脉搏血氧测量是一种无处不在的技术与应用在门诊和住院设置。尽管它被广泛使用，但早在1990年就报道了危重病人中因患者种族而导致的器械精度变化。该研究用race法评估脉搏血氧饱和度和动脉血氧饱和度的测量差异(根据动脉血气测量)的非重症监护住院患者。

该研究纳入10分钟内测得的SpO2 -SaO230039对患者，在SpO2值大于或等于92%的患者中，未调整的隐蔽性低氧血症发生率在白人患者中为15.6%(95%置信区间15.0% - 16.1%)，在黑人患者中为19.6% (18.6% - 20.6%)（p＜0.001）.这一结果与限制在5分钟和2分钟内发生的SpO2 -SaO2对一致。在白人患者中，初始饱和度差异不大的SpO2 -SaO2配对，在随后配对的SpO2 -SaO2读数显示SpO2为92%时，SaO2的概率为2.7%(95%置信区间0.1% - 5.5%)，但黑人患者的概率更高(12.9%(3.3% - 29.0%))。

在退伍军人健康管理局(Veterans Health Administration)的普通护理住院患者设置中，对动脉血气(SaO2)和脉搏血氧饱和度(SpO2)进行了配对读数，黑人患者比白人患者有更高的几率出现动脉血气记录但脉搏血氧测量未检测到的隐蔽性低氧血症。

Abstract

Objectives: To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care.

Design: Multicenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients.

Setting: Veteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019.

Participants: Adult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers.

Main outcomes measures: Occult hypoxemia (defined as arterial blood oxygen saturation (SaO2) of <88% despite a pulse oximetry (SpO2) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin.

Results: A total of 30 039 pairs of SpO2-SaO2 readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO2 values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (P<0.001 v white patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53 v white patients, P<0.05 in adjusted models). This result was consistent in SpO2-SaO2 pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO2-SaO2 pair with little difference in saturation was associated with a 2.7% (95% confidence interval -0.1% to 5.5%) probability of SaO2 <88% on a later paired SpO2-SaO2 reading showing an SpO2 of 92%, but black patients had a higher probability (12.9% (-3.3% to 29.0%)).

Conclusions: In general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO2) and pulse oximetry (SpO2) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients.

原文链接：

https://pubmed.ncbi.nlm.nih.gov/35793817/

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