经皮测量与动脉测量之间乳酸水平和二氧化碳分压差异的关系。
The relation of lactate level and carbon dioxide pressure discrepancies between transcutaneous and arterial measurements.
作者信息
Gürün Kaya Aslıhan, Özpinar Şeyda Nur, Öz Miraç, Erol Serhat, Arslan Fatma, Çiledağ Aydın, Kaya Akın
机构信息
Department of Chest Disease, Ankara University Faculty of Medicine, Ankara, Türkiye.
出版信息
Tuberk Toraks. 2024 Jun;72(2):120-130. doi: 10.5578/tt.202402920.
INTRODUCTION
Partial carbondioxide pressure of the arterial blood (PaCO2) is used to evaluate alveolar ventilation. Transcutaneous carbon dioxide pressure (TcCO2) monitoring has been developed as a non-invasive (NIV) alternative to arterial blood gas analysis (ABG). Studies have shown that decreased tissue perfusion leads to increased carbondioxide (CO2). The use of transcutaneous capnometry may be unreliable in patients with perfusion abnormalities. In this study, we aimed to evaluate the relation between TcCO2-PaCO2 and lactate level which is recognized as a marker of hypoperfusion.
MATERIALS AND METHODS
In this prospective cohort study in critical care patients with hypercapnic respiratory failure (PaCO2 ≥45 mmHg) who received NIV between April 2019 and January 2020 in the intensive care unit were enrolled in the study. Patients' simultaneously measured TcCO2 and PaCO2 values of hypercapnic patients were recorded. Each paired measurement was categorized into two groups; normal lactate (<2 mmol/L) and increased lactate (≥2 mmol/L).
RESULT
A total of 116 paired TcCO2 and PaCO2 measurements of 29 patients were recorded. Bland-Altman analysis showed the mean bias between the TcCO2 and PaCO2 and 95% limits of agreement (LOA) in all measurements (1.75 mmHg 95% LOA -3.67 to 7.17); in the normal lactate group (0.66 mmHg 95% LOA -1.71 to 3.03); and in the increased lactate group (5.17 mmHg 95% LOA -1.63 to 11.97). The analysis showed a correlation between lactate level and the difference between TcCO2 and PaCO2 (r= 0.79, p< 0.001) and a negative correlation between mean blood pressure and the difference between TcCO2 and PaCO2 (r= -0.54, p= 0.001). Multiple regression analysis results showed that lactate level was independently associated with increased differences between TcCO2 and PaCO2 (Beta= 0.875, p< 0.001).
CONCLUSIONS
TcCO2 monitoring may not be reliable in patients with increased lactate levels. TcCO2 levels should be checked by ABG analysis in these patients.
引言
动脉血二氧化碳分压（PaCO₂）用于评估肺泡通气。经皮二氧化碳分压（TcCO₂）监测已发展成为一种替代动脉血气分析（ABG）的非侵入性方法。研究表明，组织灌注减少会导致二氧化碳（CO₂）增加。对于存在灌注异常的患者，使用经皮二氧化碳测定法可能不可靠。在本研究中，我们旨在评估TcCO₂ - PaCO₂与乳酸水平之间的关系，乳酸水平被认为是低灌注的一个指标。
材料与方法
在这项前瞻性队列研究中，纳入了2019年4月至2020年1月在重症监护病房接受无创通气的高碳酸血症呼吸衰竭（PaCO₂≥45 mmHg）的重症患者。记录高碳酸血症患者同时测量的TcCO₂和PaCO₂值。每对测量值分为两组；正常乳酸（<2 mmol/L）和升高乳酸（≥2 mmol/L）。
结果
共记录了29例患者的116对TcCO₂和PaCO₂测量值。Bland - Altman分析显示，所有测量中TcCO₂和PaCO₂之间的平均偏差及95%一致性界限（LOA）为（1.75 mmHg，95% LOA - 3.67至7.17）；正常乳酸组为（0.66 mmHg，95% LOA - 1.71至3.03）；升高乳酸组为（5.17 mmHg，95% LOA - 1.63至11.97）。分析显示乳酸水平与TcCO₂和PaCO₂之间的差异存在相关性（r = 0.79，p < 0.001），平均血压与TcCO₂和PaCO₂之间的差异存在负相关性（r = - 0.54，p = 0.001）。多元回归分析结果显示，乳酸水平与TcCO₂和PaCO₂之间差异增加独立相关（β = 0.875，p < 0.001）。
结论
乳酸水平升高的患者中，TcCO₂监测可能不可靠。这些患者应通过ABG分析检查TcCO₂水平。
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