呼吸模式对经过腹部手术的中高风险患者手术后肺部并发症的影响:一项随机对照试验
Xuefei Li1, Yi Xu1, Zaili Wang2
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Anaesthesia, critical care & pain medicine
|September 15, 2024
概括
机械通风模式的选择,包括体积控制通风 (VCV),压力控制通风 (PCV) 和体积保证通风 (PCV-VG) 的PCV,没有影响腹部手术患者的术后肺部并发症 (PPC). 这一发现适用于接受此类程序的中等至高风险个体.
科学领域:
- 麻醉学和重症监护医学
- 呼吸系统医学 呼吸系统医学
- 手术结果研究研究.
背景情况:
- 各种机械通风策略对腹部手术后肺部结果的影响尚未得到充分证实.
- 手术后的肺部并发症 (PPC) 对接受腹部手术的患者,特别是那些中等或高风险的患者来说是一个重大问题.
- 了解最佳通风模式对于最大限度地减少呼吸道疾病至关重要.
研究的目的:
- 在接受腹部手术的患者中,比较PPC在三种不同的机械通风模式中的发生率.
- 评估体积控制通风 (VCV),压力控制通风 (PCV) 或带有体积保证通风 (PCV-VG) 的PCV是否会影响术后肺部结果.
- 在这个患者群体中提供基于证据的关于机械通风策略的指导.
主要方法:
- 一项随机临床试验,涉及1365名中等或高风险的PPC患者,计划进行腹部手术.
- 患者被随机分配给接受VCV,PCV或PCV-VG,在所有组中应用肺保护性通风策略.
- 主要终点是术后7天内PPC的复合发病率,二次分析包括30天PPC和并发症严重程度.
主要成果:
- 在VCV (21.8%),PCV (22.1%) 和PCV-VG (22.5%) 组 (P=0.865) 中没有观察到主要结局 (七天内复合PPC) 的统计学上显著差异.
- 二次结果,包括30天内PPC的发病率和PPC的严重程度等级,也没有显示出通风模式之间的显著差异.
- 该研究表明,评估的三种通风模式的肺安全概况相似.
结论:
- 在接受腹部手术的中高风险患者中,机械呼吸模式 (VCV,PCV或PCV-VG) 的选择似乎没有影响患上术后肺部并发症的风险.
- 这些发现表明,目前的肺保护性通风策略可能会在这种手术环境中减轻这些常见通风模式之间的差异.
- 进一步的研究可能会探索其他患者因素或特定的手术条件,这些因素可能与通风策略相互作用.
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