中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Trauma
2015年
9期
814-819
,共6页
王磊%雷晋%冯军峰%毛青%高国一%江基尧
王磊%雷晉%馮軍峰%毛青%高國一%江基堯
왕뢰%뢰진%풍군봉%모청%고국일%강기요
颅脑损伤%二氧化碳描记术%血气监测,经皮%通气机,机械
顱腦損傷%二氧化碳描記術%血氣鑑測,經皮%通氣機,機械
로뇌손상%이양화탄묘기술%혈기감측,경피%통기궤,궤계
Craniocerebral trauma%Capnography%Blood gas monitoring,transcutaneous%Ventilators,mechanical
目的 分析神经外科重症监护病房(NICU)患者呼气末二氧化碳分压(PetCO2)与动脉血二氧化碳分压(PaCO2)的相关性及其影响因素,探讨PetCO2的临床实用价值. 方法 选取32例NICU行气管插管或气管切开的患者,其中脑外伤16例,自发性脑出血9例,大面积脑梗死4例,大脑前交通动脉瘤2例,前颅窝底动静脉畸形1例.格拉斯哥昏迷评分(GCS)≤10分.每日早晨7时行动脉血气分析并将PaCO2与同步测定的PetCO2进行比较,根据PaCO2与PetCO2的差值[P(a-et)CO2]将患者分为P(a-et) CO2高值组[P(a-et)CO2 ＞5 mmHg]和P(a-et) CO2正常组[-5 mmHg≤P(a-et) CO2≤5 mmHg],观察PaCO2与PetCO2动态相关性及两组GCS、血压(BP)、心率(HR)、呼吸频率(RR)、体温(BT)、氧饱和度(SpO2)等参数的关系. 结果 对32例患者129次同步血气样本分析结果表明,PaCO2与PetCO2均呈正态分布(r=0.668,P＜0.01);根据Bland-Altman绘图得出69.8％的P(a-et) CO2值处于±5 mmHg范围内.P(a-et) CO2高值组比P(a-et) CO2正常组具有较低的初始GCS、即时GCS、BT、pH及较高的实际碳酸氢盐(AB)、PaCO2.呼气末正压通气(PEEP) ＞5 mmH2O时两者相关性快速降低(r=0.229,P＜0.01).结论 NICU患者的PaCO2与PetCO2具有较好的相关性,可以用来进行连续呼吸功能监测.初始GCS、BT、AB及PEEP可以对两者的相关性产生影响,因此用PetCO2评估患者通气状况时需考虑以上因素.
目的 分析神經外科重癥鑑護病房(NICU)患者呼氣末二氧化碳分壓(PetCO2)與動脈血二氧化碳分壓(PaCO2)的相關性及其影響因素,探討PetCO2的臨床實用價值. 方法 選取32例NICU行氣管插管或氣管切開的患者,其中腦外傷16例,自髮性腦齣血9例,大麵積腦梗死4例,大腦前交通動脈瘤2例,前顱窩底動靜脈畸形1例.格拉斯哥昏迷評分(GCS)≤10分.每日早晨7時行動脈血氣分析併將PaCO2與同步測定的PetCO2進行比較,根據PaCO2與PetCO2的差值[P(a-et)CO2]將患者分為P(a-et) CO2高值組[P(a-et)CO2 ＞5 mmHg]和P(a-et) CO2正常組[-5 mmHg≤P(a-et) CO2≤5 mmHg],觀察PaCO2與PetCO2動態相關性及兩組GCS、血壓(BP)、心率(HR)、呼吸頻率(RR)、體溫(BT)、氧飽和度(SpO2)等參數的關繫. 結果 對32例患者129次同步血氣樣本分析結果錶明,PaCO2與PetCO2均呈正態分佈(r=0.668,P＜0.01);根據Bland-Altman繪圖得齣69.8％的P(a-et) CO2值處于±5 mmHg範圍內.P(a-et) CO2高值組比P(a-et) CO2正常組具有較低的初始GCS、即時GCS、BT、pH及較高的實際碳痠氫鹽(AB)、PaCO2.呼氣末正壓通氣(PEEP) ＞5 mmH2O時兩者相關性快速降低(r=0.229,P＜0.01).結論 NICU患者的PaCO2與PetCO2具有較好的相關性,可以用來進行連續呼吸功能鑑測.初始GCS、BT、AB及PEEP可以對兩者的相關性產生影響,因此用PetCO2評估患者通氣狀況時需攷慮以上因素.
