Hakala K, Mustajoki P, Aittomäki J, Sovijärvi A R
Department of Pulmonary Diseases, Helsinki University Central Hospital, Finland.
Int J Obes Relat Metab Disord. 1995 May;19(5):343-6.
To determine, whether behavioral management of obesity including very-low-calorie-diet would produce weight loss enough to improve pulmonary mechanics and gas exchange in morbid obesity.
Pulmonary function and arterial oxygenation were studied before and after weight loss in 11 patients attending a group therapy with the program of VLCD for 6 weeks and 16 weeks' behavioral intervention.
Spirometry, diffusing capacity, body plethysmograph, closing volume and arterial blood gas analyses.
The mean initial BMI was 45.4 kg/m2 (range 39.8-58.7 kg/m2) and decreased to 39.4 kg/m2 (range 31-49.8 kg/m2) (P < 0.01). Expiratory reserve volume (ERV) and functional residual capacity (FRC) improved significantly with weight loss. Closing capacity (CC) exceeded FRC in 10 cases of 11 at the initial stage, but after weight loss only in three patients. The mean arterial oxygen tension with the patients in supine position did not change after weight loss, but standing up improved PaO2 significantly before and after weight loss.
The dietary treatment of morbid obesity was sufficient to induce improvement in lung volumes, but not enough to improve arterial oxygenation, although ventilatory mechanics was improved significantly and the tendency to early small airway closure was decreased. Hypoxemia was significantly relieved by standing up both before and after weight loss.
确定包括极低热量饮食在内的肥胖行为管理是否能产生足够的体重减轻，以改善病态肥胖患者的肺力学和气体交换。
对11名参加为期6周的极低热量饮食（VLCD）计划和16周行为干预的团体治疗患者，在体重减轻前后进行肺功能和动脉氧合研究。
肺活量测定、弥散功能、体容积描记法、闭合气量和动脉血气分析。
平均初始体重指数（BMI）为45.4kg/m²（范围39.8 - 58.7kg/m²），降至39.4kg/m²（范围31 - 49.8kg/m²）（P < 0.０1）。呼气储备量（ERV）和功能残气量（FRC）随体重减轻显著改善。11例患者中，初始阶段有10例闭合容量（CC）超过FRC，但体重减轻后仅3例。患者仰卧位时的平均动脉血氧分压在体重减轻后未改变，但站立时体重减轻前后PaO₂均显著改善。
病态肥胖的饮食治疗足以使肺容积得到改善，但不足以改善动脉氧合，尽管通气力学显著改善且早期小气道闭合倾向降低。体重减轻前后站立均可显著缓解低氧血症。
