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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (6): 410-423.DOI: 10.3969/j.issn.1673-5501.2023.06.002

• 论著 • 上一篇    下一篇

新生儿经皮二氧化碳分压监测值与动脉血气二氧化碳分压检测值差值的系统评价/Meta分析

赵卓宇1,3,王欢欢1,3,王瑞2,曹云1,张崇凡2   

  1. 复旦大学附属儿科医院上海，201102；1 新生儿科,2 临床指南制作评价中心 复旦大学GRADE中心，3并列第一作者

  • 收稿日期:2024-01-22 修回日期:2024-01-22 出版日期:2023-12-25 发布日期:2024-01-22
  • 通讯作者: 曹云；张崇凡
  • 作者简介:CAO Yun, email: yuncao@fudan.edu.cn；ZHANG Chongfan, email: chongfan_zhang@fudan.edu.cn

Differences between TcPCO2 and PCO2 values in neonates: A systematic review and meta-analysis

ZHAO Zhuoyu1,3, WANG Huanhuan1,3, WANG Rui2, CAO Yun1, ZHANG Chongfan2   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102, China; 1 Department of Neonatology, 2  Center for Clinical Guideline Development and Evaluation, Fudan University GRADE Center; 3 Co-first author
  • Received:2024-01-22 Revised:2024-01-22 Online:2023-12-25 Published:2024-01-22

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摘要： 背景：无创经皮二氧化碳分压(TcPCO2)/经皮氧分压(TcPO2)监测技术能对新生儿二氧化碳分压（PCO2）/氧分压（PO2）进行连续监测，减少采血次数，临床非常关注其安全性和监测值的准确性。 目的：通过系统评价/Meta分析反映TcPCO2/TcPO2监测值与PaCO2/PaO2检测值的一致性。 设计：系统评价/Meta分析。 方法：检索中、英文数据库（Ovid MEDLINE、Embase、中国生物医学文献数据库、万方数据库和中国知网），以新生儿和TcPCO2/TcPO2监测中英文自由词和主题词构建不同数据库的检索式，去重后的文献由2人背靠背阅读题目和摘要初筛，阅读全文复筛，提取发表年份，出生胎龄，监测时胎龄，出生体重，监测时体重，样本量和监测对数，TcPCO2/TcPO2监测组的探头温度，监测部位、时长和设备，参照组（动脉、静脉、末梢和混合）血气PCO2 /PO2，两组血气差值、相关系数和不良事件。采用STATA 17软件行Meta分析。 主要结局指标：TcPCO2/TcPO2监测值与PaCO2/PaO2检测值差值。 结果：中英文数据库检索到875篇文献，经去重、初筛和全文筛选40篇文献进入本文分析，中文14篇，英文26篇。Meta分析显示，探头温度43℃和44℃亚组、42℃亚组、40℃和41℃亚组及38℃和39℃亚组TcPCO2与PaCO2差值分别为2.37（95%CI:2.17~2.67）、2.48（95%CI:1.17~3.79）、4.47（95%CI:3.03~5.92）和5.96（95%CI:5.27~6.64）mmHg，4个亚组Pearson系数为0.78~0.89；与PaCO2偏差43℃和44℃亚组为5%、40℃和41℃亚组为11.8%~14.8%，38℃和39℃亚组为17%。Meta分析显示，探头温度43℃和44℃亚组、42℃亚组、40℃和41℃亚组、38℃和39℃亚组TcPO2与PaO2差值分别为-7.28（95%CI:-12.92~-1.63）、-5.61(95%CI:-6.61~-462)、-28.85(95%CI:-35.12~-22.58)和-31.42(95%CI:-35.97~-26.88)mmHg，4个亚组Pearson系数为0.35~0.91。8篇文献描述了轻微的皮肤发红，未发现皮肤烫伤不良事件。 结论：在没有控制TcPCO2监测部位、时长、时点、设备和新生儿疾病及其状态下，TcPCO2值与PaCO2值强相关，高于PaCO2约7 mmHg；规范操作下可选择使用TcPCO2代替PaCO2。在TcPCO2监测的临床常用探头温度38℃~44℃的范围内，探头设定的温度越高越能准确反映PaCO2，较少发生皮肤发红不良事件。TcPO2与PaO2弱相关，不建议选择使用TcPO2反映PaO2。

