中文摘要：

目的探讨呼气末二氧化碳分压（PetCO2）监测危重患者病情变化的临床意义。方法选取2007年6月—2010年5月我院重症医学科行气管插管、机械通气的87例危重患者,其中无或轻度心肺功能不全（A组）40例,心肺功能严重不全（B组）47例,机械通气后0、1、3、12、24 h抽动脉血进行血气分析并记录即刻PetCO2。结果机械通气后0、1、3、12、24 h PetCO2与二氧化碳分压（PaCO2）均呈正相关（r值分别为0.886、0.899、0.932、0.840和0.866,P〈0.05）;PaCO2-PetCO2（ADCO2）与通气时间呈负相关（r=-0.752,P〈0.05）。机械通气1 h后A组、B组PetCO2与PaCO2均呈正相关（r值分别为0.848和0.688,P〈0.05）;A组ADCO2为（2.1±5.2）mm Hg,B组为（7.7±8.0）mm Hg,差异有统计学意义（t=3.79,P=0.0003）。结论 PetCO2具有无创、连续等特点,不仅能监测通气状况,还可监测循环功能和肺部血流情况,发现呼吸机故障,确定气管插管位置,对判断危重患者病情变化及预后有现实意义。

英文摘要：

Objective To investigate the clinical significance of end - tidal carbon dioxide partial pressure （ PetCO2 ） monitoring for critieaUy ill patients. Methods A total of 87 critically ill patients who received intubation and mechanical ventila- tion in the Intensive Care Unit of our hospital from June 2007 to May 2010 were enrolled in this study. They were divided into group A （without or with mild cardiovascular diseases; n = 40） and group B （with severe cardiopulmonary dysfunction; n = 47）. The arterial blood gas analyses were performed 0, 1, 3, 12, and 24 hours after mechanical ventilation. Results The 0, 1, 3, 12, and 24 h PetCO2 showed positive correlations （r =0. 886, 0. 899, 0. 932, 0. 840, and 0. 866, respectively; all P 〈 0.05 ） with partial pressure of carbon dioxide in artery （ PaCO2 ） . ADCO2 （ PaCO2 - PetCO2 ） was negatively correlated with the duration of ventilation （ r = - 0. 752, P 〈 0. 05）. One hour after the mechanical ventilation, PetCO2 was positively related with PaCO2 in both group A and group B （r =0. 848 and 0. 688; P 〈0.05）. The ADCO2 was （2. 1 ±5.2） mm Hg in group A and （7.7 ±8. 0） mm Hg in group B （ t = 3.79, P = 0. 0003 ）. Conclusion Monitoring of PetCO2 provides a non - invasive, continuous way to observe the ventilation status as well as the cardiopulmonary functions. It is useful for checking the potential failure of the ventilator, identifying the position of intubation, and predicting the prognosis of the critically ill patients.