Page 87 - 南京医科大学自然版

第44卷第6期 孔秋月，刘 洋，李 楠，等. 经皮二氧化碳测量在腹膜后腹腔镜泌尿外科手术中的准确性：
2024年6月 一项前瞻性观察性研究［J］. 南京医科大学学报（自然科学版），2024，44（6）：818-825 ·823 ·

A B
30 15
（mmHg） 20 Upper 95% LOA （mmHg） 10 5 Upper 95% LOA

PaCO2-PETCO2 10 Bias PaCO2-PTCCO2 -5 0 Bias

Lower 95% LOA

0 Lower 95% LOA -10
30 40 50 60 70 30 40 50 60 70 80
（PaCO2+PETCO2）/2（mmHg） （PaCO2+PTCCO2）/2（mmHg）
图3 PETCO2和PaCO2 （A）或PTCCO2和PaCO2 （B）一致性的Bland⁃Altman图
Figure 3 Bland⁃Altman plots of agreement between P ETCO2 and PaCO2 （A），or between PTCCO2 and PaCO2 （B）

only 5 out of 157 measurements（3.2%）. Compared to toma，as heightened catecholamine levels exacerbate
［6-8］
other studies defining acceptable bias as ≤3 mmHg ， hemodynamic instability. Given the intermittence of
36.3% of PTCCO2 values and only 0.6% of PETCO2 val⁃ ABG analysis，a continuous，non⁃invasive method to ac⁃
ues fell within this threshold in our study. Our findings curately predict P aCO2 during retroperitoneoscopic sur⁃
suggested that P TCCO2 showed a greater accuracy than gery is necessary. P TCCO2 was found to be equivalent
PETCO2 in predicting PaCO2，with more values within or even superior to P ETCO2 in predicting PaCO2 in differ⁃
［9- 11］
3 mmHg or 5 mmHg of PaCO2. Additionally，the mean ent populations . However，the correlation between
PaCO2 ⁃ PETCO2 difference was（13.20 ± 4.43）mmHg PTCCO2 and PaCO2 remains unclear in retroperitoneo⁃
（95%CI：4.53-21.88 mmHg）. In contrast，the mean scopic surgery. In this study，PaCO2 and PTCCO2 showed
PaCO2 ⁃ PTCCO2 difference was（4.35 ± 2.56）mmHg a stronger correlation than P aCO2 and PETCO2 across all
（95% CI：- 3.18 to 10.48 mmHg）. Taken together， subject groups（0.83 vs. 0.62）. Subgroup analysis re⁃

these results indicate that P TCCO2 estimated PaCO2 vealed a declining correlation between P ETCO2 and PaCO2
more accurately than P ETCO2 in patients undergoing as PETCO2 rose from 35-40 mmHg to 45-50 mmHg（0.41
retroperitoneoscopic urologic surgery. to 0.18）. In contrast，PaCO2 ⁃ PTCCO2 correlation re⁃
Retroperitoneoscopic surgery provides a minimally mained high at 0.72 when PETCO2 exceeded 45 mmHg.
invasive approach to treating urinary system disease. This indicates PTCCO2 monitoring may have greater ac⁃
The retroperitoneum refers to the space behind the curacy and sensitivity for detecting hypercapnia than
peritoneal cavity，bounded by the posterior abdominal PETCO2. In other studies，the correlation between P aCO2
wall. This space is filled with adipose and loose con⁃ and PETCO2 values or between P aCO2 and PTCCO2 values
nective tissue，extending from the neck to the pelvis， was higher than those in the present study，especially
and it is highly vascularized. During the operation，ex⁃ at baseline. This difference may be attributed to hemo⁃
tensive tissue dissection is required to create the retro⁃ dynamic fluctuations during anesthesia induction and
peritoneal space，potentially increasing CO 2 absorption positional changes，which increased the mismatch of
compared to intraperitoneal laparoscopy. Consequently， the ventilation/perfusion（V/Q）ratio.

hypercarbia may occur. A patient position has a considerable influence on
Clinically，hypercapnia principally impacts the the accuracy of P ETCO2 monitoring. The lateral position
cerebrovascular and cardiovascular system. Elevated often used in retroperitoneoscopic surgery can increase
PaCO2 causes cerebral vasodilation and increases intra⁃ intrathoracic pressure and pulmonary pressures while
cranial pressure despite autoregulatory mechanisms. decreasing venous return. Collectively，these effects re⁃
Moreover，acute hypercapnia may increase the release duce pulmonary blood flow，creating a mismatch be⁃
of catecholamines due to β ⁃ adrenergic stimulation. tween alveolar ventilation and perfusion. Thus，the dif⁃
This may be detrimental in procedures like retroperito⁃ ference between P aCO2 and PETCO2 in lateral position
［12- 13］
neoscopic adrenalectomy，especially for pheochromocy⁃ was greater than those in other positions . Further⁃