Elphick Heather E, Mallory George
Respiratory Unit, Sheffield Children’s Hospital, Sheffield, UK.
Cochrane Database Syst Rev. 2013 Jul 25;2013(7):CD003884. doi: 10.1002/14651858.CD003884.pub4.
The most serious complications of cystic fibrosis (CF) relate to respiratory insufficiency. Oxygen supplementation therapy has long been a standard of care for individuals with chronic lung diseases associated with hypoxemia. Physicians commonly prescribe oxygen therapy for people with CF when hypoxemia occurs. However, it is unclear if empiric evidence is available to provide indications for this therapy with its financial costs and often profound impact on lifestyle.
To assess whether oxygen therapy improves the longevity or quality of life of individuals with CF.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Latest search of Group's Trials Register: 15 May 2013.
Randomized or quasi-randomized controlled trials comparing oxygen, administered at any concentration, by any route, in people with documented CF for any time period.
Authors independently assessed the risk of bias for included studies and extracted data.
This review includes 11 published studies (172 participants); only one examined long-term oxygen therapy (28 participants). There was no statistically significant improvement in survival, lung, or cardiac health. There was an improvement in regular attendance at school or work in those receiving oxygen therapy at 6 and 12 months. Four studies examined the effect of oxygen supplementation during sleep by polysomnography. Although oxygenation improved, mild hypercapnia was noted. Participants fell asleep quicker and spent a reduced percentage of total sleep time in rapid eye movement sleep, but there were no demonstrable improvements in qualitative sleep parameters. Six studies evaluated oxygen supplementation during exercise. Again, oxygenation improved, but mild hypercapnia resulted. Participants receiving oxygen therapy were able to exercise for a significantly longer duration during exercise. Other exercise parameters were not altered by the use of oxygen.
AUTHORS' CONCLUSIONS: There are no published data to guide the prescription of chronic oxygen supplementation to people with advanced lung disease due to CF. Short-term oxygen therapy during sleep and exercise improves oxygenation but is associated with modest and probably clinically inconsequential hypercapnia. There are improvements in exercise duration, time to fall asleep and regular attendance at school or work. There is a need for larger, well-designed clinical trials to assess the benefits of long-term oxygen therapy in people with CF administered continuously or during exercise or sleep or both. However, we do not expect any new research to be undertaken in this area any time soon and do not plan to update this review again until any new evidence does become available.
囊性纤维化（CF）最严重的并发症与呼吸功能不全有关。长期以来，氧疗一直是患有与低氧血症相关的慢性肺部疾病患者的标准治疗方法。当CF患者出现低氧血症时，医生通常会为其开具氧疗处方。然而，目前尚不清楚是否有实证证据可为这种疗法提供依据，以及其经济成本和对生活方式的深远影响。
评估氧疗是否能提高CF患者的寿命或生活质量。
我们检索了Cochrane囊性纤维化和遗传疾病小组试验注册库，其中包括通过全面电子数据库检索以及对相关期刊和会议论文摘要集进行手工检索所确定的参考文献。小组试验注册库的最新检索时间为2013年5月15日。
比较以任何浓度、通过任何途径给予CF患者氧疗的随机或半随机对照试验，试验时间不限。
作者独立评估纳入研究的偏倚风险并提取数据。
本综述纳入了11项已发表的研究（172名参与者）；只有一项研究考察了长期氧疗（28名参与者）。在生存率、肺部或心脏健康方面没有统计学上的显著改善。接受氧疗的患者在6个月和12个月时上学或工作的出勤率有所提高。四项研究通过多导睡眠图检查了睡眠期间吸氧的效果。虽然氧合改善，但出现了轻度高碳酸血症。参与者入睡更快，快速眼动睡眠占总睡眠时间的百分比降低，但睡眠质量参数没有明显改善。六项研究评估了运动期间吸氧的效果。同样，氧合改善，但导致了轻度高碳酸血症。接受氧疗的参与者在运动期间能够运动更长时间。使用氧气并未改变其他运动参数。
目前尚无已发表的数据可指导对晚期CF肺部疾病患者进行长期氧疗的处方。睡眠和运动期间的短期氧疗可改善氧合，但与轻度且可能在临床上无显著意义的高碳酸血症相关。运动持续时间、入睡时间以及上学或工作的出勤率有所改善。需要开展更大规模、设计良好的临床试验，以评估长期氧疗对CF患者在持续进行、运动期间、睡眠期间或两者兼有的情况下的益处。然而，我们预计短期内不会在该领域开展任何新的研究，并且在有新证据出现之前不打算再次更新本综述。
