Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine Hospital, 167 Furlong Road, St. Albans, Melbourne, Victoria, Australia.
Emerg Med Australas. 2010 Dec;22(6):493-8. doi: 10.1111/j.1742-6723.2010.01344.x.
The objectives of the present review are to describe the agreement between variables on arterial and venous blood gas analysis (in particular pH, pCO(2) , bicarbonate and base excess) and to identify unanswered questions. MEDLINE search of papers published from 1966 to January 2010 for studies comparing arterial and peripheral venous blood gas values for any of pH, pCO(2) , bicarbonate and base excess in adult patients with any condition in an emergency department setting. The outcome of interest was mean difference weighted for study sample size with 95% limits of agreement. The weighted mean arterio-venous difference in pH was 0.035 pH units (n= 1252), with narrow limits of agreement. The weighted mean arterio-venous difference for pCO(2) was 5.7 mmHg (n= 760), but with 95% limits of agreement up to the order of ±20 mmHg. For bicarbonate, the weighted mean difference between arterial and venous values was -1.41 mmol/L (n= 905), with 95% limits of agreement of the order of ±5 mmol/L. Regarding base excess, the mean arterio-venous difference is 0.089 mmol/L (n= 103). There is insufficient data to determine if these relationships persist in shocked patients or those with mixed acid-base disorders. For patients who are not in shock, venous pH, bicarbonate and base excess have sufficient agreement to be clinically interchangeable for arterial values. Agreement between arterial and venous pCO(2) is too poor and unpredictable to be clinically useful as a one-off test but venous pCO(2) might be useful to screen for arterial hypercarbia or to monitor trends in pCO(2) for selected patients.
本综述的目的在于描述动脉血气分析与静脉血气分析（特别是 pH 值、pCO2、碳酸氢盐和碱剩余）各项指标之间的一致性，并确定尚未解决的问题。检索 1966 年至 2010 年 1 月期间在急诊环境下，以任何疾病为研究对象，比较成人患者动脉血与外周静脉血气 pH 值、pCO2、碳酸氢盐和碱剩余各项指标的研究。研究结果为根据研究样本量加权的均值差及 95%一致性界限。pH 值的动脉-静脉加权平均差值为 0.035 pH 单位（n=1252），一致性界限较窄。pCO2 的动脉-静脉加权平均差值为 5.7mmHg（n=760），但一致性界限可达 ±20mmHg。对于碳酸氢盐，动脉与静脉值之间的加权平均差值为-1.41mmol/L（n=905），一致性界限在 ±5mmol/L 左右。关于碱剩余，动脉与静脉值之间的平均差值为 0.089mmol/L（n=103）。目前尚无足够的数据来确定这些关系是否在休克患者或混合性酸碱紊乱患者中仍然存在。对于未发生休克的患者，静脉 pH 值、碳酸氢盐和碱剩余与动脉值具有足够的一致性，可作为临床替代值。动脉与静脉 pCO2 的一致性太差且不可预测，无法作为一次性检测用于临床，但静脉 pCO2 可能有助于筛选动脉性高碳酸血症，或监测选定患者 pCO2 的趋势。
