Wilson R F, Tyburski J G, Kubinec S M, Warsow K M, Larky H C, Wilson S R, Schermerhorn T
Department of Surgery, Detroit Receiving Hospital, MI 48201, USA.
J Trauma. 1996 Oct;41(4):606-11. doi: 10.1097/00005373-199610000-00003.
To determine the relationship between the prognosis of seriously injured patients requiring emergency surgery and intraoperative end-tidal CO2 variables and "excess Pco2."
Retrospective chart review of 100 seriously injured patients admitted to Detroit Receiving Hospital and requiring major surgery (mortality rate of 40%). Standard intraoperative monitoring, including continuous capnography, plus arterial blood analyses every 15 to 30 minutes during surgery.
After resuscitation for 45 to 90 minutes, 11 patients had a systolic blood pressure < 100 mm Hg and, of these patients, 10 (91%) died. Of the remaining 89 patients, mortality rates were 53% (16/30), with an end-tidal CO2 of 22 mm Hg or less, versus 24% (14/59) with an end-tidal CO2 of 23 mm Hg or more (p = 0.011). An arterial to end-tidal Pco2 difference of 13 mm Hg or more after resuscitation was associated with an increased mortality rate (50% (20/34 vs. 18% (20/55)) (p < 0.005). The mortality rate was particularly high, with a final arterial to end-tidal Pco2 difference of 12 mm Hg or more (73% (30/41) versus 17% (10/59) (p < 0.001). A final Paco2 excess (i.e., the amount by which the Paco2 was higher than expected from the bicarbonate) > 1.0 mm Hg was also associated with an increased mortality rate ((62% (33/53) vs. 15% (7/47)) (p < 0.001).
Values derived from the end-tidal CO2 and the excess Pco2 should be monitored intraoperatively in critically injured patients. Efforts should be made to improve cardiac output and adjust ventilation to maintain an end-tidal Pco2 of 25 mm Hg or more, an arterial to end-tidal CO2 difference of 12 mm Hg or less, and an excess Paco2 of 1.0 mm Hg or less.
确定需要急诊手术的重伤患者的预后与术中呼气末二氧化碳变量及“额外Pco₂”之间的关系。
对底特律接收医院收治的100例需要进行大手术的重伤患者进行回顾性病历审查（死亡率为40%）。术中进行标准监测，包括持续二氧化碳监测，以及在手术期间每15至30分钟进行一次动脉血气分析。
复苏45至90分钟后，11例患者收缩压<100 mmHg，其中10例（91%）死亡。其余89例患者中，呼气末二氧化碳≤22 mmHg的患者死亡率为53%（16/30），而呼气末二氧化碳≥23 mmHg的患者死亡率为24%（14/59）（p = 0.011）。复苏后动脉血与呼气末Pco₂差值≥13 mmHg与死亡率增加相关（50%（20/34）对18%（20/55））（p < 0.005）。最终动脉血与呼气末Pco₂差值≥12 mmHg时死亡率特别高（73%（30/41）对17%（10/59））（p < 0.001）。最终的动脉血二氧化碳分压过高（即动脉血二氧化碳分压高于根据碳酸氢盐预期值的量）>1.0 mmHg也与死亡率增加相关（（62%（33/53）对15%（7/47））（p < 0.001）。
对于重症受伤患者，术中应监测呼气末二氧化碳值及额外Pco₂。应努力改善心输出量并调整通气，以维持呼气末Pco₂≥25 mmHg，动脉血与呼气末二氧化碳差值≤12 mmHg，以及动脉血二氧化碳分压过高值≤1.0 mmHg。
