将潮气末二氧化碳测量值作为小儿腹腔镜手术中动脉二氧化碳的替代值：一项前瞻性观察队列研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY Brazilian Journal of Anesthesiology Pub Date : 2024-09-01 DOI:10.1016/j.bjane.2021.07.036

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引用次数: 0

摘要

背景：强烈建议在腹腔镜手术中对麻醉儿童进行机械通气时维持正常碳酸血症。关于使用毛细血管造影（ETCO2）作为评估动脉二氧化碳水平（PaCO2）的趋势监测仪还存在争议。我们分析了择期小儿腹腔镜手术中 ETCO2 和 PaCO2 随时间变化的关系：本研究是一项前瞻性观察性队列分析，对 29 名儿童（ASA I 级，12-72 个月）计算的 PaCO2 和 ETCO2 进行了 116 次配对比较。在腹腔积气前、15 分钟和 30 分钟以及放气后 1 分钟抽取动脉血样本。抽取动脉血的同时记录 ETCO2 值。通过皮尔逊相关系数和布兰德-阿特曼一致法评估 PaCO2-ETCO2 的关系：在分析的 116 次比较中，71 次比较（61.2%）记录到 PaCO2-ETCO2 差异超过 0 至 ≤ 5 mmHg，34 次比较（29.3%）记录到负差异。在放气前（r = 0.617，p = 0.000）和 15 分钟时（r = 0.582，p = 0.001），PaCO2 和 ETCO2 之间存在正相关性，而在 30 分钟时（r = 0.142，p = 0.461）和放气后（r = 0.108，p = 0.577）则无明显相关性。Bland-Altman 图显示 ETCO2 与充气前的 PaCO2 一致，平均 PaCO2-ETCO2 差值为 0.14 ± 5.6 mmHg（95% 一致度范围为 -10.84-11.2，简单线性回归测试 p 值为 0.971），15分钟（0.51 ± 7.15，-13.5-14.5，p = 0.000）、30分钟（2.62 ± 7.83，-12.73-17.97，p = 0.000）或放气后（1.81 ± 6.56，-10.93-14.55，p = 0.015）无一致：结论：在小儿腹腔镜手术中使用毛细血管造影作为趋势监测器可能不是PaCO2水平的可靠替代物：试验注册：Clinical Trials.gov（标识符：NCT03361657）。

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End-tidal carbon dioxide measurements as a surrogate to arterial carbon dioxide during pediatric laparoscopic surgeries: a prospective observational cohort study

Background

Maintaining normocapnia during mechanical ventilation in anesthetized children during laparoscopic surgeries is highly recommended. There is a debate regarding the use of capnography (ETCO₂) as a trend monitor for evaluation of arterial carbon dioxide levels (PaCO₂). We analyzed the relationship between ETCO₂ and PaCO₂ with time in elective pediatric laparoscopic surgeries.

Methods

This study was a prospective observational cohort analysis of 116 paired comparisons between PaCO₂ and ETCO₂ computed from 29 children (ASA I, 12...72 months). Arterial blood samples were withdrawn before, at 15...minutes and 30...minutes during pneumoperitoneum and 1...minute after deflation. ETCO₂ value was recorded simultaneously, while arterial blood was withdrawn. PaCO₂...ETCO₂ relationship was evaluated by Pearson's correlation coefficients and Bland Altman Method of agreement.

Results

Out of the 116 comparisons analyzed, a PaCO₂...ETCO₂ difference beyond 0 to ..± 5...mmHg was recorded in 71 comparisons (61.2%) with negative difference in 34 comparisons (29.3%). A positive significant correlation between PaCO₂ and ETCO₂ was recorded before (r...=...0.617, p...=...0.000) and at 15...minutes (r...=...0.582, p...=...0.001), with no significant correlation at 30 minutes (r...=...0.142, p...=...0.461), either after deflation (r...=...0.108, p...=...0.577). Bland-Altman plots showed agreement between ETCO₂ and PaCO₂ before inflation with mean PaCO₂-ETCO₂ difference 0.14........5.6...mmHg (limits of 95% agreement -10.84...11.2, simple linear regression testing p-value 0.971), with no agreement at 15...minutes (0.51........7.15, -13.5...14.5, p...=...0.000), 30...minutes. (2.62........7.83, -12.73...17.97, p...=...0.000), or after deflation (1.81........6.56, -10.93...14.55, p...=...0.015).