经皮二氧化碳测量在腹膜后腹腔镜泌尿外科手术中的准确性:一项前瞻性观察性研究

The accuracy of transcutaneous carbon dioxide measurement in retroperitoneoscopic urologic surgery:a prospective observational study

目的:比较呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,P_(ET)CO_(2))和经皮二氧化碳分压(transcutane-ous carbon dioxide partial pressure,P_(a)CO_(2))预测泌尿外科腹膜后腹腔镜手术患者动脉血二氧化碳分压(arterial carbon dioxide pressure,P_(a)CO_(2))的准确性。方法:选择全身麻醉下行腹膜后腹腔镜泌尿外科手术患者50例,于气腹前及气腹后30、60、90 min分别测定P_(a)CO_(2)、P_(ET)CO_(2)、P_(TC)CO_(2)。计算P_(a)CO_(2)-PETCO_(2)和P_(a)CO_(2)-P_(TC)CO_(2)的差值。对P_(a)CO_(2)与PETCO_(2)、P_(a)CO_(2)与P_(TC)CO_(2)进行相关性和回归分析。采用Bland-Altman分析评价P_(a)CO_(2)与其他两个指标的一致性。结果:P_(a)CO_(2)-P_(ET)CO_(2)和PaCO_(2)-P_(TC)CO_(2)的绝对差值分别为(13.20±4.43)mmHg和(4.35±2.56)mmHg(P<0.05)。P_(a)CO_(2)与P_(ET)CO_(2)的相关系数为0.79(r^(2)=0.62,P<0.001),与P_(TC)CO_(2)的相关系数为0.91(r^(2)=0.83,P<0.001)。P_(a)CO_(2)与P_(ET)CO_(2)的95%一致性界限为4.53~21.88 mmHg,与P_(TC)CO_(2)的95%一致性界限为-3.18~10.48 mmHg。结论:P_(TC)CO_(2)监测可提高评估患者腹膜后腹腔镜泌尿外科手术中PaCO_(2)的准确性。

Objective:To compare the accuracy of end-tidal carbon dioxide partial pressure(P_(ET)CO_(2))and transcutaneous carbon dioxide partial pressure(P_(TC)CO_(2))in predicting arterial carbon dioxide pressure(P_(a)CO_(2))in patients undergoing retroperitoneoscopic urologic surgery.Methods:Fifty patients undergoing retroperitoneoscopic urologic surgery under general anesthesia were included.Values of P_(a)CO_(2),P_(ET)CO_(2),and P_(TC)CO_(2) were measured before and 30,60,90 min after insufflation.The differences between P_(a)CO_(2)-P_(ET)CO_(2) and P_(a)CO_(2)-P_(TC)CO_(2) were calculated.Correlation and regression analysis were conducted between P_(a)CO_(2) and P_(ET)CO_(2),as well as between P_(a)CO_(2) and P_(TC)CO_(2).Bland-Altman analysis was used to assess the agreement between P_(a)CO_(2) and the other two variables.Results:The absolute differences of P_(a)CO_(2)-P_(ET)CO_(2) and P_(a)CO_(2)-P_(TC)CO_(2)were(13.20±4.43)mmHg and(4.35±2.56)mmHg,respectively(P<0.05).The correlation coefficient between P_(a)CO_(2) and P_(ET)CO_(2) was 0.79(r^(2)=0.62,P<0.001),and between P_(a)CO_(2) and P_(TC)CO_(2) was 0.91(r^(2)=0.83,P<0.001).The 95%limits of agreement between P_(a)CO_(2) and P_(ET)CO_(2) were 4.53 to 21.88 mmHg and between P_(a)CO_(2) and P_(TC)CO_(2) were-3.18 to 10.48 mmHg.Conclusion:P_(TC)CO_(2) monitoring improves the accuracy of estimating P_(a)CO_(2) in patients undergoing retroperitoneoscopic urologic surgery.