减肥手术后的阳性末尾呼吸压力和出现氧化前:对术后氧化的影响:一项随机对照试验
Erland Östberg1, Alexander Larsson, Philippe Wagner
1From the Department of Anaesthesia and Intensive Care, and Centre for Clinical Research, Västmanland Hospital Västerås, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (EÖ, AL, LE), Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Sweden (PW), and Department of Surgery and Centre for Clinical Research at Västmanland Hospital Västerås, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (SE).
在出现前氧化发生之前取消正极终呼吸压力 (PEEP) 在肥胖的减肥手术患者中没有改变术后氧化. 输出氧气后的氧化情况恶化,这表明需要改进的应变策略.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 阳性末尾呼气压 (PEEP) 对于保持肺体积和防止麻醉时气道关闭至关重要,特别是在肥胖患者中.
- 在出现氧化前期保持PEEP可能会因氧气吸收和气道崩而悖论地增加术后的脱氧.
- 这项研究调查了PEEP在先氧化前取消对术后氧化的影响.
研究的目的:
- 测试假设,在出现前氧化发生之前取消PEEP可以改善术后氧化.
- 评估PEEP管理在出现阶段对接受腹手术的肥胖患者的氧化的影响.
主要方法:
- 一项前性随机对照试验,涉及60名肥胖患者 (BMI 35-50 kg/m2),接受腹腔镜腹手术.
- 患者接受了固定的手术内PEEP (12或14cmH2O),没有招募操作.
- 在手术后,患者随机分配在出现氧化前期间维持PEEP或零PEEP.
主要成果:
- 维持PEEP和零PEEP组之间的早期术后氧化 (通过估计的静脉添加剂测量) 没有显著差异 (平均增加9.1%与10.6%,P=0.354).
- 这两组都经历了与手术内水平相比,脱口术后的氧化受损.
- 在两个组中,尽管固定PEEP和没有招募机动,但手术期间的氧化仍然很好.
结论:
- 在出现氧化前出现PEEP之前取消PEEP不会显著改变这个患者群体的早期术后氧化.
- 手术后的氧化在输出管后下降,突出显示了潜在干预的关键时期.
- 需要进行进一步的研究,以开发在麻醉后出现期间改善氧化的策略.
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