开腹手术后肺通气量和呼吸功能的变化：一项定量磁共振成像研究

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开腹手术后肺通气量和呼吸功能的变化：一项定量磁共振成像研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：马艳燕  编辑：马艳燕  审校：曹莹

背景： 肺不张是开腹手术患者最常见的呼吸道并发症之一。外周血氧饱和度(SpO2)和用力肺活量(FVC)是术后呼吸功能障碍的床旁指标。本研究的目的是利用磁共振成像(MRI)的定量分析以及SpO2和FVC对术后肺不张的诊断准确性来描述肺通气的变化。 

方法： 对在德国德累斯顿一所大学医院进行的随机试验进行事后分析。纳入术前和术后进行肺部MRI检查的患者。定量分析MRI信号强度，以区分低充气和非充气肺区。在各自的MRI检查中，术后肺不张定义为非充气肺容量超过总肺容量的2%。 

结果： 本研究纳入45例患者，合并肺不张的有27例，没有合并肺不张的有18例。肺不张患者有较高的体重指数(p=0.024)、较多的术前充气不良肺容量(p=0.049)、较低的术前血氧饱和度(p=0.009)和较低的术前用力肺活量(p=0.029)。肺不张发生率与术前血氧饱和度(Spearman‘s ρ=-0.51，p<0.001)、术后血氧饱和度(ρ=-0.60，p<0.001)、术前用力肺活量(ρ=-0.29，p=0.047)、术后用力肺活量(ρ=-0.40，p=0.006)相关。术后SpO2≤94%诊断为肺不张的敏感性为74%，特异性为78%；术后SpO2≤50%诊断为肺不张的敏感性为56%，特异性为100%。 

结论： SpO2和FVC与术后非充气肺容量相关，在术后肺不张的床边检测中显示出可接受的诊断准确性。

原始文献来源：Ball L, Serafini SC, Braune A, Güldner A, Bluth T, Spieth P, Huhle R, Scharffenberg M, Wittenstein J, Uhlig C, Robba C, Schultz MJ, Pelosi P, Gama de Abreu M. Changes in lung aeration and respiratory function after open abdominal surgery: a quantitative magnetic resonance imaging study. Acta Anaesthesiol Scand. 2022 Jul 6.

    英文原文    

Changes in lung aeration and respiratory function after open abdominal surgery: a quantitative magnetic resonance imaging study 

Background:  Atelectasis is one of the most common respiratory complications in patients undergoing open abdominal surgery. Peripheral oxygen saturation (SpO2) and forced vital capacity (FVC) are bedside indicators of postoperative respiratory dysfunction. The aim of this study was to describe the changes in lung aeration, using quantitative analysis of magnetic resonance imaging (MRI) and the diagnostic accuracy of SpO2 and FVC to detect postoperative atelectasis. 

Methods: Post-hoc analysis of a randomized trial conducted at a University Hospital in Dresden, Germany. Patients undergoing pre- and postoperative lung MRI were included. MRI signal intensity was analyzed quantitatively to define poorly and nonaerated lung compartments. Postoperative atelectasis was defined as nonaerated lung volume above 2% of the total lung volume in the respective MRI investigation.

Results: This study included 45 patients, 27 with and 18 patients without postoperative atelectasis. Patients with atelectasis had higher body mass index (p=0.024), had more preoperative poorly aerated lung volume (p=0.049), a lower preoperative SpO2 (p=0.009), and a lower preoperative FVC (p=0.029). The amount of atelectasis correlated with preoperative SpO2 (Spearman’s ρ=-0.51, p<0.001) and postoperative SpO2 (ρ=-0.60, p<0.001), and with preoperative FVC (ρ=-0.29, p=0.047) and postoperative FVC (ρ=-0.40, p=0.006). A postoperative SpO2 ≤ 94% had 74% sensitivity and 78% specificity to detect atelectasis, while postoperative FVC ≤ 50% had 56% sensitivity and 100% specificity to detect atelectasis.

Conclusion: SpO2 and FVC correlated with the amount of postoperative non-aerated lung volume, showing acceptable diagnostic accuracy in bedside detection of postoperative atelectasis. 

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