在PEEP一步变化方向的单肺通风患者中PCV-VG组合个性化PEEP确定:随机对照试验
Guowei Li1, Saixian Ma1, Qian Shu1
1Department of Anesthesiology, Affiliated Wuxi Fifth Hospital of Jiangnan University (Infectious Diseases Hospital of Wuxi), Wuxi, Jiangsu, China.
The clinical respiratory journal
|September 19, 2023
概括
在单肺通风 (OLV) 期间,梯度定向的正极端呼气压 (PEEP) 定位改善了胸腔镜手术患者的呼吸机制和减少了并发症. 这种方法增强了气体交换,降低了炎症标志物.
科学领域:
- 麻醉学和重症监护医学
- 胸部外科手术 胸部外科手术
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 研究了压力控制体积保证通风 (PCV-VG) 结合在单肺通风 (OLV) 过程中梯度方向正极呼气压 (PEEP) 变化的疗效.
- 专注于接受胸腔镜手术的患者,这是一个常见的程序,需要仔细的呼吸管理.
研究的目的:
- 评估不同PEEP定位策略 (固定,增量,减量) 在OLV期间对呼吸机制,气体交换和炎症标志物的影响.
- 评估术后肺部并发症 (PPC) 和重症监护室 (ICU) 入院的发生率.
主要方法:
- 90名患者被随机分为三个组:固定PEEP,增量PEEP定位 (PI) 和减量PEEP定位 (PD).
- 测量包括血液动力学,呼吸机制 (峰值,平均值,动态遵守) 和动脉血液气体指数在不同的时间点.
- 使用ELISA测量了炎症标记物 (中性粒细胞弹性酶,CC16,IL-8).
主要成果:
- 与固定PEEP组相比,PI和PD组显示出改善的呼吸机制 (较低的峰值气道压力,较高的平均气道压力和动态合规性).
- 在OLV期间,在PI和PD组中观察到更好的动脉氧化 (PaO2,PaO2/FiO2) 和减少死空间通风 (VD/VT).
- 在PI和PD组中,发炎标志物水平较低,PPC和ICU入院发生率显著降低.
结论:
- 在胸腔镜手术中,OLV期间的梯度定向PEEP定位 (增量或减量) 改善了呼吸机制和气体交换.
- 这种PEEP策略有效地减轻炎症反应,并减少术后肺部并发症的发生.
- 改变PEEP标位代表了优化胸部外科手术中通风策略的有益方法.
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