Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Long-term oxygen therapy in patients with chronic respiratory failure in one university hospital

호흡부전환자의 재택산소치료 실태: 한 대학병원에서의 관찰

  • Huh, Jin Won (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jung Yeon (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Yeon Mok (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang Do (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Woo Sung (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Dong Soon (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won Dong (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 허진원 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 이정연 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 내과학교실)
  • Received : 2004.12.29
  • Accepted : 2005.01.10
  • Published : 2005.02.28
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Abstract

Background : Although home oxygen therapy in hypoxemic patients with chronic lung disease has been increasing over the decade in Korea, the present state has not been known well. This study was done to know the situation of home oxygen therapy in a Korean university hospital. Methods : Between January 1, 2000 and August 31, 2003, 86 patients prescribed home oxygen therapy by the pulmonary physicians of Asan Medical Center were investigated using their medical record and questionnaire. Results : Patients (52 men, mean age of 61 years) with home oxygen therapy were increasing by every year. Underlying diseases were COPD (n=29), tuberculous destroyed lung (n=18), bronchiectasis (n=15), ILD (n=12), and others. Baseline $FEV_1/FVC$, FVC, and $FEV_1$ of patients were $58.4{\pm}25.2%$, $54.5{\pm}17.1%$ of predicted, and $41.7{\pm}20.6%$ of pred. Mean oxygen flow was 1.5 L/min and mean duration per day was 14.5 hours. During therapy, mean $PaO_2$ values have increased from 51.2 to 77.7 mm Hg and $PaCO_2$ values have increased from 47.5 to 49.6 mm Hg. Only 16.5% of the subjects were monitored by visiting nurses or pulse oximeter. Three year survival rate was 56.6% and hypercapnic patients showed better prognosis. Conclusion : The patients with home oxygen therapy were increasing yearly and a part of them were monitored. The hypercapnea respiratory failure patients would have better prognosis.

연구배경 : 최근 국내에서도 만성폐질환을 가진 저산소증 환자에게 재택산소요법이 증가하고 있으나 그 실태는 잘 알려져 있지 않다. 이에 한 대학병원 호흡기내과에서 재택산소요법을 처방 받은 환자들의 실태를 알아보고자 하였다. 방 법 : 2000년 1월부터 2003년 8월까지 서울아산병원 호흡기내과에서 재택산소요법을 처방 받은 환자들을 대상으로 의무기록 검토와 설문조사를 시행하였다. 산소를 중단한 4명의 환자는 제외하였다. 결 과 : 총 86명의 환자가 산소요법을 처방받았고, 2000년 이후로 매년 빈도가 증가되는 추세였다.남/녀비는 52/34명, 평균연령은 61.3세였다. 환자들의 기저질환으로 만성폐쇄성폐질환 29명, 결핵파괴폐 18명, 기관지확장증 15명, 간질성폐질환 12명, 척추후측만증 7명 등으로 다양한 질환을 보였다. 산소 처방 당시 평균 53명의 폐기능 소견은 $FEV_1/FVC$ 비 $58.4{\pm}25.2%$, FVC $54.5{\pm}17.1$ (% pred.), $FEV_1$ $41.7{\pm}20.6$ (% pred.)로 측정되었다. 산소요법은 1.5 L/min에서 시작하여 평균 14.5시간 동안 사용하였다. 산소 처방 당시 동맥혈 산소농도는 77.7 mm Hg, 동맥혈 이산화탄소농도는 49.6 mm Hg 정도로 조절하였다. 전체 환자 중에서 가정간호사 방문이나 맥박산소측정기로 집에서 산소포화도를 모니터링 하는 경우는 16.5%에 불과하였고 대부분의 환자는 외래 방문시 시행하는 동맥혈가스분석이나 증상에 따라 산소량을 조절하였다. 재택산소치료를 하는 환자들의 3년 생존율은 56%였고 고탄산혈증을 가지는 환자에서 더 좋은 예후를 보였다. 결 론 : 재택산소치료는 다양한 폐질환 환자에게 시행되고 있고, 점차 빈도도 증가하고 있어 효율적인 관리 체계의 확립을 위한 보험제도의 개선이 필요할 것으로 사료된다.

Keywords

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