经皮二氧化碳测量在腹膜后腹腔镜泌尿外科手术中的准确性:一项前瞻性观察性研究  

The accuracy of transcutaneous carbon dioxide measurement in retroperitoneoscopic urologic surgery:a prospective observational study

作　　者：孔秋月 刘洋 李楠 黄少康 杨春 刘存明 丁正年 王娴[3] 刘世江 KONG Qiuyue;LIU Yang;LI Nan;HUANG Shaokang;YANG Chun;LIU Cunming;DING Zhengnian;WANGXian;LIU Shijiang(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Anesthesiology,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai 200071;Department of Anesthesiology,Women’s Hospital of Nanjing Medical University(Nanjing Maternity and Child Health Care Hospital),Nanjing 210004;Department of Anesthesiology,Chongqing Hospital of Jiangsu Province Hospita(l the People’s Hospital of Qijiang District),Chongqing 401420,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,江苏南京210029 [2]上海中医药大学附属市中医医院麻醉科,上海200071 [3]南京医科大学附属妇产医院(南京市妇幼保健院)麻醉科,江苏南京210004 [4]江苏省人民医院重庆医院(重庆市綦江区人民医院)麻醉科,重庆401420

出　　处：《南京医科大学学报（自然科学版）》2024年第6期818-825,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82002023);江苏省自然科学基金(BK20201087)。

摘　　要：目的:比较呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,P_(ET)CO_(2))和经皮二氧化碳分压(transcutane-ous carbon dioxide partial pressure,P_(a)CO_(2))预测泌尿外科腹膜后腹腔镜手术患者动脉血二氧化碳分压(arterial carbon dioxide pressure,P_(a)CO_(2))的准确性。方法:选择全身麻醉下行腹膜后腹腔镜泌尿外科手术患者50例,于气腹前及气腹后30、60、90 min分别测定P_(a)CO_(2)、P_(ET)CO_(2)、P_(TC)CO_(2)。计算P_(a)CO_(2)-PETCO_(2)和P_(a)CO_(2)-P_(TC)CO_(2)的差值。对P_(a)CO_(2)与PETCO_(2)、P_(a)CO_(2)与P_(TC)CO_(2)进行相关性和回归分析。采用Bland-Altman分析评价P_(a)CO_(2)与其他两个指标的一致性。结果:P_(a)CO_(2)-P_(ET)CO_(2)和PaCO_(2)-P_(TC)CO_(2)的绝对差值分别为(13.20±4.43)mmHg和(4.35±2.56)mmHg(P<0.05)。P_(a)CO_(2)与P_(ET)CO_(2)的相关系数为0.79(r^(2)=0.62,P<0.001),与P_(TC)CO_(2)的相关系数为0.91(r^(2)=0.83,P<0.001)。P_(a)CO_(2)与P_(ET)CO_(2)的95%一致性界限为4.53~21.88 mmHg,与P_(TC)CO_(2)的95%一致性界限为-3.18~10.48 mmHg。结论:P_(TC)CO_(2)监测可提高评估患者腹膜后腹腔镜泌尿外科手术中PaCO_(2)的准确性。Objective:To compare the accuracy of end-tidal carbon dioxide partial pressure(P_(ET)CO_(2))and transcutaneous carbon dioxide partial pressure(P_(TC)CO_(2))in predicting arterial carbon dioxide pressure(P_(a)CO_(2))in patients undergoing retroperitoneoscopic urologic surgery.Methods:Fifty patients undergoing retroperitoneoscopic urologic surgery under general anesthesia were included.Values of P_(a)CO_(2),P_(ET)CO_(2),and P_(TC)CO_(2) were measured before and 30,60,90 min after insufflation.The differences between P_(a)CO_(2)-P_(ET)CO_(2) and P_(a)CO_(2)-P_(TC)CO_(2) were calculated.Correlation and regression analysis were conducted between P_(a)CO_(2) and P_(ET)CO_(2),as well as between P_(a)CO_(2) and P_(TC)CO_(2).Bland-Altman analysis was used to assess the agreement between P_(a)CO_(2) and the other two variables.Results:The absolute differences of P_(a)CO_(2)-P_(ET)CO_(2) and P_(a)CO_(2)-P_(TC)CO_(2)were(13.20±4.43)mmHg and(4.35±2.56)mmHg,respectively(P<0.05).The correlation coefficient between P_(a)CO_(2) and P_(ET)CO_(2) was 0.79(r^(2)=0.62,P<0.001),and between P_(a)CO_(2) and P_(TC)CO_(2) was 0.91(r^(2)=0.83,P<0.001).The 95%limits of agreement between P_(a)CO_(2) and P_(ET)CO_(2) were 4.53 to 21.88 mmHg and between P_(a)CO_(2) and P_(TC)CO_(2) were-3.18 to 10.48 mmHg.Conclusion:P_(TC)CO_(2) monitoring improves the accuracy of estimating P_(a)CO_(2) in patients undergoing retroperitoneoscopic urologic surgery.

关 键 词：经皮二氧化碳 腹膜后腹腔镜 泌尿外科手术 血气监测 呼气末二氧化碳 

分 类 号：R614[医药卫生—麻醉学]