肺切除手术中最佳的保护性通风策略:一个前性的,单中心的,三臂的随机对照试验
Seihee Min1, Susie Yoon2, Hyun Woo Choe2
1Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110 Deokan-ro, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea.
Updates in surgery
|January 21, 2025
概括
最佳的单肺通风 (OLV) 策略可以防止肺损伤. 在肺切除手术期间,平均潮体积 (VT) 为6mL/kg,具有正的末端呼气压 (PEEP),改善了氧化和减少了术后肺并发症 (PPC).
科学领域:
- 麻醉学和重症监护医学
- 胸部外科手术 胸部外科手术
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 在单肺通风 (OLV) 过程中,保护性通风策略对于减轻通风器诱导的肺损伤 (VILI) 至关重要.
- 在肺切除手术中,OLV的最佳潮体积 (VT) 和正极端呼气压 (PEEP) 设置仍未完全定义.
- 手术后的肺部并发症 (PPC) 是肺切除手术后的一个重大问题.
研究的目的:
- 为了比较OLV肺切除手术期间三种保护性通风策略 (低,中,高VT) 的疗效.
- 评估不同VT策略对术后氧化 (PaO2/FiO2比率) 和即时PPCs发生率的影响.
- 确定最佳的VT和PEEP组合,以减少PPC和改善肺切除患者的治疗结果.
主要方法:
- 用OLV进行肺切除的87名患者随机分配到三个组,接受4,6或8毫升/千克预测体重 (PBW) 的VT.
- 所有组在OLV期间都接受了5cmH2O的PEEP.
- 评估了术后的PaO2/FiO2比率,急性肺损伤的放射性发现,以及72小时内立即发生PPC的发生率.
主要成果:
- 中等VT (6mL/kgPBW) 组在术后6小时表现出明显更高的PaO2/FiO2比率,与低和高VT组相比 (P=0.010).
- 在手术后3天内,在两组之间没有观察到暗示急性肺损伤的放射性发现的显著差异.
- 中等VT组表现出直接PPC的发生率最低 (P=0.007).
结论:
- 在肺切除手术的OLV期间,使用6mL/kgPBW的VT和5cmH2O的PEEP的保护性通风可以增强术后的氧化.
- 这种通风策略似乎有效地减少了手术后立即肺部并发症的发生率.
- 这些发现表明,中等VT是这种患者群体中OLV的潜在最佳保护性通风策略.
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