs. Central alveolar hypoventilation syndrome involves a genetically determined defect in central respiratory control. Treatment in all of these disorders involves coordinated management of the primary disorder (when possible) and, increasingly, the use of noninvasive positive pressure ventilation.
多种机制可导致与各种医学疾病相关的通气不足，包括中枢通气控制障碍、呼吸机械障碍以及导致死腔通气增加的气体交换异常。肥胖低通气综合征高碳酸血症的发病机制仍有些不清楚，尽管在许多患者中，合并阻塞性睡眠呼吸暂停似乎起着重要作用。神经或神经肌肉疾病中的通气不足主要归因于呼吸肌无力，但某些中枢神经系统疾病可能会影响呼吸控制。在其他胸壁疾病、气道阻塞性疾病和囊性纤维化中，大部分发病机制可通过呼吸机械障碍来解释，但死腔通气增加的因素也经常存在。中枢性肺泡通气不足综合征涉及中枢呼吸控制的遗传缺陷。所有这些疾病的治疗都涉及到对原发性疾病（如有可能）的综合管理，并且越来越多地使用无创正压通气。
