摘要
目的观察胸腔镜食管癌根治术患者CO2人工气胸期间PaCO2与呼末二氧化碳分压(PETCO2)的变化及两者相关性。方法选择ASAⅠ或Ⅱ级择期单腔气管导管全身麻醉下行胸腔镜食管癌根治术患者30例,男性19例,女性11例。麻醉诱导后置入单腔气管导管行双肺通气,手术期间持续向术侧胸腔内吹入CO2气体以使肺部分萎陷。观察人工气胸前(T0)、人工气胸后30 min(T1)、人工气胸后60 min(T2)、停止人工气胸后10 min(T3)4个时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、中心静脉压(CVP)、PaO2、PaCO2、pH值、PETCO2、Pa-ETCO2。结果CO2人工气胸建立后各时间点的MAP、HR、SpO2稍有波动,但CVP明显升高,差异有统计学意义(P<0.01);T1、T2时点的气道压力及PaCO2、PETCO2、Pa-ETCO2较T0时明显增高,差异有统计学意义(P<0.05),T2与T1相比,PaCO2、PETCO2、Pa-ETCO2及CVP的差异无统计学意义(P>0.05)。T3与T0时比较,组内及组间除CVP外,各指标差异无统计学意义(P>0.05)。各时点的PaCO2和PETCO2两者之间均呈直线正性相关,相关系数r分别为0.883、0.720、0.682、0.810。结论CO2人工气胸的应用,明显影响患者的PaCO2及PETCO2,并降低两者的相关性,降低了临床应用无创的PETCO2监测评估PaCO2的可信度,必要时应行血气检测为宜。
Objective To observe the changes of PaCO2 and PETCO2 during CO2 pneumothorax in patients undergoing thoracoscopic radical esophagectomy and their correlation analysis.Methods 30 patients(19 males and 11 females)were enrolled in this study.After anesthesia induction,a single lumen tracheal tube was inserted for double-lungs ventilation.During the operation,CO2 gas was continuously blown into the thoracic cavity of the operation side to make partial collapse of the lung.MAP,HR,SpO2,CVP,PaO2,PaCO2,pH value,PETCO2 and Pa-ETCO2 were observed and recorded at four time points of artificial pneumothorax(T0),30 minutes after artificial pneumothorax(T1),60 minutes after artificial pneumothorax(T2),and 10 minutes after stopping artificial pneumothorax(T3).Results MAP,HR and SpO2 of each time point fluctuated slightly,but CVP increased significantly(P<0.01),airway pressure and PaCO2,PETCO2 and Pa-ETCO2 at T1、T2 time point increased significantly(P<0.05).Comparing T3 with T0,there was no statistically significant difference between the indexes within and between groups except CVP(P>0.05).There was a linear positive correlation between PaCO2 and PETCO2 at each time point,and the r value were 0.883,0.720,0.682 and 0.810.Conclusion The application of CO2 artificial pneumothorax significantly affects PaCO2 and PETCO2 of patients,reduces the correlation between the two,and reduces the credibility of of non-invasive PETCO2 monitoring and PaCO2 evaluation in clinical application.Blood gas detection is appropriate when necessary.
作者
陈金红
叶炜
朱学芳
王洁
姚盛来
CHEN Jin-hong;YE Wei;ZHU Xue-fang(Depatment of Anesthesiology,Huaiyin Hospital,Huai’an,Jiangsu,223300,China)
出处
《黑龙江医学》
2020年第11期1501-1503,共3页
Heilongjiang Medical Journal
