动脉血与呼吸末二氧化碳分压差值的临床研究
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摘要
目的研究动脉血二氧化碳分压(PaCO_2)与呼吸末二氧化碳分压(P_(ET)CO_2)之间的关联以及影响P(a-ET)CO_2差值的因素。方法收集笔者医院2012年3月～2013年11月的所有血气记录,查阅PaCO_2及同步对应的P_(ET)CO_2以及合并的基础疾病等信息;通过纳入和排除标准,将所得数据(n=646),按照手术方式的不同分成骨科、普外科+妇产科、神经外科、腔镜外科与心胸外科手术5组;按照有无基础疾病分成无合并症组(对照组)、慢性阻塞性肺疾病(COPD)组、高血压组、冠心病组、其他肺部疾病组、休克组;研究不同因素对P_(a-ET)CO_2差值的影响。结果动脉血二氧化碳分压(PaCO_2)与呼吸末二氧化碳分压(P_(ET) CO_2)有较好的相关性(r=0.454,P<0.01)。按照术式不同进行分组比较发现心胸外科手术患者PaCO_2、P_(a-ET)CO_2差值与其他各组比较明显增加(P<0.05)。按照有无基础疾病分组发现合并COPD、其他肺部疾病(肺炎、肺挫裂伤等)的患者Pa CO_2、P_(a-ET)CO_2差值明显增加(P<0.05)。结论研究证实了动脉血二氧化碳分压(PaCO_2)与呼吸末二氧化碳分压(P_(ET)CO_2)之间具有较好的相关性。P_(a-ET)CO_2差值的明显增加与心胸外科手术、肺部疾病等有关。
Objective To study the correlation between the arterial carbon dioxide pressure(PaCO_2) and the end-tidal carbon dioxide pressure(P_(ET)CO_2),and to analyze the effective factors with the P_(a-ET)CO_2 difference.Methods We collected the blood gas analysis record sheets from March 2012 to November 2013 in our hospital,recorded every records of general conditions,arterial carbon dioxide pressure(PaCO_2) and the synchronous End-tidal carbon dioxide pressure(P_(ET)CO_2),and combined the basic diseases,by inclusion and exclusion criteria,selected the data(n=646),on the basis of the difference of surgery methods,classify data into the orthopaedic surgery,the general + maternity,neurosurgery,laparoscopic surgery and cardiothoracic surgery for five groups;according to the difference of complication,classify date into no complication disease groups,Chronic obstructive pulmonary disease(COPD) group,hypertension group,heart disease group,the other pulmonary disease group,and the shock group;analyse the influence of different agents to the P_(a-ET)CO_2 difference.Results There was a significant positive correlation between P_(ET)CO_2 and PaCO_2(r=0.454,P<0.01).According to the difference of disease,surgical methods,we have found that PaCO_2,P_(a-ET)CO_2 significantly increased in thoracic surgery group compared with the other groups(P<0.05),pulmonary disease patients with P_(a-ET)CO_2 increased significantly(P<0.05).Conclusion The study confirmed that there was a good correlation between P_(ET)CO_2 and PaCO_2.P_(a-ET)CO_2 difference associated with thoracic surgery,lung diseases.
Objective To study the correlation between the arterial carbon dioxide pressure(PaCO_2) and the end-tidal carbon dioxide pressure(P_(ET)CO_2),and to analyze the effective factors with the P_(a-ET)CO_2 difference.Methods We collected the blood gas analysis record sheets from March 2012 to November 2013 in our hospital,recorded every records of general conditions,arterial carbon dioxide pressure(PaCO_2) and the synchronous End-tidal carbon dioxide pressure(P_(ET)CO_2),and combined the basic diseases,by inclusion and exclusion criteria,selected the data(n=646),on the basis of the difference of surgery methods,classify data into the orthopaedic surgery,the general + maternity,neurosurgery,laparoscopic surgery and cardiothoracic surgery for five groups;according to the difference of complication,classify date into no complication disease groups,Chronic obstructive pulmonary disease(COPD) group,hypertension group,heart disease group,the other pulmonary disease group,and the shock group;analyse the influence of different agents to the P_(a-ET)CO_2 difference.Results There was a significant positive correlation between P_(ET)CO_2 and PaCO_2(r=0.454,P<0.01).According to the difference of disease,surgical methods,we have found that PaCO_2,P_(a-ET)CO_2 significantly increased in thoracic surgery group compared with the other groups(P<0.05),pulmonary disease patients with P_(a-ET)CO_2 increased significantly(P<0.05).Conclusion The study confirmed that there was a good correlation between P_(ET)CO_2 and PaCO_2.P_(a-ET)CO_2 difference associated with thoracic surgery,lung diseases.
