Ambrosino N, Di Giorgio M, Di Paco A
Pulmonary Unit, Cardio-Thoracic Department, University-Hospital Pisa, Italy.
Monaldi Arch Chest Dis. 2007 Sep;67(3):148-53. doi: 10.4081/monaldi.2007.486.
Caring for patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure is difficult independent of whether the target is survival or quality of life (QOL). The role of inhaled drug therapy in this specific set of very severe COPD patients has not previously been assessed. The only drug able to prolong survival in these patients is long term oxygen therapy, whereas there is little evidence to indicate long-term domiciliary mechanical ventilation in the routine management of stable hypercapnic patients. Supplemental oxygen during exercise reduces exercise breathlessness and improves exercise capacity of the hypoxaemic patient. Pulmonary rehabilitation including nutritional supplementation is a significant component of therapy, even in these severe patients. Relief of dyspnoea with drugs such as morphine should not be denied to severely disabled patients who share poor QOL with cancer patients. Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Lung Volume Reduction Surgery may improve mortality, exercise capacity, and QOL in selected patients, but is associated with significant morbidity and an early mortality rate in the most severe patients. Lung transplantation is a final step in end-stage patients, but short- and long-term outcomes remain significantly inferior in relation to other "solid" organs recipients.
照护慢性阻塞性肺疾病全球倡议（GOLD）III期和IV期且伴有慢性呼吸衰竭的患者具有挑战性，无论目标是生存还是生活质量（QOL）。吸入药物治疗在这类特定的极重度慢性阻塞性肺疾病患者中的作用此前尚未得到评估。在这些患者中，唯一能够延长生存期的药物是长期氧疗，而几乎没有证据表明在稳定的高碳酸血症患者的常规管理中进行长期家庭机械通气是必要的。运动期间补充氧气可减轻运动时的呼吸困难，并提高低氧血症患者的运动能力。即使对这些重症患者而言，包括营养补充在内的肺康复也是治疗的重要组成部分。对于那些与癌症患者一样生活质量较差的重度残疾患者，不应拒绝使用吗啡等药物缓解呼吸困难。无创通气已被用作减轻呼吸困难的姑息治疗方法。肺减容手术可能会改善部分患者的死亡率、运动能力和生活质量，但在最严重的患者中会伴有显著的发病率和早期死亡率。肺移植是终末期患者的最后一步，但与其他“实体”器官接受者相比，其短期和长期结果仍然明显较差。
