PaCO2-EtCO2差值：腹腔镜术中二氧化碳气体栓塞的监测指标？

［摘要］ 目的 探讨PaCO2-EtCO2差值可否作为腹腔镜术中二氧化碳气体栓塞的监测指标，用于二氧化碳气体栓塞的诊断和疗效评估。方法 回顾分析了2例腹腔镜肝切除术中的二氧化碳气体栓塞并查阅相关文献。结果 2例气体栓塞的患者主要表现为SpO2的轻度下降和呼末二氧化碳（EtCO2）短暂升高，其中1例患者心前区均可闻及“磨轮音”。2例患者的动脉血气分析均提示氧合指数下降的同时二氧化碳分压升高，PaCO2-EtCO2差值增大。经处理后，2例患者的氧合改善，PaCO2-EtCO2差值基本下降至基础水平。结论 麻醉医师围术期应警惕二氧化碳气体栓塞的发生。动脉血气分析不仅可以用于评估患者的内环境情况，还可以得出PaCO2-EtCO2差值，后者可用于二氧化碳气体栓塞的诊断和疗效评估。

PaCO2-EtCO2 gradient： an indicator of carbon dioxide gas embolism during laparoscopic surgery

［Abstract］ Objective To investigate whether the PaCO2-EtCO2 gradient can be used as a diagnosis and evaluation indicator for carbon dioxide gas embolism in laparoscopic surgery. Methods 2 cases of carbon dioxide gas embolization during laparoscopic hepatectomy were retrospectively reviewed and related literature was reviewed. Results Two patients with gas embolism showed a slight decrease in SpO2 and a transient increase in end-tidal carbon dioxide （EtCO2）. One patient had a “mill-wheel” in the precordial region. The arterial blood gas analysis of two patients showed that the oxygenation index decreased while the partial pressure of carbon dioxide increased， and the PaCO2-EtCO2 gradient increased. After treatment， the oxygenation of the two patients improved， and the PaCO2-EtCO2 gradient decreased to the basal level. Conclusion Anesthesiologists should be alert to the occurrence of carbon dioxide gas embolism during the perioperative period. Arterial blood gas analysis can be used not only to assess the patient′s internal environment， but also to derive the PaCO2-EtCO2 gradient， which can be used for the diagnosis and efficacy evaluation of carbon dioxide gas embolism.