严重肥胖成年人全身麻醉期间呼气末与经皮二氧化碳测量的比较。
Comparison of end-tidal and transcutaneous measures of carbon dioxide during general anaesthesia in severely obese adults.
作者信息
Griffin J, Terry B E, Burton R K, Ray T L, Keller B P, Landrum A L, Johnson J O, Tobias J D
机构信息
Departments of Anesthesiology and Surgery, The University of Missouri, Columbia, Missouri, USA.
出版信息
Br J Anaesth. 2003 Oct;91(4):498-501. doi: 10.1093/bja/aeg217.
BACKGROUND
Patients with severe obesity (body mass index (BMI) greater than 35 kg x m(-2)) present difficulties for end-tidal carbon dioxide (FE'(CO(2))) monitoring. Previous studies suggest that transcutaneous (TC) carbon dioxide measurements could be valuable, so we compared FE' and TC measures with Pa(CO(2)) in severely obese patients during anaesthesia.
METHODS
We studied patients with severe obesity (BMI >or=40 kg x m(-2)) undergoing gastric bypass surgery. Carbon dioxide was measured with both FE' and TC devices. The difference between each measure (FE'(CO(2)) and TC-CO(2)) and the Pa(CO(2)) was averaged for each patient to provide one value, and data compared with a non-paired, two-way t-test, Fisher's exact test.
RESULTS
We studied 30 adults (aged 18-54 yr, mean 41, SD 8.0 yr; weight: 115-267 kg, mean 162, SD 35 kg). The absolute difference between the TC-CO(2) and Pa(CO(2)) was 0.2 (0.2) (mean, SD) kPa while the absolute difference between the FE'(CO(2)) and Pa(CO(2)) was 0.7 (0.4) kPa (P<0.0001). The bias and precision were +0.1 (0.3) kPa for TC vs arterial carbon dioxide and -0.7 (0.4) kPa for FE' vs arterial carbon dioxide.
CONCLUSIONS
Transcutaneous carbon dioxide monitoring provides a better estimate of Pa(CO(2)) than FE'(CO(2)) in patients with severe obesity.
背景
重度肥胖患者（体重指数（BMI）大于35kg·m⁻²）的呼气末二氧化碳（FE'(CO₂)）监测存在困难。既往研究表明，经皮（TC）二氧化碳测量可能有价值，因此我们在麻醉期间比较了重度肥胖患者的FE'和TC测量值与动脉血二氧化碳分压（Pa(CO₂)）。
方法
我们研究了接受胃旁路手术的重度肥胖患者（BMI≥40kg·m⁻²）。使用FE'和TC设备测量二氧化碳。计算每位患者每种测量值（FE'(CO₂)和TC-CO₂）与Pa(CO₂)之间的差值并求平均值，以提供一个数值，数据采用非配对双样本t检验、Fisher精确检验进行比较。
结果
我们研究了30名成年人（年龄18 - 54岁，平均41岁，标准差8.0岁；体重：115 - 267kg，平均162kg，标准差35kg）。TC-CO₂与Pa(CO₂)之间的绝对差值为0.2（0.2）（平均值，标准差）kPa，而FE'(CO₂)与Pa(CO₂)之间的绝对差值为0.7（0.4）kPa（P<0.0001）。TC与动脉血二氧化碳的偏差和精密度为+0.1（0.3）kPa，FE'与动脉血二氧化碳的偏差和精密度为-0.7（0.4）kPa。
结论
在重度肥胖患者中，经皮二氧化碳监测比FE'(CO₂)能更好地估计Pa(CO₂)。
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