急诊气管插管后早期平均动脉压和呼气末二氧化碳对严重循环崩溃的预测价值  

The predictive value of mean arterial pressure and end expiratory carbon dioxide on severe cardiovascular collapse in early stage after emergency endotracheal intubation

作　　者：戴佳原[1] 尹路 徐胜勇[1] 付阳阳[1] 朱华栋[1] 徐军[1] 于学忠[1] Dai Jiayuan;Yin Lu;Xu Shengyong;Fu Yangyang;Zhu Huadong;Xu Jun;Yu Xuezhong(Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院急诊科,100730

出　　处：《中华急诊医学杂志》2021年第5期569-575,共7页Chinese Journal of Emergency Medicine

摘　　要：目的分析急诊气管插管(endotracheal intubation,ETI)后患者平均动脉压(mean arterial pressure,MAP)及呼气末二氧化碳(end tidal CO_(2),ETCO_(2))的变化特点,探讨急诊ETI后监测MAP和ETCO_(2)对早期预测严重循环崩溃(cardiovascular collapse,CVC)的价值。方法前瞻性顺序收集2015年3月至2020年5月北京协和医院急诊科行急诊ETI成人患者的临床资料。观察并记录患者ETI后5、10、30、60和120 min MAP和ETCO_(2)的数值。根据患者急诊ETI后是否发生严重CVC分为严重CVC组和无严重CVC组。对两组MAP和ETCO_(2)的数值进行组间相同时间点和组内相邻时间点的比较,并将ETI后MAP与ETCO_(2)的数值进行相关性分析。采用ROC曲线分析急诊ETI后5 min和10 min MAP及ETCO_(2)对严重CVC的预测能力。结果共纳入研究患者116例,其中75(64.7%)例患者ETI后发生严重CVC,严重CVC组中以男性和高龄患者居多。严重CVC组急诊ETI后5、10、30、60、120 min MAP和ETCO_(2)的数值明显低于无严重CVC组。两组MAP和ETCO_(2)在急诊ETI后5~30 min表现为同步下降,在ETI后30 min达最低值,其后至ETI后120 min表现为同步回升。ETI后MAP和ETCO_(2)两者的变化具有相关性(rs=0.653,P<0.01)。ETI后5 min MAP可准确预测严重CVC(AUC=0.86,P<0.01),最佳截断值为MAP≤72 mmHg(灵敏度为78.7%,特异度为87.8%)。ETCO_(2)也可准确预测严重CVC(AUC=0.85,P<0.01),最佳截断值为ETCO_(2)≤35 mmHg(灵敏度为77.3%,特异度为85.4%)。ETI后10 min MAP可准确预测严重CVC(AUC=0.90,P<0.01),最佳截断值为MAP≤67 mmHg(灵敏度为89.3%,特异度为85.4%)。ETI后10 min ETCO_(2)也可准确预测严重CVC(AUC=0.87,P<0.01),最佳截断值为ETCO_(2)≤33 mmHg(灵敏度为81.3%,特异度为78.0%)。急诊ETI后5 min和10 min的MAP和ETCO_(2)中任意两个指标的预测能力差异无统计学意义(P>0.05)。结论急诊ETI后严重CVC患者早期即有MAP和ETCO_(2)下降表现,但识别滞后和干预不足可能与CVC的发生发展有关。ETI后�Objective To analyze the changes of mean arterial pressure(MAP)and end expiratory carbon dioxide(ETCO_(2))in patients after emergency endotracheal intubation(ETI).To explore the values of MAP and ETCO_(2) monitoring in early prediction of severe cardiovascular collapse(CVC)after emergency ETI.Methods The clinical data of adult patients who underwent ETI from March 2015 to May 2020 were collected consecutively in the emergency departments of Peking Union Medical College Hospital.The values of MAP and ETCO_(2) were observed and recorded at 5,10,30,60 and 120 min after intubation.According to whether severe CVC occurred after ETI,the patients were divided into the severe CVC group and non-severe CVC group.The values of MAP and ETCO_(2) were compared at the same time points between the two groups and the adjacent time points within the groups.The correlation between MAP and ETCO_(2) after ETI was also analyzed.ROC curve was used to analyze the ability of MAP and ETCO_(2) at 5 min and 10 min after ETI to predict severe CVC.Results Totally 116 patients were enrolled in this study,among them 75(64.7%)cases had severe CVC after ETI.The majority were male and elderly patients in the severe CVC group.The values of MAP and ETCO_(2) in 5,10,30,60 and 120 min after ETI in severe CVC group were significantly lower than those in the non-severe CVC group.The values of MAP and ETCO_(2) in the two groups showed simultaneous decrease from 5 min to 30 min after ETI,reached the lowest value at 30 min after ETI,and appeared the synchronous recover from then to 120 min after ETI.After ETI,the changes of MAP was correlated with that of ETCO_(2)(rs=0.653,P<0.01).At 5 min after ETI,MAP could predict severe CVC(AUC=0.86,P<0.01),MAP≤72 mmHg was the best cutoff value(sensitivity 78.7%,specificity 87.8%);ETCO_(2) could also predict severe CVC(AUC=0.85,P<0.01),and ETCO_(2)≤35 mmHg was the best cutoff value(sensitivity 77.3%,specificity 85.4%).At 10 min after ETI,MAP could predict severe CVC(AUC=0.90,P<0.01),MAP≤67 mmHg was the best cutof

关 键 词：气道管理 循环崩溃 气管插管 急诊 平均动脉压 呼气末二氧化碳 

分 类 号：R459.7[医药卫生—急诊医学]