Centre for Sleep Disorders and Respiratory Failure, St George Hospital, Sydney, New South Wales, Australia.
Emergency Department, St George Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2019 Jul;49(7):834-837. doi: 10.1111/imj.14186.
Many patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have type 2 respiratory failure (T2RF). Often arterial blood gases are not performed and correlation with venous blood gases (VBG) is controversial. The venous pH and bicarbonate (HCO ) are useful, but VBG pCO (PvCO ) is considered too unpredictable.
To examine the utility of VBG in this cohort of patients.
A prospective study of AECOPD patients with T2RF presenting to the emergency department was performed. Patients being considered for non-invasive ventilation and who required an arterial blood gas were invited to participate. A subsequent VBG was also taken, and Bland-Altman plots were used for analysis.
Sixty-three patients were included in this study. The limits of agreement for pH and HCO were narrow. Wider limits of agreement with a systematic bias of 7.7 mmHg were noted with pCO .
The utility of VBG pH and HCO was again demonstrated. VBG pCO in this cohort of patients may have a role in the assessment of patients with AECOPD. Further study is needed on the possible role of VBG in the management of such patients with T2RF particularly those using non-invasive ventilation.
许多慢性阻塞性肺疾病（COPD）急性加重（AECOPD）患者存在 2 型呼吸衰竭（T2RF）。通常不进行动脉血气分析，且其与静脉血气（VBG）的相关性存在争议。静脉 pH 值和碳酸氢盐（HCO ）具有一定的相关性，但静脉血二氧化碳分压（PvCO ）变化难以预测。
检验 VBG 在该 T2RF 患者队列中的应用价值。
对因 T2RF 而在急诊科就诊的 AECOPD 患者进行前瞻性研究。对需要进行动脉血气分析的拟行无创通气的患者进行邀请并纳入本研究。同时采集静脉血标本进行 VBG 检测，采用 Bland-Altman 图进行分析。
本研究共纳入 63 例患者。pH 值和 HCO 的一致性界限较窄。pCO 的一致性界限较宽，且存在 7.7mmHg 的系统偏差。
VBG pH 值和 HCO 的应用价值再次得到验证。在本 AECOPD 患者队列中，VBG pCO 可能有助于评估患者病情。还需要进一步研究 VBG 在 T2RF 患者，尤其是使用无创通气的患者管理中的可能作用。
