呼气末二氧化碳分压监测在心胸手术中的评价

25例先天性心脏病心内直视术(分非紫绀组和紫绀组)和10例普胸病人,术中连续监测呼气末二氧化碳含量(P_(ΕT)CO_2),并与PaCO_2对照,计算 PaCO_2与P_(ΕT)CO_2的差值(P_(a-ΕT)CO_2以及PaCO_2和P_(ΕT)CO_2的相关性。结果:(1)麻醉诱导后普胸组和非紫绀组的PaCO_2和P_(ΕT)CO_2间相关性良好,而紫绀组无相关性,P_(a-ΕT)CO_2明显增高;(2)普胸组和非紫绀组开胸后、非紫绀组转流后P_(a-ET)CO_2明显增高,而紫绀组转流后P_(a-ΕT)CO_2渐缩小,PaCO_2和P_(ΕT)CO_2相关性转好。提示:(1)P_(ΕT)CO_2在普胸和非紫绀先心病病人可替代PaCO_2,而在紫绀组不能替代PaCO_2;(2)体外循环影响非紫绀先心病P_(ΕT)CO_2对PaCO_2估计的准确性,相反,在紫绀型先心病,体外后P_(ΕT)CO_2对PaCO_2的估价有一定的应用价值。

EVALUATION ON THE MONITOR OF END-TIDAL CARBON DIOXIDE PARTIAL PRESSURE DURING CARDIAC AND THORACIC SURGERY

In 25 patients of intracardiac repair under direct vision of congenital heart diseaes (divided into acyanotic and cyanotic group) and 10 cases of general thoracic surgery, the contents of carbon dioxide partial pressure in end-tidal (PrrCO2) were successively monitored durin operation and compared with PaCO2 during operation. The difference value (Pa-FT CO2) of PaCO2 and PET CO2 and the correlation between PaCO2 and PetCO2 were calculated. The results showed that (1) PetCO2 was closely correlated with the PaCO2 in the thoracic and acyanotic groups, but the Pa-ET CO2 was higher and there was no correlated between PaCO2 and PErCO2 in cyanotic group after induction anesthesia. (2)The Pa-etCO2 was increased significantly after opening thorax in thoracic group and after cardiopulmonary bypass in acyanotic group, but the Pa-etCO2 became decreased and the correlation between PaCO2 and PerCO2 became close gradually after cardiopulmonary bypass in cyanotic group. It was suggested that (1) P ET CO2 could be replace by PET CO2 in subjects with thoracic surgery and acyanotic congenital heart disease but PaCO2 could not be replaced by PetCO2 in subjects with cyanotic congenital heart disease. (2) The cardiopulmonary bypass affected the correctness of the evaluation of PETCO2 to PaCO2 in acyanotic congenital heart disease, on the contrary, the evaluation of PETCO2 to PaCO2 after cardiopulmonary bypass.in cyanotic congenital heart disease had definite applying value.