呼气末二氧化碳分压监测在急性呼吸衰竭中的应用  

Use of end-tidal Carbon dioxide tension in patients with acute respiratory failure

作　　者：陈宇清[1] 赵冰清[2] 周新[1] 

机构地区：[1]上海市第一人民医院呼吸科,200080 [2]上海市第一人民医院急诊科,200080

出　　处：《中华急诊医学杂志》2003年第1期42-44,共3页Chinese Journal of Emergency Medicine

摘　　要：目的　评价在不同呼吸系统力学特性条件下接受机械通气支持的急性呼吸衰竭 (ARF)患者中测定呼气末二氧化碳分压 (PetCO2 )与动脉血二氧化碳分压 (PaCO2 )的相关性及临床意义。方法　采用前瞻性、对照研究方法。 4 4例ARF患者 ,其中慢性阻塞性肺疾病 (COPD) 30例 ,年龄 72± 10岁 ;急性呼吸窘迫综合征 (ARDS) 14例 ,年龄 6 7± 18岁。均为接受气管插管和机械通气支持 6小时以上。在通气参数和血流动力学稳定 1小时以上时同时测定PetCO2 和PaCO2 ,计算PetCO2 与PaCO2 之差 (ADCO2 )并测定系统静态顺应性 (Cst)和气道阻力 (Raw)。结果　两组患者的PetCO2 均与PaCO2 显著相关 (r分别为0 881和 0 74 6 ,均P <0 0 1)。COPD组ADCO2 与Raw高度相关 (r =0 86 0 ,P <0 0 1) ,ARDS组ADCO2 亦与Raw有一定的相关性 (r=0 5 79,P <0 0 5 )。ARDS组PaO2 /FiO2 与Cst明显相关 (r=0 5 98,P <0 0 5 )。结论　PetCO2 可用于判断机械通气状态下paCO2 变化。ADCO2 则可反映Raw的高低。PetCO2 是一种有用的无创性指标。Objective To evaluate the relationship and clinical value between end tidal carbon dioxide tension(PetCO 2) and PaCO 2 during mechauical ventilation in patients with actue respiratory failure(ARF) and diferent respiratory mechanics.Methods 44 ARF patients in tubated and received mechanical ventilation for more than 6 hours were divided into two groups.30 patients had chronic obstructive pulmonary disease(COPD)(mean age 72±10 years) and 14 patients were acute respiratory distress syndrome(ARDS)(mean age 67±18 years).Arterial blood gas(ABG) and PetCO 2 were measured when the ventilafor parameters and hemodynamics were stable forat least 1 hour.Compliance and resistance were observed every 24～48 hours.Results PetCO 2 were significantly correlated with PaCO 2 in both COPD and ARDS groups( r =0 881 and 0 746, P <0 01).AD CO2 (PCO 2)in COPD group had a significant relationship with Raw( r =0 860, P <0 01),and it was also found in ARDS group( r =0 579, P <0 05).PaO 2/FiO 2 in ARDS group appeared to be correlated with Cst( r =0 598, P <0 05).Conclusions PetCO 2 could reflect the change of PaCO 2 in patients during mechanical ventilation. AD CO2 may be associated to Raw.PetCO 2 was a useful non invasive index.[

关 键 词：呼气末二氧化碳分压 呼吸衰竭 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]