# 一名重度COPD且慢性高碳酸血症的個案，因呼吸困難惡化、SpO2 86%被送至急診。最適當的初始氧氣處方為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391785&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名重度COPD且慢性高碳酸血症的個案，因呼吸困難惡化、SpO2 86%被送至急診。最適當的初始氧氣處方為何？

## 選項

1. 使用FiO2 100%的CPAP
2. 不給補充氧氣，身體會自行代償
3. 以非再吸入面罩給予15 L/分高流量氧氣
4. 以鼻導管2 L/分開始，滴定氧氣維持SpO2 88-92%，並監測意識與通氣變化 **✔ 正確答案**

**正確答案: 4**

## 解析

正確 (2)：慢性CO2滯留的COPD個案部分依賴低氧性呼吸驅動；過多氧氣會削弱呼吸驅動並惡化CO2滯留，造成嗜睡與呼吸性酸中毒。以最低有效流量維持SpO2 88-92%。監測神經狀態並考慮ABG。(1) 高流量可能造成CO2麻醉。(3) 此情境初始使用100% FiO2的CPAP不適當。(4) 低氧必須治療。

## 深入解析

記憶提示 COPD氧氣目標是「88-92」。心跳或呼吸停止、敗血症則目標94-98%。臨床指引 若使用氧氣後變嗜睡，懷疑CO2麻醉，檢查ABG並考慮NIV（BiPAP）。

## 臨床情境

情境 71歲男性，有重度COPD與慢性CO2滯留（基準PaCO2 58）。急診表現：呼吸困難、RR 28、室內空氣SpO2 86%，清醒但輕度嗜睡。

## 重要概念

- **低氧性呼吸驅動** — 慢性CO2滯留者的備援通氣刺激；過量氧氣可能抑制。
- **COPD氧氣目標** — 滴定至SpO2 88-92%；避免高氧血症。
- **CO2麻醉** — PaCO2上升造成中樞神經抑制；高流量氧氣後出現嗜睡與混亂。

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