新冠肺炎快樂缺氧呼吸重症照護之回顧

Respiratory Critical Care of Happy Hypoxemia in COVID-19

吳緒慧(Hsu-Huei Wu) ； 陳奕仁(Yi-Jen Chen)

《北市醫學雜誌》 預刊文章 Pp. 1-11

https://doi.org/10.6200/TCMJ.202201/PP.0027

摘要

嚴重急性呼吸系統症候群冠狀病毒2（Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2）是一種迅速蔓延的疾病，於2019年出現；2020年2月，世界衛生組織稱此病為2019 年冠狀病毒病（Coronavirus Disease-2019, COVID-19）。台灣於2021年5月爆發國內社區感染，由於COVID-19常見且明顯的併發症是急性的低血氧性呼吸功能不全或衰竭，導致急性呼吸窘迫症候群（Acute respiratory distress syndrome，簡稱ARDS），因許多患者出現明顯的動脈低血氧症時，也沒有呼吸困難的感覺，這種現象被稱為“隱形”（silent）或“快樂”低血氧症（'happy' hypoxemia）。其可能機轉有三大主因：肺內分流（Intrapulmonary shunting）、肺灌注調節喪失（Loss of lung perfusion regulation）與血管內微血栓（Intravascular microthrombi）形成有關，致使缺氧並需要氧氣治療和機械通氣，也因此加重呼吸重症照護。然而，因其死亡率比典型的ARDS患者為高，故依實證醫學與近期文獻回顧相關於COVID-19的氧氣治療和機械通氣之策略，供臨床經驗分享以期降低死亡率。

關鍵字

隱形 ； 快樂缺氧 ； 氧氣治療 ； 急性呼吸窘迫症候群

並列摘要

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a rapidly spreading disease emerging in 2019. In February 2020, the World Health Organization designated the disease coronavirus disease 2019 (COVID-19). The community transmission stage of COVID-19 occurred in May 2021 in Taiwan. The most common complication of COVID-19 is acute hypoxemic respiratory dysfunction or failure causing acute respiratory distress syndrome (ARDS). Many patients do not feel breathing difficulty when significant arterial hypoxemia develops, a phenomenon known as silent or 'happy' hypoxemia. The possible mechanisms are related to intrapulmonary shunting, loss of lung perfusion regulation, and formation of intravascular microthrombi that cause hypoxia and the requirements of oxygen therapy and mechanical ventilation, thus increasing the burden of respiratory care. Because the mortality of COVID-19 patients is higher than that of ADRS patients, we systematically reviewed recent literature related to oxygen therapy and mechanical ventilation strategies for COVID-19 to share more clinical experiences to reduce the mortality of COVID-19 patients with ARDS.

並列關鍵字

silent ； 'Happy' hypoxemia ； oxygen therapy ； acute respiratory distress syndrome