Kim Victor, Benditt Joshua O, Wise Robert A, Sharafkhaneh Amir
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Proc Am Thorac Soc. 2008 May 1;5(4):513-8. doi: 10.1513/pats.200708-124ET.
Since the introduction of oxygen as a therapeutic agent 70 years ago, much has been learned regarding the detrimental effects of hypoxemia and the beneficial impact of oxygen therapy. It is projected that there are close to 800,000 patients receiving long-term oxygen therapy (LTOT) in the United States, at a cost of approximately $1.8 billion annually. The large numbers of patients receiving supplemental oxygen as treatment and the high costs incurred in providing oxygen therapy necessitate the practitioner to know the indications for LTOT as well its effects on survival, pulmonary hemodynamics, sleep, and exercise capacity. It is now recognized that the basis for LTOT prescription for all patients is founded on data that are over 25 years old and that only involve a very select cohort of patients. It is clear that further studies are required to assess the effects of oxygen on patients with chronic obstructive pulmonary disease with only mild hypoxemia, not only survival but also on neurocognitive function, quality of life, exercise physiology, and sleep quality. In addition, although proven to be safe when prescribed long term to individuals with lung disease, there are some concerns about worsening carbon dioxide retention and increased oxidant injury. The goals of this article are to briefly describe the indications for chronic oxygen administration, the physiologic effects of treatment, and potential toxicities, as well as its effect on morbidity and mortality.
自从70年前氧气作为一种治疗药物被引入以来，我们已经对低氧血症的有害影响和氧疗的有益作用有了很多了解。据预测，美国有近80万患者接受长期氧疗（LTOT），每年花费约18亿美元。大量患者接受补充氧气作为治疗手段，且提供氧疗的成本高昂，这就要求从业者了解LTOT的适应症及其对生存、肺血流动力学、睡眠和运动能力的影响。现在人们认识到，所有患者LTOT处方的依据是25年以上的数据，且仅涉及非常特定的一组患者。显然，需要进一步研究来评估氧气对仅伴有轻度低氧血症的慢性阻塞性肺疾病患者的影响，不仅是对生存的影响，还有对神经认知功能、生活质量、运动生理学和睡眠质量的影响。此外，虽然长期给肺病患者开氧疗处方已被证明是安全的，但仍有人担心会加重二氧化碳潴留和增加氧化损伤。本文的目的是简要描述慢性氧疗的适应症、治疗的生理效应、潜在毒性以及对发病率和死亡率的影响。
