个性化肺部保护通风对患有腹腔镜检查的儿童肺部应变和压力的影响:一项观察性队列研究
Cecilia M Acosta1, Sergio Poliotto2, Diego Abrego2
1Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
Anesthesiology
|December 8, 2023
概括
在儿童的腹腔镜手术期间Capnoperitoneum增加了肺部应变. 肺部招募和优化正极端呼气压 (PEEP) 减少了压力,但稍微增加了肺部压力,压力保持在安全范围内.
科学领域:
- 麻醉学 麻醉学
- 儿科手术 儿科手术
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 接受手术的麻醉儿童面临肺部疲劳和压力的风险.
- 在腹腔镜手术中使用的Capnoperitoneum可能会加剧这些风险,可能导致肺损伤.
研究的目的:
- 为了研究卡普诺皮托尼乌姆对麻醉儿童肺部应变和压力的影响.
- 评估个性化保护性通风的有效性,包括肺部招募和优化正极呼气压 (PEEP),在腹腔镜手术期间减轻这些影响.
主要方法:
- 一项观察性队列研究,涉及3至7岁的健康儿童接受腹腔镜手术.
- 使用PEEP进行标准防护通风,并在capnoperitoneum之前,期间和之后进行测量.
- 使用肺超声波和空气测试来评估肺缩;使用卡普诺动力学和跨肺压力测量来计算肺应变和压力.
主要成果:
- 在20名儿童中,Capnoperitoneum显著增加了肺部应变 (0.29对0.20) 和肺部崩,在18名儿童中存在.
- 在capnoperitoneum期间肺部招募和优化PEEP (平均8.3厘米H2O) 将肺部压力降低到基线水平.
- 然而,在经过优化PEEP (7.29厘米H2O) 的capnoperitoneum期间,肺部压力略有增加,并在手术后 (7.25厘米H2O) 保持升高.
结论:
- 在儿科腹腔镜手术中,Capnoperitoneum会增加肺部的压力.
- 个性化的防护通风策略,包括肺部招募和优化PEEP,可以减少肺部压力.
- 虽然肺部压力可能会略有增加,但它仍然在安全的,保护肺部的范围内.
相关概念视频
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