呼吸末二氧化碳分压在诊断骨科手术患者术后肺栓塞中的价值

The value of end-tidal partial pressure of carbon dioxide in the diagnosis of pulmonary embolism in posto perative orthopaedic patients

目的探讨呼吸末二氧化碳分压(end-tidal partial pressure of carbon dioxide,P_(ET)CO_2)在诊断骨科手术患者术后肺栓塞中的价值。方法收集本院2014年1月至2017年1月收治的骨科术后可疑肺栓塞患者162例的临床资料,所有患者均行计算机体层摄影(computer tomography,CT)肺血管造影,经CT肺血管造影确诊肺栓塞27例,纳入观察组;非肺栓塞患者135例,纳入对照组。比较两组患者P_(ET)CO_2、D-二聚体水平、肺栓塞严重程度指数(pulmonary embolism severity index,PESI)及Wells评分。结果观察组患者P_(ET)CO_2、D-二聚体水平及PESI、Wells评分均显著高于对照组(P=0.000)。P_(ET)CO_2诊断骨科术后肺栓塞的接受者操作特征曲线(receiver operating characteristic,ROC曲线)下面积为0.882(P<0.05),高于D-二聚体、PESI及Wells评分的ROC曲线下面积(0.797、0.806、0.749)。P_(ET)CO_2最佳诊断界值为44.50 mm Hg,此时诊断的敏感度和特异度分别为0.889和0.674。结论P_(ET)CO_2在诊断骨科术后患者肺栓塞中具有良好的应用价值。

Objective To investigate the value of end-tidal partial pressure of carbon dioxide （PETCO2） in the diagnosis of pulmonary embolism in postoperative orthopaedic patients.Method From January 2014 to January 2017, 162 cases of patients suspected as pulmonary embolism were collected in our hospital after orthopedic surgery.All patients received computed tomography angiogram, 27 patients were made a definite diagnosis of pulmonary embolism as observation group, the other as control group. The PETCO2, D-dimer level, pulmonary embolism severity index （PESI）, Wells score were analyzed. Moreover, the value of PETCO2 in the diagnosis of pulmonary embolism in postoperative orthopaedic patients were studied.Result The PETCO2, D-dimer level, PESI and Wells score of observation group were higher than control group （P=0.000）. The area of ROC curve of PETCO2 in the diagnosis of pulmonary embolism in postoperative orthopaedic patients were 0.882 （P〈0.05）, which was higher than that of D-dimer, PESI and Wells score （0.797, 0.806, 0.749）. The best diagnosis critical value of PETCO2 in the diagnosis of pulmonary embolism was 44.50 mmHg, and the sensitivity and specificity were 0.889 and 0.674 respectively.Conclusion PETCO2 has a good value in the diagnosis of pulmonary embolism in postoperative orthopaedic patients.