儿童肺切除期间的肺保护性通风和术后肺并发症:一个前性的,单中心的,随机对照试验
Change Zhu1, Mazhong Zhang, Saiji Zhang
1From the Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (CZ, SZ, RW), Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China (CZ, MZ), Cardiothoracic Surgery Department, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (RZ).
European journal of anaesthesiology
|September 6, 2024
概括
肺保护性通风 (LPV) 在接受单肺通风 (OLV) 的儿童中没有减少术后肺并发症 (PPC). 驾驶压力导向通风显示肺机械有所改善,但PPC没有显著差异.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 呼吸系统生理学 呼吸系统生理学
- 关键护理医学 关键护理医学
背景情况:
- 由于独特的呼吸系统生理学,儿童对术后肺部并发症 (PPC) 的易感性增加.
- 对于需要单肺通风 (OLV) 的儿科患者,肺保护性通风 (LPV) 策略仍未得到充分研究.
- 这项研究调查了LPV和驱动压力导向通风在儿科OLV.
研究的目的:
- 评估肺保护性通风 (LPV) 在减少儿童手术后肺部并发症 (PPC) 的有效性.
- 评估驾驶压力导向通风与儿科OLV传统方法相比的影响.
- 分析对肺机械和氧化的影响.
主要方法:
- 进行了一项随机,受控,双盲研究,对213名6岁以下的儿童进行了肺切除.
- 参与者被分配到肺保护性通风 (LPV) 或对照组.
- 该LPV组进一步划分为带动压力导向或常规保护性通风与固定PEEP.
主要成果:
- 在LPV和对照组 (16.9%和21.1%) 之间没有观察到PPC发生率的显著差异.
- 与固定PEEP组相比,驱动压力组表现出较低的驱动压力,改善的肺部服从性和更好的氧化.
- 尽管改进了机械,但PPC率在驱动压力和固定PEEP子组之间没有显著差异.
结论:
- 与非保护性通风相比,肺保护性通风 (LPV) 在这个儿科队列中没有降低PPC的发生率.
- 虽然推动压力导向通风改善了肺机械和氧化,但这些好处并没有转化为减少PPCs.
- 该研究的小样本大小限制了最终的结论,需要进行更大的试验来证实研究结果.
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