文献学习|最佳的呼气末正压预防婴儿麻醉引起的肺不张：一项前瞻性，随机，双盲试验

2021-04-07 米勒之声

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为减少超声所测量的低腹部，泌尿生殖系统或浅表区域手术健康婴儿的麻醉引起的肺不张，PEEP 6 cmH2O比3 cmH2O更有效。9 cmH2O的PEEP与6 cmH2O相当。

本文由“拾遗知海”授权转载

原文

研究背景

儿科患者麻醉诱导肺不张的发生率特别高。在成人中应用呼气末正压(PEEP)和肺泡复张手法已被大量研究和采用；然而，很少有研究在儿童中进行。

研究目的

通过超声测量比较3、6和9 cmH2O三种PEEP水平对6~12个月婴儿全麻后肺不张的影响。

研究设计

前瞻性、随机、双盲试验。

研究单位

韩国，单中心麻醉科，2019年5月至2020年3月。

研究对象

6至12个月大，美国麻醉学家协会(ASA)身体状况为1或2，身高和体重与同龄人在两个标准差以内，计划进行泌尿外科或普通手术的儿童包括在研究中。

主要观察指标

主要结果为手术结束时的肺部超声评分。次要结果包括应用PEEP前后的动态顺应性、吸气峰压、驱动压、心脏指数、平均动脉压和心率。

结果

手术结束时，PEEP 6cmH2O的平均肺超声得分为12.8，而PEEP 9cmH2O的平均肺超声得分为12.1。两者均显着低于PEEP 3cmH2O时的18.4（分别为P =0.0002和0.00003）。但是，PEEP 6cmH2O和PEEP 9cmH2O得分之间没有显着差异。三组之间的Δ心脏指数（PEEP后的心脏指数-PEEP在3cmH2O时的心脏指数）相当。

结论

为减少超声所测量的低腹部，泌尿生殖系统或浅表区域手术健康婴儿的麻醉引起的肺不张，PEEP 6 cmH2O比3 cmH2O更有效。9 cmH2O的PEEP与6 cmH2O相当。

英文摘要

Background: Paediatric patients have a particularly high incidence of anaesthesia-induced atelectasis. Applying positive end-expiratory pressure (PEEP) with an alveolar recruitment manoeuvre has been substantially studied and adopted in adults; however, few studies have been conducted in children.

Objective: We compared the effects of three levels of PEEP (3, 6 and 9 cmH2O) on anaesthesia-induced atelectasis measured by ultrasound in infants between 6 and 12 months of age who were undergoing general anaesthesia.

Design: A prospective, randomised, double-blind trial.

Setting: Department of Anaesthesia, single centre, South Korea, from May 2019 to March 2020.

Patients: Children who were 6 to 12 months of age, whose American Society of Anesthesiologists (ASA) physical status was 1 or 2, whose height and weight were within two standard deviations of those of their peers, and who were scheduled for elective urological or general surgery were included in the study.

Main outcomes: The primary outcome was the lung ultrasound score at the end of the procedure. The secondary outcomes included dynamic compliance, peak inspiratory pressure, driving pressure, cardiac index, mean arterial pressure and heart rate before and after applying PEEP.

Results:The mean lung ultrasound score at the end of operation was 12.8 at PEEP 6 cmH2O and 12.1 at PEEP 9 cmH2O. Both were significantly lower than 18.4 at PEEP 3 cmH2O (P = 0.0002 and 0.00003, respectively). However, there was no significant difference between the scores of PEEP 6 cmH2O and PEEP 9 cmH2O. The Δ cardiac index (the cardiac index after PEEP - the cardiac index at 3 cmH2O of PEEP) was comparable among the three groups.

Conclusion: To reduce anaesthesia-induced atelectasis measured by ultrasound in healthy infants undergoing low abdominal, genitourinary or superficial regional operations, 6 cmH2O of PEEP was more effective than 3 cmH2O. PEEP of 9 cmH2O was comparable with 6 cmH2O.

常用英文释义学习

atelectasis:肺不张

alveolar：肺泡的

recruitment：增长

manoeuvre:手段，策略

genitourinary：泌尿生殖器的

dynamic compliance:动态顺应性

原始文献：Park S, Lee JH, Kim HJ, Choi H, Lee JR. Optimal positive end-expiratory pressure to prevent anaesthesia-induced atelectasis in infants: A prospective, randomised, double-blind trial. Eur J Anaesthesiol. 2021 Mar 11. doi: 10.1097/EJA.0000000000001483. Epub ahead of print. PMID: 33720065.

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