【摘要】 目的　观察肥胖通气低下综合征患者呼吸中枢反应性的改变与二氧化碳 (CO2 )潴留的相关作用。方法　测定了 5例白天动脉血二氧化碳分压 (PaCO2 ) >4 5mmHg的睡眠呼吸暂停综合征(SAS)患者呼吸中枢低氧反应性 (ΔP0 .1/ΔSaO2 、Δ VE/ΔSaO2 )及高CO2 反应性 (ΔP0 .1/ΔPaCO2 、Δ VE/ΔPaCO2 ) ,并选择 5例年龄、性别、身高、体重、呼吸暂停病程及睡眠呼吸紊乱指数 (AHI)相近但无CO2 潴留者作为对照。 10例受试者均肥胖 ,无阻塞性通气障碍。结果　 5例肥胖通气低下患者的ΔP0 .1/ΔSaO2 为 ( - 0 .0 4± 0 .0 2 )cmH2 O % ,Δ VE/ΔSaO2 为 ( - 0 .17± 0 .0 4 )L·min-1% ,ΔP0 .1/ΔPaCO2 为( 0 .2 3± 0 .1)cmH2 O/mmHg,Δ VE/ΔPaCO2 为 ( 1.3 2± 0 .7)L·min-1·mmHg-1;对照者ΔP0 .1/ΔSaO2 为( - 0 .14± 0 .0 3 )cmH2 O % ,Δ VE/ΔSaO2 为 ( - 0 .3 4± 0 .0 4 )L·min-1% ,ΔP0 .1/ΔPaCO2 为 ( 0 .4 9± 0 .1)cmH2 O/mmHg ,Δ VE/ΔPaCO2 为 ( 2 .18± 0 .81)L·min-1·mmHg-1,且ΔP0 .1/ΔSaO2 、Δ VE/ΔSaO2 及其中 3例患者的ΔP0 .1/ΔPaCO2 均低于正常值。在长期应用持续气道正压通气治疗过程中 ,第 2、4和 6周复查发现 5例肥胖通气低下患者的中枢反应性逐渐上升 ,4～ 6周均恢复正常 ,更多还原

【Abstract】 Objective To define the role of breathing control in the pathogenesis of carbon dioxide (CO 2) retention in patients with obesity hypoventilation syndrome. Methods 10 obese obstructive sleep apnea syndrome (OSAS) patients were studied . They were separated according to their waking arterial partial pressure of CO 2 (PaCO 2), 5 being eucapnic and 5 hypercapnic. Both groups had similar body mass index, apnea hypopnea index and normal lung function. The hypoxic (ΔP 0.1 /ΔSaO 2、Δ E/ΔSaO 2) and the hypercapnic response(ΔP 0.1 /ΔPaCO 2、Δ E/ΔPaCO 2)were tested before and during continuous positive airway pressure (CPAP) treatment (at 2,4,6 weeks). Results Compared with the eucapnic patients,all the hypercapnic patients had lower ΔP 0.1 /ΔSaO 2 [(-0.04±0.02) cmH 2O% vs (-0.14±0.03) cmH 2O%], Δ E/ΔSaO 2 [(-0.17±0.04) L·min -1 % vs (-0.34 ±0.04) L·min -1 %], ΔP 0.1 /ΔPaCO 2 [(0.23±0.1) cmH 2O/mm Hg vs (0.49±0.1) cmH 2O/mm Hg], Δ E/ΔPaCO 2 [(1.32±0.7) L·min -1 ·mm Hg -1 vs (2.18±0.81) L·min -1 ·mm Hg -1 ] and the ΔP 0.1 /ΔSaO 2、Δ E/ΔSaO 2 were also lower than the normal value. After treatment with CPAP, the hypercapnic and the hypoxic response of the hypercapnic patients increased gradually, at about 4～6 week, both of them increased to the normal range, PaCO 2 showed a complete return to eucapnia, their weight were unchanged. Conclusion The depressed breathing control play an important role in the development of CO 2 retention in OSAS patients, and the disorder in breathing control may be secondary to hypoxia, hypercapnia and sleep disorder related to the OSAS.更多还原