Chan C S, Bye P T, Woolcock A J, Sullivan C E
Department of Thoracic Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Am Rev Respir Dis. 1990 Apr;141(4 Pt 1):861-5. doi: 10.1164/ajrccm/141.4_Pt_1.861.
In this study, we examined two groups of patients with chronic airflow limitation (CAL) separated according to their awake, stable arterial CO2 level. The aim was to identify factors that may contribute to the development of chronic hypercapnic respiratory failure. Patients with obstructive sleep apnea were excluded from the study. Detailed lifetime histories of smoking, alcohol, and snoring were obtained from all patients together with measurements of lung function and of upper airway size. Thirty-three patients with FEV1 less than 1.5 L were studied, of whom 19 were eucapnic and 14 were hypercapnic. Both groups had a similar degree of chronic airflow limitation and similar lung volumes and DLCO. The hypercapnic group had more hypopneas and desaturated more severely during sleep. The greatest differences between the groups were in their alcohol consumptions, snoring histories, and upper airway dimensions. The eucapnic patients were characterized by lower lifetime alcohol intake, minimal snoring, and large upper airway size. In contrast, the hypercapnic patients were characterized by excessive lifetime alcohol consumption, habitual snoring over many years, and a small upper airway size. Our findings suggest that chronic, heavy alcohol use and upper airway dysfunction are important factors in the development of hypercapnic respiratory failure.
在本研究中，我们检查了两组慢性气流受限（CAL）患者，这两组患者根据其清醒、稳定状态下的动脉二氧化碳水平进行区分。目的是确定可能导致慢性高碳酸血症呼吸衰竭发生的因素。阻塞性睡眠呼吸暂停患者被排除在研究之外。从所有患者那里获取了详细的吸烟、饮酒和打鼾的终生病史，同时还测量了肺功能和上气道大小。对33例第一秒用力呼气容积（FEV1）小于1.5升的患者进行了研究，其中19例为二氧化碳正常，14例为高碳酸血症。两组患者的慢性气流受限程度相似，肺容积和一氧化碳弥散量（DLCO）也相似。高碳酸血症组睡眠期间呼吸浅慢次数更多，血氧饱和度下降更严重。两组之间最大的差异在于饮酒量、打鼾病史和上气道尺寸。二氧化碳正常的患者终生酒精摄入量较低、打鼾极少且上气道尺寸较大。相比之下，高碳酸血症患者终生酒精摄入量过多、多年习惯性打鼾且上气道尺寸较小。我们的研究结果表明，长期大量饮酒和上气道功能障碍是高碳酸血症呼吸衰竭发生的重要因素。