목적 분석신경외과중증감호병방(NICU)환자호기말이양화탄분압(PetCO2)여동맥혈이양화탄분압(PaCO2)적상관성급기영향인소,탐토PetCO2적림상실용개치. 방법 선취32례NICU행기관삽관혹기관절개적환자,기중뇌외상16례,자발성뇌출혈9례,대면적뇌경사4례,대뇌전교통동맥류2례,전로와저동정맥기형1례.격랍사가혼미평분(GCS)≤10분.매일조신7시행동맥혈기분석병장PaCO2여동보측정적PetCO2진행비교,근거PaCO2여PetCO2적차치[P(a-et)CO2]장환자분위P(a-et) CO2고치조[P(a-et)CO2 ＞5 mmHg]화P(a-et) CO2정상조[-5 mmHg≤P(a-et) CO2≤5 mmHg],관찰PaCO2여PetCO2동태상관성급량조GCS、혈압(BP)、심솔(HR)、호흡빈솔(RR)、체온(BT)、양포화도(SpO2)등삼수적관계. 결과 대32례환자129차동보혈기양본분석결과표명,PaCO2여PetCO2균정정태분포(r=0.668,P＜0.01);근거Bland-Altman회도득출69.8％적P(a-et) CO2치처우±5 mmHg범위내.P(a-et) CO2고치조비P(a-et) CO2정상조구유교저적초시GCS、즉시GCS、BT、pH급교고적실제탄산경염(AB)、PaCO2.호기말정압통기(PEEP) ＞5 mmH2O시량자상관성쾌속강저(r=0.229,P＜0.01).결론 NICU환자적PaCO2여PetCO2구유교호적상관성,가이용래진행련속호흡공능감측.초시GCS、BT、AB급PEEP가이대량자적상관성산생영향,인차용PetCO2평고환자통기상황시수고필이상인소.
Objective To examine the correlation between end-tidal carbon dioxide (PetCO2) and arterial CO2 (PaCO2) among patients admitted in neurosurgical intensive care unit (NICU) and the factors affecting the PaCO2-PetCO2 [P (a-et) CO2].Methods Thirty-two intubated or cut-trachea patients who presented in the NICU were enrolled.Arterial blood gas test was done at seven every morning,and values of PetCO2 were compared with simultaneously recorded PaCO2.The normal gap of P (a-et) CO2 was defined as-5 mmHg to 5 mmHg.Concordance between PaCO2 and PetCO2 was analyzed using the Bland-Altman plot.Parameters between the normal and high P(a-et) CO2 groups were compared to identify the factors affecting the P(a-et) CO2,including Glasgow Coma Scale(GCS),blood pressure (BP),heart rate (HR),respiration rate (RR),body temperature (BT),and pulse oxygen saturation (SpO2).Results Allvalues of PaCO2 and PetCO2 were in accordance with normal distribution (r =0.668,P ＜ 0.01) and concordance between PaCO2 and PetCO2 was 69.8％.Patients who had high P(aet) CO2 showed lower initial GCS,lower instant GCS,BT,as well as pH and higher actual bicarbonate (AB) and PetCO2 than the patients with normal P (a-et) CO2.Correlation between PaCO2 and PetCO2 rapidly declined when positive end expiratory pressure(PEEP) was greater than 5 mmH2O(r =0.229,P ＜ 0.01).Conclusions PetCO2 correlates well with PaCO2 and appears to be a useful monitor of respiratory function of the patients consecutively.Initial GCS,BT,AB and PEEP have an impact on P(a-et) CO2,so those factors should be considered when attempting to monitor the hyperventilation with PetCO2.
