气管导管远端采样用于新生儿监测PETCO2的可靠性  

Reliability of gas sampling from distal end of tracheal tube for PETCO2 monitoring in neonates

作　　者：金自瑛[1] 杨懋颖[2] 林茹[3] 黄文芳[1] 王江梅[1] 胡智勇[1] 舒强[3] 

机构地区：[1]浙江大学附属儿童医院麻醉科,杭州市310003 [2]浙江大学附属第二医院滨江院区胸外科 [3]浙江大学附属儿童医院胸外科

出　　处：《中华麻醉学杂志》2015年第4期450-452,共3页Chinese Journal of Anesthesiology

基　　金：浙江省人口和计划生育科技项目（491040-w01116）

摘　　要：目的 评价气管导管远端采样用于新生儿监测PETCO2的可靠性.方法 择期全麻下行腹部手术的足月新生儿50例,年龄1～28 d,体重2.55～4.00 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组（n=25）：气管导管近端采样组（P组）和气管导管远端采样组（D组）.利用外径为1 mm的硬膜外导管,一端连接二氧化碳采样管,另一端伸入气管导管至其远端侧孔处.机械通气15 min时采集桡动脉血样,记录PETCO2,行血气分析,记录PaCO2;PETCO2与PaCO2作一致性检验.结果 2组PETCO2低于PaCO2（P＜0.01）;2组间PaCO2比较差异无统计学意义（P＞0.05）;D组PETCO2高于P组（P＜0.01）.D组Kappa值高于P组（P＜0.01）.结论 与气管导管近端采样相比,气管导管远端采样监测新生儿PETCO2更可靠.Objective To evaluate the reliability of gas sampling from the distal end of the tracheal tube for partial pressure of end-tidal CO2 （PETCO2） monitoring in neonates.Methods A total of 50 fullterm neonates,scheduled for elective abdominal surgery under general anesthesia,aged 1-28 days,weighing 2.55-4.00 kg,of ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups （n =25 each） using a random number table：gas samples collected from proximal end of tracheal tube group （group P） and gas samples collected from distal end of tracheal tube group （group D）.Epidural catheters of 1 mm in external diameter were used.One end of the catheter was connected to a tube for carbon dioxide sampling,and the other end was inserted into the endotracheal tube and advanced toward the distal hole of the tube.At 15 min of mechanical ventilation,blood samples were collected from the radial artery for record of PETCO2 and for blood gas analysis.Consistency test was performed between PETCO2 and partial pressure of arterial CO2 （PaCO2）.Results PET CO2 was significantly lower than PaCO2 in the two groups.There was no significant difference in PaCO2between the two groups.PETCO2 was significantly higher in group D than in group P.Kappa was significantly higher in group D than in group P.Conclusion Gas sampling from the distal end of the tracheal tube is more reliable than gas sampling from the proximal end in monitoring PETCO2 in the neonates.

关 键 词：插管法 气管内 二氧化碳 动脉 监测 手术中 婴儿 新生 

分 类 号：R726.1[医药卫生—儿科]