Health-related quality of life measurement in patients with chronic respiratory failure

The improvement of health-related quality of life (HRQL) is an important goal in managing patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) and/or domiciliary noninvasive ventilation (NIV). Two condition-specific HRQL questionnaires have been developed to specifically assess these patients: the Maugeri Respiratory Failure Questionnaire (MRF) and the Severe Respiratory Insufficiency Questionnaire (SRI). The MRF is more advantageous in its ease of completion; conversely, the SRI measures diversified health impairments more multi-dimensionally and discriminatively with greater balance, especially in patients receiving NIV. The SRI is available in many different languages as a result of back-translation and validation processes, and is widely validated for various disorders such as chronic obstructive pulmonary disease, restrictive thoracic disorders, neuromuscular disorders, and obesity hypoventilation syndrome, among others. Dyspnea and psychological status were the main determinants for both questionnaires, while the MRF tended to place more emphasis on activity limitations than SRI. In comparison to existing generic questionnaires such as the Medical Outcomes Study 36-item short form (SF-36) and disease-specific questionnaires such as the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ), both the MRF and the SRI have been shown to be valid and reliable, and have better discriminatory, evaluative, and predictive features than other questionnaires. Thus, in assessing the HRQL of patients with CRF using LTOT and/or NIV, we might consider avoiding the use of the SF-36 or even the SGRQ or CRQ alone and consider using the CRF-specific SRI and MRF in addition to existing generic and/or disease-specific questionnaires.     

缓解期慢性阻塞性肺病患者氧疗的观察及护理

目的：通过对慢性阻塞性肺病（COPD）患者为期四年的随访，了解长期家庭氧疗对其生命质量和生存时间的影响，并对此提出护理措施。方法：COPD患者分为长期氧疗组和非氧疗组，定期进行血常规、血气分析和肺功能检测，并对两组患者四年中的住院率、病死率进行比较。结果：氧疗组PO2水平显著高于非氧疗组；其血红蛋白、红细胞压积显著低于非氧疗组，且氧疗组的这两项指标与氧疗前相比得到了一定程度的逆转；肺功能下降程度两组无明显差异；氧疗组在四年中的住院率和病死率均显著低于非氧疗组。结论：长期氧疗可显著降低COPD患者住院次数和远期病死率，提高其生命质量，是COPD惠者缓解期康复治疗的重要手段。     

COPD缓解期并慢性Ⅱ型呼吸衰竭长期家庭氧疗临床观察

目的 了解长期家庭氧疗（LTOT）对缓解期合并慢性Ⅱ型呼吸衰竭的慢性阻塞性肺疾病（COPD）病人预后及生活质量的影响。方法 对52例缓解期并慢性Ⅱ型呼吸衰竭的COPD病人根据其经济状况分为长期家庭氧疗组和非氧疗组，氧疗组每日吸氧时间≥15h，非氧疗组未行氧疗。对两组病人进行连续3年随访，每半年复查血常规、血气分析、肺功能。结果 氧疗组半年、1年后PaO2及SaO2显著高于非氧疗组，血红蛋白、红细胞压积显著低于非氧疗组；氧疗组每年平均住院次数显著低于非氧疗组；氧疗组3年的病死率显著低于非氧疗组。结论 长期家庭氧疗对COPD缓解期并慢性Ⅱ型呼吸衰竭的病人能显著降低远期的病死率，提高病人的生活质量。     

长期氧疗对慢性阻塞性肺疾病患者血凝状态和内皮功能的影响

目的:探索长期氧疗对慢性阻塞性肺疾病(COPD)血凝状态、内皮功能和肾功能的影响。方法:56例COPD患者,随机分成两组:(1)治疗组:30例,男性19例,女性11例,平均年龄(72.5±10.1)岁;(2)对照组:26例,男性14例,女性12例,平均年龄(73.9±9.5)岁。治疗组在出院后开始吸入申威8L压缩氧,吸入氧浓度(FIO2)29%,每日12h计1年。治疗前后常规检查肺功能(FEV1)、动脉血气,肝、肾功能、血沉(ESR)、血凝及血粘状态指标[D-二聚体、纤维蛋白原(FN)、血浆及全血粘滞度(高切、低切)、内皮素-1(ET-1)、血β2-微球蛋白]。结果:治疗组治疗后PaO2及SaO2增高(P<0.01),PCV、D-二聚体、血浆及全血粘度(高切和低切)均明显下降(P<(0.01);同时内皮功能也得到改善,ET-1下降。血肌酐降低(P<0.05);血β2-微球蛋白下降。对照组各指标均无变化(P>0.05)。两组治疗前后肝功能及尿素氮无显著差异(P>0.05)。结论:长期氧疗对改善COPD高凝状态、内皮功能和肾功能具有较好的疗效。     

