在全身麻醉患者中以EIT为指导的个性化PEEP:系统性审查和元分析
Lingyan Jiang1, Yanjun Deng2, Fuqi Xu3
1Faculty of Anesthesiology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou Science and Technology Town Hospital, Suzhou, China; Department of Anesthesiology and Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China.
Journal of clinical anesthesia
|January 26, 2024
概括
电阻断层扫描 (EIT) 导向的阳性末尾呼气压 (PEEP) 改善了全身麻醉患者的手术内氧化和肺部顺应. 这种方法比传统的PEEP设置更优越,但不会对血液动力学或术后并发症产生负面影响.
科学领域:
- 麻醉学和重症监护医学
- 呼吸系统生理学 呼吸系统生理学
- 医学成像技术 医学成像技术
背景情况:
- 在全身麻醉期间选择最佳的正极端呼气压 (PEEP) 是一个持续的临床挑战.
- 电阻断层扫描 (EIT) 为PEEP定位提供了一种新的,个性化的方法,引起了大量的研究兴趣.
- 本元分析评估了EIT引导的PEEP与传统方法相比的有效性.
研究的目的:
- 系统地评估以EIT为指导的个性化PEEP对全身麻醉患者呼吸系统参数和临床结果的影响.
- 将EIT指导的PEEP策略与固定的PEEP值和其他个性化定位方法进行比较.
- 分析对氧化,肺部顺应和术后肺部并发症的影响.
主要方法:
- 进行了全面的元分析,搜索主要数据库 (PubMed,科学网,EMBASE,科克兰图书馆) 到2023年1月.
- 包括的研究集中在EIT指导的PEEP与一般麻醉中的传统PEEP.
- 主要结局是氧化指数 (OI),肺部适应性和术后肺部并发症 (PPCs);次要结局包括平均动脉血压 (MAP) 和血管活性药物使用.
主要成果:
- 分析包括5项研究,共272名参与者.
- 与传统方法相比,EIT指导的PEEP显著改善了手术内氧化指数 (OI) 和肺部顺应.
- 没有观察到对手术后平均动脉血压 (MAP),血管活性药物需求或术后肺部并发症发生率的显著不良影响.
结论:
- 以EIT为指导的个性化PEEP显示了在全身麻醉中对手术期间的氧化和肺部顺应的潜在好处.
- 目前的证据表明,EIT引导的PEEP不会对手术内血液动力学产生不利影响,也不会增加术后并发症.
- 需要进一步的研究来巩固这些发现,并解决关于长期结果的剩余不确定性.
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