引文
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6郭向阳,罗爱伦.呼气末CO2和其它监测指标的联合应用与麻醉管理[J].中国医学科学院学报,1998,20(1):76-79
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13花晓红,谢红,费杭模.后腹腔镜手术合理通气方法的探讨[J].实用临床医药杂志,2010,14(I):94-97
14杨明华,林智平,叶允荣.不同潮气量机械通气下肺癌根治术病人动脉血二氧化碳分压与呼气末二氧化碳分压的关系[J].中华麻醉学杂志,2006,26(1):86-87
15王金荣,邵立业,郭伟,等.机械通气患者呼吸末二氧化碳分压与动脉血二氧化碳分压的相关性研究[J].中国呼吸与危重监护杂志,2018,17(1):71-75
16 Hahn J,Dumont G,Anersmino M.System identification and closedloop control of end-tidal CO2in mechanically ventilated patients[J].IEEE Trans Inf Technol Biomed,2012,16(6):1176-1184
17代金贞,李新华,杨辉.Philips监护仪呼气末二氧化碳与动脉血二氧化碳分压差异的临床观察[J].医疗卫生装备,2013,34(1):63-64
18 Yadav M,Reddy EP,Sharma A,et al.The effect of position on PaCO2and PETCO2in patients undergoing cervical spine surgery in supine and prone position[J].J Neurosurg Anesthesiol,2017,29(3):298-303
2 Akinci E,Ramadan H,Yuzbasioglu Y,et al.Comparison of endtidal carbon dioxide levels with cardiopulmonary resuscitation success presented to emergency department with cardiopulmonary arrest[J].Pak J Med Sci,2014,30(1):16-21
3 Zhao H,Wang X,Liu D.The role of end-tidal carbon dioxide partial pressure in fluid responsiveness assessment in septic shock patient[J].Chin J Intem Med,2014,53(5):359-362
4 Rasera CC,Gewehr PM,Domingues AM,et al.Measurement of end-tidal carbon dioxide in spontaneously breathing children after cardiac surgery[J].Am J Crit Care,2011,20(5):388-394
5 Rosier S,Launey Y,Bleichner JP,et al.The accuracy of transcutaneous PCO2in subjects with severe brain injury:a comparison with end-tidal PCO2[J].Respir Care,2014,59(8):1242-1247
6郭向阳,罗爱伦.呼气末CO2和其它监测指标的联合应用与麻醉管理[J].中国医学科学院学报,1998,20(1):76-79
7钱文伟.PETCO2和SpO2监测与动脉血气的比较分析[J].中华实验外科杂志,1996,13(3):168
8 Bhende MS.End-tidal carbon dioxide monitoring in pediatrics:concepts and technology[J].J Postgrad Med,2001,47:153-156
9庄心良,曾因明,陈伯蜜.现代麻醉学(第3版)[M].北京:人民卫生出版社,2003:20-28
10 Aliwalas LL,Noble L,Nesbitt K,et al.Agreement of carbon dioxide levels measured by arterial,transcutaneous and end tidal methods in preterm infants
12 Brock H,Rieger R,Gabriel C,et al.Haemodynamic changes during thoracoscopic surgery:The effects of one-lung ventilation compared with carbon dioxide insufflation[J].Anaesthesia,2000,55(1):10-16
13花晓红,谢红,费杭模.后腹腔镜手术合理通气方法的探讨[J].实用临床医药杂志,2010,14(I):94-97
14杨明华,林智平,叶允荣.不同潮气量机械通气下肺癌根治术病人动脉血二氧化碳分压与呼气末二氧化碳分压的关系[J].中华麻醉学杂志,2006,26(1):86-87
15王金荣,邵立业,郭伟,等.机械通气患者呼吸末二氧化碳分压与动脉血二氧化碳分压的相关性研究[J].中国呼吸与危重监护杂志,2018,17(1):71-75
16 Hahn J,Dumont G,Anersmino M.System identification and closedloop control of end-tidal CO2in mechanically ventilated patients[J].IEEE Trans Inf Technol Biomed,2012,16(6):1176-1184
17代金贞,李新华,杨辉.Philips监护仪呼气末二氧化碳与动脉血二氧化碳分压差异的临床观察[J].医疗卫生装备,2013,34(1):63-64
18 Yadav M,Reddy EP,Sharma A,et al.The effect of position on PaCO2and PETCO2in patients undergoing cervical spine surgery in supine and prone position[J].J Neurosurg Anesthesiol,2017,29(3):298-303
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