经皮二氧化碳监测在肥胖患者行腹腔镜胃旁路术中的应用  

Transcutaneous monitoring of carbon dioxide monitor in severe obese patients undergoing laparoscopic surgery

作　　者：刘世江[1] 孙杰[1] 于颖颖[1] 丁正年[1] 刘存明[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2016年第11期1064-1067,共4页Journal of Clinical Anesthesiology

摘　　要：目的研究肥胖患者行腹腔镜下胃旁路术中经皮二氧化碳分压(P_(TC)CO_2)监测评估PaCO_2的准确性和相关性。方法择期行腹腔镜下胃旁路术的患者22例,男9例,女13例,年龄19~55岁,体重86~160kg,BMI>35kg/m^2,ASAⅠ或Ⅱ级,在麻醉后(气腹前)和气腹后30、60和120min时测量PaCO_2、P_(ET)CO_2和P_(TC)CO_2。并计算PaCO_2-P_(ET)CO_2和PaCO_2-P_(TC)CO_2的差值,采用Bland-Altman分析、相关与回归和确切概率法分析PaCO_2与P_(ET)CO_2、PaCO_2与P_(TC)CO_2的线性回归方程和一致性界限(LOA)。结果 1例男性患者因麻醉诱导时使用了去氧肾上腺素而被排除出本研究。余患者PaCO_2-P_(ET)CO_2的差值为(10.3±2.3)mm Hg,PaCO_2-P_(TC)CO_2的差值为(0.9±1.3)mm Hg。PaCO_2与P_(ET)CO_2之间的线性回归方程为P_(ET)CO_2=11.58^+0.57×PaCO_2(r2=0.64,P<0.01);PaCO_2与P_(TC)CO_2之间的线性回归方程为P_(TC)CO_2=0.60^+0.97×PaCO_2(r2=0.89,P<0.01),气腹后30、60和120min时P_(ET)CO_2和P_(TC)CO_2与PaCO_2具有明显相关性(P<0.01)。PaCO_2-P_(ET)CO_2差值的95%LOA为(10.3±4.6)mm Hg;PaCO_2-P_(TC)CO_2差值的95%LOA为(0.9±2.6)mm Hg。结论肥胖患者行腹腔镜下胃旁路术中,P_(TC)CO_2比P_(ET)CO_2更精确地评估PaCO_2。Objective To investigate the accuracy and correlation of estimating PaCO_2 using a transcutaneous CO2pressure（P_（TC）CO_2）monitor in severe obese patients undergoing laparoscopic bariatric surgery.Methods Twenty-two patients aged 19-55 years,weighting 86^（-1）60 kg,BMI35kg/m^2,ASA Ⅰ or Ⅱ undergoing laparoscopic bariatric surgery were included in this study.Their PaCO_2,P_（ET）CO_2 and P_（TC）CO_2values were measured at 4time points before and 30 min,60min and 120 min after pneumoperitoneum and was the difference calculated between each measure（PaCO_2-P_（ET）CO_2 and PaCO_2-P_（TC）CO_2）.Agreement among measures was assessed by the Bland-Altman method.Results One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction.The average PaCO_2-P_（ET）CO_2 difference was（10.3±2.3）mm Hg.The average PaCO_2-P_（TC）CO_2 difference was（0.9±1.3）mm Hg.95% of the limits of agreement（LOA）of the average PaCO_2-P_（ET）CO_2 difference was（10.3±4.6）mm Hg.The linear regression equation of PaCO_2-P_（ET）CO_2 was P_（ET）CO_2 =11.58~＋0.57×PaCO_2（r2=0.64,P〈0.01）;whereas the one of PaCO_2-P_（TC）CO_2 was P_（TC）CO_2=0.60~＋0.97×PaCO_2（r2=0.89,P〈0.01）.The LOA of 95% average PaCO_2-P_（ET）CO_2 difference was（10.3±4.6）mm Hg,while the LOA of 95% average PaCO_2-P_（TC）CO_2 difference was（0.9±2.6）mm Hg.Conclusion While undergoing laparoscopic bariatric surgery,transcutaneous carbon dioxide monitoring estimates PaCO_2 better than P_（ET）CO_2 in patients with severe obesity.

关 键 词：经皮二氧化碳监测 肥胖 胃旁路术 麻醉 

分 类 号：R614[医药卫生—麻醉学]