慢性阻塞性肺疾病病人家庭长程氧疗调查分析

[目的]描述慢性阻塞性肺疾病(COPD)病人家庭长程氧疗应用的现状,找出病人氧疗过程中存在的问题,以更好地指导和管理病人的家庭长程氧疗。[方法]2009年5月—2010年2月对北京市4家三级综合性医院呼吸科住院的COPD病人进行问卷调查。[结果]116例研究对象在医生给予家庭长程氧疗建议后,有97.4%的病人进行了家庭氧疗,对家庭长程氧疗能够完全执行者仅18例,占15.5%,病人不能完全执行主要表现在不能坚持每日氧疗时间≥15h的标准,仅有19.8%的病人能够坚持每日吸氧时间≥15h。病人家庭氧疗在氧疗时间、时间分布、氧流量选择、自我监测氧疗效果等方面存在问题。[结论]COPD病人家庭长程氧疗应用现状不理想,有待医务人员针对病人家庭长程氧疗中存在的问题,采取有效措施进行改善。     

慢性阻塞性肺疾病病人长期家庭氧疗现状调查与护理

目的了解慢性阻塞性肺疾病病人长期家庭氧疗的现状。方法对2014年5月~2014年6月本科出院后愿意接受调查的97例慢性阻塞性肺疾病病人由专科护士进行电话随访调查。结果 97例病人中对氧疗相关知识不了解39例(40.2%);部分了解28例(28.9%);了解30例(30.9%)。未进行家庭氧疗的74例(76.3%),进行家庭氧疗的23例(23.7%),其中14例(14.4%)病人达到要求。结论 COPD患者对长期家庭氧疗的重要性认识不足,呼吸专科医护人员应加强对慢性阻塞性肺疾病病人氧疗相关知识的教育和指导,为病人提供支持和帮助。     

长期家庭氧疗对慢性阻塞性肺疾病患者生活质量的影响

目的 探讨包含长期家庭氧疗的综合护理干预措施对慢性阻塞性肺疾病(COPD)患者生活质量的影响.方法 按照随机数字法将60例COPD患者随机分为氧疗组和对照组各30例,其中对照组患者仅接受常规标准治疗,而氧疗组则在接受常规标准治疗的基础上给予包括长期家庭氧疗的一系列综合护理干预措施.比较2组干预效果.结果 氧疗组患者治疗后的生活质量评分表评分中日常生活、社会活动、抑郁、焦虑等评分结果均较治疗前明显下降,而6 min步行距离有所增加,且上述生活质量评估结果均优于对照组.在随访观察1年后,氧疗组患者的平均急诊次数和平均住院时间均较对照组明显减少.结论 长期家庭氧疗的综合护理干预不但可以提高COPD患者的生活质量,还可明显改善患者的预后.     

慢性阻塞性肺疾病患者长期家庭氧疗护理的研究进展

本文通过系统地回顾和分析国内外长期家庭氧疗的相关指南及文献,对护理人员在长期家庭氧疗管理中的角色及职责、长期家庭氧疗患者的评估、适用人群的筛选、氧流量的调整、氧疗时长、其他联合治疗以及健康教育等护理实践内容进行梳理,并提出目前长期家庭氧疗存在的不足,旨在为制订长期家庭氧疗的标准化护理实践内容提供依据,以期为长期家庭氧疗患者提供更好的护理服务。     

Long-term follow-up of chronic obstructive pulmonary disease patients on long-term oxygen treatment

