经皮二氧化碳监测在高流量鼻氧下进行长期窒息氧合中的应用

贵州医科大学  麻醉与心脏电生理课题组

翻 译：马艳燕 编 辑：柏雪 审 校：曹莹

背景：用高流量鼻氧进行窒息氧合的持续时间受到高碳酸血症和酸中毒的限制，因此监测动脉二氧化碳水平是必要的。我们在接受长期窒息氧合的患者中进行了一项研究，通过经皮二氧化碳监测进行性高碳酸血症。在这篇文章中，我们比较了经皮二氧化碳水平和动脉二氧化碳分压。

方法：这是基于一项探索窒息氧合极限研究数据的二次发表。我们用Bland-Altman分析比较了经皮二氧化碳监测值和动脉二氧化碳分压，这些患者接受了长时间的窒息氧合，直到达到预定的pH值7.15或二氧化碳分压达到12kpa的极限。

结果：我们纳入了35名患者，他们的平均窒息氧合时间为25分钟。窒息氧合结束时平均pH值为7.14，平均动脉二氧化碳分压为11.2kPa。经皮二氧化碳监测最初略微低估了动脉二氧化碳分压，但当二氧化碳水平高于10 kPa时，它高估了该值。偏差范围为-0.55至0.81 kPa，一致性极限在-1.25至2.11 kPa之间。

结论：经皮二氧化碳监测提供了一种临床可接受的动脉血气替代物，但随着高碳酸血症发展到相当高的水平，我们观察到在接受高流量鼻氧进行窒息氧合的患者中，高估了动脉二氧化碳分压。

原始文献来源 ：Pape P, Piosik ZM, Kristensen CM, Dirks J, Rasmussen LS, Kristensen MS. Transcutaneous carbon dioxide monitoring during prolonged apnoea with high-flow nasal oxygen. Acta Anaesthesiol Scand. 2023 Feb 9. doi: 10.1111/aas.14216.

英文原文：

Transcutaneous carbon dioxide monitoring during prolonged apnoea with high-flow nasal oxygen

Background: The duration of apnoeic oxygenation with high-flow nasal oxygen is limited by hypercapnia and acidosis and monitoring of arterial carbon dioxide level is therefore essential. We have performed a study in patients undergoing prolonged apnoeic oxygenation where we monitored the progressive hypercapnia with transcutaneous carbon dioxide. In this paper, we compared the transcutaneous carbon dioxide level with arterial carbon dioxide tension.

Methods: This is a secondary publication based on data from a study exploring the limits of apnoeic oxygenation. We compared transcutaneous carbon dioxide monitoring with arterial carbon dioxide tension using Bland-Altman analyses in anaesthetised and paralysed patients undergoing prolonged apnoeic oxygenation until a predefined limit of pH 7.15 or PCO2 of 12 kPa was reached.

Results: We included 35 patients with a median apnoea duration of 25 min. Mean pH was 7.14 and mean arterial carbon dioxide tension was 11.2 kPa at the termination of apnoeic oxygenation. Transcutaneous carbon dioxide monitoring initially slightly underestimated the arterial tension but at carbon dioxide levels above 10 kPa it overestimated the value. Bias ranged from -0.55 to 0.81 kPa with limits of agreement between -1.25 and 2.11 kPa.

Conclusion: Transcutaneous carbon dioxide monitoring provided a clinically acceptable substitute for arterial blood gases but as hypercapnia developed to considerable levels, we observed overestimation at high carbon dioxide tensions in patients undergoing apnoeic oxygenation with high-flow nasal oxygen.

来源 | 健康界

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