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題名 | Pulse Oximetry in Pediatric Intensine Care:Comparison of Measured Saturation and Transcutaneous Oxygen Tension=脈搏式氧和分析儀在兒科重症病嬰之使用及血氧飽和度與經皮式氧分壓之臨床比較 |
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作者 | 馮子強; 傅筱玲; 朱夢麟; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 28:6 民76.11-12 |
頁次 | 頁447-456 |
分類號 | 417.53 |
關鍵詞 | 脈搏式氧和分析儀; 兒科重症; 血氧飽和度; 經皮式氧分壓; |
語文 | 英文(English) |
中文摘要 | 動脈血液氣體分析在監測與治療患有呼吸窘迫徵候之病兒是非常重要的,但是由於個案的限制與採血技衛的困難,以及會造成感染、栓塞、壞死等缺失,使得其賓用性受到相當的限制。經皮式氧分壓監測儀是利用加熱之電極,使皮膚表面之微血管擴張,再經由氧感應器來測定微血管床擴散之氧分壓,此法可測得連續性之數值,但有皮膚灼傷之顧慮。脈搏式氧和分析儀是利用氧和血紅素與不同波長光波之反應,經由微處理機而求得血氧飽和度,是另一種不具侵襲性而反應快速,應用日廣的氧和分析儀。三軍總醫院小兒科加護病房自民國73年1月至76年3月,針對62位臨床上有呼吸窘迫徵候之病嬰,進行了非侵襲性及傳統抽血式之血氧分析研究比較。總計53位(344對資料)接受了經皮氧分壓(tcPO2)測定及動脈血氧分壓(PaO2)之比較;25位(110對資料)接受了脈搏式氧和(tcSO2)測定及抽血式血氧飽和度(SaO2)之比較;其中16位同時接受了非侵襲性血氧分壓及氧飽和度之檢測。結果得知,tcPO2與 PaO2有很好之線性關係(r=0.7, y=29.80+0.55x, P<0.001)且於PaO2界於50~90mmHg時,具有最好之對應關係。同時,tcSaO2與SaO2也有密切之線性相關(r=0.64,y=43.48+0.50x, P<0,001),當SaO2>75%時,二者之關係最為接近。此外,更發現,當SaO2界於75%~95%時,PaO2與tcPO2之差值最小。並且由動脈血氧解離曲線(Oxygen dissociation curve)得知,當tcSaO2界於75%~95%時,有90%以上之PaO2界於50~90mmHg,同時並發現,脈搏式氧和度之測定方法會受pH值之影響,當pH>7.3時,非侵襲性之tcSaO2較抽血所得之SaO2數值為低,pH>7.3時,則反之。而且,經皮式氧分壓值(tcPO2)通常書較PaO2為低,其原因可能與加熱之電極會消耗皮下之氧氣有關。總之,適當使用非侵襲性儀器,檢測接受呼吸治療嬰兒之氧和作用,可收到快速,方便、與可信度高之結果,但是亦不可偏廢了傳統動脈抽血之功能,因為唯有互相的配合,才能獲知PH,HCO3等各種酸鹼平衡的變化,而這些同為呼吸治療必備的指標。 |
英文摘要 | This study was designed to evaluate the pulse oximeter in infants, and to compare its performance with tcPO2 monitoring and measured saturation and oxygen tension from arterial blood samples. Study was performed on 62 patients. In 53 patients (344 sets of data), it revealed a good linear correlation between transcutaneous PO2 and arterial PaO2 (r=0.70, y=29.80+0.55x). In 25 patients (110 sets of data), it showed the same good correlation between pulse oximeter reading and in arterial SaO2 measurement (r=0.64, y=43.38+0.50x). In addition, advancing PH had significant effect on difference between pulse oximeter and arterial SaO2. S(a-tc)O2 is negative when pH<7.3 and is positive when pH>7.3. It increases when pH increases. Value of tcPO2 was significantly underestimated, especially when pH>7.4. Concluded from this study, both pulse oximetry and transcutaneous oxygen tension monitor are a reliable and accurate noninvasive device for measured arterial oxygenation in critical neonates, because of their rapid response time and continuous information. But neither of them can provide an estimation of arterial pH or PCO2. However, arterial sampling must be performed to evaluate acid base balance of the high-risk newborn infants, and it is important in guiding oxygen therapy. |
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