慢性阻塞性肺病的当代管理:科学综述
Don D Sin1, Finlay A McAlister, S F Paul Man
1Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada. don.sin@ualberta.ca
JAMA
|November 6, 2003
概括
长效支气管扩展剂和吸入性皮质类固醇有效地减少了COPD患者的恶化. 家庭氧气疗法是唯一被证明可以延长生存的干预措施,特别是在休息低氧症患者中.
科学领域:
- 肺部医学 肺部医学
- 呼吸系统护理 呼吸系统护理
背景情况:
- 慢性阻塞性肺病 (COPD) 护理已经显著发展.
- 新型疗法有可能改善患者的健康状况并改变疾病的进展.
研究的目的:
- 系统地审查COPD关键干预措施的临床影响.
- 评估的疗法包括支气管扩展剂,皮质类固醇,通风,康复,氧气和管理计划.
主要方法:
- 进行了随机对照试验和1980年至2002年的系统性审查的系统性审查.
- 搜索了MEDLINE和Cochrane数据库,并通过文献搜索和专家咨询进行了补充.
- 包括≥3个月的随访 (≥6周的康复) 评估生活质量,恶化或死亡率的研究.
主要成果:
- 长效支气管扩展剂和吸入性皮质类固醇可以将COPD恶化减少20-30%.
- 肺部康复改善了健康状况,但没有改善长期生存率.
- 在休息时缺氧 (PaO2 < 60 mm Hg) 的患者中,家庭氧疗增加了~40%的存活率.
- 非侵入性机械通风和疾病管理计划对生存或住院没有显著的益处.
结论:
- 强有力的证据支持长效支气管扩展剂和吸入性皮质类固醇可减少COPD恶化.
- 家庭氧气疗法是唯一已被证明可以延长存活时间的干预措施,仅限于低血量患者.
- 进一步的研究可能会完善中度至重度COPD的治疗策略.
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