Emerman C L, Connors A F, Lukens T W, Effron D, May M E
Department of Emergency Medicine, Cleveland Metropolitan General Hospital, Ohio 44109.
Ann Emerg Med. 1989 May;18(5):523-7. doi: 10.1016/s0196-0644(89)80837-6.
Previous studies have established spirometric criteria for arterial blood gas analysis during acute asthmatic attacks. However, only general guidelines have been available regarding the need for blood gas analysis during an acute exacerbation of chronic obstructive pulmonary disease (COPD). We conducted a study to determine the relationship between arterial blood gases and spirometry in 70 emergency department patients during acute exacerbations of COPD. Arterial blood gas analysis and spirometry were performed on arrival at the emergency department. All of the patients with a pCO2 of more than 45 mm Hg had an FEV1 of less than 35% of the predicted normal. We found patients with a pO2 of less than 60 mm Hg who had an FEV1 as high as 54% of the predicted normal. There was no correlation between the FEV1 and pO2. Because spirometry was not reliable for identifying patients with significant hypoxemia, we conclude that arterial blood gas analysis is indicated for patients presenting to the ED with acute exacerbations of COPD. Spirometric criteria that have been used to eliminate the need for arterial blood gases in asthmatic patients cannot be applied safely to patients with COPD.
以往的研究已经确立了急性哮喘发作期间动脉血气分析的肺量计标准。然而，关于慢性阻塞性肺疾病（COPD）急性加重期进行血气分析的必要性，仅有一些通用指南。我们开展了一项研究，以确定70例COPD急性加重期急诊患者的动脉血气与肺量计检查结果之间的关系。在患者抵达急诊科时进行动脉血气分析和肺量计检查。所有动脉血二氧化碳分压（pCO2）超过45 mmHg的患者，其第一秒用力呼气容积（FEV1）均低于预测正常值的35%。我们发现，动脉血氧分压（pO2）低于60 mmHg的患者，其FEV1高达预测正常值的54%。FEV1与pO2之间无相关性。由于肺量计检查对于识别严重低氧血症患者不可靠，我们得出结论，对于因COPD急性加重而就诊于急诊科的患者，应进行动脉血气分析。用于排除哮喘患者进行动脉血气分析必要性的肺量计标准，不能安全地应用于COPD患者。
