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目的:探讨呼吸末二氧化碳(ETCO2)在急危重患者代谢性紊乱中的预测价值。方法:分析2011-06-2011-09急诊入住武汉大学人民医院重症医学科的100例患者,入院后使用碳酸波形图监测初始ETCO2值,ETCO2监测完毕以后迅速抽血做血气分析监测HCO3值。统计数据并分析ETCO2和HCO3值的关系,同时比较分析存活组和死亡组以及HCO3≤21mmol/L和HCO3>21mmol/L的病例ETCO2和HCO3值的关系。结果:ETCO2和HCO3中度相关(R=0.593),死亡组ETCO2和HCO3值较存活组均明显减低,HCO3≤21mmol/L组ETCO2较HCO3>21mmol/L组低,差异有统计学意义。ETCO2可反映HCO3的水平,ROC曲线下面积是0.754(95%CI:0.659～0.850),ETCO2=32.5mmHg时,灵敏度=0.65,特异度=0.85,Youden指数=0.5,阳性似然比=4.3,阴性似然比=0.5,ETCO236.5mmHg时,特异度均在95%以上,甚至等于1。结论:碳酸波形图监测的ETCO2值作为一种无创的诊断工具,可有效预测危重症患者代谢性紊乱的发生,为临床评估患者的危重程度提供有力的证据,并为临床治疗的时机提供及时性的指导。
Objective: To investigate the predictive value of end-tidal carbon dioxide (ETCO2) in metabolic disorders in critically ill patients. Methods: Analysis of 2011-06-2011-09 emergency admission to Wuhan University People’s Hospital, Department of Critical Care Medicine, 100 patients admitted to the hospital after the use of carbon dioxide waveform monitoring of the initial ETCO2 value, ETCO2 monitoring blood gas analysis done after the completion of rapid monitoring of HCO3 value. Statistics and analysis of ETCO2 and HCO3 value of the relationship between the comparative analysis of survival and death groups and HCO3 ≤ 21mmol / L and HCO3> 21mmol / L cases of ETCO2 and HCO3 value relationship. Results: There was a moderate correlation between ETCO2 and HCO3 (R = 0.593). ETCO2 and HCO3 in the death group were significantly lower than those in the survival group. The ETCO2 in the HCO3≤21 mmol / L group was lower than that in the HCO3> 21 mmol / L group with statistically significant difference. ETCO2 reflects the level of HCO3, the area under the ROC curve is 0.754 (95% CI: 0.659-0.850), the sensitivity is 0.65, the specificity is 0.85, the Youden index is 0.5, the positive likelihood ratio is 4.3 when ETCO2 = 32.5mmHg, Negative likelihood ratio = 0.5, ETCO236.5mmHg, the specificity of 95% or more, or even equal to 1. CONCLUSIONS: The ETCO2 values monitored by carbonic acid waveform as a noninvasive diagnostic tool can effectively predict the occurrence of metabolic disorders in critically ill patients, provide strong evidence for clinical assessment of the severity of patients and provide prompt treatment for the timing of the treatment Guidance.