Department of Pulmonology and Lung Cancer, Wroclaw Medical University, 105 Grabiszynska St., Wroclaw, Poland,
Adv Exp Med Biol. 2013;788:167-73. doi: 10.1007/978-94-007-6627-3_25.
Chronic respiratory failure (CRF) develops in a minority of obese patients. Noninvasive mechanical ventilation (NIMV) is a new optional treatment for such patients. The aim of this study was to evaluate the effectiveness of NIMV in obese patients with CRF. The material of the study consisted of 34 obese patients (body mass index 47.3 ± 7.9 kg/m(2)) with CRF (PaO2 = 6.40 ± 0.93 kPa and PaCO2 = 8.67 ± 2.13 kPa) who were hypoxemic despite an optimal therapy. Thirteen patients had an overlap syndrome (OS) - chronic obstructive pulmonary disease (COPD) coexisting with obstructive sleep apnea syndrome (OSAS) and 21 patients had obesity-hypoventilation syndrome (OHS). Ventilation parameters were determined during polysomnography. The efficacy of NIMV was evaluated on the fifth day and after 1 year's home treatment. We observed a significant increase in the mean blood oxygen saturation during sleep in all patients; the increase was greater in patients with OHS (92.6 ± 1.4 %) than in patients with OS (90.4 ± 1.8 %). There was a significant improvement of diurnal PaO2 and PaCO2 on the fifth day of NIMV (mean PaO2 increase 2.1 kPa and PaCO2 decrease 0.9 kPa) and also after 1 year of home NIMV (mean PaO2 increase 1.9 kPa and PaCO2 decrease 2.4 kPa). Only one patient stopped treatment because of lack of tolerance during the observation period (1-3 years). In conclusion, NIMV is an effective and well tolerated treatment option in obese patients with CRF resulting in a rapid relief of respiratory disorders during sleep and a gradual, long-term improvement of gas exchange during the day, particularly in patients with OHS.
慢性呼吸衰竭（CRF）在少数肥胖患者中发展。无创机械通气（NIMV）是此类患者的新可选治疗方法。本研究的目的是评估 NIMV 在肥胖合并 CRF 患者中的有效性。研究材料由 34 名肥胖合并 CRF 患者（体重指数 47.3 ± 7.9 kg/m²）组成，尽管进行了最佳治疗，但这些患者仍存在低氧血症（PaO2 = 6.40 ± 0.93 kPa 和 PaCO2 = 8.67 ± 2.13 kPa）。13 名患者患有重叠综合征（OS）-慢性阻塞性肺疾病（COPD）合并阻塞性睡眠呼吸暂停综合征（OSAS），21 名患者患有肥胖低通气综合征（OHS）。在多导睡眠图期间确定通气参数。在第五天和家庭治疗 1 年后评估 NIMV 的疗效。我们观察到所有患者的睡眠期间平均血氧饱和度均显著增加；OHS 患者（92.6 ± 1.4%）的增加大于 OS 患者（90.4 ± 1.8%）。NIMV 的第五天和家庭 NIMV 1 年后白天 PaO2 和 PaCO2 均有显著改善（平均 PaO2 增加 2.1 kPa，PaCO2 降低 0.9 kPa）。仅 1 名患者在观察期间（1-3 年）因不耐受而停止治疗。总之，NIMV 是肥胖合并 CRF 患者的有效且耐受良好的治疗选择，可迅速缓解睡眠期间的呼吸障碍，并在白天逐渐长期改善气体交换，特别是在 OHS 患者中。
