在视频辅助胸腔镜手术后,用于预防atelectasis的单肺通风过程中的正末尾呼吸压力:三臂,随机对照试验
Seokha Yoo1, Susie Yoon1, Bo R Kim2
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Minerva anestesiologica
|November 21, 2023
概括
在单肺通风过程中,较高的阳性末尾呼气压 (PEEP) 可能会减少胸部手术后的肺透气. 这项研究发现,PEEP水平为6和9cmH2O,导致肺气化得分比3cmH2O更好.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 胸部外科手术 胸部外科手术
背景情况:
- 对于胸部手术中单肺通风时的肺保护性通风策略的证据有限.
- 手术后的脱骨症是这些手术后的常见并发症.
- 优化正极呼气压 (PEEP) 对于保持肺气化至关重要.
研究的目的:
- 为了确定PEEP在单肺通风期间的最佳水平.
- 为了最大限度地减少术后的脱氧,使用肺部超声波.
- 评估不同PEEP水平对肺空气的影响.
主要方法:
- 142名接受视频辅助胸腔镜手术的成年患者被随机分为三组.
- 组在单肺通风过程中接受了3,6或9cmH2O的PEEP.
- 肺部超声波得分被用于评估手术后一个小时的肺部通风.
主要成果:
- 较低的PEEP (3cmH2O) 与显著更高的肺超声波得分有关,这表明更多的吞.
- 较高的PEEP水平 (6和9厘米H2O) 显示出明显更好的肺透气.
- 在通风后的3cmH2OPEEP组中,PaO2/FiO2比率较低.
结论:
- 对于单肺通风的最佳PEEP水平尚未最终确定.
- 较高的PEEP应用似乎可以防止通风肺中的通风损失.
- 这表明PEEP是胸部手术期间控制肺气化的一个关键因素.
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