在腹腔镜结直肠手术后预防肺部并发症:肺部保护方案与标准护理:随机对照试验
Tao Yan1, Hui-Xian Li, Yu-Lin Sun
1From the Department of Anaesthesiology (TY, H-xL, RC, R-hP, S-jW, B-nW, HZ), State Key Laboratory of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (Y-lS), Department of Anaesthesiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan (YL), Department of Colorectal Surgery (Z-xZ), Department of Intensive Care Unit (S-nQ), Office of Cancer Screening (FW), Department of Diagnostic Radiology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (WT), Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, China (LZ), The School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (LZ), and Department of Anesthesiology, Shenzhen Samii Medical Centre, The Fourth People's Hospital of Shenzhen, Shenzhen, China (LS).
一种新的肺部保护性通风策略显著减少了腹腔镜结直肠手术患者的肺部并发症. 这种方法可以减轻风险而不会造成肺损伤,特别有利于男性和老年患者.
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:
- 拉皮镜结直肠手术在的Trendelenburg位置与肺上皮增加了气道压力,冒着肺损伤和术后肺部并发症的风险.
- 患有中高风险的肺部并发症的患者需要优化麻醉方案.
研究的目的:
- 为了比较综合麻醉方案与传统的防护通风来预防肺部并发症.
- 评估肺部保护性通风在高风险手术患者的疗效.
主要方法:
- 随机,受控,并行组试验,涉及120名接受腹腔镜结直肠手术的患者.
- 干预包括肺部保护性通风 (6毫升/千克PBW,深度神经肌肉阻塞,10毫米 PEEP) 与常规通风 (8毫升/千克PBW,中度阻塞,15毫米 PEEP).
- 主要结局:30天内肺部并发症的发生率;次要结局:肺损伤的血清生物标志物.
主要成果:
- 肺部保护性通风组显示,肺部并发症的发生率明显较低 (15.0%对38.3%,P=0.003).
- 两组之间没有观察到肺损伤生物标志物的显著差异.
- 肺部保护策略在男性和60岁及以上的患者中显示出更大的益处.
结论:
- 综合肺部保护方法有效地减轻了腹腔镜结直肠手术的高风险患者的肺部并发症.
- 这种策略似乎是安全的,没有增加肺损伤标志物.
- 对肺部并发症的预测性诺莫грам显示出潜在的临床实用性.
