潮气末二氧化碳分压监测在急性心源性肺水肿患者早期无创正压通气救治中的应用价值

Application value of end-tidal carbon dioxide partial pressure monitoring in patients with acute cardiogenic pulmonary edema receiving early nonivasive positive pressure ventilation

目的 探讨潮气末二氧化碳分压（PETCO2）监测在急性心源性肺水肿患者早期无创正压通气救治中的应用价值.方法 选择2011年2月至2015年5月在湖北医药学院附属东风医院急性心源性肺水肿患者88例,均给予无创正压通气治疗,在通气前后进行血流动力学（心率、收缩压、舒张压、平均动脉压（MAP）、心排血量、心脏指数、心搏指数）、血气指标[pH、动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）]与PETCO2监测,并随访调查预后情况.结果 通气后患者的心排血量、心脏指数与心搏指数值明显降低,与通气前比较差异有统计学意义[（3.3±1.1） L/min比（4.1 ±1.1）L/min、（2.1 ±0.4）L/（min·m^2）比（2.6 ±0.6） L/（min·m^2）、（25±7）ml/m^2比（29±4）ml/m^2,P＜0.05];心率、收缩压、舒张压与MAP通气前后差异无统计学意义（P＞0.05）.通气后患者的血气pH、PaO2值较通气前高,而PaCO2值较通气前低,差异有统计学意义[（7.35±0.45）比（7.23±0.24）、（88 ±9） mmHg（1 mmHg =0.133 kPa）比（52±8） mmHg、（39±8）mmHg比（47±9） mmHg,P＜0.05].通气后患者的PETCO2为（34±5） mmHg,明显高于通气前的（28±5）mmHg,差异有统计学意义（P＜0.05）.随访至2016年1月,88例患者中发生联合心血管不良事件12例,发生率为13.6％;Pearson相关分析显示急性心源性肺水肿的预后与通气前的PETCO2、心脏指数、心搏指数及PaCO2存在明显相关性（r=0.443、0.342、0.294、0.331,P＜0.05）.结论 无创正压通气早期救治急性心源性肺水肿能有效改善心功能与血气状况,对于PETCO2也有明显影响,而PETCO2监测能有效判定病情,预测预后情况.

Objective To investigate the application value of end-tidal carbon dioxide partial pressure （PETCO2） monitoring in patients with acute cardiogenic pulmonary edema receiving early nonivasive positive pressure ventilation.Methods Totally 88 patients confirmed as acute cardiogenic pulmonary edema from February 2011 to May 2015 underwent noninvasive positive pressure ventilation.The hemodynamic （heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure values,cardiac output,cardiac index and stroke index）,blood gas [pH,Arterial partial pressure of oxygen （PaO2）,carbon dioxide partial pressure （PaCO2）]and PETCO2 monitoring were proforming before and after ventilation;the prognosis was surveyed.Results The cardiac output,cardiac index and stroke index values were significantly decreased after ventilation compared with those before ventilation [（3.3 ± 1.1） L/min vs （4.1 ± 1.1） L/min,（2.1 ± 0.4） L/（min · m^2） vs （2.6 ± 0.6） L/（min · m^2）,（25 ±7） ml/m^2 vs （29 ±4） ml/m^2] （P〈0.05）;the heart rate,systolic blood pressure,diastolic blood pressure and mean arterial pressure values were not significantly changed after ventilation （P 〉0.05）;the pH,PaO2 values were significantly increased,the PaCO2 values were significantly decreased after ventilatory compared with those before ventilation [（7.35 ± 0.45） vs （7.23 ± 0.24）,（88 ± 9） mmHg vs （52 ± 8） mmHg,（39 ±8） mmHg vs （47 ±9） mmHg] （P 〈0.05）;the PETCO2 values after ventilatory were （34 ± 5） mmHg,significantly higher than that before ventilation [（28 ± 5） mmHg] （P 〈 0.05）.The patients were followed-up to January 2016,12 cases were complicated with cardiovascular adverse events （13.6%）;Pearson correlation analysis showed that the prognosis were related to PETCO2,cardiac index,stroke index and PaCO2 before ventilation （r =0.443,0.342,0.294,0.331;P 〈 0.05）.Conclusions Early treatment of noninvasive positive pressure ventilation in acute cardiogenic pulmonary edema can not only improve the heart function and blood gas status,but also has significant effect on PETCO2;PETCO2 monitoring can effectively determine disease situation and predict prognosis.