胸部外围麻醉与成人患者的驱动压力之间的关联,这些患者接受了可选的大型上腹部手术:一种随机对照试验
Xuan Li1, Yi Yang1, Qinyu Zhang1
1Department of anesthesiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
胸部外周麻醉 (TEA) 在主要腹部手术中在机械呼吸过程中降低了驱动压力 (ΔP). 然而,与单独全身麻醉相比,TEA并没有显著减少手术后肺部并发症 (PPC).
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:
- 关于胸部外周麻醉 (TEA) 机制在肺部保护和减少术后肺部并发症 (PPCs) 的知识缺口存在.
- 驱动压力 (ΔP) 是气膜张力的一个关键指标,较低的值与减少的PPC相关.
- 研究TEA在机械通风过程中降低 ΔP 的作用至关重要.
研究的目的:
- 为了确定胸部外围麻醉 (TEA) 是否降低机械通风期间的驱动压力 (ΔP) 在接受主要上腹部手术的患者中.
- 评估TEA对减少术后肺部并发症 (PPC) 的影响.
主要方法:
- 一个前性的,随机的,患者和评估者盲目的并行研究.
- 接受选择性主要腹部上部手术的成年患者被分配给TEA与全身麻醉 (TEA-GA) 或单独全身麻醉 (GA) (n=30).
- 主要结局是最小的ΔP;次要结局包括PPC,不同时间点的ΔP,血液气体分析,ICU入院,住院和死亡率.
主要成果:
- 与GA组 (12.67 ± 2.70 cmH2O; P=0.028) 相比,TEA组的最低 ΔP 值显著较低 (11.23 ± 2.19 cmH2O).
- 在手术期间的TEA与降低的ΔP显著相关 (B = -1.289;P = 0.008).
- 虽然整体PPCs没有差异,但TEA组显示出显著较低的阿特莱克塔सिस发病率 (16.7%vs. 40.7%;P=0.012). ΔP与PPC有显著的相关性 (aOR=2.190;P=0.003).
结论:
- 胸部外周麻醉 (TEA-GA) 在主要腹部上部手术,特别是腹腔镜手术中有效降低手术内驱动压力 (ΔP).
- 与GA相比,TEA-GA与ΔP导向通风相结合并没有降低术后肺部并发症 (PPC) 的总体风险.
- 两组之间使用血管活性药物的情况没有显著差异.
更多相关视频
03:14Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
05:39Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Local Anesthetics: Clinical Application as Spinal Anesthesia
General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Stages of General Anesthesia
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
