长期家庭无创机械通气结合家庭氧疗治疗合并呼吸衰竭慢性阻塞性肺疾病患者的临床观察

目的 观察长期家庭无创机械通气(NIPPV)结合家庭氧疗对合并呼吸衰竭COPD患者的治疗效果.方法 通过对13例合并呼吸衰竭COPD患者的长期随访,观察他们在应用长期家庭无创机械通气前后血气指标中PaCO2、PaO2的变化,以及对比他们每年COPD急性加重频率、年医疗费用支出、平均住院天数的变化,同时了解家庭无创机械通气开展存在的问题.结果 13例患者通过家庭无创机械通气结合家庭氧疗PaCO2较治疗前明显下降(P＜0.05),PaO2得到增高(P＜0.05),同时每年COPD急性加重频率明显下降(P＜0.01),年医疗费用支出减少(P＜0.01),平均住院天数下降(P＜0.01).结论 长期家庭无创机械通气结合家庭氧疗可以改善合并呼吸衰竭COPD患者的血气指标,同时减少COPD急性加重的频率及医疗支出.     

深圳市慢性阻塞性肺疾病合并呼吸衰竭患者长期家庭氧疗的现状分析

目的 了解深圳市慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者长期家庭氧疗(LTDOT)状况及用氧知识掌握情况.方法 对2010年1月至2011年11月在深圳市8家综合性医院住院的1600例COPD合并呼吸衰竭患者采用调查问卷的形式进行调查.结果 1600例患者中475例(30.1％)未实施氧疗,1125例(69.9％)实施氧疗,其中只有253例(22.5％)达到LTDOT的治疗要求,完全了解氧疗相关知识的只有21.7％～41.8％.结论 COPD合并呼吸衰竭患者LTDOT知识严重缺乏,医务工作者尤其是呼吸专科医师应加强LTDOT的健康宣教,教育和指导患者正确的氧疗并开详细的氧疗处方.社会上应有更多的人关心COPD合并呼吸衰竭的患者,给COPD合并呼吸衰竭患者LTDOT治疗提供帮助.     

The effects of long-term oxygen therapy on survey in patients with chronic respiratory failure

Long-term (> or = 15 hours) oxygen therapy (LTOT) increases life-span and improves quality of life (QOL) in patients with chronic respiratory failure (CRF). However, in our clinical practice, we observed that very few patients are using oxygen therapy 15 hours or more. Furthermore, very few literatures about survival of non- or inadequate oxygen users were found. Thus, the aim of this study was to assess the effect of LTOT in patients with CRF. A total of 305 LTOT recommended patients with CRF in our clinic between 1996 and 2001 were found. A hundred and five patients with documented subject characteristics were included the study and followed-up approximately 20 months prospectively. They were divided into two groups whether to take LTOT (group 1, n= 71) or not (group 2, n= 34). Average life-span of the patients was 50 months in group 1 and 39 months in group 2 (p< 0.05). Survival (months) in group 1 was significantly correlated with hrs of oxygen use (r= 0.684, p= 0.001). One more hour oxygen use was statistically significantly correlated with 0.002 months more survival (F= 48.44, p< 0.05) in group 1 in logistic regression analysis. In comparisons, there were significant improvement in the post-treatment blood gas values in group 1 (p< 0.05). There were significant decreases in PFT values in the post-treatment period when compared to baseline values in both groups (p< 0.05). There was a less decrease in FEV(1) values per year in group 1 than group 2 but difference was not statistically significant (p> 0.05). In conclusion our findings revealed that LTOT provides improvement of the life-span of the patients with CRF.     

