【適応と基準】在宅酸素療法についてご存じですか?
あなたは「在宅酸素療法」という言葉を聞いたことがありますか。新型コロナウィルスの流行により、自宅待機を必要とされた方にも、必要な場合、この在宅酸素療法を行っているケースについても、メディアでは取り上げられていました。この記事では、在宅酸素療法がどのような方に適応されるのか、その基準についてまとめています。
目次
在宅酸素療法とはどんな治療を指すのか？
ここで、最初に「在宅酸素療法」とは何なのかということについてご紹介します。
肺に慢性的な疾患を持った方や、なんらかの理由で、身体に酸素を運ぶことができない状態にある方に対し、濃い濃度の酸素を身体に（血液中に）取り入れてもらう治療を「酸素療法」と言います。
一定の酸素量を身体に保つことができない場合、入院中だけでなく、自宅でも酸素療法を必要とすることもあります。
その場合に、酸素療法を自宅で（在宅で）行うことを「在宅酸素療法」と言います。英語では「Home Oxygen Therapy」と言い、その頭文字をとって、医療の現場では、在宅酸素療法のことをＨＯＴ(ホット)とも呼びます。
在宅酸素療法の目的はなんでしょうか
酸素療法の一番の目的は、体が必要としている酸素を補うことです。
肺は、呼吸をすることで、酸素を多く含んだ空気を体内に取り込み、二酸化炭素を吐いて体外に出す働きを持っています。
しかし、肺がなんらかの理由で病気になって、交換の機能が十分に果たせない場合、全身のあらゆる、臓器や細胞に必要な酸素が不足することとなります。
その場合、酸素の濃度が低下するため、補充をしてあげる必要がでてきます。酸素が不足し、不足した状態が続くことで、脳などの重要な臓器に、大変な負担がかかり、機能の低下が危ぶまれます。
また、脳卒中や心不全といった合併症を生じてしまうこともあります。その結果、生命維持に影響し、寿命を縮めてしまいます。
医師は、肺に病気がある人に対し、酸素の量を決め、必要分の酸素を充填できるように治療を行います。
鼻のチューブから酸素が通り、吸入を行います。
私たちが、自然に呼吸している場合、普段すっている空気の中に酸素は、約21%含まれています。
しかし、肺になんらかの病気を抱えている場合は、その濃度の酸素では、必要量を取り込むことができず、不足してしまうのです。
そのため、酸素療法では、21％より濃い濃度の酸素を吸うことになります。
どんな時に、在宅酸素療法の適応となるのか？基準は？
在宅酸素療法は、どのような場合に適応となるのでしょうか。
様々な疾患が存在しますが、おもに症状から見ていくと、肺、もしくは心臓に、高度機能障害を抱えている方に対し、在宅でも酸素療法を行います。
主に、呼吸機能に関係する臓器である、肺や心臓が慢性的な障害を抱えると、臓器としての機能が低下してしまうため、在宅酸素療法が必要となります。
具体的な疾患としては、高度慢性呼吸不全例、肺高血圧症、慢性心不全、チアノーゼ型先天性心疾患および重度の群発頭痛などが挙げられます。
そのなかでも、慢性呼吸器性疾患（COPD）の患者が最も多く、肺線維症、間質性肺炎、肺結核後遺症と続きます。持っている方です。
具体的には高度慢性呼吸不全患者、肺高血圧患者、慢性心不全患者、チアノーゼ型先天性心疾患患者が挙げられます。
しかし、いずれの疾患を抱えていたとしても、呼肺や心臓が慢性的に障害されており、臓器の機能低下が一定の状態まで認められた場合に、在宅酸素療法が必要になることがあります。
重症でなければ、在宅酸素療法を必ずしも必要とするわけではありません。
在宅酸素の適応か否かを診るためには、医師によって、患者さんの動脈の採血を行い、酸素の圧を測ることや、酸素がどれだけ体内に取り込まれているかをテストする（酸素飽和度）評価を行います。
また、多少専門的にはなりますが、在宅酸素は社会保険が適用されるもので、次のような基準を満たしている場合に、適応となります。(*1)
１・高度慢性呼吸不全例
動脈血酸素分圧55mmHg 以下の者及び動脈血酸素分圧60mgHg 以下で睡眠時又は運動負荷時に著しい低酸素血症を来す者であって、医師が在宅酸素療法を必要であると認めたもの。
２・肺高血圧症
３・慢性心不全
医師の診断によりNYHA3 度以上であると認められ、睡眠時のチェーン・ストーク呼吸がみられ、無呼吸低呼吸指数（1 時間当たりの無呼吸数及び低呼吸数をいう）が20 以上であることが、睡眠ポリグラフィー上確認されている症例。
４・チアノーゼ型先天性心疾患
在宅酸素療法を受けることで、患者さんに得られる効果
患者さん個々により、症状や疾患の程度により、在宅酸素療法を行うことによる効果の期待の程は異なります。
しかし、在宅酸素療法を行うことで、主に次のような効果を期待することができると言われています。
・息切れが軽減し、歩行距離の延長や生活行動範囲の拡大が可能になる
・肺や心臓への負担を軽減し、心不全への進行を防ぐ効果が期待できる
・睡眠中の酸素不足を改善させる
・頭痛、イライラ、注意力低下、記憶力低下などの症状改善が期待できる
・寿命の延長が期待できる場合もある
酸素療法を行うことで、いずれも、患者さんの生活の質（Quality of Life : クオリティーオブライフ）が改善したり、社会復帰を目指すことが期待できると言えます。
それだけ、体の中に酸素を取り入れると言うことは、生きていくうえで重要なことで、在宅酸素療法がいかに大切な在宅治療であるかということが、わかりますね。
まとめ
酸素療法は、体が必要としている酸素の量を補うための治療法で、肺や心臓の機能低下がみられ、慢性的に疾患を抱えている方に対し、適応となります。
この様な患者さんは、入院中以外にも、自宅で生活を行っていくためには、酸素療法が自宅でも必要となります。
自宅で行う酸素療法を「在宅酸素療法」と呼びます。
在宅酸素療法には、適応となる基準が存在し、医師の指示のもと行われます。
在宅酸素療法は、患者さんの生活の質を改善させるためにも、重要な治療と言えます。
参考サイト 独立行政法人 環境再生機構 【知識編】在宅酸素療法とは より
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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