中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

机械通气患者呼气末二氧化碳分压与动脉血二氧化碳分压的相关性研究

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目的 分析机械通气条件下,呼气末二氧化碳分压(PETCO2)与 动脉血二氧化碳分压(PaCO2) 之间的相关性。 方法 选择 2016 年 6 月至 2017 年 3 月在重症医学科行有创机械通气的成年患者,每例患者需要评估动脉血气时,同一时间检测 PETCO2,待数值稳定后,记录 PETCO2 数据。动脉血气分析采集桡动脉或股动脉血标本,床旁完成检测。PETCO2 数据和动脉血气分析在 5 min 内完成。比较不同呼吸机治疗模式、不同疾病类型和不同氧合指数下二者之间相关性。 结果 共有 104 例患者 225 组 PETCO2-PaCO2 成对数据纳入分析。在未区分呼吸机模式下,PETCO2 和 PaCO2 之间具有明显正相关,相关系数为 0.70,直线回归方程 Y=11.08+0.77X(Y:PaCO2;X:PETCO2)。不同呼吸机模式情况下,仅辅助/控制通气(A/C)模式下二者不具相关性(r=0.31,P=0.10);而同步间歇指令通气(SIMV)和自主通气(SPONT)模式下,二者具有明显相关性,但 SPONT 模式下相关性相对较弱(r=0.60,P<0.001)。在慢性阻塞性肺疾病、多发伤、严重脑血管疾病以及重症肺炎患者,PETCO2 和 PaCO2 均呈正相关,相关系数分别为 0.76、0.64、0.53 和 0.56。氧合指数<200 mm Hg 或≥200 mm Hg 时,二者之间均明显正相关,相关系数分别为 0.69 和 0.71。 结论 接受有创机械通气的病情稳定患者,不同呼吸机模式下、不同疾病类型、不同氧合指数时,PETCO2与PaCO2均具有明显正相关。

Objective To analyze the relationship between end-tidal carbon dioxide partial pressure (PETCO2) and arterial CO2 pressure (PaCO2) in invasive ventilated patients. Methods An observational study was conducted in adult patients admitted to Intensive Care Unit (ICU) between June 2016 and March 2017. Samples were immediately analyzed for PaCO2 using a blood gas analyzer. At the same time the arterial to end-tidal CO2 gradient was determined. Relationship in different mechanical ventilation modes, disease categories and PaO2/FiO2 were analyzed in this study. Results A total of 225 arterial blood gases were obtained from the 104 patients. In each of these modes the PETCO2 was generally lower than the PaCO2. There was a positive correlation between PaCO2 and PETCO2 regardless of different mode (r=0.70, Y=11.08+0.77X). A positive correlation was found in SIMV and SPONT modes, but not in A/C mode. The relationship between PaCO2 and PETCO2 in COPD, trauma, cerebrovascular disease and severe pneumonia patients shown a positive correlation (r value was 0.76, 0.64, 0.53, and 0.56, respectively). There was a significant correlation whether PaCO2/FiO2<200 mm Hg (r=0.69, P<0.001) or ≥200 mm Hg (r=0.71, P<0.001). Conclusions The results of this study show that PETCO2 monitoring accurately reflects PaCO2 during mechanical ventilation. A positive correlation is found in different ventilation modes, regardless of disease categories or PaCO2/FiO2.

关键词: 呼气末二氧化碳分压; 动脉血二氧化碳分压; 机械通气; 相关性分析

Key words: End-tidal carbon dioxide partial pressure gradients; Arterial carbon dioxide pressure; Mechanical ventilation; Correlation analysis

引用本文: 王金荣, 邵立业, 郭伟, 杨晓亚, 崔朝勃. 机械通气患者呼气末二氧化碳分压与动脉血二氧化碳分压的相关性研究. 中国呼吸与危重监护杂志, 2018, 17(1): 71-75. doi: 10.7507/1671-6205.201708009 复制

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