Muakkassa F F, Rutledge R, Fakhry S M, Meyer A A, Sheldon G F
Department of Surgery, University of Mississippi Medical Center, Jackson 39216-4505.
J Trauma. 1990 Sep;30(9):1087-93; discussion 1093-5.
Arterial blood gas measurements (ABGs) are the most common tests ordered in an ICU. ABG utilization in a surgical ICU over a 1-year period (September 1, 1987-October 31, 1988) was evaluated to identify factors that might help reduce overutilization. A total of 842 admissions comprising 2,381 patient days were reviewed. ABGs were the most commonly ordered test (mean of 4.8/patient/day). Patients with arterial lines (A-lines) had more ABGs drawn than those who did not regardless of the value of PaO2 (p less than 0.01), PaCO2 (p less than 0.01 except for PaCO2 greater than 55), APACHE II score (p less than 0.01), use of ventilators (p less than 0.01), pulse oximeters (p less than 0.01), or a combination of the last two (p less than 0.01). Multivariate analysis demonstrated that the presence of an A-line was the most powerful predictor of the number of ABGs drawn per patient (p less than 0.0001) independent of all other measures of the patient's clinical status such as the use of ventilators, oximeters, and values of PaO2, PaCO2, or the APACHE II score. This suggests that ABGs are being drawn unnecessarily simply because of the presence of an A-line. To reduce the number of ABGs drawn, a policy for specific indications for placement of A-lines and ABG analysis should be adopted.
动脉血气分析（ABGs）是重症监护病房（ICU）中最常进行的检查项目。对一个外科ICU在1年期间（1987年9月1日至1988年10月31日）的ABG使用情况进行了评估，以确定可能有助于减少过度使用的因素。共审查了842例入院患者，涵盖2381个患者日。ABGs是最常进行的检查（平均每位患者每天4.8次）。无论动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）（除PaCO2大于55外，p均小于0.01）、急性生理与慢性健康状况评分系统II（APACHE II）评分（p小于0.01）、是否使用呼吸机（p小于0.01）、脉搏血氧饱和度仪（p小于0.01）或后两者的组合情况（p小于0.01）如何，有动脉置管（A管）的患者进行ABG检查的次数都比没有的患者多。多变量分析表明，A管的存在是每位患者ABG检查次数的最有力预测因素（p小于0.0001），独立于患者临床状况的所有其他指标，如呼吸机的使用、血氧饱和度仪、PaO2、PaCO2的值或APACHE II评分。这表明仅仅因为存在A管就不必要地进行了ABG检查。为了减少ABG检查的次数，应采用关于A管放置和ABG分析的特定指征的政策。
