What Is Obesity Hypoventilation Syndrome?

Obesity hypoventilation syndrome

Obesity hypoventilation syndrome is a comprehensive condition caused by the patient's own obesity. The main clinical manifestations of the patient are: symptoms of inability to lie flat, palpitations, cyanosis of the lips, edema of the whole body and dyspnea. With the development of the disease, the patient has intermittent or tide breathing, unconscious drowsiness or lethargy.

Chinese name for obesity and hypoventilation syndrome

Obesity hypoventilation syndrome

obesity hypoventilation syndrome

Obesity hypoventilation syndrome

Obesity Cardiopulmonary Insufficiency Syndrome; Obesity Hypoventilation Syndrome; Pickwicker Syndrome; Hypoventilation Syndrome; Hypoventilation Syndrome; Obesity with Cardiopulmonary Failure; Idiopathic Hypoventilation Syndrome Cardiopulmonary-obesity syndrome; Obesity-dyspnea-sleepiness syndrome; narcolepsy with diabetic hyperinsulin syndrome; Obesity-hypoventilation syndrome; Piquevecan syndrome; Piquevecan Syndrome; obesity-hypoventilation obesity syndrome; obesity-pulmonary hypoventination syndrome; pickwickian syndrome

Clinical manifestations of obesity and hypoventilation syndrome

1. Insufficient ventilation and health search symptoms and signs appear a series of symptoms of respiratory failure, such as bruising and respiratory distress blood gas examination see hypoxemia and carbon dioxide retention.

2. Respiratory symptoms and signs: shallow breathing, frequent apnea attacks at night, peripheral or mixed sleep apnea, healthy search, and upper respiratory tract obstruction and nighttime sleep snoring.

3. Symptoms and signs of the heart Early symptoms include cough, shortness of breath, palpitations, and lower limb edema. Long-term inadequate ventilation can lead to chronic pulmonary heart disease and heart failure. When right heart failure is exacerbated, dyspnea, cyanosis, etc. can occur, and a few patients have symptoms of total heart failure.

4. Nervous system symptoms and signs Hypoxia, headache, dizziness, palpitations, sweating, restlessness, delirium, convulsions, carbon dioxide retention can cause hallucinations, drowsiness, and mental retardation or retardation in a small number of children.

Such patients have poor response to general cardiotonic and diuretic treatments. Intermittent oxygen inhalation or selective application of central respiratory stimulants can improve symptoms to a certain extent.

Complications of obesity hypoventilation syndrome

1. Cardiovascular network due to long-term overload of the cardiovascular system and heart failure. Although right heart failure is common, attention should also be paid to left heart failure (sometimes the main manifestation) and common arrhythmias.

2. Gastrointestinal bleeding may occur in healthy search when digestive system is complicated by gastritis or ulcer. The reason is that patients with stress, gastric dilatation, hyperacidity, and the use of hormones should pay close attention to hematocrit. Patients with changes in hemoglobin and the presence or absence of fecal occult blood may have varying degrees of fatty liver and gallstone disease.

3. Disorders of hormone metabolism Androgen can be increased to twice the normal value in severely obese women, and estrogen is also significantly increased, which can make adolescent girls menarche healthy search in advance, adult women have abnormal ovarian function, and have amenorrhea Rare pregnancy or menstruation can also stimulate abnormal breast and uterine hyperplasia.

4. Infection Lung infection is a common complication Health search causes are secondary immunodeficiency, impaired lung clearance function, healthy search, placement of respiratory therapy, and other equipment contamination, and other health searches often reach respiratory infections, respiratory tract Acute respiratory failure can occur after infection. Also prone to dermatitis, bloated skin, urinary and digestive health search infections.

5. Other respiratory distress, sleep apnea can reach sudden death, renal failure and acid-base balance disorder can occur, and deep vein thrombosis and pulmonary embolism can be induced by prolonged bed rest and dehydration.

Diagnosis of obesity and hypoventilation syndrome

Those who weigh more than 20% of the average children of the same gender and normal height are considered to be healthy for obesity. Weights greater than 30% to 39% are moderately obese. For those who are more than 40% to 59% are severely obese. Search for more than 60% are extremely obese. Accompanied by a decrease in ventilation function, the symptoms and signs of heart and nervous system canning can be diagnosed in combination with pulmonary function tests and blood gas analysis.

Differential diagnosis:

1. Inhibition of the respiratory center and drug encephalitis and other diseases cause the respiratory center to be inhibited, reducing respiratory motility, and ventilatory dysfunction, resulting in the identification of hypoxia and carbon dioxide retention.

