Ergan Begum, Nava Stefano
a Department of Pulmonary and Critical Care, Faculty of Medicine , Dokuz Eylul University , Izmir , Turkey.
b Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital , Alma Mater University , Bologna , Italy.
COPD. 2017 Jun;14(3):351-366. doi: 10.1080/15412555.2017.1319918. Epub 2017 May 16.
Chronic respiratory failure due to chronic obstructive pulmonary disease (COPD) is an increasing problem worldwide. Many patients with severe COPD develop hypoxemic respiratory failure during the natural progression of disease. Long-term oxygen therapy (LTOT) is a well-established supportive treatment for COPD and has been shown to improve survival in patients who develop chronic hypoxemic respiratory failure. The degree of hypoxemia is severe when partial pressure of oxygen in arterial blood (PaO) is ≤55 mmHg and moderate if PaO is between 56 and 69 mmHg. Although current guidelines consider LTOT only in patients with severe resting hypoxemia, many COPD patients with moderate to severe disease experience moderate hypoxemia at rest or during special circumstances, such as while sleeping or exercising. The efficacy of LTOT in these patients who do not meet the actual recommendations is still a matter of debate, and extensive research is still ongoing to understand the possible benefits of LTOT for survival and/or functional outcomes such as the sensation of dyspnea, exacerbation frequency, hospitalizations, exercise capacity, and quality of life. Despite its frequent use, the administration of "palliative" oxygen does not seem to improve dyspnea except for delivery with high-flow humidified oxygen. This narrative review will focus on current evidence for the effects of LTOT in the presence of moderate hypoxemia at rest, during sleep, or during exercise in COPD.
慢性阻塞性肺疾病（COPD）所致的慢性呼吸衰竭在全球范围内是一个日益严重的问题。许多重度COPD患者在疾病自然进展过程中会发生低氧性呼吸衰竭。长期氧疗（LTOT）是一种成熟的COPD支持性治疗方法，已被证明可提高发生慢性低氧性呼吸衰竭患者的生存率。当动脉血氧分压（PaO）≤55 mmHg时，低氧血症程度为重度；当PaO在56至69 mmHg之间时，为中度。尽管当前指南仅考虑对重度静息性低氧血症患者进行LTOT，但许多中重度COPD患者在静息时或特殊情况下，如睡眠或运动时会出现中度低氧血症。LTOT对这些不符合实际推荐标准的患者的疗效仍存在争议，目前仍在进行广泛研究，以了解LTOT对生存和/或功能结局（如呼吸困难感、急性加重频率、住院次数、运动能力和生活质量）可能带来的益处。尽管“姑息性”氧疗使用频繁，但除了高流量湿化给氧外，似乎并不能改善呼吸困难。本叙述性综述将聚焦于目前关于LTOT对COPD患者静息、睡眠或运动时存在中度低氧血症影响的证据。
