[护士家访对长期氧疗依从性的影响。14个月随访]

[Effects of nurse home visits on compliance to long-term oxygen therapy. 14 months follow-up].

作者信息

Nasiłowski Jacek, Przybyłowski Tadeusz, Klimiuk Joanna, Leśkow Artur, Orska Katarzyna, Chazan Ryszarda

机构信息

Klinika Chorób Wewnetrznych, Pneumonologii i Alergologii Warszawskiego Universytetu Medycznego, Warszawa.

出版信息

Pneumonol Alergol Pol. 2009;77(4):363-70.

PMID:19722141

Abstract

INTRODUCTION

Long-term oxygen therapy (LTOT) is the only treatment improving survival of patients with respiratory failure due to chronic obstructive pulmonary disease (COPD). Benefits of treatment depend mainly on daily duration of oxygen use. The aim of the study was to assess daily use of oxygen and to evaluate influencing factors.

MATERIAL AND METHODS

Consecutive patients qualified to LTOT were included. Eligibility for LTOT was based on the ATS//ERS guidelines. All patients were instructed to use oxygen from oxygen concentrator for 15 hours per day or more. Duration of oxygen therapy was verified every 4 weeks by visiting respiratory nurse using counter clock of oxygen concentrator. The nurses were also encouraging patients to breathe oxygen for at least 15 h/d.

RESULTS

Study group consisted of 30 patients (77% with COPD) aged 67+/-9 yrs, mean FEV, 46+/-18% pred., RV%TLC 64+/-16%, PaO2 50+/-6 mm Hg. Mean duration of oxygen therapy for the group was 12.5+/-4.6 h/d. Eleven (37%) subjects followed prescription during whole follow-up period (mean oxygen use 17.4+/-2.6 h/d). Mean oxygen use in the non-compliant group was 9.6+/-2.7 h/d. In COPD group compliant patients had significantly lower TLC (100+/-19% pred. v. 152+/-36% pred., p=0.001) and lower PaCO2 (38+/-6 mm Hg v. 47+/-8 mm Hg, p<0.05) when compared to the non-compliant group. During the first month of treatment 48% of patients were compliant. From the second month onward percentage of compliant patients fell to 30% and remained stable to the end of the study. Fourteen patients (47% complained of electricity consumption and 7 patients (23%) complained of the noise of working concentrator. Daily oxygen use in the latest group was significantly lower when compared to those who did not complain of the noise (9+/-3.7 h/d v. 13.5+/-4.4 h/d; p=0.02).

CONCLUSIONS

The best compliance to home oxygen therapy is observed at the beginning of treatment. Frequent home nurse visits do not improve compliance. We hypothesize that the use of other oxygen sources eg. liquid oxygen, that are silent and do not increase the cost of electricity, could improve compliance.

摘要

引言

长期氧疗（LTOT）是改善慢性阻塞性肺疾病（COPD）所致呼吸衰竭患者生存率的唯一治疗方法。治疗的益处主要取决于每日吸氧时间。本研究的目的是评估每日吸氧情况并评估影响因素。

材料与方法

纳入符合LTOT标准的连续患者。LTOT的资格依据美国胸科学会（ATS）//欧洲呼吸学会（ERS）指南确定。所有患者均被指导每天使用制氧机吸氧15小时或更长时间。每4周由呼吸科护士通过查看制氧机的计数器来核实氧疗时间。护士还鼓励患者每天至少吸氧15小时。

结果

研究组由30例患者组成（77%为COPD患者），年龄67±9岁，平均第一秒用力呼气容积（FEV₁）为预计值的46±18%，残气量/肺总量（RV%TLC）为64±16%，动脉血氧分压（PaO₂）为50±6 mmHg。该组患者的平均氧疗时间为12.5±4.6小时/天。11例（37%）受试者在整个随访期间遵循医嘱（平均吸氧时间为17.4±2.6小时/天）。未遵医嘱组的平均吸氧时间为9.6±2.7小时/天。在COPD组中，与未遵医嘱组相比，遵医嘱的患者肺总量（TLC）显著更低（分别为预计值的100±19%和152±36%，p = 0.001），动脉血二氧化碳分压（PaCO₂）也更低（分别为38±6 mmHg和47±8 mmHg，p<0.05）。在治疗的第一个月，48%的患者遵医嘱。从第二个月起，遵医嘱患者的比例降至30%，并在研究结束时保持稳定。14例患者（47%）抱怨电费支出，7例患者（23%）抱怨制氧机工作时的噪音。与未抱怨噪音的患者相比，抱怨噪音组的每日吸氧时间显著更低（分别为9±3.7小时/天和13.5±4.4小时/天；p = 0.02）。