脉冲氧计的准确性用于长期氧气治疗评估慢性阻塞性肺部疾病
Brian Garnet1,2, Rodrigo Diaz-Lankenau3, Elie Jean3
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miami, Florida; and.
Annals of the American Thoracic Society
|July 6, 2023
概括
脉冲氧计 (SpO2) 在需要长期氧气治疗 (LTOT) 的COPD患者中经常错过严重的低氧症. 动脉血液气体 (ABG) 分析至关重要,SpO2 值需要调整,特别是对于活跃吸烟者.
科学领域:
- 肺部医学 肺部医学
- 呼吸系统生理学 呼吸系统生理学
- 诊断的准确性 诊断的准确性
背景情况:
- 具有里程碑意义的长期氧疗法 (LTOT) 研究使用了动脉氧气压 (PaO2).
- 脉冲氧计 (SpO2) 现在用于评估COPD的低氧化.
- 全球慢性阻塞性肺病倡议 (GOLD) 的指导方针建议,如果SPO2≤92%,则进行动脉血液气体 (ABG) 分析.
研究的目的:
- 评估SPO2与ABG的性能,以检测COPD患者的严重休息低氧症.
- 评估SPO2在识别需要LTOT的患者中的准确性.
主要方法:
- 从518名稳定的COPD门诊患者中对联SpO2和ABG值的回顾性分析.
- 基于SpO2值和PaO2水平计算的虚假负值 (FNs).
- 使用接收器操作特征 (ROC) 分析,类内相关系数 (ICC),偏差,精度和精度平方根平均值 (ARMS) 进行测试性能评估.
主要成果:
- 严重的休息低氧症的患病率为14.3% (74名患者).
- 10% (52名患者) 的严重低氧症病例 (FNs) 中,SpO2错过了10%,其中2.5%的SpO2>92% (隐性低氧症).
- 在黑人患者和活跃吸烟者中观察到更高的FN和隐性低氧症率. 建议ABG评估的最佳SpO2截止值为≤94%.
结论:
- 单独的SpO2对于检测COPD患者的严重低氧症具有很高的假阴性率,这些患者被评估为LTOT.
- 黄金指南建议进行ABG分析,并且应考虑在SPO2截止值高于≤92%的情况下进行ABG分析,特别是对于活跃吸烟者.
- 准确的低氧症评估对于适当的LTOT启动和COPD的管理至关重要.
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