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目的 评价在不同呼吸系统力学特性条件下接受机械通气支持的急性呼吸衰竭 (ARF)患者中测定呼气末二氧化碳分压 (PetCO2 )与动脉血二氧化碳分压 (PaCO2 )的相关性及临床意义。方法 采用前瞻性、对照研究方法。 4 4例ARF患者 ,其中慢性阻塞性肺疾病 (COPD) 30例 ,年龄 72± 10岁 ;急性呼吸窘迫综合征 (ARDS) 14例 ,年龄 6 7± 18岁。均为接受气管插管和机械通气支持 6小时以上。在通气参数和血流动力学稳定 1小时以上时同时测定PetCO2 和PaCO2 ,计算PetCO2 与PaCO2 之差 (ADCO2 )并测定系统静态顺应性 (Cst)和气道阻力 (Raw)。结果 两组患者的PetCO2 均与PaCO2 显著相关 (r分别为0 881和 0 74 6 ,均P <0 0 1)。COPD组ADCO2 与Raw高度相关 (r =0 86 0 ,P <0 0 1) ,ARDS组ADCO2 亦与Raw有一定的相关性 (r=0 5 79,P <0 0 5 )。ARDS组PaO2 /FiO2 与Cst明显相关 (r=0 5 98,P <0 0 5 )。结论 PetCO2 可用于判断机械通气状态下paCO2 变化。ADCO2 则可反映Raw的高低。PetCO2 是一种有用的无创性指标。
Objective To evaluate the correlation between the end-tidal carbon dioxide partial pressure (PetCO2) and the arterial partial pressure of carbon dioxide (PaCO2) in patients with acute respiratory failure (ARF) receiving mechanical ventilation support under different respiratory system mechanical properties and their clinical significance. Methods A prospective, controlled study was used. Forty four ARF patients, including 30 cases of chronic obstructive pulmonary disease (COPD), aged 72 ± 10 years; 14 cases of acute respiratory distress syndrome (ARDS), aged 6 7 ± 18 years. All received endotracheal intubation and mechanical ventilation support 6 hours or more. PetCO2 and PaCO2 were measured simultaneously with ventilation parameters and hemodynamic stability for more than 1 hour. The difference between PetCO2 and PaCO2 (ADCO2) was calculated and the system static compliance (Cst) and airway resistance (Raw) were determined. Results PetCO2 in both groups was significantly correlated with PaCO2 (r = 0 881 and 0 746, respectively, P <0.01). ADCO2 in COPD group was highly correlated with Raw (r = 0 86 0, P <0.01). ADCO2 in ARDS group was also correlated with Raw (r = 0 5 79, P 0 05). PaO2 / FiO2 in ARDS group was significantly correlated with Cst (r = 0598, P <0 05). Conclusion PetCO2 can be used to determine the change of paCO2 under mechanical ventilation. ADCO2 can reflect the level of Raw. PetCO2 is a useful noninvasive indicator.