Aims: Few studies exist on influence of long‐term oxygen treatment (LTOT) on survival of chronic obstructive pulmonary disease (COPD) patients. This study was designed to determine whether LTOT improves survival or not in severely hypoxaemic COPD patients. Materials: COPD patients prescribed oxygen concentrator were consecutively included. Patients’ baseline characteristics were noted. During follow‐up, patients were divided into three groups according to LTOT utilisation: (i) non‐utilisers, (ii) intermittent utilisers (< 15 h/day) and (iii) true utilisers (≥ 15 h/day). Patients’ status (live or death) and, if died, the date of death were checked throughout the study. The factors which might influence mortality during 5‐year period were analysed. Results: Two‐hundred and twenty‐eight patients completed the study. Of these patients, 55 were in Group 1, 112 were in Group 2 and 61 were in Group 3. Regarding the initial characteristics, there was not any significant difference between groups. Mean follow‐up for whole group was 27.8 ± 18.5 months. Median survivals were similar between groups (19.5 ± 5.6, 32.5 ± 4.1 and 30.0 ± 5.7 months respectively) (p > 0.05). Compared with Group 1, survival was improved in Group 2 (p < 0.05) and there was a positive trend for Group 3 during first 2‐year period. However, this improvement disappeared during further follow‐up. Analysis of multiple factors which might influence mortality during 5‐year period did not yield statistically significant parameter. Discussion and conclusion: We found that, regarding survival, any kind of LTOT proved to be beneficial over no LTOT only in the first 2 years of follow‐up, and that there was not any difference between intermittent and true LTOT utilisation.     

Reevaluation of continuous oxygen therapy after initial prescription in patients with chronic obstructive pulmonary disease

BACKGROUND: Long-term oxygen therapy improves survival and quality of life in hypoxemic patients with chronic obstructive pulmonary disease (COPD). The need for long-term oxygen therapy should be determined when patients are medically stable. The Third Oxygen Consensus Conference recommended reevaluating patients 1-3 months after continuous oxygen therapy (COT) is initiated, if initiated when the patient is medically unstable. METHODS: A cross-sectional study was performed to examine how often orders for COT are reevaluated pursuant to the guidelines promulgated by the Third Oxygen Therapy Consensus Conference, and to assess the impact that following these guidelines would have on the cost of COT. RESULTS: Of 226 patients prescribed home oxygen therapy, 92 had COPD as a primary diagnosis and 57 were prescribed COT. Only 19 (35%) of 55 patients who returned to the clinics were appropriately reevaluated. The rate of appropriate reevaluation was significantly higher among pulmonary physicians than among primary care physicians (65% vs 17%; odds ratio: 9.0; 95% confidence interval: 2.5-32). Of 19 patients who were appropriately reevaluated, 11 (58%) were discontinued from COT. The patients who were discontinued from COT had a significantly higher percent of predicted forced expiratory volume in the first second than those who were not (34 +/- 8.6% vs 25 +/- 8.8%; p = 0.04). CONCLUSIONS: In our study, most patients were clinically unstable when COT was prescribed, and a significant number of patients remained on COT without reevaluation. Up to 60% of those patients could potentially be discontinued from COT if appropriately reevaluated. Referring a patient initiated on COT to a pulmonary specialist for the proper use of oxygen is strongly recommended. Reevaluating such patients in a timely fashion and discontinuing unnecessary oxygen concentrators could possibly save $106-153 million per year in the United States.     

慢性阻塞性肺疾病病人规范化治疗

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是危害公众健康的常见慢性疾病之一,目前是世界上第4位主要死亡原因.     

慢性阻塞性肺疾病、肺心病患者长期氧疗依从性及氧疗效果调查分析

目的 调查慢性阻塞性肺疾病(COPD)、肺心病患者的氧疗依从性和分析氧疗效果.方法 对山区23个乡村有喘憋症状人群进行入户调查共4 028例,筛查出有K期氧疗指征重型COPD、肺心病患者202例进行氧疗护理干预.结果 18个月后只有50例COPD、肺心病患者长期坚持吸氧.吸氧患者吸氧前和吸氧后比较心电图RV1+SV5有明显变化,肺动脉压、右室内径均较吸氧前明显下降,不吸氧患者明显增高;吸氧患者PaO2、SaO2、FEV1/FVC均显著高于不吸氧患者,PaCO2,明显降低;不吸氧患者住院例数明显高于吸氧患者.结论 长期氧疗可有效地降低肺动脉压,减轻右心负倚,改善心、肺功能,降低住院例数,提高患者的生活质量.护士要加强对氧疗患者的护理干预,提高患者的吸氧依从性.     

