PaCO2-EtCO2差值：腹腔镜术中二氧化碳气体栓塞的监测指标？  

PaCO2-EtCO2 gradient:an indicator of carbon dioxide gas embolism during laparoscopic surgery

作　　者：杜素娟[1] 陈瑞霞[1] 廖朝霞[1] 叶西就[1] DU Sujuan;CHEN Ruixia;LIAO zhaoxia;Ye Xijiu(Department of Anesthesia,Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University,Guangzhou510120,China.)

机构地区：[1]中山大学孙逸仙纪念医院麻醉科

出　　处：《岭南现代临床外科》2019年第4期426-428,共3页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨PaCO2-EtCO2差值可否作为腹腔镜术中二氧化碳气体栓塞的监测指标,用于二氧化碳气体栓塞的诊断和疗效评估。方法回顾分析了2例腹腔镜肝切除术中的二氧化碳气体栓塞并查阅相关文献。结果2例气体栓塞的患者主要表现为SpO2的轻度下降和呼末二氧化碳(EtCO2)短暂升高,其中1例患者心前区均可闻及"磨轮音"。2例患者的动脉血气分析均提示氧合指数下降的同时二氧化碳分压升高,PaCO2-EtCO2差值增大。经处理后,2例患者的氧合改善,PaCO2-EtCO2差值基本下降至基础水平。结论麻醉医师围术期应警惕二氧化碳气体栓塞的发生。动脉血气分析不仅可以用于评估患者的内环境情况,还可以得出PaCO2-EtCO2差值,后者可用于二氧化碳气体栓塞的诊断和疗效评估。Objective To investigate whether the PaCO2-EtCO2 gradient can be used as a diagnosisand evaluation indicator for carbon dioxide gas embolism in laparoscopic surgery.Methods 2 cases ofcarbon dioxide gas embolization during laparoscopic hepatectomy were retrospectively reviewed and relatedliterature was reviewed.Results Two patients with gas embolism showed a slight decrease in SpO2 anda transient increase in end-tidal carbon dioxide(EtCO2).One patient had a"mill-wheel"in the precor-dial region.The arterial blood gas analysis of two patients showed that the oxygenation index decreasedwhile the partial pressure of carbon dioxide increased,and the PaCO2-EtCO2 gradient increased.Aftertreatment,the oxygenation of the two patients improved,and the PaCO2-EtCO2 gradient decreased to thebasal level.Conclusion Anesthesiologists should be alert to the occurrence of carbon dioxide gas embo-lism during the perioperative period.Arterial blood gas analysis can be used not only to assess the patient′s internal environment,but also to derive the PaCO2-EtCO2 gradient,which can be used for the diagno-sis and efficacy evaluation of carbon dioxide gas embolism.

关 键 词：腹腔镜手术 二氧化碳气体栓塞 PaCO2-EtCO2差值 

分 类 号：R614[医药卫生—麻醉学]