周术通风支持,临床医生和研究人员必须知道的内容
Joris Pensier1, Manuel A Guerrero2, Joana Berger-Estilita3
1Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, CEDEX 5, 9214, France.
Anaesthesia, critical care & pain medicine
|May 24, 2025
概括
手术后的肺部并发症 (PPC) 在重大手术后很常见. 术后的正压通风策略可以帮助预防呼吸系统问题并减少并发症.
科学领域:
- 麻醉学和重症监护医学
- 呼吸系统医学 呼吸系统医学
- 手术科学 手术科学
背景情况:
- 手术后肺部并发症 (PPC) 影响超过10%的手术患者,特别是在腹部,胸部或心脏手术后.
- 大型手术,特别是在隔膜附近,会导致显著的呼吸系统变化,包括肺部体积减少,限制力学,吞吐症和隔膜功能障碍.
- 低氧症和急性呼吸衰竭 (ARF) 是常见的,可能导致重新输管,增加死亡率和与医疗保健相关的肺炎.
研究的目的:
- 探索PPC的病理生理学和危险因素.
- 概述经营期间正压通风 (POP) 概念及其组成部分.
- 讨论术后干预措施在缓解呼吸道并发症中的作用.
主要方法:
- 对PPC病理生理学,风险因素和预防策略的现有文献的审查.
- 对P.O.P通风概念的组件进行分析:正压前氧化,手术内肺保护性通风和术后非侵入性呼吸辅助.
- 在PPC预防和ARF治疗中,评估非侵入性通风 (NIV) 和高流量鼻氧化 (HFNO) 的证据.
主要成果:
- 经外科手术后的干预可以显著减少PPC,尽管不可避免的呼吸系统变化.
- 阳性压力预氧化改善了输管安全性,并防止了肺体积的减少.
- 在手术期间的肺保护通风 (低潮量,PEEP,招募机动) 有效地减少了PPC.
结论:
- 经过大手术后,为管理呼吸功能提供量身定制的外科手术期间通风支持至关重要.
- 非侵入性通风 (NIV) 是治疗术后ARF的黄金标准.
- 需要进一步的研究来澄清NIV和HFNO在PPC预防中的作用,特别是在高风险患者中.
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