Bongard J P, de Haller R
Département de médecine, Hôpital cantonal universitaire, Genève.
Schweiz Med Wochenschr. 1989 Jan 28;119(4):110-5.
In Switzerland long-term oxygen treatment is chiefly performed with oxygen concentrators provided by the Swiss Association against Tuberculosis and Pulmonary Diseases through its cantonal leagues. Prescription and supervision are carried out according to the Association's guidelines. To assess compliance with these guidelines, the prescription forms of 447 patients (1981-1985) were analyzed concerning diagnosis, lung function and blood gases. Of the 398 diagnoses mentioned, 73% were COPD, 16% restrictive syndromes and 11% cardiovascular diseases (including cor pulmonale). Lung function results were given in 81% of the total but in only 73% and 67% of two non-COPD groups. Blood gases at ambiant air were given in 92% and under oxygen at the flow chosen for treatment in 72%. At ambiant air the PaO2 was greater than 7.33 kPa in 21% (8.18 +/- 0.85 kPa) and less than 5.33 kPa in 19% (4.86 +/- 0.33 kPa). - These results show that prescription criteria are not always correctly met, especially in non-COPD patients. They also suggest that long-term oxygen treatment is often prescribed mainly on the basis of clinical criteria, despite a PaO2 which would not require it, and also in unstable state, as indicated by the high proportion of cases with very low PaO2. The rationale behind the guidelines should be explained more clearly to prescribing doctors, in order to confine this difficult and costly treatment to patients who really need it.
在瑞士，长期氧疗主要通过瑞士抗结核和肺部疾病协会通过其各州分会提供的制氧机来进行。处方和监管按照该协会的指导方针执行。为评估对这些指导方针的遵守情况，分析了447例患者（1981 - 1985年）的处方表格，内容涉及诊断、肺功能和血气情况。在所提及的398例诊断中，73%为慢性阻塞性肺疾病（COPD），16%为限制性综合征，11%为心血管疾病（包括肺心病）。肺功能结果在全部病例中的提供率为81%，但在两个非COPD组中仅为73%和67%。在室内空气中的血气数据提供率为92%，在治疗所选流量的氧气条件下的血气数据提供率为72%。在室内空气中，动脉血氧分压（PaO2）大于7.33千帕的占21%（8.18±0.85千帕），小于5.33千帕的占19%（4.86±0.33千帕）。——这些结果表明，处方标准并非总能得到正确满足，尤其是在非COPD患者中。它们还表明，尽管PaO2不需要长期氧疗，但长期氧疗往往主要基于临床标准进行处方，而且在不稳定状态下也是如此，极低PaO2病例的高比例就表明了这一点。应向开处方的医生更清楚地解释指导方针背后的基本原理，以便将这种困难且昂贵的治疗局限于真正需要的患者。
