Clini E, Vitacca M, Foglio K, Simoni P, Ambrosino N
Salvatore Maugeri, Clinica del Lavoro Foundation IRCCS, Divisions of Pneumology, Medical Centers of Gussago (BS), Italy.
Eur Respir J. 1996 Aug;9(8):1605-10. doi: 10.1183/09031936.96.09081605.
Long-term oxygen therapy (LTOT) has been shown to improve survival in chronic obstructive pulmonary disease (COPD) patients. The clinical effectiveness of long-term home mechanical ventilation (HMV) is still discussed, nevertheless both LTOT and HMV are often included in the home care programmes of these patients. To evaluate the effectiveness of home care programmes including either HMV or LTOT, 34 COPD patients were studied. They were admitted to either HMV (Group A: 12 males and 5 females, aged 62 +/- 5 yrs), or LTOT (Group B: 9 males and 8 females, aged 62 +/- 8 yrs). They were compared to a historical group (Group C: 19 males and 10 females, aged 67 +/- 16 yrs) performing only their usual standard LTOT during the same period. Spirometry, maximal inspiratory pressure and arterial blood gas values were assessed at baseline and at 6, 12 and 18 months of follow-up. Mortality rate and number of hospital and intensive care unit (ICU) admissions and days of hospitalization were also assessed. Four out of 17 (23%) patients in Group A, 3 out of 17 (18%) in Group B, and 5 out of 29 (17%) in Group C died within 18 months. Of the lung function tests, only maximal inspiratory pressure in Group A showed a significant increase in the 18th month (50 +/- 4 to 56 +/- 7 cmH2O; p<0.01). In comparison to 18 months prior to the study, hospital admissions (from 2.2 +/- 0.6 to 1.3 +/- 1.1 and from 2.0 +/- 0.7 to 1.0 +/- 0.9 for Group A and B, respectively; p<0.005 for both), and days of hospitalization (from 60 +/- 34 to 34 +/- 40 and from 55 +/- 23 to 18 +/- 20 days in Group A and B, respectively; p<0.005 for both) significantly decreased only in the two groups submitted to the home care programme. We conclude that home care programmes may be effective in the long-term treatment of chronically hypercapnic chronic obstructive pulmonary disease patients in reducing hospital admissions.
长期氧疗（LTOT）已被证明可提高慢性阻塞性肺疾病（COPD）患者的生存率。长期家庭机械通气（HMV）的临床有效性仍在讨论中，不过LTOT和HMV通常都被纳入这些患者的家庭护理计划中。为了评估包括HMV或LTOT的家庭护理计划的有效性，对34例COPD患者进行了研究。他们被纳入HMV组（A组：12名男性和5名女性，年龄62±5岁）或LTOT组（B组：9名男性和8名女性，年龄62±8岁）。将他们与同期仅进行常规标准LTOT的历史组（C组：19名男性和10名女性，年龄67±16岁）进行比较。在基线以及随访的6、12和18个月时评估肺活量测定、最大吸气压力和动脉血气值。还评估了死亡率、住院次数、重症监护病房（ICU）住院次数和住院天数。A组17例患者中有4例（23%）、B组17例患者中有3例（18%）、C组29例患者中有5例（17%）在18个月内死亡。在肺功能测试中，只有A组的最大吸气压力在第18个月时显示出显著增加（从50±4增至56±7 cmH2O；p<0.01）。与研究前18个月相比，仅接受家庭护理计划的两组患者的住院次数（A组从2.2±0.6降至1.3±1.1，B组从2.0±0.7降至1.0±0.9；两组p均<0.005）和住院天数（A组从60±34降至34±40天，B组从55±23降至18±20天；两组p均<0.005）显著减少。我们得出结论，家庭护理计划在长期治疗慢性高碳酸血症性慢性阻塞性肺疾病患者以减少住院次数方面可能是有效的。
