(n = 19)
p
Госпитализация в ОРИТ, n (%)
13 (68)
18 (95)
0,095
ИВЛ, n (%)
2 (11)
17 (90)
<0,001
Длительность респираторной поддержки, дни
5,2 ± 4,3
14,7 ± 10,5
<0,001
Длительность пребывания в ОИТ, дни
5,8 +- 2,7
14,4 +- 10,2
0,007
Длительность пребывания в стационаре, дни
18,1 +- 7,2
28,4 +- 12,7
0,006
Госпитальная летальность, n (%)
0 (0)
5 (26)
0,055
Повторные госпитализации в течение 3 мес
1 (5)
3 (16)
0,559
Летальность в течение 3 мес, n (%)
0 (0)
6 (32)
0,026
СПИСОК ЛИТЕРАТУРЫ
1.Kessler R, Chaouat A, Schinkewitch Ph, et al. The obesity-hypoventilation syndrome revisited. A prospective study of 34 consecutive cases. Chest 2001; 120: 369-376.
2.Olson AL, Zwillich C. The obesity hypoventilation syndrome. Amer J Med 2005; 118: 948-956.
3.Burwell CS, Robin ED, Whaley RD, et al. Extreme obesity associated with alveolar hypoventilation: a pickwickian syndrome. Am J Med 1956; 21: 811-818.
4.Gastaut H, Tassinari C, Duron В. Etude polygraphique des manifestations episodiques (hypniques et respiratoires) diurnes et nocturnes du syndrome de Pickwick. Rev Neurol 1965: 112; 568 - 579.
5.Guilleminault C, Eldridge FL, Dement WC. Insomnia with sleep apnea a new syndrome. Science 1973; 181: 856 - 858.
6.Rochester DF, Enson Y. Current concepts in the pathogenesis of the obesity-hypoventilation syndrome: mechanical and circulatory factors. Am J Med 1974; 57: 402-420.
7.Rabec C, Merati M, Baudouin N, et al. Prise en charge de d’obèse en décompensation respiratoire: intérêt da la ventilation nasal à double niveau de pression. Rev Mal Respir 1998; 15: 269-278.
8.Piper AJ, Sullivan CE. Effects of short-term NIPPV in the treatment of patients with severe obstructive sleep apnea and hypercapnia. Chest 1994; 105: 434 - 440.
9.American Academy of Sleep Task Force. Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research, Sleep 22 (1999), pp. 667 - 689.
10.Nowbar S, Burkhart KM, Gonzales R. et al. Obesity associated hypoventilation in hospitalized patients prevalence, impact, and outcome. Am J Med 2004; 116: 1 - 7.
11.Miller A, Granada M. In-hospital mortality in the Pickwickian syndrome.
Am J Med 1974; 56:144-50.
12.Strumpf DA, Millman RP, Hill NS. The management of chronic hypoventilation.
Chest 1990; 98: 474-80.
13.Lin, CC, Tsan, KW, Chen, PJ. The relationship between sleep apnea syndrome and hypothyroidism. Chest 1992; 102: 1663-8.
14.Rochester DF. Obesity and pulmonary function. In: Alpert MA, Alexander JK, eds. The heart and lung in obesity. New York, NY: Futura Publishing Co; 1998:109-131.
15.Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth 2000; 85:91-108.
16.Guo YF. Contribution of polygraphy and polysomnography to nocturnal monitoring of patients with obesity-hypoventilation syndrome (OHS) and non-invasive ventilation (NIV). Thèse N 0;: Genève, 2004.
17.Reybet-Degat O, Massin F, Grangeon C, et al. Les décompensations respiratoires aiguës de l’obèse. Rev Pneumol Clin 2002; 58: 111-116.
18.Weitzenblum E, Kessler R, Chaouat A. L’hypoventilation alvéolaire de l’obèse: le syndrome obésité-hypoventilation. Rev Pneumol Clin 2002; 58: 83-90.
19.Sharp JT, Henry JP, Sweany SK, et al. The total work of breathing in normal and obese men. J Clin Invest 1964; 43:728-739.
20.Kaufman BJ, Ferguson MH, Cherniack RM. Hypoventilation in obesity. J Clin Invest 1959; 38:500-507.
21.Lopata M, Onal E. Mass loading, sleep apnea, and the pathogenesis of obesity hypoventilation. Am Rev Respir Dis 1982; 126: 640 - 645.
22.Koenig SM. Pulmonary complications of obesity. Am J Med Sci 2001; 321:249-279.
23.Cooper KR, Phillips BA. Effect of short-term sleep loss on breathing. J Appl Physiol 1982; 53: 855 - 858.
24.Harman EM, Wynne JW, Block AJ. The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men. Chest 1982; 82: 291 - 294.
25.Sutton, F, Zwillich, C, Creagh, C, et al. Progesterone for outpatient treatment of Pickwickian syndrome. Ann Intern Med 1975; 83: 476-80.
26.Brochard L. Non-invasive ventilation: practical issues. Intensive Care Med 1993; 19: 431-432.
27.Leger P, Muir JF. Selection of patients for long-term nasal intermittent positive pressure ventilation: practical aspects. Eur Respir Monogr 1998; 8: 328-347.
28.Masa JF, Celli BR., Riesco JA, et al. The Obesity Hypoventilation Syndrome Can Be Treated With Noninvasive Mechanical Ventilation. Chest 2001; 119: 1102-1107.
29.Heinemann F, Budweiser S, Dobroschke J, Pfeifer M. Non-invasive positive pressure ventilation improves lung volumes in the obesity hypoventilation syndrome. Respir Med 2007; 101: 1229-1235.
30.Chouri-Pontarollo N, Borel J-C, Tamisier R. Impaired objective daytime vigilance in obesity-hypoventilation syndrome. Impact of noninvasive ventilation. Chest 2007; 131: 148-55.
31.El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davis J. Morbid obesity in the medical ICU. Chest 2001; 120: 1989 - 1997.
32.Muir JF, Bota S, Cuvelier A, et al. Acute respiratory failure and obesity. Incidence of management with noninvasive mechanical ventilation. Am J Respir Crit Care Med 1998; 157: S309.
33.Meduri G, Turner R, Tolley E, Wunderink R, Abou-Shala N. Noninvasive positive pressure ventilation via face mask: first line intervention in patients with acute hypercapnic and hypoxemic acute respiratory failure. Chest 1996; 109: 179- 193.
34.Avdeev SN, Chuchalin AG. Noninvasive positive pressure ventilation (NPPV) in the treatment of acute respiratory failure in patients with morbid obesity: a prospective cohort study [P2001]. Eur.Respir.J. 2004; 24 (Suppl.48): 313s.
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: 17.1. ДЫХАТЕЛЬНАЯ НЕДОСТАТОЧНОСТЬ: ОПРЕДЕЛЕНИЕ, КЛАССИФИКАЦИЯ, ПОДХОДЫ К ДИАГНОСТИКЕ И ТЕРАПИИ
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author:
fio[ru]: С.Н. Авдеев
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ОПРЕДЕЛЕНИЕ
Дыхательная недостаточность (ДН) - неспособность системы дыхания обеспечить нормальный газовый состав артериальной крови. Более практичным является следующее определение: ДН - патологический синдром, при котором парциальное напряжение кислорода в артериальной крови (РаО<sub>2</sub>) <60 мм рт.ст. и/или парциальное напряжение углекислого газа (РаСО<sub>2</sub>) >45 мм рт.ст.