在开放腹部手术全身麻醉期间,高与低的阳性末端呼气压 (PROVHILO试验):多中心随机对照试验
Lancet (London, England)
|June 5, 2014
概括
高正末尾呼气压与招募机动并没有减少腹部开放手术患者的术后肺并发症. 防护通风策略应包括低潮体积和低正末尾呼气压力,而无需招募机动.
科学领域:
- 麻醉学 麻醉学
- 临界护理医学 临界护理医学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 在外科手术全身麻醉期间,积极的终端呼气压 (PEEP) 的最佳使用是有争议的.
- 高PEEP可能会预防术后的肺部并发症,但可能导致循环抑制和肺损伤.
- 这项研究调查了PEEP在开放腹部手术机械通风期间预防并发症的作用.
研究的目的:
- 为了测试高PEEP与招募机动是否能在接受开放腹部手术的高风险患者中预防术后肺部并发症.
- 评估PEEP策略对手术内血动力学和血管活性药物的需要的影响.
主要方法:
- 一项随机对照试验,涉及900名患有术后肺部并发症风险的患者,他们接受了开放腹部手术.
- 患者接受了低潮量机械通风 (8毫升/公斤).
- 两个组进行了比较:高PEEP (12厘米H2O) 与招聘机动相比低PEEP (≤2厘米H2O) 没有招聘机动. 结果在术后的第5天被评估.
主要成果:
- 在高PEEP组 (40%) 和低PEEP组 (39%) 之间没有观察到术后肺部并发症的显著差异.
- 高PEEP组经历了更多的手术内低血压,需要增加血管活性药物的使用.
- 该研究包括900名在30个欧洲和美国中心随机分配的患者.
结论:
- 使用高PEEP和招募机动的通风策略不会在这个患者群体中防止术后肺部并发症.
- 术内保护性通风策略应优先考虑低潮体积和低PEEP,省略招募机动.
- 研究结果表明,在没有招募机动的情况下,低PEEP对于接受开放腹部手术的患者来说是一种更安全的方法.
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