创伤性脑损伤手术中的驱动压力引导个体化正极呼吸压力:随机对照试验
Xiaoping Chen1, Zi Wang2, Yali Ge3
1Clinical Medical College, Yangzhou University, 225009 Yangzhou, Jiangsu, China; Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 225002 Yangzhou, Jiangsu, China.
Annali italiani di chirurgia
|December 26, 2024
概括
驱动压力引导的个性化正极呼气压 (PEEP) 改善了肺部氧化,并减少了创伤性脑损伤 (TBI) 患者的并发症. 这种肺保护性通风策略也有助于神经恢复,而不会增加内压力.
科学领域:
- 关键护理医学 关键护理医学
- 麻醉学 麻醉学
- 神经外科 神经外科
背景情况:
- 为手术患者制定了肺保护性通风策略 (LPVS).
- 在紧急创伤性脑损伤 (TBI) 中基于PEEP的LPVS的应用需要进一步调查.
研究的目的:
- 在TBI患者中评估驱动压力引导的个性化PEEP.
- 评估对外科手术期间氧化,肺部并发症和神经恢复的影响.
主要方法:
- 111名TBI患者随机分为三个组:0 PEEP,5 cmH2O PEEP和个性化PEEP.
- 主要终点:肺超声波得分 (LUS),视神经外直径 (ONSD),NSE和HMGB1.
- 二级终点:血液动力学/呼吸系统参数,肺部并发症,肺部感染得分.
主要成果:
- 个体化PEEP组与0PEEP相比,LUS显著较低.
- 在个性化PEEP组中,手术后血清NSE和HMGB1水平显著降低.
- 两组之间ONSD没有显著差异,这表明内压力没有大幅增加.
结论:
- 个性化PEEP改善了外科手术期间的氧化,并减少了TBI中的肺部并发症.
- 这种策略通过潜在地减少炎症来促进神经恢复.
- 它不会显著提高手术期间的内压力.
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