先天性心脏病患儿P_(ET)CO_2、TcPCO_2与PaCO_2监测的相关性

Relationship between end-tidal pressure of CO_2,transcutaneous partial pressure of CO_2 and arterial partial pressure of CO_2 in pediatric patients with congenital heart disease

目的：评估先天性心脏病患儿PET CO 2、经皮二氧化碳分压（TcPCO 2）与 PaCO 2值的相关性。方法选择拟在体外循环下行先天性心脏病手术患儿80例,男42例,女38例,年龄1月~5岁,ASA Ⅱ~Ⅳ级,分为四组：紫绀型伴严重肺动脉高压组（N1组）、紫绀型不伴肺动脉高压组（N2组）、非紫绀型伴严重肺动脉高压或肺血流增加组（N3组）和非紫绀型伴轻度肺动脉高压或肺动脉压力正常组（N4组）,每组20例。统一选取相同的麻醉方案,在手术开始前记录患儿的 PET CO 2、TcPCO 2与 PaCO 2值,计算PET CO 2、TcPCO 2与 PaCO 2的差值,并进行相关性分析。结果 N1、N2、N3组PET CO 2与 PaCO 2差值较大,N4组中相对较小；四组患儿 TcPCO 2与 PaCO 2差值都相对较小；N1、N2、N3组中 TcPCO 2-PaCO 2值明显低于PET CO 2-PaCO 2值,N4组中 TcPCO 2-PaCO 2值明显高于PET CO 2-PaCO 2值。PET CO 2与 PaCO 2的相关性分析中,N1、N2、N3、N4组的 R2分别为0.028、0.197、0.390、0.711（P 〉0.05、0.02〈P 〈0.05、P 〈0.01、P 〈0.01）,在 N1、N2组相关性较低,N3、N4组相关性较高；TcPCO 2与 PaCO 2的相关性分析中,R2在 N1、N2、N3、N4组分别为0.750、0.827、0.835、0.691（P 〈0.01）,各组均表现良好的相关性。结论小儿先天性心脏病无论是肺血流增加还是右向左分流均可使PET CO 2与 PaCO 2的相关性较差,PET CO 2与 PaCO 2仅在左向右分流的先天性心脏病患儿中表现较好的相关性；TcPCO 2与 PaCO 2在小儿先天性心脏病监测中有良好的相关性,更适合为小儿先天性心脏病无创监测 CO 2提供依据。

Objective To evaluate the relevance of PET CO 2 ,TcPCO 2 and PaCO 2 in pediatric patients with congenital heart disease.Methods Eighty pediatric patients with congenital heart disease were scheduled for elective cardiac operation with cardiopulmonary bypass,aged 1 month to 5 years, 42 male and 38 female,were divided into 4 groups：group N1,cyanotic type congenital heart disease with severe pulmonary hypertension;group N2,cyanotic type congenital heart disease without pul-monary hypertension;group N3,non-cyanotic congenital heart disease with severe pulmonary hyper-tension;group N4,non-cyanotic congenital heart disease with mild pulmonary hypertension or normal of pulmonary artery pressure,20 cases in each group.The same anesthesia methods were selected in each group.PET CO 2 ,TcPCO 2 and PaCO 2 before operation were recorded,and the relevance among them was analyzed.Results In groups N1,N2 and N3,the differences of PET CO 2 and PaCO 2 were significant,,while the difference was relatively small in group N4;the difference of TcPCO 2 and PaCO 2 were relatively small between the four groups.In Groups N1,N2 and N3,the values of TcP-CO 2-PaCO 2 value were significantly less than that of PET CO 2-PaCO 2 ;in group N4,TcPCO 2-PaCO 2 value was obviously higher than that of PET CO 2-PaCO 2 values （P 0.05,0.02〈P 〈0.05,P 〈0.01,P 〈0.01）,respectively,meanwhile correlation analysis of TcPCO 2 with PaCO 2 revealed R2 in the N1,N2,N3,N4 group were 0.750,0.827,0.835 and 0.691 （P 〈0.01）.Conclusion The relevance of PET CO 2 and PaCO 2 is poor in pediatric patients with＆nbsp;congenital heart diseases,either increased blood flow to the lungs or right to left shunt,except for children with congenital heart disease of left to right shunt.TcPCO 2 used in monitoring children with congenital heart disease is well correlated with PaCO 2 and is more suitable for the noninvasive monito-ring of CO 2 with congenital heart disease in children.