长期家庭氧疗配合氟替卡松-沙美特罗气雾剂治疗慢性阻塞性肺病

目的探讨长期家庭氧疗(LTOT)配合吸入氟替卡松—沙美特罗气雾剂(舒利迭)治疗慢性阻塞性肺病(COPD)的疗效。方法选择COPD稳定期患者63例,分为两组,治疗组接受长期家庭氧疗配合吸入舒利迭气雾剂,对照组接受常规治疗。结果治疗组治疗24个月后PO2、FEV1、6MWT、BMI、ALB、TLC等指标明显上升,HCT、MPAP等指标下降(P<0.05),而对照组上述指标改变不明显(P>0.05)。结论 LTOT配合吸入舒利迭气雾剂治疗COPD稳定期患者有利于纠正低氧血症,延缓肺功能恶化,改善患者营养状态及全身免疫功能,提高患者的生活质量及生活时间,值得推广。     

COPD合并慢性呼吸衰竭长期家庭氧疗的疗效观察

目的:探讨长期家庭氧疗(LTOT)对慢性阻塞性肺疾病(COPD)合并慢性呼吸衰竭的疗效。方法:选择36例2009年1月1日-2010年12月1日在我科住院,诊断为COPD合并慢性呼吸衰竭的出院患者为研究对象,随机分为治疗组18例和对照组18例,治疗组出院后长期LTOT,对照组未予吸氧治疗,随访观察2年,比较两组患者的指脉血氧饱和度(SaO2)、测定6min步行距离(6MWD),记录病情变化情况。结果:2年后,治疗组患者指脉搏血氧饱和度明显提高,6min步行距离延长,生活质量及运动耐力明显改善,对照组患者低氧血症、生活质量及运动耐力均无明显改善,两组疗效比较差异有显著性(P<0.05)。结论:COPD合并慢性呼吸衰竭患者应用LTOT可明显改善生活质量和运动耐力,值得推广应用。     

Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis

STUDY OBJECTIVES: To evaluate the long-term clinical course of patients with idiopathic pulmonary fibrosis (IPF) complicated with pulmonary arterial hypertension. DESIGN: Prospective analysis of consecutive IPF patients undergoing initial workup with right-heart catheterization (RHC) and pulmonary function testing (PFT). Pulmonary arterial pressure (PAP) and diffusion capacity of the lung for carbon monoxide (Dlco) were focused on. SETTING: University hospital. PATIENTS: Seventy-eight patients with IPF (67 men, 11 women; diagnosis by pathology, n = 59; clinical diagnosis, n = 19) had been followed up after initial workup for a maximum of 14 years. MEASUREMENTS AND RESULTS: RHC data on 61 patients and PFT data on 52 patients were available. Five-year survival rates were 62.2% in the normal-PAP group (mean PAP < 17 mm Hg, n = 37) and 16.7% in the high-PAP group (mean PAP > 17 mm Hg, n = 24) [p < 0.001]; 70.4% in the preserved-Dlco group (percentage of predicted > 40%, n = 27) and 20.0% in the low-Dlco group (percentage of predicted < 40%, n = 25) [p < 0.001]; and 82.6% in group 1 (normal PAP and preserved Dlco, n = 23) and 15.6% in group 2 (high PAP, low Dlco, or both, n = 32) [p < 0.0001]. The relative risks of mortality within 5 years after RHC were 2.20 (95% confidence interval [CI], 1.40 to 3.45) in the high-PAP group, 2.70 (95% CI, 1.46 to 4.99) in the low-Dlco group, and 4.85 (95% CI, 1.97 to 11.97) in group 2. CONCLUSION: Dlco was a critical factor for evaluating disease status and prognosis, and PAP status provided feasible information in the initial workup of IPF patients.     

长期家庭氧疗对慢性阻塞性肺疾病的治疗作用

目的　通过对一组伴严重低氧血症的COPD患者进行长期家庭氧疗 (LTOT) ,以了解该治疗的临床意义。方法　选择缓解期COPD患者 5 0例 (PaO2 <7 3kPa(5 5mmHg)或SaO2 <88% )进行家庭氧疗 2个月 ,氧疗前后进行血气分析和血细胞比容测定。结果　每日持续吸氧 >15h者的PaO2 升高同时不伴有PaCO2 的升高 ,血细胞比容较氧疗前明显下降 ,临床症状明显改善。结论　应对伴有严重低氧血症的COPD患者进行LTOT。     

慢性阻塞性肺疾病患者长期家庭氧疗的疗效分析

目的:探讨慢性阻塞性肺疾病(COPD)稳定期患者长期家庭氧疗(LTOT)的临床疗效。方法:69例COPD患者分为LTOT组(36例)和对照组(33例),两组患者均接受常规治疗,LTOT组同时接受LTOT。用FEV1占预计值的百分比、BODE指数来判定疗效。结果:FEV1%pred、BODE指数分值比较,治疗前两组间差异无统计学意义(P>0.05),对照组治疗前、后差异无统计学意义(P>0.05),LTOT组治疗后与治疗前及对照组治疗后比较差异均有统计学意义(P均<0.05);结论:LTOT对COPD稳定期患者疗效明显。