Pankow W, Hijjeh N, Schüttler F, Penzel T, Peter J H, von Wichert P
Medizinische Poliklinik, Schlafmedizinisches Labor, Klinikum der Philipps-Universität Marburg.
Med Klin (Munich). 1997 Apr 28;92 Suppl 1:54-60.
Noninvasive ventilation with nose- or face-masks has been increasingly used in the past. The objective of mechanical ventilation is in addition to improve gas exchange to reduce breathing work. While improvement on breathing work has been shown mainly on normal-weight patients with different respiratory diseases, there is no existing data about the effect of noninvasive ventilation on the breathing work of patients with massive obesity.
Assisted mask-ventilation with bilevel positive airway pressure (BiPAP) was carried out on 5 overweight control subjects (overweight controls), 7 overweight patients with obstructive sleep apnea (OSA), 6 patients with obesitas-hypoventilation syndrome (OHS), and 7 overweight patients with chronic obstructive lung disease (COLD). Inspiratory pressure assist (IPAP) was set to 12 or 16 cm H2O, exspiratory pressure (EPAP) was set to 5 cm H2O. All, subjects were massive overweight (body mass index [BMI] 42.2 +/- 5.8; range 31.8 to 55.4 kg/m2). Respiratory muscle activity was measured as esophageal pressure change (delta Pes) and transdiaphragmatic pressure change (delta Pdi) and calculated as pressure time integral.
With noninvasive ventilation respiratory muscle activity was significantly (p < 0.05) reduced in all groups at least 40% compared to baseline values during spontaneous respiration.
Noninvasive ventilation via face masks can efficiently reduce work of breathing in subjects with massive obesity.
过去，鼻罩或面罩无创通气的应用越来越广泛。机械通气的目的除了改善气体交换外，还在于减少呼吸功。虽然呼吸功的改善主要在患有不同呼吸系统疾病的正常体重患者中得到证实，但目前尚无关于无创通气对重度肥胖患者呼吸功影响的数据。
对5名超重对照受试者（超重对照组）、7名患有阻塞性睡眠呼吸暂停（OSA）的超重患者、6名患有肥胖低通气综合征（OHS）的患者以及7名患有慢性阻塞性肺疾病（COLD）的超重患者进行双水平气道正压（BiPAP）辅助面罩通气。吸气压力辅助（IPAP）设置为12或16 cm H₂O，呼气压力（EPAP）设置为5 cm H₂O。所有受试者均为重度超重（体重指数[BMI] 42.2±5.8；范围31.8至55.4 kg/m²）。呼吸肌活动通过食管压力变化（ΔPes）和跨膈压变化（ΔPdi）进行测量，并计算为压力时间积分。
与自主呼吸时的基线值相比，所有组在无创通气时呼吸肌活动均显著降低（p < 0.05），至少降低40%。
通过面罩进行无创通气可有效降低重度肥胖受试者的呼吸功。
