一位病人被診斷為慢性阻塞性肺病（COPD）。護理師預期穩定期的 COPD 病人其動脈血氣分析（ABG）結果最可能為何？
A client is diagnosed with chronic obstructive pulmonary disease (COPD). Which arterial blood gas (ABG) result should the nurse expect for a client with stable COPD?
- ApH 7.25, PaCO2 60, HCO3 24pH 7.25、PaCO2 60、HCO3 24
- BpH 7.33, PaCO2 55, HCO3 29✓ 正解pH 7.33、PaCO2 55、HCO3 29
- CpH 7.48, PaCO2 30, HCO3 22pH 7.48、PaCO2 30、HCO3 22
- DpH 7.35, PaCO2 40, HCO3 24pH 7.35、PaCO2 40、HCO3 24
慢性 COPD 病人長期存在二氧化碳滯留，導致慢性呼吸性酸中毒。為了維持生理平衡，腎臟會進行代償，保留重碳酸根（HCO3-）以緩衝酸性，這稱為補償性呼吸性酸中毒。選項 B 顯示 pH 值略低但接近正常（7.33），PaCO2 升高（55 mmHg），且 HCO3- 同步升高（29 mEq/L），這正是典型的部分代償狀態。選項 C 是呼吸性鹼中毒；選項 D 是正常值；選項 A 則是未代償的急性呼吸性酸中毒。護理師應理解這種『基準點』的偏移，避免過度糾正穩定的 CO2 濃度。
Clients with chronic COPD have long-standing CO2 retention, resulting in chronic respiratory acidosis. To maintain physiologic balance, the kidneys compensate by retaining bicarbonate (HCO3-) to buffer the acid; this is known as compensated respiratory acidosis. Option B shows a pH slightly low but near normal (7.33), elevated PaCO2 (55 mmHg), and concurrently elevated HCO3- (29 mEq/L), which is a classic partially compensated state. Option C reflects respiratory alkalosis; Option D represents normal values; Option A shows uncompensated acute respiratory acidosis. The nurse should understand this 'baseline shift' and avoid over-correcting a stable CO2 level.
美國 NCLEX 非常強調對 ABG 的補償機轉（compensated vs uncompensated）判讀；台灣護理養成中，ABG 的判讀通常與醫師診斷緊密結合，護理師需在急診或 ICU 具備更強的獨立判讀能力。