机械通气患者呼气末二氧化碳分压与动脉血二氧化碳分压的相关性研究
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摘要
目的分析机械通气条件下,呼气末二氧化碳分压(PETCO2)与动脉血二氧化碳分压(PaCO_2)之间的相关性。方法选择2016年6月至2017年3月在重症医学科行有创机械通气的成年患者,每例患者需要评估动脉血气时,同一时间检测PETCO2,待数值稳定后,记录PETCO_2数据。动脉血气分析采集桡动脉或股动脉血标本,床旁完成检测。PETCO_2数据和动脉血气分析在5 min内完成。比较不同呼吸机治疗模式、不同疾病类型和不同氧合指数下二者之间相关性。结果共有104例患者225组PETCO_2-PaCO_2成对数据纳入分析。在未区分呼吸机模式下,PETCO_2和PaCO_2之间具有明显正相关,相关系数为0.70,直线回归方程Y=11.08+0.77X(Y:PaCO_2;X:PETCO_2)。不同呼吸机模式情况下,仅辅助/控制通气(A/C)模式下二者不具相关性(r=0.31,P=0.10);而同步间歇指令通气(SIMV)和自主通气(SPONT)模式下,二者具有明显相关性,但SPONT模式下相关性相对较弱(r=0.60,P<0.001)。在慢性阻塞性肺疾病、多发伤、严重脑血管疾病以及重症肺炎患者,PETCO2和PaCO_2均呈正相关,相关系数分别为0.76、0.64、0.53和0.56。氧合指数<200 mmHg或≥200 mmHg时,二者之间均明显正相关,相关系数分别为0.69和0.71。结论接受有创机械通气的病情稳定患者,不同呼吸机模式下、不同疾病类型、不同氧合指数时,PETCO_2与PaCO_2均具有明显正相关。
Objective To analyze the relationship between end-tidal carbon dioxide partial pressure(PETCO_2)and arterial CO_2 pressure(PaCO_2) in invasive ventilated patients. Methods An observational study was conducted in adult patients admitted to Intensive Care Unit(ICU) between June 2016 and March 2017. Samples were immediately analyzed for PaCO_2 using a blood gas analyzer. At the same time the arterial to end-tidal CO_2 gradient was determined.Relationship in different mechanical ventilation modes, disease categories and PaO_2/FiO_2 were analyzed in this study.Results A total of 225 arterial blood gases were obtained from the 104 patients. In each of these modes the PETCO_2 was generally lower than the PaCO_2. There was a positive correlation between PaCO_2 and PETCO_2 regardless of different mode(r=0.70, Y=11.08+0.77 X). A positive correlation was found in SIMV and SPONT modes, but not in A/C mode. The relationship between PaCO_2 and PETCO_2 in COPD, trauma, cerebrovascular disease and severe pneumonia patients shown a positive correlation(r value was 0.76, 0.64, 0.53, and 0.56, respectively). There was a significant correlation whether PaCO_2/FiO_2<200 mmHg(r=0.69, P<0.001) or ≥200 mmHg(r=0.71, P<0.001). Conclusions The results of this study show that PETCO_2 monitoring accurately reflects PaCO_2 during mechanical ventilation. A positive correlation is found in different ventilation modes, regardless of disease categories or PaCO_2/FiO_2.
Objective To analyze the relationship between end-tidal carbon dioxide partial pressure(PETCO_2)and arterial CO_2 pressure(PaCO_2) in invasive ventilated patients. Methods An observational study was conducted in adult patients admitted to Intensive Care Unit(ICU) between June 2016 and March 2017. Samples were immediately analyzed for PaCO_2 using a blood gas analyzer. At the same time the arterial to end-tidal CO_2 gradient was determined.Relationship in different mechanical ventilation modes, disease categories and PaO_2/FiO_2 were analyzed in this study.Results A total of 225 arterial blood gases were obtained from the 104 patients. In each of these modes the PETCO_2 was generally lower than the PaCO_2. There was a positive correlation between PaCO_2 and PETCO_2 regardless of different mode(r=0.70, Y=11.08+0.77 X). A positive correlation was found in SIMV and SPONT modes, but not in A/C mode. The relationship between PaCO_2 and PETCO_2 in COPD, trauma, cerebrovascular disease and severe pneumonia patients shown a positive correlation(r value was 0.76, 0.64, 0.53, and 0.56, respectively). There was a significant correlation whether PaCO_2/FiO_2<200 mmHg(r=0.69, P<0.001) or ≥200 mmHg(r=0.71, P<0.001). Conclusions The results of this study show that PETCO_2 monitoring accurately reflects PaCO_2 during mechanical ventilation. A positive correlation is found in different ventilation modes, regardless of disease categories or PaCO_2/FiO_2.
引文
1急诊呼气末二氧化碳监测专家共识组.急诊呼气末二氧化碳监测专家共识.中华急诊医学杂志,2017,26(5):507-511.
2 Kartal M,Goksu E,Eray O,et al.The value of ETCO2measurement for COPD patients in the emergency department.Eur J Emerg Med,2011,18(1):9-12.
