先天性心脏病患儿气管导管末端穿刺法与旁气流法监测PETCO2和PaCO2的相关性

徐玉洁; 何明枫; 张斯璧

文章摘要

先天性心脏病患儿气管导管末端穿刺法与旁气流法监测P_ETCO₂和PaCO₂的相关性

Relationship between end-tidal carbon dioxide tension obtained from the distal ends of the tracheal tube and arterial pressure of carbon dioxide with the side stream capnometerin infants with congenital heart disease

DOI：

中文关键词: 患儿先天性心脏病呼气末二氧化碳分压

英文关键词: Infant patients Congenital heart disease End-tidal carbon dioxide tension

基金项目:

作者	单位
徐玉洁	210029,江苏省人民医院麻醉科
何明枫	210029,江苏省人民医院麻醉科
张斯璧	210029,江苏省人民医院麻醉科

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中文摘要:

目的比较先天性心脏病（简称先心病）患儿经气管导管末端穿刺法与旁气流法监测P_ETCO₂和PaCO₂的相关性。方法选择全麻下行先心病手术的患儿20例,男12例,女8例,年龄3～48个月,ASA Ⅰ～Ⅲ级。同时采取22 G套管针气管导管末端穿刺持续监测(简称末端穿刺法)与旁气流法测P_ETCO₂。采集动脉血测PaCO₂。记录两种方法在麻醉诱导后和心肺转流（CPB）停止后的P_ETCO₂和桡动脉血PaCO₂,采用配对t检验及线性相关分析两者的相关性。结果末端穿刺法测得的P_ETCO₂在麻醉诱导后［(36.8±2.7)mm Hg vs.(32.5±1.4)mm Hg,P＜0.05］以及CPB停止后［(40.8±2.5)mm Hg vs.(36.5±1.6)mm Hg，P＜0.05]均明显高于旁气流法。桡动脉血PaCO₂与末端穿刺法P_ETCO₂的差值在麻醉诱导后［(7.1±0.7)mm Hg vs. (11.4±1.5) mm Hg，P＜0.01］和CPB停止后［(9.3±1.2)mm Hg vs. (13.5±2.3) mm Hg，P＜0.01］均明显低于PaCO₂与旁气流法P_ETCO₂的差值。麻醉诱导后和CPB停止后PaCO₂与末端穿刺法测得P_ETCO₂的线性确定系数(R²)分别为0.94和0.93（P＜0.05）,旁气流法测得的麻醉诱导后、CPB停止后P_ETCO₂与PaCO₂的R²分别为0.68和0.66（P＜0.05）。结论在血流动力学稳定的患儿中，经22 G套管针气管导管末端穿刺持续监测P_ETCO₂与PaCO₂的相关性更好,可准确反映机体二氧化碳分压的变化。

英文摘要:

Objective To determine the relationship between end-tidal carbon dioxide tension (P_ETCO₂) obtained from the distal ends of the tracheal tube and arterial pressure of carbon dioxide (PaCO₂) compared with the sidestream capnometer in infants with congenital heart disease. Methods Twenty infants undergoing congenital heart disease surgery, 12 males and 8 females, aged 3-48 months, ASA physical status Ⅰ-Ⅲ were enrolled. Measurements of P_ETCO₂ were obtained from the distal ends of the tracheal tube using a sterile 22 G catheter that was inserted into the tube and from the proximal end with a sidestream capnometer in 20 intubated infants with congenital heart disease. The data including P_ETCO₂ and the arterial PaCO₂ were obtained both after the anesthesia induction and the CPB. Results The data of P_ETCO₂ obtained from the distal ends of the tracheal tube after the anesthesia induction [(36.8±2.7) mm Hg vs. (32.5±1.4) mm Hg, P＜0.05] and the CPB [(40.8±2.5) mm Hg vs. (36.5±1.6) mm Hg， P＜0.05] were both higher than those from the proximal end with a sidestream capnometer. The difference between PaCO₂ and P_ETCO₂ obtained from the distal ends of the tracheal tube after the induction [(7.1±0.7) mm Hg vs. (11.4±1.5) mm Hg,P＜0.01] and the CPB [(9.3±1.2) mm Hg vs. (13.5±2.3) mm Hg,P＜0.01] were significantly lower than that between PaCO₂ and P_ETCO₂ obtained from the proximal end. Distal sidestream P_ETCO₂ correlated with the PaCO₂ (R²=0.94 after induction and R²=0.93 after the CPB, P＜0.05). However, the proximal P_ETCO₂ with the sidestream capnometer correlated very poorly with PaCO₂ whether after the induction (R²=0.68, P＜0.05) nor the CPB (R²=0.66, P＜0.05). Conclusion We conclude that the P_ETCO₂ obtained from the distal ends of the tracheal tube provides accurate estimates of the PaCO₂ in critically ill infants with congenital heart disease.

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