Physiologic correlates of dyspnea in patients with morbid obesity
Physiologic correlates of dyspnea in patients with morbid obesity
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DOI：
10.1038/sj.ijo.0803460
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发表时间：
2007-04-01
影响因子：
4.9
通讯作者：
Perez, T.
中科院分区：
文献类型：
--
作者：
Collet, F.;Mallart, A.;Perez, T.
目的：肥胖患者呼吸困难的机制尚不清楚。本研究旨在确定肥胖症患者在减肥手术前呼吸困难和肺功能包括吸气肌耐力（IME）之间的关系。体重指数（BMI）为49.4 +/- 7.0 kg/m2。通过基线呼吸困难指数（BDI; 0- 12，0最大呼吸困难）评价呼吸困难。肺功能检查包括体积描记术，通过增量阈值负荷试验评估最大吸气压（PImax）和IME，确定持续2分钟的最大压力（Plim（2））和Plim（2）/PImax比率。患者根据他们的BMI分为两组：BMI p49（n = 27）和449 kg/m2（n =28）。与BMI p49 kg/m2组相比，BMI 449 kg/m2组的呼吸困难程度更高（BMI 449 kg/m2组的BDI评分为6.9 +/- 2.2，BMI p49 kg/m2组为8.972.5，P < 0.01）。与BMI p49 kg/m2组相比，BMI 449 kg/m2组患者的PaCO 2水平显著较高，肺活量、吸气量和PImax值显著较低。BDI与肺功能之间的相关性为中度：1秒用力呼气量（FEV 1）% pred：Rho 0.27; P =0.05;肺活量% pred：Rho=0.40; P =0.004; Plim（2）/PImax：Rho=0.40; P=0.003。BMI p49 kg/m2组与呼吸困难的相关性更高：FEV1%pred：Rho=0.38; P=0.05; Plim（2）/PImax：Rho=0.49; P= 0.01。讨论：病态肥胖者吸气肌功能中度降低。这些患者的呼吸困难仍然与肺功能和吸气肌功能中度相关。然而，在BMI p49 kg/m（2）的患者中，吸气肌功能与呼吸困难的相关性更显著。
Objective: Mechanisms of dyspnea in obesity remain unclear. This study was undertaken to determine the relationships between dyspnea and pulmonary function including inspiratory muscle endurance (IME) in morbidly obese patients before bariatric surgery.Research methods and procedures: Fifty-five patients with a mean +/- s.d. body mass index (BMI) of 49.4 +/- 7.0 kg/m(2) were included. Dyspnea was evaluated by the Baseline Dyspnea Index (BDI; 0-12,0 maximal dyspnea). Pulmonary function tests included a plethysmography, maximal inspiratory pressure (PImax) and IME was assessed by the incremental threshold loading test, determining the maximal pressure sustained for 2 min (Plim(2)) and Plim(2)/PImax ratio. Patients were classified according to their BMI in two groups: BMI p49 (n = 27) and 449 kg/m(2) (n =28).Results: Breathlessness was higher in the BMI 449 kg/m(2) group compared to the BMI p49 kg/m(2) group ( BDI score at 6.9 +/- 2.2 in the BMI 449 kg/m(2) group vs 8.972.5 in the BMI p49 kg/m(2) group, P < 0.01). Patients with BMI 449 kg/m(2) had significantly higher PaCO2 level and significantly lower vital capacity, inspiratory capacity and PImax values compared with the BMI p49 kg/m2 group. Correlations between BDI and lung function were moderate: forced expiratory volume in 1 s (FEV1)% pred: Rho 0.27; P =0.05; vital capacity % pred: Rho=0.40; P =0.004; and Plim(2)/PImax: Rho=0.40; P=0.003. Higher correlations with dyspnea were found in the BMI p49 kg/m(2) group: FEV1% pred: Rho=0.38; P=0.05; and Plim(2)/PImax: Rho=0.49; P=0.01.Discussion: Inspiratory muscle performance is moderately reduced in morbid obesity. Dyspnea in these patients remains moderately related to lung function and inspiratory muscle performance. However, inspiratory muscles performance correlates more significantly with dyspnea in patients with a BMI p49 kg/m(2).