全麻术中应用呼气末二氧化碳分压监测的临床体会  

A Clinical Experience on End-tidal Carbon Dioxide Monitoring in General Anesthesia

作　　者：石翊飒[1] 李体中[1] 罗炜[1] 

机构地区：[1]兰州大学第二医院麻醉科,兰州730030

出　　处：《麻醉与监护论坛》2005年第4期225-226,共2页Forum of Anesthesia and Monitoring

摘　　要：目的：本文摘取25例全麻病人的术中呼气末二氧化碳分压（PetCO2）监测资料进行分析总结，以探讨PetCO2，监测的临床应用价值。方法：择期腹部手术的病人25例，心肺功能不常，无通气障碍，常规静脉诱导后行气管插管，以Ohmeda210型麻醉机行机械通所，潮气量10ml·kg^-1，呼吸频率12次·min^-1，静吸复合维持麻醉。病人入室后Datex-Ohmads AS-Ⅲ监护仪监测Bp、HR、ECG及SpO2。气管插管成功后接好D-lite传感器开始监测PetCO2数值及波形、机械通气30分钟后足背动脉穿刺抽取血气标本并记录取血时的PetCO2。结果：PetCO2与PaCO2（动脉血二氧化碳分压）呈正相关，r=0.339，P〈0.05。术中监测到的异常情况：一例胃癌病人，PetCO2 3.6%，查血气PetCO2升至4.8%。1例肾积水病人，手术50分钟后PetCO2在10分钟内从5%升至5.6%排除机器故障后检查钠石灰已发硬，发白，更换钠石灰5分钟后PetCO2降至4.9%。25例中有19例术中呼吸开始恢复时看到PetCO2波形肺泡平台期有深切迹。17例查血气后减小潮气量，依据PetCO2及PaCO2进行相应调整。结论：本文观察到PetCO2与PaCO2呈直线相关，提示用Pet CO2可以估计PaCO2值，这与既往的报道相一致。由于应用了PetCO2监测，使得术中酸碱失衡、钠石灰失效、通气量过大等情况都能及时发现和调整，大大提高了全麻病人术中管理的客观性和安全性。PetCO2还能用于判断神经肌肉阻滞的部分恢复，自主呼吸恢复时几个正常的PetCO2波形中间可以夹着一个深切迹波形。我们体会到PetCO2监测这一指标灵敏、准确、稳定、可靠，建议全麻病人术中常规监测PetCO2为宜。Objective： To evaluale tbe values of end-deal caroan dioxide （PetCO2） monitoring in general anesthesia. Methods： 25 ASA Ⅰ-Ⅱ patients, undergoing elective abdom,nal surgery, D-lite transmitter were used and PetCO2 were mondored after induclion and intubation Arterial blood samples were taken from arleda dorsalis pedis and PetCO2 were recorded after 30minutes mechanical ventilation. Results： PelCO2,correiated positively wbh arterial partial pressure of carbon dioxide （PaCO2）, r=0 399, P〈0.05 Deep symbol on PetCO2, wave platrorrn could be seen when spontaneous respiration recovery beginning in 19 patients Tidal volume of mechanical ventilation were reduced according to blaod gas results in 17 patients. Conclusions： We examined PetCO2 correlate positively with PaCO2. Wren PetCO2, monitor were used, acid-base imbalance, calx natdca ineffective and hyperventilation could be found in time We think PetCO2 monitor should be used routinely in general anesthesia.

关 键 词：呼气末二氧化碳分压 监测 全麻 全麻病人 分压监测 术中应用 PETCO2监测 临床体会 动脉血二氧化碳分压 PaCO2 

分 类 号：R614[医药卫生—麻醉学] R651.15[医药卫生—外科学]