传统开胸术和微创开胸术后患者的肺通气分布：一项观察性研究

  本文由“罂粟花”授权转载

传统开胸术和微创开胸术后患者的肺通气分布：一项观察性研究

贵州医科大学 麻醉与心脏电生理课题组

翻译：马艳燕    编辑：潘志军    审校：曹莹

1   

背景        

本研究的目的是观察经传统全胸骨切开(FS)和微创开胸(MIT)行心脏手术的患者术后通气分布的变化。 

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方法  

本研究共纳入40名计划在双肺通气下经FS行心脏手术或在单肺通气下经MIT行心脏手术的患者。用电阻抗断层扫描(EIT）在T1（术前72小时）、T2（术后在ICU脱机前，术后24小时内）、T3（拔管后24小时）时测量通气量分布。计算基于EIT的参数以评估通气分布，包括左右肺通气分布比、腹侧背侧通气分布比和整体不均匀性指数（GI）。

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结果  

与T1相比，所有患者在T2和T3的GI增加，但只有MIT患者的GI增加具有有统计学意义(FS，p=0.06；MIT，p<0.01)。T2时，背侧(FS)或非通气侧(MIT)明显减少。在T3时通气分布得到部分改善，但在所有患者中，无论何种手术类型，恢复进展都存在巨大差异。亚组分析显示，MIT组手术时间显著降低(FS组240±40分钟vs MIT组205±90分钟，中位数±四分位数范围，p<0.05)，但房颤、房扑发生率显著升高(FS组5% vs MIT组50%，p<0.01)。其他观察结果无统计学差异。

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 结论  

心脏手术后通气分布受损。通气均匀性的恢复过程强烈依赖于个体，因此MIT在这方面并不总是占优势。EIT可能有助于确定术后需要进一步护理的患者。

 原始文献来源 

Zhao Z, Yuan TM, Chuang YH, et al. Lung ventilation distribution in patients after traditional full sternotomy and minimally invasive thoracotomy: An observational study. Acta Anaesthesiol Scand. 2021 Aug;65(7):877-885. 

英文原文

Lung ventilation distribution in patients after traditional full sternotomy and minimally invasive thoracotomy: an observational study

Abstract

  A    Introduction:

The aim of the study was to examine the post-operative ventilation distribution changes in cardiac surgical patients after traditional full sternotomy (FS) or minimally invasive thoracotomy (MIT).

  B    Methods:

A total of 40 patients scheduled for FS with two-lung ventilation or MIT with one-lung ventilation were included. Ventilation distribution was measured with electrical impedance tomography (EIT) at T1, before surgery; T2, after surgery in ICU before weaning; T3, 24 hours after extubation. EIT-based parameters were calculated to assess the ventilation distribution, including the left-to-right lung ratio, ventral-to-dorsal ratio and the global inhomogeneity index.

  C    Results:

The global inhomogeneity index increased at T2 and T3 compared to T1 in all patients but only statistically significant in patients with MIT (FS, p=0.06; MIT, p<0.01). Notable decrease in the dorsal regions (FS) or in the nonventilated side (MIT) was observed at T2. Ventilation distribution was partially improved at T3 but huge variations of recovery progresses were found in all patients regardless of the surgery types. Subgroup analysis indicated that operation duration was significantly lower in the MIT group (240±40 in FS vs. 205±90 minutes in MIT, median±interquartile range, p<0.05) but the incidence of atrial fibrillation/flutter was significantly higher (5% in FS vs. 50% in MIT, p<0.01). Other exploratory outcomes showed no statistical differences.

  D    Conclusion:

Ventilation distribution was impaired after cardiac surgery. The recovery process of ventilation homogeneity was strongly depending on individuals so that MIT was not always superior in this aspect. EIT may help to identify the patients requiring further care after surgery.

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