流量控制与压力控制的通风在胸部手术与一个肺的通风 - 一个随机对照试验
Julia Abram1, Patrick Spraider1, Judith Martini1
1Department of Anesthesia and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
与压力控制通风 (PCV) 相比,流控通风 (FCV) 在胸部手术患者的单肺通风过程中显著改善了氧化和二氧化碳的去除. 此外,FCV还减少了人工通风的机械影响,改善了患者的治疗结果.
科学领域:
- 麻醉学 麻醉学
- 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:
- 胸部手术期间的单肺通风 (OLV) 在维持充足的气体交换方面存在挑战.
- 压力控制通风 (PCV) 是标准的,但可能无法优化氧化或尽量减少肺损伤.
- 流量控制通风 (FCV) 提供了一个替代的通风策略.
研究的目的:
- 为了比较流量控制通风 (FCV) 与压力控制通风 (PCV) 的疗效,在需要OLV的胸部手术的患者中.
- 评估FCV对氧化,二氧化碳去除和机械通风参数的影响.
主要方法:
- 一项前性的,非盲目的,随机对照试验与预定接受选择性胸部手术的患者进行.
- 参与者被随机分配在整个麻醉期间接受FCV或PCV.
- 主要终点是OLV启动30分钟后的paO2/FiO2比率;次要终点包括每分钟的二氧化碳去除量和应用的机械功率.
主要成果:
- 这项研究包括43名患者,其中46名被录取.
- 与PCV (136 mmHg) 相比,FCV显示了明显更高的paO2/FiO2比率 (187 mmHg) (p=0.047).
- 对于去除二氧化碳,FCV需要显著更低的分钟容量 (3.0 L/min vs 4.5 L/min,p<0.001),并且应用了显著更低的机械功率 (3.5 J/min vs 7.6 J/min,p<0.001).
结论:
- 控制流量通风 (FCV) 在胸部手术中在单肺通风过程中显著改善了氧化,并促进了二氧化碳的排出.
- FCV减少了向肺部传递的机械功率,可能减轻了呼吸机引起的肺损伤.
- 这项研究支持FCV作为胸部手术环境中有益的通风策略.
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