用固定和可变的潮体积对氧化和肺结局进行单肺通风:一个随机试验
Katalin Szamos1, Boglárka Balla1, Balázs Pálóczi1
1University of Debrecen, Department of Anesthesiology and Intensive Care, Debrecen, Hungary.
Journal of clinical anesthesia
|April 6, 2024
概括
在单肺麻醉期间的可变潮体积通风没有显著改善手术期间的氧化,也没有减少手术后的并发症. 这项随机试验发现,这种通风策略在肺切除手术中没有显著的临床益处.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 关键护理医学 关键护理医学
背景情况:
- 一个肺通风 (OLV) 可以导致脱氧和氧化受损.
- 对急性呼吸困扰综合征 (ARDS) 的研究表明,可变的潮体积可以改善氧化.
- OLV与ARDS具有共同的特征,促使人们对可变潮体积策略进行研究.
研究的目的:
- 为了测试单肺通风与可变的潮体积是否能改善手术期间的氧化.
- 为了确定这种策略是否可以减少手术后的肺切除后的肺部并发症.
主要方法:
- 一项随机试验,涉及接受肺切除手术的成年患者.
- 患者被分配到固定潮体积 (6毫升/公斤PBW) 或可变潮体积 (6毫升/公斤PBW±33%变化) 的手术内通风.
- 主要结局是手术期间的氧化;次要结局包括术后并发症和死亡率.
主要成果:
- 在OLV期间的时间加权平均PaO2与固定潮体积相比,在可变潮体积下没有临床上有意义的改善.
- 虽然在早期的术后期与可变的潮体积中,阿特莱克塔सिस的发病率较少,但整体复合并发症和死亡率并没有显著减少.
- 没有其他二次结果显示出统计学上显著和临床上有意义的差异.
结论:
- 单肺通风与可变的潮体积在手术内氧化时没有显著的优势.
- 这种通风策略并不能有意义地减少术后的肺部并发症.
- 目前的证据不支持在OLV期间常规使用可变的潮体积来进行肺切除.
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