​呼气末正压/肺复张动作与呼气末零压对儿童肺不张影响:一项随机临床试验

2021
09/24

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本文由“罂粟花“授权转载

呼气末正压/肺复张动作与呼气末零压对儿童肺不张影响:一项随机临床试验

贵州医科大学 麻醉与电生理课题组

翻译:佟睿 编辑:佟睿 审校:曹莹

背景

肺不张是常见的术后并发症。围手术期肺保护可以减少肺不张;然而,这种情况是否会持续到术后还不清楚。

目的

评估肺保护性通气在何种程度上减少接受非腹部手术的儿童围手术期肺不张。

试验设计

随机、对照、双盲研究。

范围设置

2019725日至2020118日的单中心三级医院。

受试患者

共纳入了60名年龄在1-6岁、美国麻醉医师协会分级I~II级的患儿,计划在机械通气的全麻(2h)下进行非腹部手术。

干扰因素

患者被随机分为肺保护组和零呼气末压力组(对照组)。肺保护需要每30min进行5cmH2O呼气末正压和肺复张动作。两组均采用容量控制通气,潮气量6ml kg-1体重。分别于麻醉诱导前、诱导后即刻、手术拔管即刻、拔管后15min3h12h24h进行肺部超声检查。

主要观察指标

比较各组在各时间段肺部超声评分的差异。得分越高,说明肺部充气状况越差。

结果

与对照组患者相比,肺保护组患者术后即刻肺部超声评分中位数[IQR]更低(4[4~5] vs. 8[4~6],组间差异的95%可信区间为-4~-4Z=-6.324)和拔管后也表现相同情况(3[3~4] vs. 4[4~4]95%CI -1~0Z=-3.161)。从拔管后15分钟开始,这种情况不再持续。两组拔管后3h肺通气均恢复正常。

结论

肺保护性通气减少的肺不张从拔管后15min开始不再持续。还需要进一步的研究来确定它在其他类型的手术中是否产生更好的效果。

原始文献来源

Change Zhu, Saiji Zhang, Junli Dong, et al. Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis in children: A randomised clinical trial [J]Eur J Anaesthesiol 2021; 38:908915.

英文摘要 Abstract  


Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis in children: A randomised clinical trial



Abstract

BACKGROUND: Atelectasis is a common postoperative complication. Peri-operative lung protection can reduce atelectasis; however, it is not clear whether this persists into the postoperative period.


OBJECTIVE: To evaluate to what extent lung-protective ventilation reduces peri-operative atelectasis in children undergoing nonabdominal surgery.


DESIGN: Randomised, controlled, double-blind study.


SETTING: Single tertiary hospital, 25 July 2019 to 18 January 2020.


PATIENTS: A total of 60 patients aged 1 to 6 years, American Society of Anesthesiologists physical status 1 or 2, planned for nonabdominal surgery under general anaesthesia (2h ) with mechanical ventilation.


INTERVENTION: The patients were assigned randomly into either the lung-protective or zero end-expiratory pressure with no recruitment manoeuvres (control) group. Lung protection entailed 5 cmH2O positive end-expiratory pressure and recruitment manoeuvres every 30 min. Both groups received volume-controlled ventilation with a tidal volume of 6 ml kg-1 body weight. Lung ultrasound was conducted before anaesthesia induction, immediately after induction, surgery and tracheal extubation, and 15 min, 3 h, 12 h and 24 h after extubation.


MAIN OUTCOME MEASURES: The difference in lung ultrasound score between groups at each interval. A higher score indicates worse lung aeration.


RESULTS:Patients in the lung-protective group exhibited lower median [IQR] ultrasound scores compared with the control group immediately after surgery, 4 [4 to 5] vs. 8 [4 to 6], (95% confidence interval for the difference between group values-4 to -4,Z=-6.324) and after extubation 3 [3 to 4] vs. 4 [4 to 4], 95% CI -1 to 0, Z=-3.161. This did not persist from 15 min after extubation onwards. Lung aeration returned to normal in both groups 3 h after extubation.


CONCLUSION:The reduced atelectasis provided by lungprotective ventilation does not persist from 15 min after extubation onwards. Further studies are needed to determine if it yields better results in other types of surgery.


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关键词:
麻醉,科普,之声,呼气,米勒

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