慢性阻塞性肺疾病急性加重期的氧疗

Oxygen Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

处理慢性阻塞性肺疾病急性加重时吸氧是基本疗法,习惯上一直采用低流量吸氧。这种方法没有合理纠正低氧血症以及由此给机体造成的损害。我国2007版慢性阻塞性肺疾病诊治指南已经提出控制吸氧的概念,国际相关指南要求吸氧后使血氧饱和度维持在90%～93%,这样既可避免二氧化碳麻醉的担忧,又可以纠正低氧血症。现就缺氧和高碳酸血症时肺部病理生理改变,以及控制吸氧的具体方法予以综述。

Oxygen therapy is one of the basics in management of acute exacerbations of chronic obstructive pulmonary disease. Low flow oxygen inhalation has been used traditionally. However, this method does not always correct hypoxemia and the detrimental effects thereof. The Chinese Guidelines in Diagnosis and Treatment of COPD（2007 updated version）proposed the idea of controlled oxygen therapy. The related international guidelines require blood oxygen saturation targeted between 90%-93%, which corrects hypoxemia while avoiding the concern of hypercapnic narcosis. Here is to make a review on the pathophysiology of lungs in hypoxia and hypercapnia and introduce the details of controlled oxygen therapy.