经皮二氧化碳分压与经皮氧分压在NICU监测中的应用

崔晶

[摘要] 目的 探究经皮二氧化碳分压（TcPCO2）与经皮氧分压（TcPO2）监测在新生儿重症监护病房（NICU）中的应用价值。 方法 选取2018年1月至2020年5月我院NICU收治的新生兒60例为研究对象，按照具体病情分为呼吸障碍组（A组）、循环障碍组（B组）、极低出生体重儿组（C组）。监测三组TcPCO2、TcPO2、PaCO2、PaO2，并比较TcPCO2与PaCO2、TcPO2与PaO2间的关系。 结果 A组TcPCO2、PaCO2明显高于B组及C组，TcPO2、PaO2明显低于B组及C组，差异有统计学意义（P<0.05）。三组的TcPCO2与PaCO2均呈正相关（rA=0.765，rB=0.920，rC=0.875，P<0.05）;A组TcPO2与PaO2呈中等相关（r=0.601，P<0.05），B组TcPO2与PaO2无相关性（r=-0.006，P>0.05），C组TcPCO2与PaCO2、TcPO2与PaO2均呈较高相关（r=0.875、0.825，P<0.05）。三组TcPCO2、PaCO2差值均接近0（A组、B组、C组测量差值均数分别为0.101、2.991、-0.072），且TcPCO2与PaCO2均有较好的一致性（A组、B组、C组一致性界限内差值绝对值最大值分别为12.000、11.000、8.700）。三组不良反应总发生率比较，差异无统计学意义（P>0.05）。 结论 TcPCO2测定可准确、连续、无创地评估NICU新生儿，尤其是极低出生体重儿的PaCO2，TcPO2能较真实地反映新生儿的氧合情况，值得在NICU广泛应用。

[关键词] 新生儿;经皮;二氧化碳分压;氧分压;血气分析

[中图分类号] R722.1          [文献标识码] B          [文章编号] 1673-9701（2021）12-0083-04

Application of transcutaneous carbon dioxide partial pressure and transcutaneous oxygen partial pressure in NICU monitoring

CUI Jing

Department of Neonatology， Yichun Women and Children′s Hospital in Jiangxi Province， Yichun   336000， China

[Abstract] Objective To explore the application value of transcutaneous carbon dioxide partial pressure（TcPCO2） and transcutaneous oxygen partial pressure（TcPO2） monitoring in the neonatal intensive care unit （NICU）. Methods A total of 60 newborns who were admitted to our hospital from January 2018 to May 2020 were selected as the study subjects. According to the specific conditions， they were divided into respiratory disorder group （group A）， circulatory disorder group （group B）， and very low birth weight infant group （group C）. TcPCO2， TcPO2， PaCO2 and PaO2 were monitored in the three groups. The correlations between TcPCO2 and PaCO2， TcPO2 and PaO2 were compared. Results The TcPCO2 and PaCO2 test results in group A were significantly higher than those in group B and C. The results of TcPO2 and PaO2 were significantly lower than those in group B and group C， the differences were statistically significant（P<0.05）. The TcPCO2 and PaCO2 in the three groups were positively correlated（rA=0.765， rB=0.920， rC=0.875， P<0.05）. The correlation between TcPO2 and PaO2 in group A was moderate（r=0.601， P<0.05）. There was no correlation between TcPO2 and PaO2 in group B （r=-0.006， P>0.05）. There was a good correlation between TcPCO2 and PaCO2， TcPO2 and PaO2 in children in group C （r=0.875， 0.825， P<0.05）. The differences of TcPCO2 and PaCO2 in the three groups were close to 0 （the mean of the measured differences between the two were 0.101， 2.99， and -0.072） and there was a good consistency （the maximum absolute value of the difference within the consistency limit was respectively 12.000， 11.000， 8.700）. There was no statistically significant difference among the three groups in adverse reactions（P>0.05）. Conclusion TcPCO2 measurement can accurately， continuously and non-invasively assess PaCO2 of NICU newborns， especially very low birth weight infants. TcPO2 can better reflect the true oxygenation of newborns and is worthy of widespread application in NICU.

[Key words] Newborns; Percutaneous; Carbon dioxide partial pressure; Oxygen partial pressure; Blood gas analysis

在胎儿阶段，多胎、孕周不足、母体营养欠缺或失调及相关合并症都可能引发胎儿发育迟缓，致使出生时体重显著低于健康新生儿[1]。这类患儿皮下脂肪薄弱，缺乏较好的保温功能，适应外界能力较差，其呼吸中枢系统发育不完全，呼吸、代谢机能较弱，可导致呼吸功能不全与呼吸衰竭等，故常需配合呼吸支持等对症处理[2-3]。虽然呼吸机的应用在保证患儿存活率方面具有积极作用，但长时间机械通气易并发腹胀、感染、呼吸机相关性肺炎、慢性肺炎等症状，严重影响其预后，需按高危新生儿开展监护工作，不断获取其动脉血氧分压（Arterial partial pressure of oxygen，PaO2）和二氧化碳分压（Partial pressure of carbon dioxide，PaCO2）监测数据，避免出现因PaO2、PaCO2水平异常损害患儿的眼、脑、肺等身体器官的情况[4-5]。目前，临床多采用动脉血气分析评估患儿肺部气体交换功能，然而动脉血气结果的获得依赖于多次动脉血收集，具有有创性、不能连续监测等不足[6]，患儿疼痛感与不适感较明显，增加其身体负担。……