经皮二氧化碳监测在肥胖患者行腹腔镜胃旁路术中的应用

目的研究肥胖患者行腹腔镜下胃旁路术中经皮二氧化碳分压(P_(TC)CO_2)监测评估PaCO_2的准确性和相关性。方法择期行腹腔镜下胃旁路术的患者22例,男9例,女13例,年龄19~55岁,体重86~160kg,BMI35kg/m~2,ASAⅠ或Ⅱ级,在麻醉后(气腹前)和气腹后30、60和120min时测量PaCO_2、P_(ET)CO_2和P_(TC)CO_2。并计算PaCO_2-P_(ET)CO_2和PaCO_2-P_(TC)CO_2的差值,采用Bland-Altman分析、相关与回归和确切概率法分析PaCO_2与P_(ET)CO_2、PaCO_2与P_(TC)CO_2的线性回归方程和一致性界限(LOA)。结果 1例男性患者因麻醉诱导时使用了去氧肾上腺素而被排除出本研究。余患者PaCO_2-P_(ET)CO_2的差值为(10.3±2.3)mm Hg,PaCO_2-P_(TC)CO_2的差值为(0.9±1.3)mm Hg。PaCO_2与P_(ET)CO_2之间的线性回归方程为P_(ET)CO_2=11.58~+0.57×PaCO_2(r2=0.64,P0.01);PaCO_2与P_(TC)CO_2之间的线性回归方程为P_(TC)CO_2=0.60~+0.97×PaCO_2(r2=0.89,P0.01),气腹后30、60和120min时P_(ET)CO_2和P_(TC)CO_2与PaCO_2具有明显相关性(P0.01)。PaCO_2-P_(ET)CO_2差值的95%LOA为(10.3±4.6)mm Hg;PaCO_2-P_(TC)CO_2差值的95%LOA为(0.9±2.6)mm Hg。结论肥胖患者行腹腔镜下胃旁路术中,P_(TC)CO_2比P_(ET)CO_2更精确地评估PaCO_2。

Transcutaneous monitoring of carbon dioxide monitor in severe obese patients undergoing laparoscopic surgery

Objective To investigate the accuracy and correlation of estimating PaCO 2 using a transcutaneous CO 2 pressure (PTC CO 2 )monitor in severe obese patients undergoing laparoscopic bar-iatric surgery.Methods Twenty-two patients aged 1 9-55 years,weighting 86-1 60 kg,BMI > 35 kg/m2 ,ASA Ⅰ or Ⅱ undergoing laparoscopic bariatric surgery were included in this study.Their PaCO 2 ,PET CO 2 and PTC CO 2 values were measured at 4 time points before and 30 min,60 min and 120 min after pneumoperitoneum and was the difference calculated between each measure (PaCO 2 -PET CO 2 and PaCO 2 - PTC CO 2 ).Agreement among measures was assessed by the Bland-Altman method.Results One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction.The average PaCO 2 -PET CO 2 difference was (10.3±2.3)mm Hg.The average PaCO 2 -PTC CO 2 difference was (0.9±1.3)mm Hg.95% of the limits of agreement(LOA) of the average PaCO 2 -PET CO 2 difference was (10.3 ±4.6)mm Hg.The linear regression equation of PaCO 2 -PET CO 2 was PET CO 2 =1 1.58 +0.57 ×PaCO 2 (r2 =0.64,P <0.01 );whereas the one of PaCO 2 -PTC CO 2 was PTC CO 2 =0.60+0.97×PaCO 2 (r2 =0.89,P <0.01).The LOA of 95% aver-age PaCO 2 -PET CO 2 difference was (10.3±4.6)mm Hg,while the LOA of 95% average PaCO 2 -PTC CO 2 difference was (0.9±2.6)mm Hg.Conclusion While undergoing laparoscopic bariatric sur-gery,transcutaneous carbon dioxide monitoring estimates PaCO 2 better than PET CO 2 in patients with severe obesity.