长期氧疗对改善慢性阻塞性肺疾病患者右心功能的疗效观察

目的 评价长期氧疗对改善慢性阻塞性肺疾病（COPD）患者右心功能的疗效。方法 选择2011年10月至2012年3月无锡市人民医院门诊或住院检查二维心脏超声未见异常、肺功能Ⅰ级的COPD患者40例,其中男性22例、女性18例,每日夜间连续吸氧10h,氧流量为2L/min,观察1年。并于氧疗前1d、氧疗后3个月、6个月、1年,同时进行心脏超声及肺功能检测。比较氧疗前后右心功能、肺功能各项指标的变化。结果 应用心脏超声斑点追踪技术测得右室游离壁基底段应变（Sbasfw）、右室游离壁基底段应变率（SRbasfw）、右室游离壁中间段应变（Smidfw）及右室游离壁中间段应变率（SRmidfw）于氧疗后3个月比氧疗前1d升高,且差异有统计学意义（P＜0.05）;随着氧疗持续时间的延长,Sbasfw,SRbasfw,Smidfw及SRmidfw升高更加显著（P＜0.01）;右心室纵向缩短率（Tm%）于氧疗后3个月即有升高,且与氧疗前比较,差异有统计学意义（P＜0.05）,随着氧疗持续时间的延长继续升高（P＜0.01）;右室游离壁三尖瓣环收缩期峰值位移（T1）,室间隔三尖瓣环收缩期峰值位移（T2）,三尖瓣环连线中点收缩期峰值位移（Tm）在氧疗后6个月出现升高,与氧疗前比较,差异有统计学意义（P＜0.05）,并随氧疗持续升高。1s用力呼气容积（FEV1）、FEV1占预计值百分比氧疗后1年比氧疗前升高,且差异有统计学意义（P＜0.05）。结论 长期氧疗可明显改善COPD患者的右心收缩功能,且对右心功能的改善早于肺功能。     

Predictors of survival in patients with chronic hypercapnic respiratory failure receiving domiciliary NPPV

Fifty-four cases (36 men) with chronic hypercapnic respiratory failure were prescribed domiciliary NPPV during 9 years. COPD (26 patients) and sequelae of tuberclosis (16 patients) were the major primary diseases. At the initiation of NPPV, the age was 71.2 +/- 7.3 years-old (mean +/- standard deviation) and PaCO2 was 76.7 +/- 16.2Torr. Overall, the 1-year and 5-year survival rates were 63.8% and 26.0%, respectively. Multivariate analysis identified BMI (body mass index) (hazzard ratio : 0.837, p = 0.020) and the number of days of hospitalization during 1 year before NPPV (hazzard ratio: 1.013, p = 0.016) as predictors of survival. Patients with frequent hospitalization for exacerbation or with malnutrition had poor prognosis, so comprehensive supports aimed to improve general status are needed for patients with chronic respiratory failure received domiciliary NPPV.     

S-erythropoietin levels decrease in patients with chronic hypoxia starting domiciliary oxygen therapy

Consecutive determinations of erythropoietin in serum (s-Epo) were made in ten patients with chronic hypoxia starting domiciliary long-term oxygen therapy (LTO). After 24 h of supplementary oxygen treatment there was a fall in the median s-Epo level from 11.3 to 4.4 IU.l-1 (p less than 0.01). The initial decrease in s-Epo in conjunction with oxygen treatment was not sustained after one and three months of LTO. S-Epo levels above the reference range (3.3-13.5 IU.l-1) were found in three patients before and during LTO and in another two patients during LTO. Markedly elevated s-Epo levels were found in two patients with hypoxia and hypercapnia at the time of blood sampling. A significant negative relationship was found between the arterial oxygen tension and the log value for the s-Epo level (r = 0.40, p less than 0.005). The s-Epo levels were found to be normal in half of the measurements in patients using oxygen less than 15 h daily, a fact that indicates that s-Epo measurements are probably not suitable as indicators of compliance with LTO.     

Pulmonary hemodynamics and home oxygen therapy in patients with chronic respiratory failure]

