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PET CO 2和 PaCO 2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PET CO 2。采集动脉血测 PaCO 2。记录两种方法在麻醉诱导后和心肺转流(CPB)停止后的PET CO 2和桡动脉血 PaCO 2,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PET CO 2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PaCO 2与末端穿刺法PET CO 2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 PaCO 2与旁气流法PET CO 2的差值。麻醉诱导后和 CPB 停止后 PaCO 2与末端穿刺法测得PET CO 2的线性确定系数(R 2)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 PET CO 2与PaCO 2的 R 2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PET CO 2与 PaCO 2的相关性更好,可准确反映机体二氧化碳分压的变化。%Objective To determine the relationship between end-tidal carbon dioxide tension (PET CO 2 )obtained from the distal ends of the tracheal tube and arterial pressure of carbon dioxide (PaCO 2 ) 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 statusⅠ-Ⅲ were enrolled.Measurements of PET CO 2 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 dis-ease.The data including PET CO 2 and the arterial PaCO 2 were obtained both after the anesthesia induc-tion and the CPB.Results The data of PET CO 2 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 PaCO 2 and PET CO 2 obtained from the distal ends of the tracheal tube after the induction [(7.1 ±0.7)mm Hg vs.(1 1.4 ± 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 sig-nificantly lower than that between PaCO 2 and PET CO 2 obtained from the proximal end.Distal side-stream PET CO 2 correlated with the PaCO 2 (R 2 =0.94 after induction and R 2 =0.93 after the CPB,P<0.05).However,the proximal PET CO 2 with the sidestream capnometer correlated very poorly with PaCO 2 whether after the induction (R 2 = 0.68,P < 0.05 )nor the CPB (R 2 = 0.66,P < 0.05 ). Conclusion We conclude that the PET CO 2 obtained from the distal ends of the tracheal tube provides accurate estimates of the PaCO 2 in critically ill infants with congenital heart disease.
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