呼出气二氧化碳和体表氧饱和度监测在慢性阻塞性肺疾病呼吸衰竭患者中的应用  

Application of capnography and SpO_2 measurement in the evaluation of respiratory failure in patients with chronic obstructive pulmonary disease

作　　者：刘杰[1] 陈荣昌 钟南山[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所/呼吸疾病国家重点实验室,广东广州510120

出　　处：《南方医科大学学报》2010年第7期1565-1568,共4页Journal of Southern Medical University

基　　金：广东省科技计划项目(2007B031507010)

摘　　要：目的在慢性阻塞性肺疾病(COPD)患者中探索应用呼出气二氧化碳分压(PCO2)监测推算动脉血二氧化碳分压(PaCO2)的方法和在特定范围内应用SpO2推算PaO2和计算氧合指数(OI)的准确性和误差范围,为临床动态监测、无创评估和在没有血气分析的基层医院中对呼吸衰竭病人的评价提供方法学依据。方法 30例COPD并呼吸衰竭患者给予常规药物治疗,如支气管解痉剂、祛痰剂、糖皮质激素及抗生素等,部分患者联用BiPAP呼吸机鼻(面)罩双水平正压辅助通气,治疗疗程5～7d,治疗前后均采用平静呼气法和延长呼气法记录呼出气PCO2和SpO2数据。结果治疗前平静呼吸呼气末二氧化碳分压[PETCO2(Q)]为(50.72±8.93)mmHg,延长呼吸呼气末二氧化碳分压[PETCO2(P)]为(70.35±8.91)mmHg,PaCO2为(71.25±9.08)mmHg。PETCO2(Q)显著低于PaCO2(P<0.01),而PETCO2(P)与PaCO2无显著性差异(P>0.05);治疗后结果与治疗前类似。通过直线相关分析,治疗前后的PETCO2(P)和PaCO2均呈高度相关(r前=0.96和r后=0.97,P<0.01)。治疗前根据SpO2测定,从氧解离曲线图查得到相应的PaO2(Y)值。PaO2为(59.07±2.22)mmHg,PaO2(Y)为(59.96±1.42)mmHg,两组结果相当接近,差异无统计学意义(P>0.05);同时,由PaO2(Y)计算得到OI(Y)为219.15±24.63,用PaO2计算的OI为215.70±22.77,两者差异无统计学意义(P>0.05)。运用直线相关分析,PaO2与PaO2(Y)具有较好的相关性(r=0.81,P<0.01);OI与OI(Y)亦具有较好的相关性(r=0.95,P<0.01)。结论对于COPD伴Ⅱ型呼吸衰竭患者,采用改进的呼出气CO2监测方法和调节吸入氧浓度使SpO2在90%左右时,可较准确地估计PaCO2和PaO2,适合于无创动态监测和在没有血气分析条件的基层医院用于评估呼吸衰竭。Objective To investigate the accuracy and potential error range of noninvasive estimation of CO2 pressure （PCO2）, arterial O2 pressure （PaO2）, and oxygenation index （OI） by measuring the end-tidal CO2 pressure （PETCO2） and pulse oxygen saturation （SpO2） in patients with chronic obstructive pulmonary disease （COPD） and respiratory failure, and assess the feasibility of this method for dynamic monitoring of arterial CO2 pressure （PaCO2） and PaO2 in the primary care facilities where arterial blood gases analysis is not available. Methods All the 30 patients with COPD and respiratory failure received routine clinical treatment including bronchodilators, mucolytics, glucocorticosteroid, antibiotics and oxygen therapy （titrated to keep SpO2 above 90%） for 5-7 days. A subgroup of the patients also received NIPPV treatment. All the patients were tested with both the eupnea method and prolonged expiratory method before and after the treatment to obtain the data of PCO2 and SpO2 were respectively performed before and after treatment. Results The PETCO2 with eupnea （PETCO2（Q）） was 50.72±8.93 mmHg, significantly lower than PaCO2 （71.25±9.08 mmHg, P0.01）, but the PETCO2（P） （70.35±8.91 mmHg） was comparable with PaCO2 （P0.05）. Similar results were obtained after the treatment. The PETCO2（P） before treatment and after treatment was positively correlated to PaCO2 （r=0.96 and 0.97, respectively, P0.01）. The PaO2（Y） before the treatment derived from the oxygen dissociation curve based on SpO2 measurement was close to SpO2 （59.96±1.42 mmHg vs 59.07±2.22 mmHg, P0.05）. The OI derived from PaO2 and OI（Y） from PaO2 （Y） was also similar （215.70±22.77 vs 219.15±24.63, P0.05）. Linear regression analysis showed positive correlations between PaO2（Y） to PaO2 （r=0.81, P0.01） and between OI（Y） and OI （r=0.95, P0.01）. Conclusions In patients with COPD （especially those with also type II respiratory failure）, the modified monitoring meth

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 二氧化碳 呼出气 血氧饱和度 氧合指数 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]