End-tidal carbon dioxide monitoring improves patient safety during propofol-based sedation for breast lumpectomy A randomised controlled trial
End-tidal carbon dioxide monitoring improves patient safety during propofol-based sedation for breast lumpectomy A randomised controlled trial
复制标题
潮气末二氧化碳监测可提高乳房肿瘤切除术中丙泊酚镇静期间患者的安全性
DOI：
10.1097/eja.0000000000000859
复制
发表时间：
2018-11-01
影响因子：
3.6
通讯作者：
Li, Cheng
中科院分区：
文献类型：
--
作者：
Li, Mengzhu;Liu, Zhiqiang;Li, Cheng
背景镇静的使用正变得越来越普遍。虽然脉搏血氧仪是镇静期间的标准监测程序，但它不能准确检测早期低通气。潮末二氧化碳（EtCO2）监测可作为气道损害的早期指标；然而，现有文献仅限于少数研究，结果不一。目的评价EtCO2监测是否能降低异丙酚镇静中CO2潴留和呼吸中断事件的发生率。设计：随机对照研究。三级医院。2017年6月至2017年8月，200名女性（年龄18至65岁，ASA身体状态1或2）计划进行乳房肿瘤切除术。干预措施随机分配患者接受标准监测或标准监测和EtCO2监测。主要结局指标主要结局指标为CO2潴留发生率。次要结果为恢复通气的次数、PaCO2和pH的变化、呼吸暂停的频率和恢复时间。结果：EtCO2监测组的CO2滞留发生率明显降低（10比87%；P < 0.0001）。标准监测组麻醉诱导后5、10、20、30 min及手术结束时PaCO2平均值大于6 kPa (45 mmHg)， pH值小于7.35。EtCO2监测组两值均在正常范围内。EtCO2监测组气道干预次数显著高于对照组（9.8 +/- 1.8次vs. 1.9 +/- 1.0次；P < 0.0001）。EtCO2监测组呼吸暂停发生率明显降低（0 vs. 10%, P < 0.0001），恢复时间更短（9.9 +/- 1.4 vs. 11.4 +/- 2.1 min, P = 0.048）。结论异丙酚镇静期间在标准监测基础上增加EtCO2监测，可通过早期识别呼吸暂停降低CO2潴留发生率，从而降低低氧血症风险，提高患者安全性，并可缩短恢复时间。该试验已注册（ChiCTR-INR-17011537）。
BACKGROUND The use of sedation is becoming more commonplace. Although pulse oximetry is a standard monitoring procedure during sedation, it cannot accurately detect early hypoventilation. End-tidal carbon dioxide (EtCO2) monitoring can be an earlier indicator of airway compromise; however, the existing literature is limited to a few studies with varying outcomes. OBJECTIVES To evaluate whether EtCO2 monitoring decreases the incidences of CO2 retention and apnoeic events in propofol-based sedation. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Two hundred women (aged 18 to 65 years, ASA physical status 1 or 2) who were scheduled for breast lumpectomy between June 2017 and August 2017. INTERVENTIONS Patients were allocated randomly to receive either standard monitoring or standard monitoring and EtCO2 monitoring. MAIN OUTCOME MEASURES The primary outcome was the incidence of CO2 retention. The secondary outcomes were the number of actions taken to restore ventilation, variations in PaCO2 and pH, the frequency of apnoea and the recovery time. RESULTS CO2 retention occurred significantly less often in the EtCO2 monitoring group (10 vs. 87%; P < 0.0001). In the standard monitoring group, the mean PaCO2 was more than 6 kPa (45 mmHg) and the pH was less than 7.35 at 5, 10, 20 and 30 min after induction of anaesthesia and at the end of the procedure. Both values were within the normal range in the EtCO2 monitoring group. The number of airway interventions performed was significantly higher in the EtCO2 monitoring group (9.8 +/- 1.8 vs. 1.9 +/- 1.0; P < 0.0001). Apnoea occurred significantly less often in the EtCO2 monitoring group (0 vs. 10%; P < 0.0001) and recovery time was shorter (9.9 +/- 1.4 vs. 11.4 +/- 2.1 min; P = 0.048). CONCLUSION The addition of EtCO2 monitoring to standard monitoring during propofol-based sedation can improve patient safety by decreasing the incidence of CO2 retention, and therefore the risk of hypoxaemia through early recognition of apnoea, and can also shorten recovery time. TRIAL REGISTRATION This trial is registered with (ChiCTR-INR-17011537).