脉搏血氧饱和仪对慢性阻塞性肺疾病患者进行血氧监测的价值研究

目的探究慢性阻塞性肺疾病(COPD)患者脉搏血氧饱和度(SpO2)与动脉血气分析血氧饱和度(SaO2)的一致性,以确定脉搏血氧饱和仪对COPD患者进行血氧监测的价值。方法收集2019年1-6月我院急诊科收治入院的69例慢性支气管炎和/或肺气肿患者相关数据,根据住院后的肺功能和胸部平扫检查结果分为慢支炎组16例、肺气肿组11例和COPD组42例,用GraphPad Prism 8统计学软件对3组患者的SpO2值和SaO2值进行一致性检验(Bland-Altman分析)和偏倚分析;用Excel 2007对3组病例SpO2值的敏感性、特异性、阴性预测值和阳性预测值进行公式计算。结果 Bland-Altman分析提示,当患者血氧饱和度>90%时,SpO2值与SaO2值的差值在"0"上下,随着患者缺氧程度的加重,SaO2和SpO2之间的差值也越来越大。3组病例数据均显示其SpO2值与SaO2值存在一定差异,且偏倚值均为正数,说明脉搏血氧饱和仪对SaO2存在一致性的低估(COPD组偏倚3.76,慢支组偏倚5.25,肺气肿组偏倚1.46)。3组病例SpO2值的敏感性均较高,且肺气肿(83.33%)患者较COPD(75.00%)和慢支炎(75.00%)患者的灵敏度高;3组病例SpO2值的特异性均低,肺气肿患者SpO2值的特异性为0;3组病例SpO2值的阴性预测值和阳性预测值均较高。结论 (1)脉搏血氧饱和仪在血氧饱和度正常的患者中极具参考价值。(2)脉搏血氧饱和仪在评估COPD患者、严重低氧血症患者的低氧血症方面存在可疑。(3)脉搏血氧饱和仪有助于监测慢支炎和/或肺气肿患者的血氧变化趋势。(4)脉搏血氧饱和仪对不同病理生理条件下的监测价值是不同的。

Study on the value of pulse oximetry in monitoring oxygen saturation in COPD patients

Objective To explore the consistency of pulse oxygen saturation(SpO 2)and arterial blood gas analysis(SaO 2)in COPD patients,so as to determine the value of pulse oxygen saturation instrument in monitoring blood oxygen in COPD patients.Methods The data of 69 patients with chronic bronchitis and/or emphysema admitted to the emergency department of Huzhou first people undefineds hospital from January 2019 to June 2019 were collected.According to the results of pulmonary function and chest plain scan after hospitalization,they were divided into chronic branch group,emphysema group and COPD group.SpO 2 and SaO 2 values of the three groups were analyzed by GraphPad Prism 8 statistical software for Bland-Altman analysis and bias analysis.The sensitivity,specificity,negative predictive value and positive predictive value of SpO 2 values in the three groups were calculated by excel 2007.Results There were 16 cases in the COPD group,11 cases in emphysema group and 42 cases in COPD group.Bland-Altman analysis showed that the difference between SpO 2 and SaO 2 was around"0"when the patient's blood oxygen saturation was>90%.With the aggravation of hypoxia in patients,the difference between SaO 2 and SpO 2 becomes larger and larger.The data of the three groups showed that there was a certain difference between SpO 2 value and SaO 2 value,and the bias value was positive,indicating that the pulse oximeter had a consistent underestimate of SaO 2(bias 3.76 in COPD group,5.25 in chronic bronchitis group,1.46 in emphysema group).The sensitivity of SpO 2 values in all three groups was higher,and the sensitivity of emphysema(83.33%)patients was higher than that of COPD(75%)and chronic bronchitis(75%)patients.The specificity of SpO 2 value in the three groups was low,and the specificity of SpO 2 value in emphysema patients was 0.The negative predictive value and positive predictive value of SpO 2 in the three groups were both higher.Conclusion(1)Pulse oximeter is of great reference value in patients with normal oximetry.(2)Pulse oximetry is questionable in evaluating hypoxemia in patients with COPD and patients with severe hypoxemia;(3)Pulse oximetry is helpful to monitor the changes of oximetry in patients with chronic bronchitis and/or emphysema;(4)The monitoring value of pulse oximeter in different pathophysiological conditions is different.