胃肠粘膜pH值监测在机械通气撤离中的临床应用  

A Clinical Study on Gastric Intramucosal PCO_2 and pH During Weaning from mechanical Ventilation

作　　者：张思泉[1] 刘寿荣[1] 王可富[2] 陈晓梅[2] 李琛[2] 叶为江[1] 王先开[1] 

机构地区：[1]浙江省杭州市第六人民医院ICU室,310014 [2]山东大学齐鲁医院ICU室

出　　处：《医学研究杂志》2006年第7期21-24,共4页Journal of Medical Research

摘　　要：目的应用自动空气张力监测仪动态观察撤机期间患者胃肠粘膜pH值(pHi)和二氧化碳分压(PgCO2)的变化,探讨监测pHi和PgCO2两项参数的动态变化对预撤机效果的价值。方法选择32例急性呼吸衰竭正接受机械通气支持并具备撤机条件的患者,随机分配为SIMV+PSV+PEEP组和CPAP+PSV组,每组各16例。在撤机过程中监测呼吸及血流动力学指标,并同时测定动脉血气、pHi和PgCO2。结果16例患者撤机成功,14例失败。撤机失败组pHi在撤机过程中由撤机前的7.35±0.13降低到7.238±0.118(P<0.05),而撤机成功组pHi从7.46±0.059降至7.41±0.045(P0.05)。两组间pHi在撤机前后均具有显著性差异(P<0.05)。撤机前pHi≤7.36预测撤机失败的灵敏度、特异度分别1和0.89。撤机失败组PgCO2显著高于撤机成功组(P<0.05)。撤机前PgCO2≥40mmHg预测撤机失败的灵敏度和特异度分别为86%和89%。结论胃粘膜酸中毒和撤机成败之间有一定关系。pHi和PgCO2可作为预测是否能撤机的较好指标。Objective To observe the gastric intramucosal pH（phi） and gastric intramucosal carbon dioxide tension （ PgCO2） in patients, using an automated recirculating air tonometer during weaning from mechanical ventilation ,and to study the value of intramucosal PCO2 and pH measurements to predict weaning outcome from mechanical ventilation. Methods The study population included thirty - two adult critically patients who were mechanically ventilated because of acult respiratory failure and were considered ready to be weaned. Thirty - two patients were randomly assigned to synchronized intermittent mandatory ventilation combined with positive end - expiratory pressure and pressure support ventilation （ SIMV ＋ PEEP ＋ PSV） group and continuous positive airway pressure with pressure support ventilation （ CPAP ＋ PSV） group,sixteen patients in each group . Respiratory and hemodynamic variables were measured during the weaning process, Simulaneously, the gastric intramucosal PCO2 and pH were measured, At the same time, an arterial blood sample was drawn for blood gas analysis, Results Eighteen patients were successfully weaned from mechanical ventilation and fourteen failed. The gastric intramucosal pH was initially 7.35 ± 0.13 and decreased to 7. 238 ± 0.18 during the weaning process in patients who failed （ P 〈 0.05 ）. At the same time, the gastric intramucosal pH showed nonsignificant change from 7.46 ± 0. 059 to 7.41 ± 0. 045 in the patients who were successfully weaned. The gastric intramucosal pH was statistically different when both grorups were compared during the initial and the final evaluations （ P 〈 0.05 ）. For the initial evaluation, the sensitivity and specificity to predict weaning failure when the gastric intramucosal pH was ≤7.36 were 1 and 0.89, respectively. The gastric intramucosal PCO2 was higher in patients who failed （ P 〈 0.05 ）. When gastric intramucosal PCO2 was ≥40mmHg during the initial evaluation, weaning failure occurred with a sensitivity of 0.86 and

关 键 词：胃张力计 胃粘膜pH(pHi) 胃粘膜二氧化碳分压(PgCO2) 胃粘膜酸中毒 急性呼吸衰谒 

分 类 号：R573.1[医药卫生—消化系统] R733.4[医药卫生—内科学]