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无呼吸氧化下肺体积变化与儿童不同的流速:一个单中心前性随机控制非劣试验
Jonas Aebli1, Vera Bohnenblust1, Gabriela Koepp-Medina1
1Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
低流量鼻氧在防止儿童在呼吸暂停期间失去肺体积方面与非常高流量氧一样有效. 早期出现的高流氧也可能有助于减少肺体积损失.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 呼吸系统生理学 呼吸系统生理学
- 医疗器械 医疗器械
背景情况:
- 众所周知,儿科患者的高流氧疗法可以延长呼吸暂停的持续时间.
- 这种影响背后的精确生理机制仍然不完全理解.
研究的目的:
- 为了确定低流量和高流量鼻氧是否与非常高流量氧在预防全身麻醉下的儿童在呼吸暂停期间的肺体积损失方面不劣.
- 为了评估是否通过OptiFlow开关软管提供早期开始的高流量氧气,与传统的晚期开始应用相比,减少了肺体积损失.
- 用电阻断层扫描 (EIT) 来评估肺体积变化的时间和区域分布.
主要方法:
- 一个单中心,随机控制的非劣势性试验与108名接受选择性全身麻醉的儿童 (ASA 1-2,10-20公斤) 进行.
- 患者通过高流量系统以不同的速度 (低流量0.2L/分钟/公斤,高流量2L/分钟/公斤,非常高流量4L/分钟/公斤) 或早期高流量 (2L/分钟/公斤) 在面罩通风后的5分钟呼吸暂停期间接受加湿和加热氧气.
- 主要终点是EIT从呼吸暂停开始到结束测量的肺体积 (mL/kg) 的正常化减少.
主要成果:
- 在四组中分析了89名儿童 (低流量n=20,高流量n=24,非常高流量n=21,早期发病高流量n=24).
- 肺体积的平均减少在各组中是相似的:低流量5.9毫升/千克,高流量6.5毫升/千克,非常高流量5.7毫升/千克,早期高流量6.7毫升/千克.
- 只有在低流量组与非常高流量组 (对照组) 相比,肺体积损失的非劣势才被证明.
结论:
- 使用低流量鼻氧的无呼吸氧化在预防儿科患者的肺体积损失方面与非常高流量氧相比并非劣.
- 早期启动高流动无呼吸氧化可能会减轻面罩通风后无呼吸期间的肺体积减少.
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