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目的探讨胃黏膜二氧化碳分压监测在ICU患者中应用的意义。方法对50例住ICU患者进行24h连续二氧化碳张力(PgCO2)监测,同时监测心率、Bp、平均动脉压(MAP)、中心静脉压(CVP)、脉搏血氧饱和度(SpO2)、动脉血气。按急性生理和慢性健康评分(APACHEⅡ)和多器官功能障碍综合征(MODS)评分法将患者分为重症组和轻症组,20例无器官功能障碍的热疗后肿瘤患者作为对照组。对各组监测结果进行比较。结果重症组、轻症组、对照组之间的PgCO2[(73±20)、(55±16)、(39±10)mmHg]、胃黏膜-动脉血二氧化碳间隙[Pg-aCO2,(38±21)、(23±15)、(6±5)mmHg]、胃黏膜-呼出气二氧化碳间隙[Pg-etCO2,(40±21)、(22±13)、(7±6)mmHg]比较差异均有统计学意义;Pg-aCO2与Pg-etCO2比较无差异。结论Pg-CO2是动态观察重症患者病情变化的有效指标,PgCO2≥45mmHg、Pg-aCO2≥15mmHg可作为术后或危重患者可能出现脏器功能衰竭或死亡的预警信号,Pg-etCO2可以替代Pg-aCO2作为连续监测的指标。
Objective To investigate the significance of gastric mucosal carbon dioxide partial pressure monitoring in patients with ICU. Methods 50 consecutive ICU patients underwent continuous carbon dioxide (PgCO2) monitoring. Heart rate, Bp, mean arterial pressure (MAP), central venous pressure (CVP), pulse oxygen saturation (SpO2) and arterial blood gas were monitored at the same time. The patients were divided into two groups according to acute physiology and chronic health score (APACHEⅡ) and multiple organ dysfunction syndrome (MODS) score method. Twenty patients with post-hyperthermia tumor without organ dysfunction were selected as the control group. Comparison of the monitoring results of each group. Results PgCO2 [(73 ± 20), (55 ± 16), (39 ± 10) mmHg], Pg-aCO2, (38 ± 21), (23 ± 15), (6 ± 5) mmHg], gastric mucosa-exhaled carbon dioxide gap [Pg-etCO2, (40 ± 21), (22 ± 13), (7 ± 6) mmHg] There was no significant difference between Pg-aCO2 and Pg-etCO2. Conclusion Pg-CO2 is an effective indicator for the dynamic observation of the changes of the severity of critically ill patients. PgCO2≥45mmHg and Pg-aCO2≥15mmHg can be used as early warning signals for postoperative or critical patients with organ failure or death. Pg-etCO2 can replace Pg- aCO2 as an indicator of continuous monitoring.