在肥胖患者的手术后透症上个性化正极呼吸压:一项随机对照临床试验
1Department of Anesthesiology, Eye & Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
动态遵从导向的正极呼气压 (PEEP) 在减肥手术患者中显著降低了手术后的脱氧. 这种个性化的PEEP方法为改善手术期间肺部保护提供了一个有希望的策略.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
背景情况:
- 已知以动态遵守为指导的个性化阳性末尾呼气压 (PEEP) 可以改善氧化和减少非肥胖患者的手术后脱氧.
- 该研究调查了这种动态合规引导的PEEP策略在接受减肥手术的患者中的有效性,这些患者易患呼吸道并发症.
研究的目的:
- 评估动态合规导向PEEP是否可以降低腹腔镜腹腔外科手术的患者的手术后骨质疏松症.
- 在这个患者群体中,比较动态合规导向PEEP与8厘米H2O固定PEEP的有效性.
主要方法:
- 招募了40名经历了腹腔镜腹手术的患者,并接受了动态合规引导的PEEP定位.
- 患者随机分配,在手术期间接受动态合规导向PEEP或固定PEEP的8厘米H2O.
- 使用计算机断层扫描来评估术后的脱氧,其次要结果包括氧化 (PaO2 / FiO2) 和肺部并发症.
主要成果:
- 与8厘米H2O组的PEEP (13.1% ± 5.3%) (P = 0.025) 相比,在动态合规引导的PEEP组 (9.5% ± 4.3%) 中,术后吞明显较低.
- 在动态合规引导的PEEP组 (1小时后的肺上) 中,氧化率 (PaO2 / FiO2) 较高 (397 mmHg对337 mmHg;P = 0.017).
- 术后肺部并发症的发生率在两组之间是相似的 (每组4个20个).
结论:
- 动态合规引导的PEEP有效地减少了腹腔镜减肥手术的患者的术后脱.
- 虽然引导PEEP的初始氧化得到改善,但长期氧化和并发症率在各组之间没有显著差异.
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