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  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Pulmonológiai Klinika, Budapest, Tömő u. 25–29., 1083
  • | 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Klinika, Budapest
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Összefoglaló. Számos közlemény született arról, hogy a COVID–19-pneumoniás betegek jelentős hányadában az artériás parciális oxigéntenzió kifejezetten alacsony, mégsem jellemző a dyspnoe, és a pulzusoximetria sem mutat – a csökkent oxigéntenzióval arányos – súlyos hypoxaemiát. A jelenséget „happy hypoxaemia” néven említik. Ugyanakkor a légszomjról nem panaszkodó, de súlyos alveolocapillaris O2-felvételi zavarban szenvedő COVID–19-pneumoniás betegek a legkisebb fizikai megterhelést sem tűrik, és állapotuk gyorsan kritikussá válhat, tehát a hypoxaemia mértékének időben való felismerése kulcskérdés. A jelen közleményben egy ilyen eset rövid ismertetése után összefoglaljuk a súlyos, de tünetmentes hypoxaemia hátterében meghúzódó élettani okokat. Ezek között szerepel a hypocapnia (respiratoricus alkalosis) is, mely alacsony oxigéntenzió mellett is a hemoglobin viszonylag megtartott oxigénszaturációját eredményezi. Ezért a mindennapi COVID–19-ellátásban a megismételt artériásvérgáz-meghatározások jelentősége nem hangsúlyozható eléggé. Orv Hetil. 2021; 162(10): 362–365.

Summary. Many COVID-19 patients have very low arterial partial oxigen tension while severe dyspnoe does not develop. Pulse oxymetry indicates only moderate reduction of arterial O2 saturation in these patients. The phenomenon is named “happy hypoxaemia”. Lack of (severe) dyspnoe and only moderately decreased O2 saturation in severely impaired alveolo-capillary O2 uptake may partially be explained by an increased oxygen affinity of hemoglobin in the presence of low arterial partial pressure of CO2. The latter results from increased alveolar ventilation, while low partial pressure of O2 in COVID-19 patients reflects right-to-left shunting of pulmonary blood flow and ventilation-perfusion mismatch of the diseased lungs. While such patients may have mild complaints as related to the real impairment of alveolo-capillary oxygen exchange, severe hypoxaemia is a negative prognostic factor of outcome in this state where severe clinical deterioration may rapidly appear. The latter circumstance together with the unusual relationship of O2 partial pressure and O2 saturation of hemoglobin in COVID-19 emphasize the importance of repeated complete arterial blood gas analyses in these patients. Orv Hetil. 2021; 162(10): 362–365.

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