在肥胖患者手术后肺部并发症中,手术内高正气压 (PEEP) 与低PEEP的影响:随机临床试验
, Thomas Bluth1, Ary Serpa Neto2
1Department of Anesthesiology and Critical Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
JAMA
|June 4, 2019
概括
在肥胖的手术患者中,通过膜招募操作增加的阳性末尾呼吸压力 (PEEP) 并没有减少术后的肺部并发症. 然而,这种通风策略确实减少了手术期间的低氧化.
科学领域:
- 麻醉学
- 危急护理医学
- 胸部手术
背景情况:
- 接受手术的肥胖患者面临术后肺部并发症的风险增加.
- 术内通风策略,包括阳性末尾呼吸压力 (PEEP) 和气泡招募机动 (ARM),可能会影响这些结果.
- 之前的研究表明,使用更高的PEEP和ARM可以改善呼吸功能,但临床结果数据仍然不确定.
研究的目的:
- 在接受非心脏手术的肥胖患者中,研究更高水平的PEEP与ARM相结合是否会减少术后的肺部并发症.
- 为了比较高PEEP策略 (12厘米H2O) 与ARM与低PEEP策略 (4厘米H2O) 在预防肺病率方面的有效性.
主要方法:
- 一项随机临床试验,涉及2013年接受非心脏手术的高风险肥胖成年人 (BMI≥35).
- 患者被分配到高PEEP (12厘米H2O) 与ARM组或低PEEP (4厘米H2O) 组,两者都接受体积控制呼吸.
- 主要结局是手术后5天内出现的肺部并发症. 二次结局包括手术内低氧症.
主要成果:
- 主要综合结果发生在高PEEP组的21. 3%,低PEEP组的23. 6% (P=0. 23),表明整体肺部并发症没有显著差异.
- 然而,高PEEP组的手术内低氧症显著减少 (5.0%对13.6%,P<0.001).
- 其中六个次要结局,包括特定的肺部并发症,在两组之间没有显著差异.
结论:
- 在接受非心脏手术的全身麻醉的肥胖患者中,使用高PEEP与ARM的手术内通风策略与低PEEP相比,不会降低术后肺部并发症的发生率.
- 这种策略可能有助于减少手术期间的低氧化,因此需要进一步研究其具体应用.
- 这些发现表明,目前的机械通风策略可能需要改进,以优化这种高风险手术群体的结果.
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