[General problems posed by the domiciliary treatment of chronic respiratory insufficiency].

P Sadoul, J M Polu
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Abstract

Hypoxaemia secondary to chronic bronchopulmonary disease may lead to total invalidity and be complicated by right heart failure. Consistent and meticulous medical care may produce a notable improvement by not smoking, using bronchodilators, mucolytics and physiotherapy. If, despite these measures, frank hypoxaemia persists, then domiciliary oxygen should be considered. The need for prolonged oxygen therapy of more than 15 hours is often countered by the scepticism and lack of discipline of the patient and family. In cases of hypoxaemia which are partially refractory or are associated with hypercapnia prolonged mechanical ventilation with a tracheotomy will ensure considerable salvage in those with severe restrictive defects and right heart failure. The supervision of oxygen therapy requires not only adequate control of blood gases, but also collaboration between the family doctor, the respiratory physician and home visitors such as the nurse or technician.

【住院治疗慢性呼吸功能不全的一般问题】。
继发于慢性支气管肺疾病的低氧血症可导致完全失能并并发右心衰。持续细致的医疗护理可以通过不吸烟、使用支气管扩张剂、黏液溶解剂和物理治疗产生显著的改善。如果尽管采取了这些措施,仍然存在明显的低氧血症,则应考虑居家供氧。需要延长超过15小时的氧气治疗,往往会受到病人和家属的怀疑和缺乏纪律的抵制。在部分难治性低氧血症或伴有高碳酸血症的病例中,气管切开术延长机械通气将确保对严重限制性缺陷和右心衰患者有相当大的挽救作用。氧疗的监督不仅需要充分控制血气,还需要家庭医生、呼吸内科医生和护士或技术人员等家访人员之间的合作。
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