[罂粟摘要]肺保护性通气策略对中度风险腹部手术患者肺通气功能障碍和术后肺部并发症的影响

肺保护性通气策略对中度风险腹部手术患者肺通气功能障碍和术后肺部并发症的影响

贵州医科大学 麻醉与心脏电生理课题

翻译:  李奕 

编辑:  严旭

审校: 曹莹

背景：关于使用肺保护性通气策略(LPVS)是否可以降低术后肺部并发症(PPCs)的发生率并改善中度风险患者的临床结果，在加泰罗尼亚手术患者呼吸风险评估(ARISCAT)中存在争议。

方法：将100例择期行腹部手术的中度风险患者随机分为两组：常规通气策略组（G0）和肺保护性通气策略组（G1）。在麻醉诱导前（T0）、拔管后30 min（T1）、术后24h（T2）、72h（T3）分别进行肺超声检查（LUS）和LUS评分。记录术后7天内PPCs的发生率和严重程度、术后氧时间、术后住院时间（PHS）。

结果：两组在T1-3时的LUS评分均高于T0（P<0.05），而在T1-3时G1的LUS评分均低于G0。G1 PPCs的发生率（10.9%）低于G0（29.8%）（相对风险，0.37；95%可信区间[CI]，0.14~0.93；P=0.02)，G1 PPCs的严重程度低于G0（P<0.05）。G1的PHS小于G0（8[7-10] vs. 9[8-11]，P<0.05）。

结论：LPVS可降低LUS评估的肺通气损失，并降低中危患者PPCs的发生率。

原始文献来源  ：

Yu Fu , Yan-Wei Zhang , Jie Gao, et al. Effects of lung-protective ventilation strategy on lung aeration loss and postoperative pulmonary complications in moderate-risk patients undergoing abdominal surgery.[J].Minerva Anestesiol. 2021 Jun;87(6):655-662.

英文原文：

Effects of lung-protective ventilation strategy on lung aeration loss and postoperative pulmonary complications in moderate-risk patients undergoing abdominal surgery

Abstract

Background: There is a controversy about whether the use of a lung-protective ventilation strategy(LPVS) can reduce the incidence of postoperative pulmonary complications (PPCs) and improve the clinical outcomes in moderate-risk patients were assessed by the Assess Respiratory Risk in Surgical Patients in Catalonia(ARISCAT).

Method:One hundred moderate-risk patients predicted by the ARISCAT, scheduled to undergo abdominal surgery were randomized into two groups: conventional ventilation strategy group (G<inf>0</inf>) and lung-protective ventilation strategy group (G<inf>1</inf>). Lung ultrasonography (LUS) and the LUS score were performed before induction of anesthesia (T<inf>0</inf>), 30min after extubation (T<inf>1</inf>), and 24h (T<inf>2</inf>), 72h (T<inf>3</inf>) after surgery. The incidence and severity of PPCs within the postoperative 7 days, the duration of postoperative oxygen supplementation, and postoperative hospital stay (PHS) were recorded.

Results:The LUS score of both groups at T<inf>1-3</inf> was higher than those at T<inf>0</inf> (P<0.05), moreover, the LUS score of G<inf>1</inf> was lower than that of G<inf>0</inf> at T<inf>1-3</inf>. The incidence of PPCs of G<inf>1</inf> (10.9%) was lower than that of G<inf>0</inf> (29.8%) (relative risk, 0.37; 95% confidence interval [CI], 0.14 to 0.93; P=0.02) and the severity of PPCs of G<inf>1</inf> were lower than those of G<inf>0</inf> (P<0.05). The PHS of G<inf>1</inf> was less than that of G<inf>0</inf> (8[7-10] vs. 9[8-11], P<0.05).

Conclusion:The LPVS can decrease lung aeration loss assessed by LUS and reduce the incidence of PPCs in moderate-risk patients.

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