Ahrens T
Crit Care Nurse. 1993 Aug;13(4):78-83.
Changing the perspective of clinical assessment to cellular oxygenation assessment will be a trend in the 1990s, particularly with the development of new technologies. New technologies such as MRI and PET scanning will increase clinicians' ability to assess cellular dysfunction and oxygenation disturbances. Because of improved technology, the focus in assessing oxygenation of the critically ill also will change. Critical care clinicians must accurately identify whether arterial or cellular oxygenation is being assessed. Arterial oxygenation problems are usually a reflection of a loss of hemoglobin or deteriorating lung function (through increased intrapulmonary shunting). Cellular oxygenation problems are more related to the relationship between oxygen delivery and cellular utilization of oxygen. In most critical care situations, cellular oxygenation is the aspect of oxygenation that is of most interest. The more familiar the clinician is with the role oxygen plays in cellular metabolism, the more meaningful the oxygenation assessment becomes. Common nursing techniques for the assessment of oxygenation (eg, physical assessment, blood gases and pulse oximetry) still have a place, but their limited accuracy must be kept in perspective when assessing cellular oxygenation.
将临床评估视角转变为细胞氧合评估将是20世纪90年代的一个趋势，尤其是随着新技术的发展。诸如磁共振成像（MRI）和正电子发射断层扫描（PET）等新技术将提高临床医生评估细胞功能障碍和氧合紊乱的能力。由于技术的改进，对危重病患者氧合评估的重点也将发生变化。重症监护临床医生必须准确识别所评估的是动脉氧合还是细胞氧合。动脉氧合问题通常反映血红蛋白减少或肺功能恶化（通过肺内分流增加）。细胞氧合问题更多地与氧输送和细胞对氧的利用之间的关系有关。在大多数重症监护情况下，细胞氧合是氧合中最受关注的方面。临床医生对氧在细胞代谢中所起作用越熟悉，氧合评估就越有意义。常见的氧合评估护理技术（如体格检查、血气分析和脉搏血氧饱和度测定）仍有其作用，但在评估细胞氧合时，必须正确看待其有限的准确性。
