经膜肺出气口实时二氧化碳监测用于评估二氧化碳分压的临床意义和可行性  

Clinical significance and feasibility of real-time CO_(2) monitoring via air outlet of membrane oxygenator for evaluation of PaCO_(2)

作　　者：端木剑宇 梁永年 喻翔 杜磊[2] 熊际月[2] Duanmu Jianyu;Liang Yongnian;Yu Xiang;Du Lei;Xiong Jiyue(Department of Cardiovascular Surgery,The First Affiliated Hospital of Nanjin Medical University,Jiangsu Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院江苏省人民医院胸心血管外科,南京210029 [2]四川大学华西医院麻醉科,成都610041

出　　处：《中国体外循环杂志》2024年第4期318-323,共6页Chinese Journal of Extracorporeal Circulation

摘　　要：二氧化碳溶解于动脉血液产生的分压称二氧化碳分压(PaCO_(2)),在维持血液酸碱度、调节血管张力等方面发挥着极其重要的作用。生理状态下,机体化学感受器实时接收PaCO_(2)信号,并通过肺脏将PaCO_(2)维持在正常范围。然而体外循环中人工通气和人工血流的建立、术野吹入CO_(2)气体等可引起PaCO_(2)异常,但此时缺乏正常反射弧调节,导致PaCO_(2)异常加剧而对重要脏器,特别是脑血管产生不利影响。因此在体外循环中行实时PaCO_(2)监测具有极其重要意义,遗憾的是,我国目前因缺乏相应设备而仍无实施。基于麻醉过程中实时监测呼吸末CO_(2)评估PaCO_(2),经膜肺气体出口实时监测CO_(2)(OeCO_(2))用于评估PaCO_(2)可能是一种简单、可行的方法,但该技术使用中受到诸多因素影响。本文将对这些内容进行综述,旨在通过对OeCO_(2)的实时监测而改善预后。PaCO_(2),which means the partial pressure of carbon dioxide(CO_(2))in arterial blood,is important in maintaining blood pH and regulating vascular tone.In physiological states,the body's chemoreceptors continuously receive PaCO_(2) signals and maintain PaCO_(2) within normal ranges through the lungs.During cardiopulmonary bypass(CPB),however,PaCO_(2) may be out of normal range,because of mechanical ventilation,artificial circulation,as well as usage of CO_(2) gas for covering the surgical field.Unfortunately,lack of physiological reflex during CPB would aggravate the abnormality of PaCO_(2) and thus the adverse effects occur,such as its adverse effect on the cerebral vessel.Therefore,real-time PaCO_(2) monitoring during CPB is significant,but not implemented due to the lack of equipment.Inspired by the real-time EtCO_(2) to evaluate PaCO_(2) during general anesthesia,real-time CO_(2) monitoring through the exhaust of membrane oxygenator(OeCO_(2))may be simple and feasible to evaluate PaCO_(2).However,OeCO_(2) can be affected by many factors.This review will focus on the real-time OeCO_(2) monitring and its significance,in the hope of improving the outcomes.

关 键 词：体外循环 二氧化碳分压 氧合器出口二氧化碳 

分 类 号：R654.1[医药卫生—外科学]