Department of Respiratory and Critical Care Medicine, Taizhou First People's Hospital, Taizhou, China.
Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
Ann Palliat Med. 2022 Apr;11(4):1473-1481. doi: 10.21037/apm-22-336.
at present, arterial blood gas (ABG) analysis is widely used in the diagnosis and treatment evaluation of acute exacerbation of chronic obstructive pulmonary disease (COPD) in emergency department, but it has the risk of thrombosis and bleeding. In recent years, venous blood gas (VBG) analysis has become more and more popular, but its clinical diagnostic value in emergency patients with acute exacerbation of COPD remains unclear.
relevant clinical studies on the diagnosis of acute exacerbation of COPD by blood gas analysis were searched in Medline, Excerpta Medica Database (EMBASE), Elton B. Stephens. Company (EBSCO), OVID, China Biomedical Database, and Wanfang Database from the establishment of the database to January 2010 to September 2021, Meta-analysis was performed on the data with RevMan5.3. The differences of blood gas analysis indicators potential of hydrogen (pH), partial pressure of carbon dioxide (PaCO2), and hydro-carbonate (HCO3) were compared between the arterial blood gas group and the venous blood gas group. Heterogeneity of results was assessed with Chi2 test and I2 in RevMan5.3.
a total of 7 articles with 1,257 subjects were included in this study. Newcastle-Ottawa scale (NOS) scores were higher than six points. In relation to the ABG analysis and VBG analysis, there was no significant difference in the potential of hydrogen (pH) [mean difference (MD) =-0.00, 95% confidence interval (CI) =0.05-0.04, Z=0.19, P=0.85]; however, there were significant differences in the partial pressure of carbon dioxide (PaCO2) (MD =5.32, 95% CI =3.32-7.33, Z=5.20, P<0.00001) and hydro-carbonate (HCO3) (MD =1.05, 95% CI =0.27-1.83, Z=2.63, P=0.009).
there were differences between ABG and VBG in the diagnosis of patients with acute exacerbation of COPD in the emergency department. Due to the small number of included literatures, further verification is needed.
目前，动脉血气（ABG）分析广泛应用于急诊科慢性阻塞性肺疾病（COPD）急性加重的诊断和治疗评估，但存在血栓和出血的风险。近年来，静脉血气（VBG）分析越来越流行，但在急诊科急性加重 COPD 患者中的临床诊断价值尚不清楚。
在 Medline、Excerpta Medica Database（EMBASE）、Elton B. Stephens. Company（EBSCO）、OVID、中国生物医学数据库和万方数据库中检索了从数据库建立到 2010 年 1 月至 2021 年 9 月期间关于血气分析诊断 COPD 急性加重的相关临床研究，使用 RevMan5.3 对动脉血气组和静脉血气组的氢离子（pH）、二氧化碳分压（PaCO2）和碳酸氢盐（HCO3）的血气分析指标差异进行了 Meta 分析。RevMan5.3 中的 Chi2 检验和 I2 评估结果的异质性。
共纳入 7 项研究，共 1257 例患者。纽卡斯尔-渥太华量表（NOS）评分均高于 6 分。ABG 分析与 VBG 分析比较，pH 值差异无统计学意义[均数差（MD）=-0.00，95%置信区间（CI）=0.05-0.04，Z=0.19，P=0.85]；而 PaCO2（MD=5.32，95%CI=3.32-7.33，Z=5.20，P<0.00001）和 HCO3（MD=1.05，95%CI=0.27-1.83，Z=2.63，P=0.009）差异有统计学意义。
在急诊科 COPD 急性加重患者的诊断中，ABG 与 VBG 存在差异。由于纳入文献数量较少，需要进一步验证。
