Ekström Magnus, Ahmadi Zainab, Larsson Hillevi, Nilsson Tove, Wahlberg Josefin, Ström Kerstin E, Midgren Bengt
Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund.
Department of Medicine, Blekinge Hospital, Karlskrona, Sweden.
Int J Chron Obstruct Pulmon Dis. 2017 Oct 30;12:3159-3169. doi: 10.2147/COPD.S140264. eCollection 2017.
Long-term oxygen therapy (LTOT) improves prognosis in COPD with severe hypoxemia. However, adherence to criteria for eligibility and quality of LTOT is often insufficient and varies between countries. The aim of this study was to evaluate a national structure for prescription and management of LTOT over three decades in Sweden.
The study was a prospective, population-based study of 23,909 patients on LTOT from 1987 to 2015 in the Swedish National Register of Respiratory Failure (Swedevox). We assessed the prevalence, incidence, and structure of LTOT; completeness of registration in Swedevox; and validity of prescription and management of LTOT in Sweden according to seven published quality indicators.
LTOT was prescribed by 48 respiratory or medicine units and managed mainly by specialized oxygen nurses. Swedevox had a stable completeness of 85% of patients starting LTOT since 1987. The national incidence of LTOT increased from 3.9 to 14.7/100,000 inhabitants over the time period. In 2015, 2,596 patients had ongoing therapeutic LTOT in the registry, a national prevalence of 31.6/100,000. Adherence to prescription recommendations and fulfillment of quality criteria was stable or improved over time. Of patients starting LTOT in 2015, 88% had severe hypoxemia (partial pressure of arterial oxygen [PaO] <7.4 kPa) and 97% had any degree of hypoxemia (PaO <8.0 kPa); 98% were prescribed oxygen ≥15 hours/day or more; 76% had both stationary and mobile oxygen equipment; 75% had a mean PaO >8.0 kPa breathing oxygen; and 98% were non-smokers.
We present a structure for prescription, management, and follow-up of LTOT. The national registry effectively monitored adherence to prescription recommendations and most likely contributed to improved quality of care.
长期氧疗（LTOT）可改善重度低氧血症慢性阻塞性肺疾病（COPD）患者的预后。然而，LTOT的适应证标准遵循情况和治疗质量在各国往往不尽人意且存在差异。本研究旨在评估瑞典三十多年来LTOT处方和管理的国家体系。
本研究是一项基于人群的前瞻性研究，纳入了1987年至2015年瑞典国家呼吸衰竭登记册（Swedevox）中23909例接受LTOT治疗的患者。我们评估了LTOT的患病率、发病率和体系；Swedevox登记的完整性；以及根据七项已发表的质量指标评估瑞典LTOT处方和管理的有效性。
LTOT由48个呼吸科或内科单位开具处方，主要由专业吸氧护士管理。自1987年以来，Swedevox对开始接受LTOT治疗的患者的登记完整性稳定在85%。在此期间，LTOT的全国发病率从3.9/10万居民增加到14.7/10万居民。2015年，登记册中有2596例患者正在接受LTOT治疗，全国患病率为31.6/10万。随着时间的推移对处方建议的遵循情况和质量标准的达标情况保持稳定或有所改善。2015年开始接受LTOT治疗的患者中，88%患有重度低氧血症（动脉血氧分压[PaO]＜7.4 kPa），97%有任何程度的低氧血症（PaO＜8.0 kPa）；98%的患者吸氧时间≥15小时/天或更长；76%的患者同时配备了固定和移动吸氧设备；75%的患者在吸氧时平均PaO＞8.0 kPa；98%的患者不吸烟。
我们展示了LTOT的处方、管理和随访体系。国家登记册有效地监测了对处方建议的遵循情况，很可能有助于提高医疗质量。
