Kissoon N, Peterson R, Murphy S, Gayle M, Ceithaml E, Harwood-Nuss A
Department of Pediatrics, University of Florida, Jacksonville.
Crit Care Med. 1994 Jun;22(6):1010-5. doi: 10.1097/00003246-199406000-00021.
To compare the pH and PCO2 values determined from of simultaneously corrected samples of central venous and intraosseous blood during sequential changes in cardiac output.
Prospective, descriptive study.
An animal laboratory in a university medical center.
Fourteen mixed breed 4-wk-old piglets.
Animals were anesthetized with ketamine hydrochloride and neuromuscular blockade was induced by the administration of pancuronium bromide. After endotracheal intubation and the institution of mechanical ventilation, a 4-Fr pulmonary artery catheter and a carotid artery cannula were inserted via a cutdown into the right neck of each piglet. A 16-gauge intraosseous needle was inserted into the anteromedial surface of the right tibia.
Central venous and intraosseous blood gas samples were obtained simultaneously with thermodilution cardiac output measurements. Cardiac output measurements were as follows: during steady state (0.80 +/- 0.14 L/min), after volume loading of 15 mL/kg (1.00 +/- 0.25 L/min), after three successive bleeds of 15 mL/kg each at 30-min intervals (0.70 +/- 0.28, 0.54 +/- 0.22, and 0.43 +/- 0.16 L/min, respectively) and at exsanguination (unrecordable). Paired t-tests demonstrated no significant differences in pH and PCO2 values between intraosseous and central venous samples under all study conditions. Limits of agreement for difference in PCO2 between sites, within the range of cardiac outputs studied, were -12.86 to 11.38 torr (-1.71 to 1.46 kPa) and for pH were -0.09 to 0.15.
Intraosseous blood samples can be obtained without difficulty even during extreme hypovolemia. The pH and PCO2 values of intraosseous and central venous blood samples were similar under all study conditions. Intraosseous blood may be a useful alternative to central venous blood to assess tissue acid-base status during hemorrhagic shock and other low-flow states.
比较在心输出量连续变化期间，同时校正的中心静脉血和骨内血样本所测定的pH值和PCO₂值。
前瞻性描述性研究。
大学医学中心的动物实验室。
14只4周龄的杂种仔猪。
用盐酸氯胺酮麻醉动物，并用潘库溴铵诱导神经肌肉阻滞。气管插管并开始机械通气后，通过切开术将一根4F肺动脉导管和一根颈动脉插管插入每只仔猪的右颈部。将一根16号骨内针插入右胫骨的前内侧表面。
在进行热稀释法心输出量测量的同时，采集中心静脉血和骨内血气样本。心输出量测量结果如下：稳态时（0.80±0.14L/min），15mL/kg容量负荷后（1.00±0.25L/min），每隔30分钟连续三次每次放血15mL/kg后（分别为：0.70±0.28、0.54±0.22和0.43±0.16L/min）以及放血时（未记录到）。配对t检验显示，在所有研究条件下，骨内样本和中心静脉样本的pH值和PCO₂值无显著差异。在所研究的心输出量范围内，部位间PCO₂差值的一致性界限为-12.86至11.38托（-1.71至1.46kPa），pH值的一致性界限为-0.09至0.15。
即使在极度低血容量期间，也能顺利采集骨内血样本。在所有研究条件下，骨内血样本和中心静脉血样本的pH值和PCO₂值相似。在失血性休克和其他低流量状态下，骨内血可能是评估组织酸碱状态的中心静脉血的有用替代物。
