急诊转运期间接受高流量氧疗发生呼吸性酸中毒患者的临床背景分析。

Analysis of the clinical backgrounds of patients who developed respiratory acidosis under high-flow oxygen therapy during emergency transport.

作者信息

Ogino Hirokazu, Nishimura Naoki, Yamano Yasuhiko, Ishikawa Genta, Tomishima Yutaka, Jinta Torahiko, Takahashi Osamu, Chohnabayashi Naohiko

机构信息

Division of Pulmonary Medicine St. Luke's International Hospital Tokyo Japan.

Center for Clinical Epidemiology St. Luke's Life Science Institute Tokyo Japan.

出版信息

Acute Med Surg. 2015 Jun 30;3(1):26-31. doi: 10.1002/ams2.138. eCollection 2016 Jan.

DOI:10.1002/ams2.138

PMID:29123744

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5667224/

Abstract

AIM

High-flow oxygen is often administered to patients during emergency transport and can sometimes cause respiratory acidosis with disturbed consciousness, thereby necessitating mechanical ventilation. Although oxygen titration in chronic obstructive pulmonary disease patients during emergency transport reduces mortality rates, the clinical risk factors for respiratory acidosis in emergency settings are not fully understood. Therefore, we analyzed the clinical backgrounds of patients who developed respiratory acidosis during pre-hospital transport.

METHODS

This was a retrospective study of patients who arrived at our hospital by emergency transport in 2010 who received high-flow oxygen while in transit. Respiratory acidosis was defined by the following arterial blood gas readings: pH, ≤7.35; PaCO , ≥45 mmHg; and HCO , ≥24 mmol/L. The risk factors were identified using multivariable logistic regression analysis.

RESULTS

In 765 study patients, 66 patients showed respiratory acidosis. The following risk factors for respiratory acidosis were identified: age, ≥65 years (odds ratio [OR] 1.4; 95% confidence interval [CI], 0.7-2.8); transportation time, ≥10 min (OR 2.0; 95% CI, 1.1-3.7); three digits on the Japan Coma Scale (OR 3.1; 95% CI, 1.7-5.8); percutaneous oxygen saturation, ≤90% (OR 1.6; 95% CI, 0.8-3.0); tuberculosis (OR 4.5; 95% CI, 1.4-15.1); asthma (OR 1.8; 95% CI, 0.6-5.3); pneumonia (OR 1.5; 95% CI, 0.7-3.1); and lung cancer (OR 3.9; 95% CI, 1.5-10.1). These underlying diseases as risk factors included both comorbid diseases and past medical conditions.

CONCLUSIONS

The factors identified may contribute to the development of respiratory acidosis. Further studies on preventing respiratory acidosis will improve the quality of emergency medical care.

摘要

目的

在紧急转运过程中常对患者给予高流量氧气，有时会导致呼吸性酸中毒并伴有意识障碍，从而需要机械通气。尽管在紧急转运期间对慢性阻塞性肺疾病患者进行氧滴定可降低死亡率，但紧急情况下呼吸性酸中毒的临床危险因素尚未完全明确。因此，我们分析了在院前转运期间发生呼吸性酸中毒的患者的临床背景。

方法

这是一项对2010年通过紧急转运抵达我院且在转运途中接受高流量氧气的患者的回顾性研究。呼吸性酸中毒由以下动脉血气读数定义：pH值≤7.35；动脉血二氧化碳分压（PaCO₂）≥45 mmHg；碳酸氢根（HCO₃⁻）≥24 mmol/L。使用多变量逻辑回归分析确定危险因素。

结果

在765例研究患者中，66例出现呼吸性酸中毒。确定了以下呼吸性酸中毒的危险因素：年龄≥65岁（比值比[OR] 1.4；95%置信区间[CI]，0.7 - 2.8）；转运时间≥10分钟（OR 2.0；95% CI，1.1 - 3.7）；日本昏迷量表评分为三位数（OR 3.1；95% CI，1.7 - 5.8）；经皮血氧饱和度≤90%（OR 1.6；95% CI，0.8 - 3.0）；肺结核（OR 4.5；95% CI，1.4 - 15.1）；哮喘（OR 1.8；95% CI，0.6 - 5.3）；肺炎（OR 1.5；95% CI，0.7 - 3.1）；以及肺癌（OR 3.9；95% CI，1.5 - 10.1）。这些作为危险因素的基础疾病包括合并症和既往病史。