关键词: 新生儿, 经皮二氧化碳分压, 经皮氧分压, 二氧化碳分压, 动脉

Abstract: Background：Transcutaneous carbon dioxide partial pressure (TcPCO2) and transcutaneous oxygen partial pressure (TcPO2) monitoring make it possible to continuously monitor neonatal PCO2/PO2 and reduce the number of blood collections. However, clinicians are very concerned about its safety and accuracy. Objective：To reflect the consistency of TcPCO2/TcPO2 monitoring values and PaCO2/PaO2 monitoring values through a systematic review and meta-analysis. Design：Systematic review and meta-analysis. Methods：A systematic literature retrieval was performed in English databases of Ovid MEDLINE, Ovid Embase and Chinese databases of SinoMed, Wanfang and CNKI. Search strategy was developed using key words of neotate, TcPCO2 and TcPO2. After deduplication, the literature was first screened by reading titles and abstracts by two leading authors independently who then finished the full-text screening. A self-made excel form was used to extract the year of publication, gestational age at birth, gestational age at monitoring, birth weight, weight at monitoring, sample size and the number of monitored pairs, the probe temperature, monitoring site, duration and equipment, blood gas values difference by TcPCO2/TcPO2and PaCO2/PaO2 , correlation coefficient and adverse events. Meta-analysis was performed by Stata 17. Main outcome measures：Difference in blood gas results between TcPCO2/TcPO2and PaCO2/PaO2. Results：A total of 875 articles were retrieved in both Chinese and English. After deduplication, preliminary screening, and full-text screening, 40 articles were included in the analysis, including 14 in Chinese and 26 in English. The summarized differences between TcPCO2 and PaCO2 in probe temperature subgroups of 44℃ vs 43℃, 42℃, 40℃ vs 41℃, and 38℃ vs 39℃ were 2.37(95%CI: 2.17 to 2.67), 2.48(95%CI: 1.17 to 3.79), 4.47(95%CI: 3.03 to 5.92), and 5.96(95%CI: 5.27 to 6.64) respectively, and the Pearson coefficient ranged from 0.78 to 0.89 among the four subgroups. For the deviation from PaCO2, it was 5% in the 43℃ vs 44℃ subgroup, 118% to 14.8% in the 40℃ vs 41℃ subgroups, and 17% in the 38℃ vs 39℃ subgroups. The summarized difference between TcPO2 and PaO2 in probe temperature subgroups of 44℃ vs 43℃, 42℃, 40℃ vs 41℃, and 38℃ vs 39℃ were -7.28(95%CI: -12.92 to -1.63), -5.61(95%CI: -6.61 to -4.62), -28.85(95%CI: -35.12 to -22.58) and -31.42(95%CI: -35.97 to -26.88) respectively, and the Pearson coefficient was 0.35~0.91 among the four subgroups. Eight studies described mild skin redness and no adverse events of skin burns were reported. Conclusion：Without controlling the monitoring site, duration, time point, equipment, and neonatal diseases and conditions, TcPCO2 values are strongly correlated with the PaCO2 values, which is about 7mmHg higher than PaCO2. Under standardized operations, TcPCO2 can replace PaCO2. Within 38℃ to 44℃, the commonly used clinical probe temperature, the higher the probe temperature, the more accurately TcPCO2 can reflect PaCO2, the less skin redness adverse events will occur. Since TcPO2 is weakly related to PaO2, it is not recommended to use TcPO2 to reflect PaO2.

Key words: Newborn, Transcutaneous carbon dioxide partial pressure, Transcutaneous oxygen partial pressure, Oxygen partial pressure, Artery