呼气末二氧化碳分压评估重症急性胰腺炎患者液体复苏的价值  

The value of end -tidal carbon dioxide partial pressure in fluid resuscitation in severe acute pancreatitis patients

作　　者：柳彦涛[1] 李叶宁[1] 周文静[1] 徐欢欢[1] 

机构地区：[1]漯河市中心医院重症医学科,河南省漯河462000

出　　处：《中国基层医药》2016年第13期2016-2019,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨呼气末二氧化碳分压（PET CO2）评估重症急性胰腺炎（SAP）患者液体复苏容量反应性的价值。方法选择机械通气的 SAP 患者43例，行补液试验，监测试验前后的血流动力学指标[心指数（CI）及 PET CO2]，评估 PET CO2的变化对容量反应性的预测价值。结果入选43例 SAP 患者，31例有容量反应性，12例无容量反应性。有反应者与无反应者相比心指数变化（ΔCI）增加[（0．9±0．3）比（0．2±0．3），t ＝3．24，P ＜0．05]、ΔPET CO2增加[（4．1±1．9）比（0．7±1．2），t ＝4．01，P ＜0．05]。ΔPET CO2与ΔCI 呈正相关（r ＝0．74，P ＜0．05）。ΔPET CO2的 ROC 曲线下面积为0．872（95％ CI 0．754～0．923，P ＜0．05），以5％为界ΔPET CO2预测容量反应性的敏感性为86．7％，特异性为89．5％。结论补液试验后ΔPET CO2的变化可以有效评估 SAP 患者液体复苏时的容量反应性。Objective To investigate the value of end-tidal carbon dioxide partial pressure （PET CO2 ）in fluid resuscitation in severe acute pancreatitis（SAP）patients.Methods SAP patients under mechanical ventilation with the need of a fluid challenge test were included.Hemodynamic parameter cardiac index（CI）and PET CO2 were conducted before and after the fluid challenge test.The value of ΔPET CO2 was used to predict fluid responsiveness. Results Totally 43 patients with SAP were prospectively recruited.31 patients had volume responsiveness, 12 patients had no volume responsiveness.Compared with no volume responsiveness group,volume responsiveness group led to a greater increase in ΔCI[（0.9 ±0.3）vs.（0.2 ±0.3）,t =3.24,P 〈0.05]and ΔPET CO2 [（4.1 ± 1.9）vs.（0.7 ±1.2）,t =4.01,P 〈0.05].ΔPET CO2 and ΔCI were correlated（r =0.74,P 〈0.05）.The area under ROC curve of ΔPET CO2 was 0.872（95% CI 0.754 ~0.923,P 〈0.05）.An increase of 5% in ΔPET CO2 predicted fluid responsiveness with a sensitivity of 86.7%,and specificity of 89.5%.Conclusion The change of ΔPET CO2 induced by fluid challenge test is an effective way to predict fluid responsiveness in SAP patients.

关 键 词：呼气末二氧化碳分压 胰腺炎 容量反应性 液体复苏 监测 血流动力学 

分 类 号：R576[医药卫生—消化系统]