减重代谢手术改善肥胖低通气综合征的有效性和影响因素研究  

Efficacies and risk factors of metabolic and bariatric surgery for improving obesity hypoventilation syndrome

作　　者：马帅[1] 杨珵璨 王兵[1] 刘超凡 朱冬梓 戴谦诚[1] 胡敏[1] 顾芬 徐晓珍 徐蓓[1] 陶秀蓉 Ma Shuai;Yang Chengcan;Wang Bing;Liu Chaofan;Zhu Dongzi;Dai Qiancheng;Hu Min;Gu Fen;Xu Xiaozhen;Xu Bei;Tao Xiurong(Department of General Surgery I,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院普外一科,上海200011

出　　处：《腹部外科》2024年第5期319-324,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金面上项目(82070917);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ202216)。

摘　　要：目的评估减重代谢手术(metabolic and bariatric surgery,MBS)对肥胖低通气综合征(obesity hypoventilation syndrome,OHS)的有效性和影响因素。方法回顾性分析2018年1月至2022年6月上海交通大学医学院附属第九人民医院普外一科行MBS的OHS病例。回顾性记录术前和术后2年随访的临床数据,包括一般基线资料、动脉血气、睡眠监测和人体学测量参数。对比MBS后OHS病人以上指标的变化。研究OHS缓解和各变量的关系,使用多因素分析的方法确定影响OHS缓解的危险因素。结果在957例行MBS的病例中,有105例术前合并OHS,体重指数(body mass index,BMI)为(40.1±7.2)kg/m^(2),动脉血气二氧化碳分压(PaCO_(2))为(48.5±4.0)mmHg。在术后2年的随访中,89例(84.8%)符合OHS缓解标准。BMI降至(28.9±5.4)kg/m^(2),与术前比较差异有统计学意义(P<0.001);PaCO_(2)降至(44.4±4.8)mmHg,与术前比较差异有统计学意义(P<0.001)。OHS未缓解组的总体重减轻百分比(percentage of total weight loss,%TWL)幅度小于OHS缓解组[(25.8±7.9)%比(27.7±8.9)%,P=0.017]。术前动脉血气分析pH<7.35(OR=3.227,95%CI:1.002~10.392,P=0.049)和术前高血压(OR=5.018,95%CI:1.476~17.064,P=0.010)是影响MBS后OHS缓解的独立危险因素。结论MBS是治疗OHS的有效手段之一,OHS的缓解有赖于?BMI、%TWL达到一定程度,术前失代偿可能为术后OHS不缓解的独立危险因素。Objective To evaluate the efficacies and risk factors of metabolic and bariatric surgery for obesity hypoventilation syndrome(OHS).Methods Between January 2018 and June 2022,retrospective review was conducted for 957 OHS patients undergoing metabolic and bariatric surgery.Clinical data of baseline profiles,arterial blood gas analysis,sleep study and anthropometric parameters were collected retrospectively for preoperative assessments and 2-year postoperative follow-ups.Perioperative changes of body mass index(BMI),arterial blood gas,sleep study and anthropometric parameters were compared.The relationship between OHS resolution and variables was examined.Multivariate analysis was utilized for identifying the risk factors for OHS resolution.Results Among them,105 were preoperatively diagnosed as OHS[BMI(40.1±7.2)kg/m^(2),partial pressure of carbon dioxide in arterial blood(PaCO_(2))(48.5±4.0)mmHg].At 2-year postoperative follow-up 89 cases(84.8%)fulfilled the criteria for OHS resolution.BMI dropped to(28.9±5.4)kg/m^(2)(P<0.001,vs.BMI in preoperation period)and PaCO_(2) declined to(44.4±4.8)mmHg(P<0.001,vs.PaCO_(2) in preoperation period).Percentage of total weight loss(%TWL)was lower in non-resolution group than that in OHS resolution group[(25.8±7.9)%vs.(27.7±8.9)%,P=0.017].Multivariate analysis revealed that preoperative arterial blood pH<7.35(OR=3.227,95%CI:1.002–10.392,P=0.049)and preoperative hypertension(OR=5.018,95%CI:1.476–17.064,P=0.010)were independent risk factors affecting OHS resolution after metabolic and bariatric surgery.Conclusion Metabolic and bariatric surgery is efficacious for OHS.And resolution of OHS depends upon achieving a certain level ofΔBMI and%TWL.Preoperative decompensation may be an independent risk factor for postoperative non-resolution of OHS.

关 键 词：减重代谢手术 肥胖低通气综合征 危险因素 

分 类 号：R615[医药卫生—外科学]