在视频辅助胸部外科手术中,在单肺通风之前最大化中风体积的影响:一项随机对照试验
Man-Ling Wang1, Po-Ni Hsiao1, Hsao-Hsun Hsu2,3
1Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan.
Diagnostics (Basel, Switzerland)
|June 13, 2025
概括
在VATS患者的单肺通风 (OLV) 之前最大化中风体积 (SV) 减少了液体输入和炎症. 虽然在统计学上并不显著,但它显示出较少使用血管压缩剂的趋势,这表明胸部手术的潜在益处.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 胸部外科手术 胸部外科手术
背景情况:
- 以中风体积 (SV) 变化为指导的目标定向流体治疗 (GDFT) 对于使用单肺通风 (OLV) 的胸部手术尚未得到充分证实.
- 在OLV期间优化流体管理对于患者的治疗结果至关重要.
研究的目的:
- 确定OLV前最大化中风体积 (SV) 是否降低了视频辅助胸腔镜手术 (VATS) 期间需要血管活性剂的手术内低血压.
主要方法:
- 接受VATS的60名患者被随机分配到SV最大化 (SVM) 组 (n=30) 或对照组 (n=30).
- 在OLV之前,SVM组接受了液体负荷,以达到<10%的SV变化;对照组没有接受活性液体治疗.
- 在SVM组的SV目标和对照组的基线指导了手术内液体的使用.
主要成果:
- 在SVM组接受的晶化物 (林格的乳酸盐) 显著低于对照组 (4.2比6.1毫升/公斤/小时,p=0.005).
- 在SVM组中,较少的患者需要血管活性剂 (20%对40%),尽管这在统计学上没有显著意义 (p=0.091).
- 在SVM组的OLV期间,介质素-6 (IL-6) 水平显著降低.
结论:
- 前OLV SV最大化减少了手术内结晶体的使用,并减轻了VATS患者的炎症反应.
- 观察到减少血管压缩剂使用的非显著趋势.
- 需要进行更大规模的试验来证实胸部外科手术中SV最大化的临床疗效.
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