p_(et)(CO_2)和V(CO_2)的改变对患者容量反应性的预测  

Changes of patient in end-tidal carbon dioxide and volumetric carbon dioxide as predictors of volume responsiveness

作　　者：王亚林[1,2] 张广[1] 吴太虎[1] 姜佳星[3] 

机构地区：[1]军事医学科学院卫生装备研究所,天津300161 [2]海军总医院医学工程科,北京100048 [3]解放军255医院,河北唐山063000

出　　处：《医疗卫生装备》2014年第9期71-73,共3页Chinese Medical Equipment Journal

基　　金：国家科技支撑计划项目(2012BAI20B00)

摘　　要：目的:探讨呼气末CO2分压(end-tidal carbon dioxide partial pressure,pet(CO2)及患者单次呼吸呼出CO2气体的体积(volumetric carbon dioxide,V(CO2))的改变是否能有效预测心脏前负荷(在舒张末期心室所承受的容量负荷或压力)后患者的液体反应性。方法:对患者进行被动抬腿试验(passive leg raising,PLR)或者输液500 mL,通过心排量监护仪观察其每搏指数,若增加超过10%就定义为患者有液体反应。通过监护仪测量pet(CO2)和V(CO2)。对机械通气患者,潮气量控制在8 mL/kg,分钟通气量恒定。结果:54%的患者对静脉液体量的增加有反应,pet(CO2)增加(5.9±7.6)%,V(CO2)增加(11.1±8.6)%;而没有液体反应的患者,pet(CO2)增加(1.4±4.4)%,V(CO2)增加(0.8±5.6)%。两两比较差异有统计学意义(P<0.05)。因此,对于没有肺部疾病的患者,pet(CO2)和V(CO2)可以预测患者的液体反应性。有液体反应的患者,每搏量变化是(15.8±3.7)%,而没有液体反应的患者,每搏量变化是(13.6±4.8)%(P=0.15)。结论:对于没有肺部疾病的患者,pet(CO2)和V(CO2)的动态变化可以作为液体反应性的辅助预测指标。Objective To determine whether changes in Pet（CO2） （partial pressure of C02 at the end of an exhaled breath） and exhaled CO2 V（CO2） can predict fluid responsiveness after a preload challenge, Methods FlUid responsiveness was determined by a passive leg raising （PLR） maneuver and/or a 500 mL crystalloid challenge. An increase in the stroke volume index 〉10% as measured by a NICOM bioreactance cardiac output monitor （Cheetah Medical） was used to made clear fluid responsiveness, Pet（CO2） and volumetric capnography V（CO2） were monitored via a combined CO2 and flow sensor capnostat （Respironics NM3 Monitor; Philips Healthcare）. Patients were mechanically ventilated with tidal volumes controlled at 8 mL/kg, allowing for consistent minute ventilation. Results During the study period, 44 challenges （10 PLR and 34 fluid boluses） were performed on 34 patients. There were 24（54%） positive fluid responses, Pet（CO2） increased by （5.9±7.6）% in the responders compared with （1.4±4.4）% in the nonresponders （P=0.02）. Similarly, V（CO2） increased by （11.0±8.6）% in the responders compared with （0.8±5.6）% in the nonresponders （P=0.001）. pet（CO2） and V（CO2） were predictive of fluid responsiveness only in those patients without underlying lung disease. The stroke volume variation was （15.8±3.7）% in the responders compared with （13.6±4.8）% in the nonresponders （P=0.15）. Conclusion Dynamic changes in Pet（CO2） and V（CO2） may be used as adjunctive indicators of fluid responsiveness in Datients without under-lying lung disease.

关 键 词：容积反应 呼气末CO2分压 体积CO2体积 心排量 

分 类 号：R318.6[医药卫生—生物医学工程]