Wilson A T, Channer K S
Pinderfields Hospital, West Yorkshire.
J R Coll Physicians Lond. 1997 Nov-Dec;31(6):657-61.
To assess the incidence and degree of hypoxaemia in patients with acute myocardial infarction and evaluate the nation-wide perception and usage of oxygen therapy.
Postal survey of all coronary care units (CCU) in England of their use of prescribed oxygen and pulse oximetry. Prospective randomised study of 50 patients presenting within 24 hours of onset of myocardial infarction, half of whom received oxygen therapy. Oxygen saturation (SpO2) as continuously measured by pulse oximetry, and arrhythmias and ST segment changes were recorded on simultaneous 24-hour ambulatory Holter monitors.
In 53% of UK coronary care units oxygen is not routinely prescribed but in only 3% is a pulse oximeter used to aid management. In patients presenting with acute myocardial infarction the incidence of hypoxaemia (SpO2 < 90%) was 70% and severe hypoxaemia 35% in those not given oxygen, compared with only 27% and 4% in patients given oxygen therapy. The only patient to receive oxygen on clinical grounds had an oxygen saturation of 71%. Severe hypoxaemia (SpO2 < 80%) occurred significantly less often (1 and 7 patients, p < 0.05) in patients given oxygen. There were no differences in arrhythmias or ST segment changes between groups.
Hypoxaemia occurs frequently in patients in the first 24 hours after acute myocardial infarction. It is effectively and easily treated with supplemental oxygen which can be guided by pulse oximetry. This is rarely done. Measurements of oxygen saturation are therefore justified in all patients to guide oxygen therapy unless there is a decision to give all patients supplemental oxygen: this we believe to be unnecessary.
评估急性心肌梗死患者低氧血症的发生率及程度，并评价全国范围内氧疗的认知和使用情况。
对英格兰所有冠心病监护病房（CCU）使用处方氧和脉搏血氧饱和度测定情况进行邮政调查。对50例在心肌梗死发病24小时内就诊的患者进行前瞻性随机研究，其中一半患者接受氧疗。通过脉搏血氧饱和度仪连续测量血氧饱和度（SpO2），并在同步24小时动态心电图监测仪上记录心律失常和ST段变化。
在英国53%的冠心病监护病房中，氧并非常规处方用药，而仅3%的病房使用脉搏血氧饱和度仪辅助治疗。在急性心肌梗死患者中，未接受氧疗者低氧血症（SpO2 < 90%）的发生率为70%，严重低氧血症发生率为35%，而接受氧疗的患者中这一比例分别为27%和4%。唯一因临床原因接受氧疗的患者血氧饱和度为71%。接受氧疗的患者中，严重低氧血症（SpO2 < 80%）的发生频率显著较低（分别为1例和7例，p < 0.05）。两组间心律失常或ST段变化无差异。
急性心肌梗死后24小时内患者常发生低氧血症。补充氧气可有效且简便地治疗低氧血症，可通过脉搏血氧饱和度仪进行指导。但目前很少这样做。因此，除非决定对所有患者都给予补充氧气（我们认为这没有必要），否则对所有患者进行血氧饱和度测量以指导氧疗是合理的。