The authors examined pulmonary hemodynamics with respect to underlying diseases, severity and type of chronic respiratory failure, and the incidence and effect of home oxygen therapy (HOT) in 155 patients with chronic lung diseases (old pulmonary tuberculosis (OTB) 45, chronic pulmonary emphysema (CPE) 54, chronic bronchitis (CBR) 42 and fibrosing lung disease (FLD) 14). They underwent right heart catheterization during a stable period, while breathing room air. The arterial PO2 ranged from 64.3 +/- 9.7 Torr (CBR) to 69.9 +/- 10.0 Torr (CPE), and the mean pulmonary arterial pressure ranged from 17.3 +/- 4.6 mmHg (CPE) to 20.6 +/- 5.4 mmHg (OTB). The incidence of pulmonary hypertension (PH, PA mean greater than or equal to 20 mmHg) was 53.3% in OTB, 40% in CBR, 35.7% in FLD, 23.8% in CPE, 69% in respiratory failure, 40% in quasi-respiratory failure, and 2.1% in non-respiratory failure. The percentage of patients who received HOT was 84.5% in respiratory failure and 54.1% in quasi-respiratory failure. Comparing Type I with Type II chronic respiratory failure, the incidence of PH was lower in the former than the latter (38.3% vs 80.6%), whereas HOT was applied to an equal percentage of patients (67.4%) in both groups. The effect of HOT was evaluated in 11 patients with chronic respiratory failure. The mean pulmonary arterial pressure was 22.7 +/- 4.7 mmHg before HOT, and decreased to 20.7 +/- 5.6 mmHg after 24.5 +/- 10.1 months of HOT. Although this difference was not significant statistically, this result suggests the desirable effect of HOT on pulmonary hemodynamics.     

Assessment of right ventricular function by echocardiography in patients with chronic heart failure

Background

The main focus of most of the studies in heart failure (HF) is the assessment of the left ventricular functions, while the right ventricle was much less studied. Much of this neglect is due to the complexity of anatomy and physiology of the right ventricle which are considered challenges during assessment of RV.

Effect of oxygen on right ventricular performance evaluated by radionuclide angiography in two young patients with chronic lung disease

Pulmonary hypertension is a relatively common complication of chronic lung disease in children that can cause diminished right ventricular performance (RVP) and, eventually, cor pulmonale and heart failure. Since oxygen may decrease pulmonary artery pressure in these patients, we questioned whether RVP would also improve concomitantly. We evaluated the effect of oxygen on RVP in two young hypoxemic patients by radionuclide angiography. A child with bronchopulmonary dysplasia and cor pulmonale who was not clinically in heart failure had acutely better RVP while breathing oxygen and a further improvement after continuous oxygen therapy for 1 year. In a young adult with cystic fibrosis who was suspected of being in heart failure RVP acutely improved when the FIO2 was increased. We conclude that oxygen may improve RVP in hypoxemic patients and speculate that the observation of such improvement may be valuable for the early detection of patients who can benefit from long-term oxygen therapy.     

Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure

OBJECTIVES: We sought a better understanding of the coupling between right ventricular ejection fraction (RVEF) and pulmonary artery pressure (PAP), as it might improve the accuracy of the prognostic stratification of patients with heart failure. BACKGROUND: Despite the long-standing view that systolic function of the right ventricle (RV) is almost exclusively dependent on the afterload that this cardiac chamber must confront, recent studies claim that RV function is an independent prognostic factor in patients with chronic heart failure. METHODS: Right heart catheterization was performed in 377 consecutive patients with heart failure. RESULTS: During a median follow-up period of 17 +/- 9 months, 105 patients died and 35 underwent urgent heart transplantation. Pulmonary artery pressure and thermodilution-derived RVEF were inversely related (r = 0.66, p < 0.001). However, on Cox multivariate survival analysis, no interaction between such variables was found, and both turned out to be independent prognostic predictors (p < 0.001). It was found that RVEF was preserved in some patients with pulmonary hypertension, and that the prognosis of these patients was similar to that of the patients with normal PAP. In contrast, when PAP was normal, reduced RV function did not carry an additional risk. CONCLUSIONS: These observations emphasize the necessity of combining the right heart hemodynamic variables with a functional evaluation of the RV when trying to define the individual risk of patients with heart failure.     

Relief of right ventricular angina and increased exercise capacity with long-term oxygen therapy.

Long-term low-flow oxygen therapy can lead to improved exercise capacity and improved hemodynamics in selected patients with pulmonary hypertension. We report a patient who presented with severe exercise limitation and anginal chest pain that appeared to result from pulmonary hypertension and predominantly right ventricular ischemia. Acute oxygen therapy led to relief of pain but no change in exercise capacity or of pulmonary hypertension. After eight months of oxygen therapy, the patient's pulmonary hypertension was unchanged, but right ventricular hypertrophy and marked increases in exercise cardiac output and exercise capacity developed. Thus, oxygen can relieve right ventricular angina and facilitate the development of compensatory hypertrophy.     