2. Lung disease

(1) Physiologically ineffective cavity enlarges ventilation and decreases: in pneumonia, bronchiolitis, asthma, and pulmonary edema, breathing is shallow, airway spasm is narrowed or obstructed, ventilation decreases, physiologically ineffective cavity increases, and respiratory efficiency decreases. Respiratory muscle palsy such as infectious polyradiculitis and pleural effusion, healthy search of thorax and lung dilatation restricted alveoli cannot expand normally and tidal volume decreases, resulting in decreased ventilation and increased PaCO2 and decreased PaO2.

(2) Ventilation / blood flow ratio (V / Q) imbalance: normal V / Q average is 0.8 V / Q ratio increases. Invalid cavity-like ventilation health search, that is, alveolar ventilation but insufficient blood flow. Health search is seen in local blood perfusion. When decreasing. The ratio of ineffective cavity volume (VD) to tidal volume (VT) (VD / VT) can be used to indicate that 0.3 is normal for acute pulmonary injury with pulmonary embolism, and VD / VT increases significantly during ARDS. ARDS can be increased to 0.75. V / Q decrease means pathological pulmonary arteriovenous shunt, which means that blood flow through unventilated or poorly ventilated alveoli is the cause of severe hypoxemia, which is mainly manifested by a significant decrease in PaO2. Increasing oxygen concentration cannot improve the arterial blood oxygen partial pressure. The search is more common in local ventilation abnormalities, such as pneumonia, atelectasis, pulmonary edema, etc. The shunt score is used to indicate that only 5% is normal, and greater than 15% will seriously affect oxygenation.

(3) Diffusion disorder: Refers to the abnormality of oxygen diffusion through the alveolar capillary membrane. Diminished diffusion area (such as pneumonia, atelectasis) or thickened diffusion film (such as pulmonary edema, pulmonary fibrosis) can lead to diffusion disorder. network. Because the diffusion capacity of carbon dioxide is about 20 times greater than that of oxygen, diffusion barriers mainly refer to the characteristics of oxygen, which results in a decrease in PaO2 but no carbon dioxide retention. Generally, the difference in partial pressure of oxygen from the alveolar arteriovenous oxygen is used to judge the ventilation disorder. It is more sensitive than PaO2. It can respond to the health search of oxygen intake earlier. The alveolar arterial oxygen partial pressure difference [(A-a) DO2] is normal. 2.0kPa (5 ~ 15mmHg), the difference is mainly due to the existence of some short circuits in normal anatomy and inconsistent V / Q values in various parts of the lung. (A-a) Elevated DO2 indicates ventilation disorder. Some people have suggested that> 6.7kPa (50mmHg) is the diagnostic criterion for acute respiratory failure. However, it should be noted that this value can also increase when the cardiac output decreases and oxygen is inhaled.

Consequences of insufficient ventilation function have the following three characteristics: PaO2 will inevitably decrease; PaCO2 health search generally does not increase; increasing oxygen intake cannot increase PaO2.

In short, the most common cause of PaO2 decline in acute respiratory failure is the most serious V / Q imbalance. The most fundamental cause is increased pulmonary arteriovenous shunts and increased PaCO2. The most fundamental cause is insufficient alveolar ventilation. Children with respiratory diseases may have different conditions. Caused by impaired ventilation. ARDS increases significantly with intrapulmonary shunts; V / Q disorders are more common in healthy searches for general lung lesions.

Obesity hypoventilation syndrome simple suppression of secondary obesity

Combined with medical history and signs, laboratory data, etc., the first identification is simple suppression of secondary obesity, such as hypertension, concentric obesity, purple amenorrhea, etc. with 24h urine high 17-hydroxysteroids should be considered as cortisolism A small dose (2mg) of dexamethasone inhibition test should be performed for identification. Those with low metabolic rate should further check thyroid function tests such as T3, T4 and TSH to determine whether there is hypothyroidism. Patients with anterior pituitary dysfunction or hypothalamic syndrome should perform pituitary and target gland endocrine tests, check the saddle, visual field, vision, etc. If necessary, a CT scan such as a skull CT should be used. The pituitary enlargement should consider the pituitary Tumors do not include empty saddle syndrome. Amenorrhea with virilization should exclude polycystic ovary without obvious endocrine disorders. Afternoon foot swelling should be eliminated in the morning and those who relieve in the morning should exclude water and sodium retention obesity. In addition, it is often necessary to pay attention to whether there are concomitant diseases such as diabetes, coronary heart disease, atherosclerotic gout, cholelithiasis, and other types of obesity, which can be analyzed and judged in accordance with its clinical characteristics.