TcpCO2监测在极低/超低出生体重儿撤机后的临床应用

The clinical application and significance of TcpCO2 after weaning of machanical ventilation in very or extreme low birth weight infants

目的探讨经皮二氧化碳分压(transcutaneous carbon dioxide pressure,TcpCO2)监测在极低出生体重儿(very low birth weight infant,VLBW)和超低出生体重儿(extremely low birth weight infant,ELBW)撤机后的应用,进一步指导VLBW和ELBW拔管撤机后的呼吸管理.方法收集2016年3月至2018年12月我院住院的胎龄<32周、出生体重<1500 g、生后24 h内因呼吸窘迫需要机械通气支持并拟行撤机的患儿.观察组55例患儿给予TcpCO2监测并于撤机后1 h、6 h、12 h、24 h、48 h、72 h采集血气,对照组55例患儿为单纯采集动脉血气.当TcpCO2监测及PaCO2提示高碳酸血症时积极给予临床干预,记录两组患儿在撤机后不同时间点(1 h、6 h、12 h、24 h、48 h、72 h)血气PaCO2结果及观察组TcpCO2数值,并同时记录撤机失败情况.结果观察组与对照组患儿的一般资料(性别、胎龄、出生体重、孕母产前是否应用糖皮质激素)比较,差异无统计学意义(P>0.05);两组患儿的机械通气时间、无创通气模式及时间等方面比较,差异无统计学意义(P>0.05).两组患儿在24 h及总72 h内撤机失败率比较观察组低于対照组[3.6%(2/55)比14.0%(8/55),7.3%(4/55)比21.0%(12/55)],差异有统计学意义(P<0.05).两组患儿在撤机后6 h、12 h、24 h的血气PaCO2比较差异有统计学意义(P<0.05),但在1 h、48 h、72 h两组间比较,差异无统计学意义(P>0.05).观察组患儿同一时间点TcpCO2与PaCO2间差异无统计学意义(P>0.05),同时TcpCO2与PaCO2两者间具有相关性(r=0.761,P<0.05).结论接受机械通气的VLBW和ELBW撤机后给予持续TcpCO2监测,不仅具有连续、无创监测的特点,同时可以及早发现高碳酸血症并给予对症处理,降低患儿撤机失败发生率,且证实TcpCO2与PaCO2具有较好的相关性.

Objective To analysis the transcutaneous carbon dioxide pressure(TcpCO2)in very low birth weight infant(VLBW)and extremely low birth weight infant(ELBW)after the time of tube drawing,and further guidance the management of premature ventilator breathing.Methods Premature infants with gestational age less than 32 weeks,birth weight below 1500 g,hospitalized from March 2016 to December 2018 in our hospital,who needed early mechanical ventilation due to respiratory distress within 24 hours after birth and intended to be withdrawn were enrolled.Fifty-five infants in the observation group were monitored by TcpCO2 and blood gas was collected at 1 h,6 h,12 h,24 h,48 h,and 72 h after weaning;55 infants in the control group were collected arterial blood gas only.When TcpCO2 monitoring and PaCO2 indicated hypercapnia,clinical intervention was actively given.The value of blood gas PaCO2 in the two groups and the TcpCO2 value of the observation group were recorded at different time points(1 h,6 h,12 h,24 h,48 h,72 h)after weaning,and the failure of weaning was recorded in both group.Results There was no significant difference in the general information(gender,gestational age,birth weight,and whether prenatal maternal glucocorticoids)between the two groups(P>0.05).There were no significant differences in mechanical ventilation time,noninvasive ventilation mode and time between the two groups(P>0.05).The failure rate of withdrawal within 24 h and 72 h was lower in the observation group than the control group[3.6%(2/55)vs.14.0%(8/55),7.3%(4/55)vs.21.0%(12/55)],the difference was statistically significant(P<0.05).There was a significant difference in blood gas PaCO2 between the two groups at 6 h,12 h,and 24 h after weaning(P<0.05),but had no significant difference between the two groups at 1 h,48 h,and 72 h(P>0.05).The values of TcpCO2 and PaCO2 had no significant difference in the observation group at the same time point(P>0.05),and there was a correlation between them(r=0.761,P<0.05).Conclusion VLBW and ELBW undergoing mechanical ventilation are given continuous TcpCO2 monitorings after weaning,which not only has the characteristics of continuous and non-invasive monitoring,but also help to identify hypercapnia early and give symptomatic treatment,and reduce the incidence of weaning failure.And it proves a good correlation between TcpCO2 and PaCO2.