Urushidani Seigo, Kuriyama Akira, Matsumura Masami
Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, JPN.
Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JPN.
Cureus. 2020 Dec 25;12(12):e12273. doi: 10.7759/cureus.12273.
Background Patients with psychogenic hyperventilation frequently visit emergency departments (EDs). Arterial blood gas (ABG) analysis is performed to evaluate patients with dyspnea. This may show respiratory alkalosis in patients with hyperventilation. ABG may also reveal elevated serum lactate levels, although psychogenic hyperventilation syndrome is a benign condition. However, arterial puncture is a painful and risky procedure. We hypothesized that venous blood gas (VBG) analysis would be sufficient for evaluating patients with suspected psychogenic hyperventilation. Objectives To compare the clinical utility of VBG analysis with ABG analysis for evaluating psychogenic hyperventilation. Methods This was a single-center retrospective cross-sectional study of patients aged ≥18 years with psychogenic hyperventilation attending a tertiary care hospital. We extracted data on age, sex, vital signs, blood gas components, and serum lactate. Spearman's rank correlation coefficient (ρ) was used to examine the associations between the serum lactate levels and the carbon dioxide partial pressure (PCO) in the ABG and VBG groups. Results A total of 236 patients (ABG group, n=57; VBG group, n=179) were included in the analysis. Both the ABG and VBG groups had respiratory alkalosis and similarly elevated serum lactate levels (p=0.44). The PCO and serum lactate levels were inversely correlated, and the ρ values were -0.74 and -0.50 for the ABG and VBG groups, respectively (both p<0.001). In addition, the bicarbonate ion ([Formula: see text]) level was inversely correlated with the serum lactate level, and the pH was positively correlated with the serum lactate levels in both the ABG and VBG groups. Conclusions Among patients with psychogenic hyperventilation, respiratory alkalosis, and the correlation between the PCO and serum lactate levels were similar in the ABG and VBG groups, indicating that VBG analysis might be used as an alternative to ABG analysis for evaluating psychogenic hyperventilation.
心因性过度通气患者经常前往急诊科就诊。动脉血气（ABG）分析用于评估呼吸困难患者。这可能显示过度通气患者存在呼吸性碱中毒。尽管心因性过度通气综合征是一种良性疾病，但ABG也可能显示血清乳酸水平升高。然而，动脉穿刺是一种痛苦且有风险的操作。我们假设静脉血气（VBG）分析足以评估疑似心因性过度通气的患者。
比较VBG分析与ABG分析在评估心因性过度通气方面的临床效用。
这是一项对一家三级医院中年龄≥18岁的心因性过度通气患者进行的单中心回顾性横断面研究。我们提取了年龄、性别、生命体征、血气成分和血清乳酸的数据。采用Spearman等级相关系数（ρ）来检验ABG组和VBG组中血清乳酸水平与二氧化碳分压（PCO）之间的关联。
共有236例患者（ABG组，n = 57；VBG组，n = 179）纳入分析。ABG组和VBG组均存在呼吸性碱中毒，且血清乳酸水平同样升高（p = 0.44）。PCO与血清乳酸水平呈负相关，ABG组和VBG组的ρ值分别为 -0.74和 -0.50（均p < 0.001）。此外，ABG组和VBG组中碳酸氢根离子（[公式：见正文]）水平与血清乳酸水平呈负相关，pH与血清乳酸水平呈正相关。
在心因性过度通气患者中，ABG组和VBG组的呼吸性碱中毒以及PCO与血清乳酸水平之间的相关性相似，表明VBG分析可能可作为ABG分析的替代方法用于评估心因性过度通气。
