Marrone O, Sanci S, Cibella F, Pipitone P, Milone F, Bellia V, Bonsignore G
Ann Ital Med Int. 1989 Oct-Dec;4(4):408-12.
An obese woman with respiratory failure and bilateral diaphragmatic paralysis, was studied in order to investigate the effects of weight loss on respiratory function during wakefulness and sleep. The patient was studied on 5 different occasions during which diurnal blood gas analysis, spirometry, CO2 rebreathing test, nitrogen wash-out test and a nocturnal polysomnographic study were performed. The follow-up period lasted 9 months, during which the patient progressively lost 19 kg. Progressive improvement in awake blood gas tensions (PaO2 + 21 mmHg, PaCO2 - 16 mmHg) as well as in nocturnal oxyhemoglobin saturation and transcutaneous PCO2 were observed; at the same time only minor changes in responsiveness to CO2 and in lung volumes were found. Conversely alveolar efficiency for CO2, obtained with the nitrogen wash-out test, in the supine posture increased from 81.7 to 90.5%, indicating an improvement in ventilation/perfusion ratio as a possible determinant of blood gas tension improvement during wakefulness and, as a consequence, also during sleep. We conclude that obesity is one possible cause of the occurrence of respiratory failure in bilateral diaphragmatic paralysis.
对一名患有呼吸衰竭和双侧膈肌麻痹的肥胖女性进行了研究，以探讨体重减轻对清醒和睡眠期间呼吸功能的影响。在5个不同时间点对该患者进行了研究，期间进行了日间血气分析、肺量测定、二氧化碳再呼吸试验、氮洗脱试验和夜间多导睡眠图研究。随访期持续9个月，在此期间患者逐渐减重19千克。观察到清醒时血气张力（动脉血氧分压增加21 mmHg，动脉血二氧化碳分压降低16 mmHg）以及夜间氧合血红蛋白饱和度和经皮二氧化碳分压有进行性改善；同时发现对二氧化碳的反应性和肺容量仅有轻微变化。相反，通过氮洗脱试验获得的仰卧位时二氧化碳的肺泡效率从81.7%提高到90.5%，表明通气/灌注比有所改善，这可能是清醒期间血气张力改善的决定因素，因此也是睡眠期间血气张力改善的决定因素。我们得出结论，肥胖是双侧膈肌麻痹患者发生呼吸衰竭的一个可能原因。
