神经外科重症监护病房患者呼气末与动脉血二氧化碳分压的相关性  

Correlation of end-tidal carbon dioxide with arterial carbon dioxide among patients in neurosurgical intensive care unit

作　　者：王磊[1] 雷晋[1] 冯军峰[1] 毛青[1] 高国一[1] 江基尧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,上海市颅脑创伤研究所,200127

出　　处：《中华创伤杂志》2015年第9期814-819,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金面上资助项目（30872671）

摘　　要：目的分析神经外科重症监护病房（NICU）患者呼气末二氧化碳分压（PetCO2）与动脉血二氧化碳分压（PaCO2）的相关性及其影响因素，探讨PetCO2的临床实用价值。方法选取32例NICU行气管插管或气管切开的患者，其中脑外伤16例，自发性脑出血9例，大面积脑梗死4例，大脑前交通动脉瘤2例，前颅窝底动静脉畸形1例。格拉斯哥昏迷评分（GCS）≤10分。每日早晨7时行动脉血气分析并将PaCO2与同步测定的PetCO2进行比较，根据PaCO2与PetCO2的差值[P（a—et）C02]将患者分为P（a—et）C02高值组[P（a—et）CO2〉5mmHg]和P（a—et）C02正常组[-5mmHg≤P（a—et）C02≤5mmHg]，观察PaC02与PetC02动态相关性及两组GCS、血压（BP）、心率（HR）、呼吸频率（RR）、体温（BT）、氧饱和度（SpO：）等参数的关系。结果对32例患者129次同步血气样本分析结果表明，PaCO2与PetCO2均呈正态分布（r=0．668，P〈0．01）；根据Bland—Altman绘图得出69．8％的P（a—et）C02值处于-4-5mmHg范围内。P（a—et）C02高值组比P（a—et）CO2正常组具有较低的初始GCS、即时GCS、BT、pH及较高的实际碳酸氢盐（AB）、PaCO2。呼气末正压通气（PEEP）〉5mmH20时两者相关性快速降低（r=0．229，P〈0．01）。结论NICU患者的PaCO2与PetCO2具有较好的相关性，可以用来进行连续呼吸功能监测。初始GCS、BT、AB及PEEP可以对两者的相关性产生影响，因此用PetCO2评估患者通气状况时需考虑以匕因素。Objective To examine the correlation between end-tidal carbon dioxide （PetCO2 ） and arterial CO2 （PaCO2 ） among patients admitted in neurosurgical intensive care unit （NICU） and the factors affecting the PaCO2-PetCO2 [ P （ a-et ） CO2 ]. Methods Thirty-two intubated or cut-trachea patients who presented in the NICU were enrolled. Arterial blood gas test was done at seven every morning, and values of PetCO2 were compared with simuhaneously recorded PaCO2. The normal gap of P （a-et） CO2 was defined as -5 mmHg to 5 mmHg. Concordance between PaC02 and PetCO2 was analyzed using the Bland-Altman plot. Parameters between the normal and high P（a-et） C02 groups were compared to identify the factors affecting the P （a-et） CO2, including Glasgow Coma Scale （ GCS）, blood pressure （BP） , heart rate （HR） , respiration rate （RR） , body temperature （BT） , and pulse oxygen saturation （SpO2 ）. Results Allvalues of PaCO2 and PetCO2 were in accordance with normal distribution （r = 0. 668, P 〈 0.01 ） and concordance between PaC02 and PetCO2 was 69.8%. Patients who had high P（ a- et） C02 showed lower initial GCS, lower instant GCS, BT, as well as pH and higher actual bicarbonate （AB） and PetCO2 than the patients with normal P（a-et） C02. Correlation between PaCO2 and PetCO2 rapidly declined when positive end expiratory pressure（PEEP） was greater than 5 mmH20 （r = 0.229, P 〈 0.01 ）. Conclusions PetCO2 correlates well with PaCO2 and appears to be a useful monitor of respiratory function of the patients consecutively. Initial GCS, BT, AB and PEEP have an impact on P（a-et） CO2, so those factors should be considered when attempting to monitor the hyperventilation with PetCO2.

关 键 词：颅脑损伤 二氧化碳描记术 血气监测 经皮 通气机 机械 

分 类 号：R651.1[医药卫生—外科学]