3Delerme S,Freund Y,Renault R,et al.Concordance between capnography and capnia in adults admitted for acute dyspnea in an ED.Am J Emerg Med,2010,28(6):711-714.
4 Prause G,Hetz H,Lauda P,et al.A comparison of the end-tidalCO2 documented by capnometry and the arterial PCO2 in emergency patients.Resuscitation,1997,35(2):145-148.
5Lee SW,Hong YS,Han C,et al.Concordance of end-tidal carbon dioxide and arterial carbon dioxide in severe traumatic brain injury.J Trauma,2009,67(3):526-530.
6 Yamanaka MK,Sue DY.Comparison of arterial-end-tidal PCO2difference and dead space/tidal volume ratio in respiratory failure.Chest,1987,92(5):832-835.
7Tusman G,Suarez-Sipmann F,Bohm SH,et al.Capnography reflects ventilation/perfusion distribution in a model of acute lung injury.Acta Anaesthesiol Scand,2011,55(5):597-606.
8 Tusman G,Suarez-Sipmann F,Bohm SH,et al.Monitoring dead space during recruitment and PEEP titration in an experimental model.Intensive Care Med,2006,32(11):1863-1871.
9史雪,杨国玲,陈杨,等.呼气末二氧化碳分压评估特发性肺动脉高压与慢性血栓栓塞性肺动脉高压严重程度的价值.中华结核和呼吸杂志,2017,40(1):34-39.
10 Guo FM,Chen J,Liu SQ,et al.Dead space fraction changes during PEEP titration following lung recruitment in patients with ARDS.Respir Care,2012,57(10):1578-1585.
11蔡英丽,詹红.呼气末二氧化碳分压联合平台压监测在急性呼吸窘迫综合征机械通气中的应用进展.医学综述,2017,23(6):1210-1214.
12 Razi E,Moosavi GA,Omidi K,et al.Correlation of end-tidal carbon dioxide with arterial carbon dioxide in mechanically ventilated patients.Arch Trauma Res,2012,1(2):58-62.
13中华医学会重症医学分会.机械通气临床应用指南(2006).中国危重病急救医学,2007,19(2):65-72.
14 Fletcher R,Jonson B.Deadspace and the single breath test for carbon dioxide during anaesthesia and artificial ventilation.Effects of tidal volume and frequency of respiration.Br J Anaesth,1984,56(2):109-119.
15杨相梅,洪跃玲,罗艳.呼气末二氧化碳监测在慢性阻塞性肺疾病中的应用.中华肺部疾病杂志(电子版),2010,3(4):243-245.
16 谭伟,刘璠,侯海佳,等.平静呼气法与延长呼气法测定呼气末二氧化碳分压在呼吸内科应用价值的比较.中华危重病急救医学,2013,25(10):608-613.
17Sivan Y,Eldadah MK,Cheah TE,et al.Estimation of arterial carbon dioxide by end-tidal and transcutaneous PCO2measurements in ventilated children.Pediatr Pulmonol,1992,12(3):153-157.
18 Russell GB,Graybeal JM.The arterial to end-tidal carbon dioxide difference in neurosurgical patients during craniotomy.Anesth Analg,1995,81(4):806-810.
19Weinger MB,Brimm JE.End-tidal carbon dioxide as a measure of arterial carbon dioxide during intermittent mandatory ventilation.J Clin Monit,1987,3(2):73-79.
20 Takki S,Aromaa U,Kauste A.The validity and usefulness of the end-tidal pC O2 during anaesthesia.Ann Clin Res,1972,4(5):278-284.
21Whitesell R,Asiddao C,Gollman D,et al.Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference.Anesth Analg,1981,60(7):508-512.
22 Hopper K.Respiratory acid-base disorders in the critical care unit.Vet Clin North Am Small Anim Pract,2017,47(2):351-357.
23Kerr ME,Zempsky J,Sereika S,et al.Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma.Crit Care Med,1996,24(5):785-790.
24 Morley TF,Giaimo J,Maroszan E,et al.Use of capnography for assessment of the adequacy of alveolar ventilation during weaning from mechanical ventilation.Am Rev Respir Dis,1993,148(2):339-344.
25Barton CW,Wang ES.Correlation of end-tidal CO2 measurements to arterial Pa CO2 in nonintubated patients.Ann Emerg Med,1994,23(3):560-563.
26 Tobias JD,Meyer DJ.Noninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants:end-tidal versus transcutaneous carbon dioxide.Anesth Analg,1997,85(1):55-58.
27Thrush DN,Mentis SW,Downs JB.Weaning with end-tidal CO2and pulse oximetry.J Clin Anesth,1991,3(6):456-460.
28 Mc Donald MJ,Montgomery VL,Cerrito PB,et al.Comparison of end-tidal CO2 and Pa CO2 in children receiving mechanical ventilation.Pediatr Crit Care Med,2002,3(3):244-249.