慢性阻塞性肺疾病病人规范化治疗

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是危害公众健康的常见慢性疾病之一，目前是世界上第4位主要死亡原因。COPD现已引起世界各国的重视，在我国COPD占据死因第3位，而在农村则占死因首位。COPD是以呼气气流受限为特征的病变，临床上表现为咳嗽、咳痰及呼吸困难。COPD发病多年后出现的呼吸困难症状是病人求医的主要原因，也是最终导致病人日常活动受限的主要因素之一。由于其迁延不愈，反复发作，病程长，病情复杂，易反复感染且呈进行性加重，严重影响病人的劳动能力和生活质量，给病人身心造成极大痛苦，给社会及个人经济带来严重损失。为普及㈣的防治知识及推广慢性阻塞性肺疾病全球创议（C-OLD），达到控制发作、预防复发、气道重建以及降低致残致死率及节约医疗资源开支的目的，我院于2003年在全市率先成立了COPD俱乐部（以下简称俱乐部）及郊区农村COPD防治网络。     

Home respiratory therapy for patients with chronic obstructive pulmonary disease.

The goals of the South Hills Health System Home Health Agency's program of home respiratory therapy for patients with chronic obstructive pulmonary disease are to support life; to improve physical, emotional, and social well-being and productivity; to promote patient and family self-sufficiency; to provide respiratory care of high quality; and to ensure the cost effectiveness of respiratory therapy services. In the patient's home, qualified respiratory therapists perform respiratory assessments, deliver and supervise respiratory therapy treatments and related procedures, and educate patients and their families. This program of home respiratory care has been shown to be a cost-effective solution to the care of homebound patients with chronic obstructive pulmonary disease.     

护理干预对老年慢性阻塞性肺疾病患者用氧效果影响

目的探讨护理干预对老年慢性阻塞性肺疾病患者用氧治疗效果。方法选取本院呼吸科收治慢性阻塞性肺疾病(COPD)老年患者125例,根据护理方法不同分为观察组和对照组,给予相应护理后比较2组患者满意度,同时分析影响护理干预的相关影响因素。结果观察组患者护理满意程度高于对照组;病程、合并症、不良情绪、机械损伤4项为影响护理干预老年慢性阻塞性肺病患者用氧效果的相关风险因素。结论老年慢性阻塞性肺疾病采取护理干预后能提高用氧治疗效果,改善患者治疗期间生存质量,同时应根据患者情况对认知和依从性进行纠正。     

慢性阻塞性肺病病人家庭氧疗依从性调查分析

[目的]调查有长期家庭氧疗(LTOT)指证的慢性阻塞性肺病(COPD)病人,实施LTOT的依从性,为护理干预提供依据。[方法]采用自行设计的问卷调查表,对有LTOT指证的住院病人进行调查。[结果]COPD病人对LTOT的依从性与年龄、文化程度、住院次数有关,并普遍存在依从性差的情况。[结论]COPD病人住院期间应加强LTOT相关知识的宣教,并重视对家属的宣教工作。     

Influence of long-term oxygen therapy on cardiac acceleration and deceleration capacity in hypoxic patients with chronic obstructive pulmonary disease