Comparison of nasal cannulas and the OxyArm in patients requiring chronic domiciliary oxygen therapy

OBJECTIVES:

The present study was designed to compare the performance of a new oxygen delivery device, the OxyArm (OA) (Southmedic Inc, Canada), with a standard nasal cannula (NC) (Salter-Style 1600, Salter Labs, USA) for both oxygen delivery and patient preference in patients on long-term oxygen therapy (LTOT).

DESIGN AND SETTING:

Randomized crossover study conducted in an outpatient setting.

PATIENTS AND METHODS:

Twenty-five clinically stable LTOT patients were randomly assigned to an oxygen device (NC or OA) sequence. The baseline saturation level was determined, and patients were then treated at oxygen flow rates of 2 L/min, 3 L/min, 4 L/min, 5 L/min, 6 L/min and 7 L/min for 10 min each while at rest. Patients were then crossed over to the second device and the procedure was repeated. Oximetry values were then obtained following a 5 min walk test using the same device sequence. Lastly, the patients were sent home for a four-week home OA trial, after which, they filled out a questionnaire.

RESULTS:

This sample of patients was primarily elderly ex-smokers with severe chronic obstructive pulmonary disease on oxygen therapy for the majority of the day. The primary findings were that the OA and NC were equally effective in delivering oxygen to patients and maintaining their oxygen saturation at both rest (P=0.82) and during a 5 min walk test (P=0.83). A patient’s personal experience and comfort were identified as the most important factors in deciding on an oxygen device. Most patients felt that the OA was most suited for oxygen therapy while at rest.

CONCLUSIONS:

The OA proved to be similar to the NC in delivering oxygen and maintaining saturation in patients on LTOT. The OA is one of the few alternatives to using NCs for these patients and, with its current design, appears to be most suited for resting conditions.     

Continuous oximetry monitoring in patients undergoing home oxygen therapy for chronic respiratory failure]

We investigated the clinical usefulness of continuous nocturnal oxygen saturation monitoring in patients undergoing home oxygen therapy (HOT). The subjects were 11 patients with chronic respiratory disease in the process of healing from acute exacerbation. None were mechanically ventilated. Each subject underwent full overnight oximetry. One patient was excluded from further investigation because of periodic desaturation suggestive of sleep apnea. The remaining 10 subjects included 5 patients with sequelae of pulmonary tuberculosis, 2 with diffuse panbronchiolitis, 1 with chronic pulmonary emphysema, 1 with chronic bronchitis, and 1 with kyphoscoliosis. All underwent full overnight and 30 min daytime oximetry monitoring for 23.7 +/- 7.4 (mean +/- SD) consecutive days. Daytime oximetry was performed when subjects were awake and resting in supine position. Mean nocturnal oxygen saturation (NmSpO2) and mean daytime oxygen saturation (DmSpO2) were calculated from data obtained from 0:00 through 5:00 hrs and from data obtained during a stable 10 min daytime period, respectively. The difference between NmSpO2 and DmSpO2 (delta SpO2), the percentage of total sleep time with SpO2 < or = 90% (DST 90) and nocturnal lowest oxygen saturation (NLSpO2) were calculated once daily for each subject. There were significant (p < 0.05) correlations between NmSpO2 and NLSpO2, between NmSpO2 and DST 90, and between NLSpO2 and DST 90 in all subjects. However, significant (p < 0.05) correlations between NmSpO2 and DmSpO2 were observed in only 6. During acute exacerbation, NmSpO2 was lower than DmSpO2, and delta SpO2 increased. Conversely, with the amelioration of acute symptoms, delta SpO2 decreased and NmSpO2 was higher than DmSpO2. There was a significant (p < 0.05) reverse correlation between NmSpO2 and delta SpO2 in 9 subjects. We concluded that monitoring nocturnal oxygen saturation is clinically useful to assessments of oxygenation status in patients undergoing HOT, and that it may assist the early diagnosis of acute exacerbation of respiratory failure.