Pépin J L, Barjhoux C E, Deschaux C, Brambilla C
AGIR, Service de Pneumologie, CHU de Grenoble, France.
Chest. 1996 May;109(5):1144-50. doi: 10.1378/chest.109.5.1144.
Daily duration of oxygen administration is an important factor in the effectiveness of long-term oxygen therapy (LTOT) for hypoxic chronic pulmonary disease. We have assessed the daily use of oxygen therapy in 930 patients with COPD and examined factors associated with the effective use of this treatment.
Objective daily duration of oxygen use over a 3-month period was prospectively measured using the counter clock of the oxygen concentrators or by weighing the liquid oxygen container at each delivery. A questionnaire was filled in by an independent investigator asking about home situation, lifestyle, and whether oxygen therapy was used during all domestic and outside activities. In addition, prescribing physicians were asked about the duration and modalities of oxygen prescribed in each case.
The patients had been receiving LTOT for 36 +/- 24 months and had hypoxemia (PaO2 = 56 +/- 9 mm Hg), hypercapnia (PaCO2 = 47 +/- 8 mm Hg), and severe airflow obstruction (FEV1/VC = 42 +/- 14%). The mean duration of oxygen treatment prescribed was 16 +/- 3 h/d. The mean duration of oxygen therapy achieved was 14.5 +/- 5 h, but only 45% of the patients achieved oxygen therapy for 15 h or more per day. Patients with effective use of LTOT, ie receiving oxygen therapy for at least 15 h/d, were significantly more hypoxic (PaO2 = 54 +/- 9 vs 57 +/- 9 mm Hg; p < 0.001), more hypercapnic (PaCO2 = 48 +/- 8 vs 46 +/- 7 mm Hg; p < 0.005), and also more obstructed (FEV1/VC = 39.5 +/- 13 vs 45 +/- 14%; p < 0.001) than the rest of the patients under treatment. Other factors associated with effective use of oxygen were (1) initial prescription for 15 h or more per day, (2) supplementary education on oxygen therapy by a nurse or physiotherapist, (3) cessation of smoking, (4) use of oxygen in all domestic situations (toilet, meals, leisure, etc.), and (5) absence of side effects from oxygen treatment.
Attention by the prescribing physicians to such factors could optimize oxygen prescription and constitute goals for education of patients.
对于缺氧性慢性肺病，每日吸氧时长是长期氧疗（LTOT）有效性的一个重要因素。我们评估了930例慢性阻塞性肺疾病（COPD）患者的每日氧疗使用情况，并研究了与该治疗有效使用相关的因素。
前瞻性地使用氧气浓缩器的计数器或在每次送气时称量液氧容器的重量，来测量3个月期间客观的每日吸氧时长。由一名独立调查员填写一份问卷，询问家庭情况、生活方式以及在所有家庭和户外活动期间是否使用氧疗。此外，还向开处方的医生询问了每个病例中规定的吸氧时长和方式。
这些患者接受长期氧疗的时间为36±24个月，存在低氧血症（动脉血氧分压[PaO2]=56±9毫米汞柱）、高碳酸血症（动脉血二氧化碳分压[PaCO2]=47±8毫米汞柱）以及严重气流阻塞（第1秒用力呼气容积/肺活量[FEV1/VC]=42±14%）。规定的氧疗平均时长为16±3小时/天。实际实现的氧疗平均时长为14.5±5小时，但只有45%的患者每天吸氧达到15小时或更长时间。有效使用长期氧疗的患者，即每天接受氧疗至少15小时的患者，比其他接受治疗的患者明显更缺氧（PaO2=54±9对比57±9毫米汞柱；p<0.001）、高碳酸血症更严重（PaCO2=48±8对比46±7毫米汞柱；p<0.005），并且气流阻塞也更严重（FEV1/VC=39.5±13对比45±14%；p<0.001）。与有效使用氧气相关的其他因素包括：（1）初始处方为每天15小时或更长时间；（2）护士或物理治疗师对氧疗进行补充教育；（3）戒烟；（4）在所有家庭场景（厕所、用餐、休闲等）中使用氧气；（5）氧疗无副作用。
开处方的医生关注这些因素可优化氧疗处方，并为患者教育设定目标。
