没有招募机动的个性化PEEP改善了手术期间的氧化:一项随机对照研究
Lili Pan1, Li Yang1, Lingling Gao1
1Department of Anesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
电阻断层扫描 (EIT) 引导的个性化正极呼气压 (PEEP) 改善了机器人辅助前列腺切除术患者的氧化和减少了低氧化. 这种由EIT指导的PEEP策略为优化手术期间通风提供了一个安全的替代方案.
科学领域:
- 麻醉学 麻醉学
- 呼吸系统生理学 呼吸系统生理学
- 医疗技术 医疗技术 医学技术
背景情况:
- 在机器人辅助前列腺切除术中,与招募机动的个性化正极端呼气压 (PEEP) 增强了手术期间的氧化.
- 没有招募机动的电阻断层扫描 (EIT) 引导的个性化PEEP的有效性仍然未确定,以改善手术内氧化.
研究的目的:
- 调查EIT指导的个性化PEEP是否可以改善在接受机器人辅助腹腔镜前列腺切除术的患者的手术内氧化.
主要方法:
- 56名男性患者被随机分为两组:由EIT指导的个性化PEEP (PEEP_IND组) 和5厘米H2O的固定PEEP (PEEP_5组).
- 在整个过程中,PEEP_IND组获得了由EIT指导的个性化PEEP,而PEEP_5组则获得了5厘米H2O的固定PEEP.
- 主要结果是动脉氧部分压力与输出氧气 (PaO2 / FiO2) 在输出之前的比例.
主要成果:
- 与固定PEEP组相比,个性化PEEP组 (中位数为16厘米H2O) 在输出之前显示出明显更高的PaO2 / FiO2比率 (71.6 ± 10.7与56.8 ± 14.1 kPa相比,p = 0.003).
- 在个性化PEEP组中,术后低氧症的发生率较低 (3.8%对26.9%,p=0.021).
- 个性化PEEP组还显示出较低的驾驶压力 (12.0 ± 3.0对比15.0 ± 4.4厘米H2O,p = 0.044) 和更好的呼吸系统遵守 (44.5 ± 12.8对比33.6 ± 9.1毫升/厘米H2O,p = 0.017).
结论:
- 在没有招募机动的情况下,EIT引导的个性化PEEP有效地改善了在接受机器人辅助腹腔镜激进前列腺切除术的患者的术后氧化.
- 这种方法可能为招募机动提供更安全的替代方案,可能减轻手术内血动力学不稳定性.
- 这些发现表明,以EIT为指导的个性化PEEP是优化该患者群体呼吸管理的有价值策略.
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