# COPD的68歲病人因呼吸困難入院,室內空氣SpO2 86%。醫師開立氧氣輔助。下列何者為最適合此病人的初始供氧方式?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

COPD的68歲病人因呼吸困難入院,室內空氣SpO2 86%。醫師開立氧氣輔助。下列何者為最適合此病人的初始供氧方式?

## 選項

1. 簡單面罩 8 L/分
2. 非再吸入面罩 15 L/分
3. 甦醒球(BVM)100% FiO2
4. 鼻導管 2 L/分 **✔ 正確答案**

**正確答案: 4**

## 解析

慢性CO2滯留之COPD病人依賴低氧呼吸驅動。高流量氧氣會抑制此驅動,引發CO2麻醉與呼吸衰竭。GOLD建議COPD目標SpO2 88~92%,先以鼻導管1~2 L/分逐步調整。較高流量裝置應在頑固性低氧血症且醫師指示下使用。

## 深入解析

臨床判斷
部分COPD病人為CO2滯留者,依賴低氧呼吸驅動。過量氧氣將消除此驅動,造成換氣不足。目標SpO2 88-92%(非100%)。從低流量鼻導管1-2 L/分開始。

記憶口訣
COPD氧氣: 低開始、調至88-92% — 不是95+

韓 vs 美
GOLD 2025臺美共通,目標88-92%。臺灣急診亦採低流量優先;不足時加用Venturi面罩精準調控FiO2。

## 臨床情境

臨床指引
GOLD 2025: COPD急性惡化以SpO2 88-92%為目標,先用低流量鼻導管1-2 L/分。鼻導管不足時加Venturi面罩(24-28%)。30-60分鐘內測ABG確認換氣以避免CO2麻醉。

注意
因擔心CO2滯留而暫停氧氣同樣危險。先矯正低氧血症,以最低有效流量。觀察意識狀態 — 嗜睡或混亂可能為CO2上升警訊。

## 重要概念

- **低氧呼吸驅動** — 由PaO2降低而非PaCO2升高所觸發的呼吸驅動。發生於部分慢性CO2滯留(進行性COPD)病人。過量氧氣會消除此驅動,導致換氣不足與CO2麻醉。
- **SpO2目標** — 一般成人標準目標: 94%以上。慢性CO2滯留COPD: 目標88-92%,在矯正低氧的同時保留低氧驅動。每班重新評估。
- **Venturi面罩** — 不受呼吸型態影響、可精準輸送FiO2(24, 28, 31, 35, 40%)的高流量裝置。COPD需精細調控FiO2時優先選用。

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