成人单肺通气和微创手术期间PaCO₂的无创监测：呼气末与经皮技术

Noninvasive monitoring of PaCO(2) during one-lung ventilation and minimal access surgery in adults: End-tidal versus transcutaneous techniques.

作者信息

Cox Paul, Tobias Joseph D

机构信息

University of Missouri School of Medicine, Columbia, Missouri, USA.

出版信息

J Minim Access Surg. 2007 Jan;3(1):8-13. doi: 10.4103/0972-9941.30680.

DOI:10.4103/0972-9941.30680

PMID:20668612

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2910382/

Abstract

BACKGROUND

Previous studies have suggested that end-tidal CO(2) (ET-CO(2)) may be inaccurate during one-lung ventilation (OLV). This study was performed to compare the accuracy of the noninvasive monitoring of PCO(2) using transcutaneous CO(2) (TC-CO(2)) with ET-CO(2) in patients undergoing video-assisted thoracoscopic surgery (VATS) during OLV.

MATERIALS AND METHODS

In adult patients undergoing thoracoscopic surgical procedures, PCO(2) was simultaneously measured with TC-CO(2) and ET-CO(2) devices and compared with PaCO(2).

RESULTS

The cohort for the study included 15 patients ranging in age from 19 to 71 years and in weight from 76 to 126 kg. During TLV, the difference between the TC-CO(2) and the PaCO(2) was 3.0 +/- 1.8 mmHg and the difference between the ET-CO(2) and PaCO(2) was 6.2 +/- 4.7 mmHg (P=0.02). Linear regression analysis of TC-CO2 vs. PaCO(2) resulted in an r(2) = 0.6280 and a slope = 0.7650 +/- 0.1428, while linear regression analysis of ET-CO(2)vs. PaCO(2) resulted in an r(2) = 0.05528 and a slope = 0.1986 +/- 0.1883. During OLV, the difference between the TC-CO(2) and PaCO(2) was 3.5 +/- 1.7 mmHg and the ET-CO(2) to PaCO(2) difference was 9.6 +/- 3.6 mmHg (P=0.03 vs. ET-CO(2) to PaCO(2) difference during TLV; and P<0.0001 vs. TC-CO(2) to PaCO(2) difference during OLV). In 13 of the 15 patients, the TC-CO(2) value was closer to the actual PaCO(2) than the ET-CO(2) value (P =0.0001). Linear regression analysis of TC-CO(2)vs. PaCO(2) resulted in an r(2) = 0.7827 and a slope = 0.8142 +/- 0.0.07965, while linear regression analysis of ET-CO(2)vs. PaCO(2) resulted in an r(2) = 0.2989 and a slope = 0.3026 +/- 0.08605.

CONCLUSIONS

During OLV, TC-CO(2) monitoring provides a better estimate of PaCO(2) than ET-CO2 in patients undergoing VATS.

摘要

背景

先前的研究表明，在单肺通气（OLV）期间，呼气末二氧化碳（ET-CO₂）可能不准确。本研究旨在比较在电视辅助胸腔镜手术（VATS）患者的OLV期间，使用经皮二氧化碳（TC-CO₂）进行无创PCO₂监测与ET-CO₂监测的准确性。

材料与方法

在接受胸腔镜手术的成年患者中，使用TC-CO₂和ET-CO₂设备同时测量PCO₂，并与动脉血二氧化碳分压（PaCO₂）进行比较。

结果

该研究队列包括15例年龄在19至71岁之间、体重在76至126 kg之间的患者。在双肺通气（TLV）期间，TC-CO₂与PaCO₂之间的差值为3.0±1.8 mmHg，ET-CO₂与PaCO₂之间的差值为6.2±4.7 mmHg（P=0.02）。TC-CO₂与PaCO₂的线性回归分析得出r² = 0.6280，斜率 = 0.7650±0.1428，而ET-CO₂与PaCO₂的线性回归分析得出r² = 0.05528，斜率 = 0.1986±0.1883。在OLV期间，TC-CO₂与PaCO₂之间的差值为3.5±1.7 mmHg，ET-CO₂与PaCO₂之间的差值为9.6±3.6 mmHg（与TLV期间ET-CO₂与PaCO₂的差值相比，P=0.03；与OLV期间TC-CO₂与PaCO₂的差值相比，P<0.0001）。在15例患者中的13例中，TC-CO₂值比ET-CO₂值更接近实际PaCO₂值（P =0.0001）。TC-CO₂与PaCO₂的线性回归分析得出r² = 0.7827，斜率 = 0.8142±0.07965，而ET-CO₂与PaCO₂的线性回归分析得出r² = 0.2989，斜率 = 0.3026±0.08605。