2 Kartal M,Goksu E,Eray O,et al.The value of ETCO2measurement for COPD patients in the emergency department.Eur J Emerg Med,2011,18(1):9-12.
3Delerme S,Freund Y,Renault R,et al.Concordance between capnography and capnia in adults admitted for acute dyspnea in an ED.Am J Emerg Med,2010,28(6):711-714.
4 Prause G,Hetz H,Lauda P,et al.A comparison of the end-tidalCO2 documented by capnometry and the arterial PCO2 in emergency patients.Resuscitation,1997,35(2):145-148.
5Lee SW,Hong YS,Han C,et al.Concordance of end-tidal carbon dioxide and arterial carbon dioxide in severe traumatic brain injury.J Trauma,2009,67(3):526-530.
6 Yamanaka MK,Sue DY.Comparison of arterial-end-tidal PCO2difference and dead space/tidal volume ratio in respiratory failure.Chest,1987,92(5):832-835.
7Tusman G,Suarez-Sipmann F,Bohm SH,et al.Capnography reflects ventilation/perfusion distribution in a model of acute lung injury.Acta Anaesthesiol Scand,2011,55(5):597-606.
8 Tusman G,Suarez-Sipmann F,Bohm SH,et al.Monitoring dead space during recruitment and PEEP titration in an experimental model.Intensive Care Med,2006,32(11):1863-1871.
9史雪,杨国玲,陈杨,等.呼气末二氧化碳分压评估特发性肺动脉高压与慢性血栓栓塞性肺动脉高压严重程度的价值.中华结核和呼吸杂志,2017,40(1):34-39.
10 Guo FM,Chen J,Liu SQ,et al.Dead space fraction changes during PEEP titration following lung recruitment in patients with ARDS.Respir Care,2012,57(10):1578-1585.
11蔡英丽,詹红.呼气末二氧化碳分压联合平台压监测在急性呼吸窘迫综合征机械通气中的应用进展.医学综述,2017,23(6):1210-1214.
12 Razi E,Moosavi GA,Omidi K,et al.Correlation of end-tidal carbon dioxide with arterial carbon dioxide in mechanically ventilated patients.Arch Trauma Res,2012,1(2):58-62.
13中华医学会重症医学分会.机械通气临床应用指南(2006).中国危重病急救医学,2007,19(2):65-72.
14 Fletcher R,Jonson B.Deadspace and the single breath test for carbon dioxide during anaesthesia and artificial ventilation.Effects of tidal volume and frequency of respiration.Br J Anaesth,1984,56(2):109-119.
15杨相梅,洪跃玲,罗艳.呼气末二氧化碳监测在慢性阻塞性肺疾病中的应用.中华肺部疾病杂志(电子版),2010,3(4):243-245.
16 谭伟,刘璠,侯海佳,等.平静呼气法与延长呼气法测定呼气末二氧化碳分压在呼吸内科应用价值的比较.中华危重病急救医学,2013,25(10):608-613.
17Sivan Y,Eldadah MK,Cheah TE,et al.Estimation of arterial carbon dioxide by end-tidal and transcutaneous PCO2measurements in ventilated children.Pediatr Pulmonol,1992,12(3):153-157.
18 Russell GB,Graybeal JM.The arterial to end-tidal carbon dioxide difference in neurosurgical patients during craniotomy.Anesth Analg,1995,81(4):806-810.
19Weinger MB,Brimm JE.End-tidal carbon dioxide as a measure of arterial carbon dioxide during intermittent mandatory ventilation.J Clin Monit,1987,3(2):73-79.
20 Takki S,Aromaa U,Kauste A.The validity and usefulness of the end-tidal pC O2 during anaesthesia.Ann Clin Res,1972,4(5):278-284.
21Whitesell R,Asiddao C,Gollman D,et al.Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference.Anesth Analg,1981,60(7):508-512.
22 Hopper K.Respiratory acid-base disorders in the critical care unit.Vet Clin North Am Small Anim Pract,2017,47(2):351-357.
23Kerr ME,Zempsky J,Sereika S,et al.Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma.Crit Care Med,1996,24(5):785-790.
24 Morley TF,Giaimo J,Maroszan E,et al.Use of capnography for assessment of the adequacy of alveolar ventilation during weaning from mechanical ventilation.Am Rev Respir Dis,1993,148(2):339-344.
25Barton CW,Wang ES.Correlation of end-tidal CO2 measurements to arterial Pa CO2 in nonintubated patients.Ann Emerg Med,1994,23(3):560-563.
26 Tobias JD,Meyer DJ.Noninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants:end-tidal versus transcutaneous carbon dioxide.Anesth Analg,1997,85(1):55-58.
27Thrush DN,Mentis SW,Downs JB.Weaning with end-tidal CO2and pulse oximetry.J Clin Anesth,1991,3(6):456-460.
28 Mc Donald MJ,Montgomery VL,Cerrito PB,et al.Comparison of end-tidal CO2 and Pa CO2 in children receiving mechanical ventilation.Pediatr Crit Care Med,2002,3(3):244-249.