术后低潮量与常规潮量对进行重大手术的患者肺部并发症的影响:一项随机临床试验
Dharshi Karalapillai1,2, Laurence Weinberg1, Philip Peyton1
1Department of Anesthesia, Austin Hospital, Melbourne, Victoria, Australia.
JAMA
|September 2, 2020
概括
与传统通风相比,大手术期间的低潮量通风并没有减少术后的肺部并发症. 这一发现表明目前的通风策略可能不会在短期内显著改变患者的结果.
科学领域:
- 麻醉学
- 危急护理医学
- 胸部手术
背景情况:
- 机械通风在重大手术期间至关重要, 但最佳的潮体积设置仍在争论中.
- 术后肺部并发症 (PPC) 是一个严重的问题,影响患者的康复和医疗费用.
研究的目的:
- 在非心胸和非内重大手术中,研究低潮量通风是否能降低PPC与传统潮量相比.
- 评估潮体积对各种次要结果的影响,包括死亡率和停留时间.
主要方法:
- 一个单中心的随机临床试验, 涉及1236名接受重大手术的成年患者.
- 患者被分配到低潮体积 (预计6毫升/ 千克体重) 或常规潮体积 (预计10毫升/ 千克体重) 和一致的阳性末尾呼吸压力 (PEEP).
主要成果:
- 主要结果,即7天内PPC的组合,发生在低潮量组的38%和常规潮量组的39% (风险比,0.97;P=.64).
- 两组之间没有观察到主要结果或任何次要结果的显著差异.
结论:
- 与传统的潮通风相比,手术内低潮通风并没有显著减少接受重大手术的成年患者的肺部并发症.
- 这些发现表明,单独优化潮体积可能不足以防止PPC在这个手术群体中.
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