不同类型正压通气治疗肥胖低通气综合征的疗效差异

Difference between effect of BiPAP and CPAP in obesity hypoventilation syndrome

目的:分析双水平正压通气(BiPAP)与持续气道正压通气(CPAP)治疗肥胖低通气综合征(OHS)的效果及差异。方法:将29例已确诊OHS患者按随机原则分为BiPAP组(15例)及CPAP组(14例)。BiPAP组给予BiPAP联合饮食控制、合理运动治疗,CPAP组给予CPAP联合饮食控制、合理运动治疗。治疗1月后观察动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、最低血氧饱和度(L-SaO2)、体重指数(BMI)、呼吸暂停低通气指数(AHI)变化。结果:两组治疗后AHI均显著下降,PaO2、L-SaO2显著升高(P<0.05);BiPAP组PaCO2显著降低(P<0.05),而CPAP组较前无明显改变(P>0.05)。两组治疗后PaCO2差异有统计学意义(P<0.05)。结论:BiPAP与CPAP均可通过气道正压改善低氧血症;BiPAP可提供吸呼气压差,增加肺泡通气量,减轻二氧化碳潴留,纠正高碳酸血症优于CPAP。

Objective： To analyze the difference of effects between bilevel positive airway pressure （BiPAP） and continuous positive airway pressure （CPAP） in obesity hypoventilation syndrome （OHS）. Methods： 29 patients diagnosed of OHS were randomly divided into CPAP group （14 ca- ses） who were treated with CPAP, diet control, exercise, BiPAP group （15 cases） who were trea- ted with BiPAP, diet control, exercise. After 1 month＇ s treatment, indexes were observed such as arterial partial pressure of carbon dioxide （PaCO2 ）, arterial blood oxygen partial pressure （PaO2）, lowest oxygen saturation （L-SaO2）, body mass index （BMI）, apnea-hypopnea index（AHI）. Results： AHI in 2 groups significantly decreased, PaO2 and L-SaO2 significantly in- creased, no significant difference was found in BMI. PaCO2 was significantly different between the two groups. Conclusion： Both BiPAP and CPAP could improve hypoxemia by positive airway pres- sure; BiPAP also provided difference pressure between inspiration and expiration, which increased alveolar ventilation and reduced carbon dioxide retention.