经皮血气监测在评估儿童体外循环外周组织微循环中的应用价值  

Application value of transcutaneous blood gas monitoring in evaluating microcirculation in peripheral tissues of children with extracorporeal circulation

作　　者：李娜[1] 尹小娟[1] 孙伟[1] LI Na;YIN Xiao-juan;SUN Wei(Department of Pediatrics,Jiyuan People's Hospital,Jiyuan 459000,China)

机构地区：[1]济源市人民医院儿科,河南济源459000

出　　处：《社区医学杂志》2022年第4期207-211,共5页Journal Of Community Medicine

摘　　要：目的探究经皮血气监测应用于先天性心脏病儿童术中体外循环时,对微循环正常及微循环障碍患儿外周组织微循环灌注状态的评估价值。方法收集2019-07-01-2021-07-04济源市人民医院先天性心脏病儿童行外科手术治疗患者100例,根据年龄将其分为≤7岁组(67例)和>7岁组(33例),术中均给予经皮血气监测和间断动脉血气分析监测。将术中体外循环稳定后经皮血气分析监测所测经皮氧分压(TcpO_(2))、经皮二氧化碳分压(TcpCO_(2))、经皮氧饱和度(TcsO_(2))与取动脉血所测得动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))进行Pearson相关性分析。采用受试者工作特征曲线(ROC)评价TcpO_(2)和TcpCO_(2)对低氧血症和二氧化碳潴留的敏感度和特异度。检验水准α=0.05(双尾)。结果TcpO_(2)与PaO_(2)、TcpCO_(2)与PaCO_(2)、TcsO_(2)与SaO_(2)呈正性相关,r值分别为0.635、0.872和0.772,均P<0.05。≤7岁组TcpO_(2)与PaO_(2)、TcpCO_(2)与PaCO_(2)和TcsO_(2)与SaO_(2)呈正相关,r值分别为0.789、0.798和0.881,均P<0.05;>7岁组TcpO_(2)与PaO_(2)、TcpCO_(2)与PaCO_(2)和TcsO_(2)与SaO_(2)呈正相关,r值分别为0.467、0.901和0.619,均P<0.05。70例微循环正常患者TcpO_(2)与PaO_(2)、TcpCO_(2)与PaCO_(2)、TcsO_(2)与SaO_(2)呈正性相关,r值分别为0.635、0.872和0.772,均P<0.05;30例微循环障碍患者TcpCO_(2)与PaCO_(2)呈正性相关,r=0.901,P<0.05,TcpO_(2)与PaO_(2)、TcsO_(2)与SaO_(2)无相关性,r值分别为0.862和0.734,均P>0.05。微循环正常患者中,TcpO_(2)诊断低氧血症的AUC为0.881(95%CI:0.714~0.962);TcpCO_(2)诊断二氧化碳潴留的AUC为0.763(95%CI:0.622~0.839)。微循环障碍患者中,TcpCO_(2)诊断二氧化碳潴留的AUC为0.892(95%CI:0.754~0.991)。结论经皮血气监测指标与动脉血气分析指标存在良好相关性,且对微循环正常及微循环障碍患儿的外周组织微循环灌注状态具有较高的诊断效能。Objective To explore the value of percutaneous blood gas monitoring in evaluating the perfusion state of peripheral tissue in children with normal microcirculation and children with microcirculation disorders when they are applied to intraoperative cardiopulmonary bypass in children with congenital heart disease.Methods A total of 100children with congenital heart disease treated by surgery in Jiyuan City People’s Hospital of Henan Province from July 1,2019to July 4,2021were collected and divided into groups of≤7years old(67cases)and of>7-year-old(33cases).Percutaneous blood gas monitoring and intermittent arterial blood gas analysis were given during the operation.Transcutaneous partial pressure of O_(2)(TcpO_(2)),percutaneous partial pressure of CO_(2)(TcpCO_(2)),percutaneous O_(2)saturation(TcsO_(2))measured by percutaneous blood gas analysis after stabilization of cardiopulmonary bypass during operation and arterial blood O_(2)measured by taking arterial blood were compared.Partial pressure(PaO_(2)),arterial blood CO_(2)partial pressure(PaCO_(2)),and arterial blood O_(2)saturation(SaO_(2))were analyzed by Pearson correlation.Receiver operating characteristic(ROC)curves were used to evaluate the sensitivity and specificity of TcpO_(2)and TcpCO_(2)for hypoxemia and carbon dioxide retention.Test levelα=0.05(two-tailed).Results There was a positive correlation between TcpO_(2)and PaO_(2),TcpCO_(2)and PaCO_(2),TcsO_(2)and SaO_(2)(r=0.635,0.872,0.772,all P<0.05).There were positive correlations between TcpO_(2)and PaO_(2),TcpCO_(2)and PaCO_(2),and TcsO_(2)and SaO_(2)in the≤7-year-old group(r=0.789,0.798,0.881,all P<0.05),r=0.467,0.901,0.619,all P<0.05).There were positive correlations between TcpO_(2)and PaO_(2),TcpCO_(2)and PaCO_(2),TcsO_(2)and SaO_(2)in 70patients with normal microcirculation(r=0.635,0.872,0.772,all P<0.05).30patients with microcirculation disorder showed a positive correlation between TcpCO_(2)and PaCO_(2)(r=0.901,P<0.05),there was no correlation between TcpO_(2)and PaO_(2),TcsO_(2)and Sa

关 键 词：经皮血气 体外循环 微循环 灌注 

分 类 号：R726.5[医药卫生—儿科]