Background: There is increasing interest in cardiovascular co‐morbidities of chronic obstructive pulmonary disease (COPD). Heart rate turbulence (HRT) and phase‐rectified signal averaging (PRSA) techniques quantify the heart’s acceleration/deceleration capacities. We postulated that these methods can help assess the integrity of cardiac control in hypoxic COPD. Methods: Eight hypoxic stable COPD patients, nine healthy age‐matched older adults and eight healthy young adults underwent ECG monitoring for 24 h. Patients with COPD were also monitored following 4 weeks of standardized oxygen therapy. HRT measures [turbulence onset (TO), turbulence slope (TS)] and PRSA‐derived acceleration/deceleration (AC, DC) indices were quantified within 6‐h blocks to assess circadian variation. Results: There were between‐group differences for variables TS, DC and AC (P<0·0005, η² = 0·54–0·65), attributable solely to differences between healthy young and COPD subjects. Only HR (P<0·0005) and DC index (P = 0·008) showed circadian variation. A significant interaction ‘trend’ effect for HR (F_9,87 = 2·52, P = 0·015, η² = 0·21) reflected the strong influence of COPD on HR circadian variation (afternoon and night values being different to those in healthy subjects). Conclusions: As expected, heart rate dynamics were substantially diminished in older (healthy and COPD) groups compared with healthy young controls. Patients with COPD showed similar heart rate dynamics compared with age‐matched controls, both before and after hypoxia correction. However, there was a suggestion of diminished DC in COPD compared with age‐matched controls (P = 0·059) that was absent following oxygen therapy. TS, DC and AC indices were altered by similar degrees in older subjects, apparently indicating equivalent tonic dysfunction of sympathetic/parasympathetic systems with ageing.     

心理支持对慢性阻塞性肺疾病患者氧疗依从性的影响

目的探讨心理支持对COPD患者氧疗依从性的影响。方法将82例COPD患者随机分为干预组与对照组,所有病例均采用呼吸内科常规治疗,支持组增加心理干预,用Barthel指数、3年内病情急性发作住院次数以及临床功能改善情况作为治疗效果的测查指标。结果干预组患者氧疗知识掌握程度、3年内病情急性发作住院次数以及患者日常生活能力、临床功能改善明显高于对照组(P<0.01)。结论加强心理支持,采取多种形式大力普及氧疗知识,对提高COPD患者氧疗的依从性有积极的意义。     

Efficacy and indications of home oxygen therapy for patients with chronic obstructive pulmonary disease]

Efficacy of home oxygen therapy (HOT) is well established for patients with chronic obstructive pulmonary disease who fall into chronic respiratory failure. We should consider now how the quality of life improves with HOT in those patients. According to the guideline of the Japanese Respiratory Society, indications of HOT are as follows: 1) A PaO2 of less than 55 Torr at rest while breathing room air, 2) A PaO2 between 55 Torr and 60 Torr in the presence of clear evidence of cor pulmonale, pulmonary hypertension, or a long history of severe hypoxemia during sleep or during exercise. Further studies are definitely required to pick up the patients who do not necessarily meet these indications but who may benefit from HOT.     

Effects of oxygen supplementation on cerebral oxygenation during exercise in chronic obstructive pulmonary disease patients not entitled to long-term oxygen therapy

Background: The rate of change (Δ) in cerebral oxygenation (COx) during exercise is influenced by blood flow and arterial O₂ content (CaO₂). It is currently unclear whether ΔCOx would (i) be impaired during exercise in patients with chronic obstructive pulmonary disease (COPD) who do not fulfil the current criteria for long‐term O₂ therapy but present with exercise‐induced hypoxaemia and (ii) improve with hyperoxia (FIO₂ = 0·4) in this specific sub‐population. Methods: A total of 20 non‐hypercapnic men (FEV₁ = 47·2 ± 11·5% pred) underwent incremental cycle ergometer exercise tests under normoxia and hyperoxia with ΔCOx (fold‐changes from unloaded exercise in O₂Hb) being determined by near‐infrared spectroscopy. Pulse oximetry assessed oxyhaemoglobin saturation (SpO₂), and impedance cardiography estimated changes in cardiac output (ΔQT). Results: Peak work rate and ΔCOx in normoxia were lower in eight O₂‘desaturators’ compared with 12 ‘non‐desaturators’ (P<0·05). Area under ΔCOx during sub‐maximal exercise was closely related to SpO₂ decrements in ‘desaturators’ (r = 0·92, P<0·01). These patients showed the largest improvement in peak exercise capacity with hyperoxia (P<0·05). Despite a trend to lower sub‐maximal ΔQT and mean arterial pressure with active intervention, ΔCOx was significantly improved only in this group (0·57 ± 0·20 versus 2·09 ± 0·42 for ‘non‐desaturators’ and ‘desaturators’, respectively; P<0·05). Conclusions: ΔCOx was impaired in non‐hypoxaemic patients with COPD who desaturated during exercise. Hyperoxic breathing was able to correct for these abnormalities, an effect related to enhanced CaO₂ rather than improved central haemodynamics. This indicates that O₂ supplementation ameliorates exercise COx in patients with COPD who are not currently entitled to ambulatory O₂ therapy.     

Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis

Astract Objective: To analyze the prognosis and costs of mechanical ventilation in patients with exacerbations of chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy. Design: A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis. Setting: A medical-surgical intensive care unit (ICU) in a university hospital. Patients: 20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure. Measurements and main results: Mortality in the ICU, in-hospital mortality (ICU plus ward), and mortality at 1 and 5 years, and factors associated with prognosis and cost–utility were assessed. The mean Acute Physiology and Chronic Health Evaluation II score was 20 (median 20 range 12–36). Cumulative mortality was 35 % in the ICU, 50 % in hospital, 75 % at 1 year, and 85 % at 5 years. Factors significantly associated with mortality in the ICU were low levels of albumin (p = 0.05) and sodium (p = 0.01) at admission. Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEV₁) than survivors (p = 0.03 and p = 0.05, respectively). The cost per Quality Adjusted Life Year (QALY) was U. S. $ 26 283 and U. S. $ 44 602 in a “best” (cost/QALY calculated for the life expectancy in Spain) and a “worst case scenario” (cost/QALY calculated for a 68-year life expectancy), respectively. Conclusions: Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost. Factors significantly associated with mortality in the ICU were albumin and sodium concentrations and FEV₁ in hospital and in the first year after discharge. Received: 4 August 1998 Final revision received: 28 January 1999 Accepted: 3 February 1999     

超短波治疗对慢性阻塞性肺疾病患者细胞因子变化的影响

目的:观察超短波疗法对慢性阻塞性肺疾病(chronicobstructivepul-monarydisease,COPD)患者气道炎症的影响,探讨超短波治疗慢性阻塞性肺疾病的作用机制。方法:随机选取74例急性发作期COPD患者,根据治疗方法不同随机分为超短波治疗组(常规治疗+超短波治疗)42例,对照组(常规治疗)32例。两组病程、病情及常规治疗同质,治疗前后分别检测2组患者血液中白介素8(interleukin-8,IL-8)、肿瘤坏死因子(tumornecrosisfac-tor-α,TNF-α)、粒细胞集落刺激因子(granulocyte,G-CSF)。结果:对照组治疗前后IL-8犤(236.10±52.60)ng/L和(197.90±62.80)ng/L犦,G-CSF犤(120.75±21.32)ng/L和(109.92±22.96)ng/L犦差异有显著性意义(t=1.93,1.95;P均<0.05);TNF-α犤(38.01±7.10)pmol/L和(36.85±4.08)pmol/L犦差异无显著性意义(t=1.47;P>0.05)。超短波治疗组患者治疗前后IL-8犤(232.36±76.34)ng/L和(108.48±40.50)ng/L犦,TNF-α犤(39.96±6.01)pmol/L和(27.50±3.88)pmol/L犦,G-CSF犤(125.40±21.93)ng/L和(96.52±19.01)ng/L犦,差异均有显著性意义(t=1.92,1.97,1.89;P均<0.05);与对照组比较上述3项指标差异亦有显著性意义(t=1.98,1.87,1.89;P<0.05)。结论:超短波通过降低气道炎症,改善COPD患者的肺功能,可用于急性期COPD