Nurcan TÜRKOĞLU, Tacettin ÖRNEK, Figen ATALAY, Fatma ERBOY, Bülent ALTINSOY, Hakan TANRIVERDİ, Fırat UYGUR, Meltem TOR

Evaluating the Efficiency of Long Term Oxygen Therapy and Mortality in Chronic Obstructive Pulmonary Disease

Kronik Obstrüktif Akciğer Hastalığı (KOAH) olan hastalarda uzun süreli oksijen tedavisi (USOT) hipoksemiye sekonder polisitemiyi ve sağ kalp yetmezliğini düzelttiği, pulmoner hipertansiyonu düşürdüğü, yaşam kalitesini ve yaşam süresini uzattığı gösterilmiştir. Çalışmamızda oksijen konsantratörü ile USOT alan KOAH’lı hastaların klinik verilerini ve mortaliteyi değerlendirmeyi ve bu hastalarda tedavi uyumunu ve USOT’un KOAH’lı hastalar üzerindeki tedavi yararlılığını değerlendirmeyi amaçladık. Çalışmaya alınan hastaların yaş ortalaması %70.5±9.7 olup %57’si erkek idi. USOT sonrası bir yıllık hastane yatış sayısının (0.56±0.79), USOT öncesi bir yıllık hastane yatış sayısına (1.14±1.64) göre azaldığı bulundu. USOT sonrası kan gazlarının, oksijen konsantratörü verildiği dönemdeki kan gazlarıyla kıyaslandığında PaO2’nin (47.9±4, 53.4±9) arttığı, PaCO2’nin (56.1±11, 50.5±11) azaldığı tespit edildi. USOT sonrası pulmoner arter basıncı ve hemoglobinde belirgin bir değişiklik olmazken hematokrit’de (38.37±6, 40.14±6) artış tespit edildi. Çalışmaya katılan hastaların %41.1’i oksijen konsantratörüne en az bir kere bakım yaptırdığı ve USOT sonrası hastaların sadece %38.4’ü (n:43) KOAH nedeniyle en az bir kere poliklinik kontrolüne geldiği tespit edildi. En sık düzensiz USOT kullanma nedeni ise ihtiyaç duymama idi. Çalışmaya alınan hastaların günlük USOT kullanım süresi 13.88±4.35 saat/gün olup, hastaların %68.8’i oksijeni günlük ortalama 15 saat ve üzeri kullanıyordu. Çalışmaya alınan hastaların takip süresi 17.85±14.53 ay olup takip süresi içinde mortalite oranı %67 idi. USOT’ni 15 saat/gün ve üzeri kullanan hastaların mortalitesi kullanmayanlara göre daha yüksekti (%54.6, %12.5). Sonuç olarak USOT endikasyonu olan tüm olgular ulusal kayıt sistemi ile takip edilmeli ve teknik hizmetler yönünden de izlenmelidir. USOT verilen hastaların tedaviye uyumu incelenmeli ve hastaların düzenli kontrole gelmeleri sağlanmalıdır

Anahtar Kelimeler:

KOAH, mortalite, konsantratör, oksijen, USOT

Evaluating the Efficiency of Long Term Oxygen Therapy and Mortality in Chronic Obstructive Pulmonary Disease

It has been shown that Long Term Oxygen Therapy (LTOT) improves polycythemia secondary to hypoxemia and right heart failure, decreases pulmonary hypertension, improves quality of life and increases life expectancy in COPD patients. In our study we aimed to evaluate clinical data, mortality, patient's adherence and efficiency of the therapy in COPD patients receiving LTOT. Mean age was 70.5%±9.7 and 57% of the participiants were male. It was shown that one year hospital admission count after LTOT (0.56±0.79) was decreased according to one year hospital admission count before LTOT (1.14±1.64). When arterial blood gas values after LTOT compared to the values at the time prescription PaO2 was increased (47.9±4, 53.4±9) and PaCO2 was decreased (56.1±11, 50.5±11). Although there was no significant difference in pulmonary artery pressure after LTOT, a significant increase was determined in hematocrit (38.37±6, 40.14±6). 41.1% of the patients had at least once device maintanence, and after LTOT only 38.4% had a clinical control due to COPD. The most common reason for irregular use was lack of necessity. Mean daily oxygen usage was 13.88±4.35 hours/day and 68.8% of the patients were using 15 hours or more. Mean follow-up of the patients were 17.85±14.53 (1-55) months and mortality rate in this period was 67%. Mortality was higher in LTOT with 15hours/day or more compared to less than 15 hours (respectively 54.6%, 12.5%). In conclusion, all patients with an indication for LTOT should be followed by national registry system and monitored in terms of technical services. Patients adherence and routine controls should be provided.

Keywords:

COPD, mortality, concentrator, oxygen, LTOT,

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