呼气末二氧化碳分压和连续有创动脉压监测在儿科急诊危重症救治中的应用价值研究

Analysis of application value of end-tidal carbon dioxide partial pressure and continuous invasive arterial pressure in pediatric emergency critical care

目的:探讨呼气末二氧化碳分压(PetCO2)和连续有创动脉压在儿科急诊危重症救治中的应用价值。方法:依据其救治后转归情况将收治的118例危重症患儿分为生存组和死亡组,患儿均接受气管插管、机械通气。记录分析两组患儿通气0min、5min、10min、0.5h、1h、1.5h时PetCO2值和连续有创动脉收缩压(SDP)、舒张压(DBP)、平均动脉压(MAP)水平变化情况,并用Pearson线性相关分析法分析PetCO2值与有创动脉MAP水平间相关性。结果:生存组通气5min、10min、0.5h时PetCO2值及有创动脉SDP、DBP、MAP水平均呈现明显上升趋势(P<0.05);通气0.5h、1h、1.5h时PetCO2值及有创动脉SDP、DBP、MAP水平均保持平稳(P>0.05)。死亡组5min、10min时PetCO2值及有创动脉SDP、DBP、MAP水平均呈现明显上升趋势(P<0.05),而通气0.5h、1h、1.5h时则呈现出明显下降趋势(P>0.05)。组间对比,死亡组在通气5min、10min、0.5h、1h、1.5h时PetCO2值均明显低于生存组(P<0.05);0.5h、1h、1.5h时有创动脉SDP、DBP、MAP水平亦明显低于生存组(P<0.05)。两组患儿PetCO2值与有创动脉MAP水平间均呈现明显正相关(P<0.05)。结论:PetCO2值与连续有创动脉压具有良好相关性,均可作为预测儿科急诊危重症患儿救治结果的重要指标。尤其是通气0.5h后,PetCO2值趋于平稳,连续有创动脉压显著下降可能预示患儿救治结局不良。

Objective:To explore the application value of end-tidal carbon dioxide partial pressure(Pet CO 2)and continuous invasive arterial pressure in the emergency treatment of pediatric emergency.Methods:According to the outcome of the treatment,118 critically ill children admitted to our hospital from February 2017 to April 2019 were divided into survival group and death group.All children underwent endotracheal intubation and mechanical ventilation.The changes of Pet CO 2 and continuous invasive arterial SDP,DBP and MAP levels at 0 min,5 min,10 min,0.5 h,1 h and 1.5 h were recorded and analyzed.Pearson linear correlation analysis was used to analyze the correlation between Pet CO 2 value and invasive arterial MAP level.Results:The levels of Pet CO 2 and SDP,DBP and MAP in the invasive arteries showed a significant upward trend in the survival group at 5 min,10 min and 0.5 h(P<0.05).The levels of Pet CO 2 and invasive arterial SDP,DBP and MAP remained stable at 0.5h,1h and 1.5h after ventilation(P>0.05).The levels of Pet CO 2 and SDP,DBP and MAP in the invasive arteries showed a significant upward trend at 5 min and 10 min in the death group(P<0.05),but decreased significantly at 0.5 h,1 h and 1.5 h in the death group(P>0.05).Compared with the survival group,the Pet CO 2 values in the death group were significantly lower than those in the survival group at 5 min,10 min,0.5 h,1 h,and 1.5 h(P<0.05).Invasive arterial SDP,DBP,MAP at 0.5 h,1 h,and 1.5 hwas also significantly lower than the survival group(P<0.05).There was a significant positive correlation between Pet CO 2 and invasive arterial MAP levels in both groups(P<0.05).Conclusion:Pet CO 2 value has a good correlation with continuous invasive arterial pressure,and can be used as an important indicator for predicting the outcome of children with critically ill critically ill.In particular,after 0.5 h of ventilation,the Pet CO 2 value tends to be stable,and a significant decrease in continuous invasive arterial pressure may indicate a poor outcome in the treatment of the child.