在接受视频辅助胸部手术的患者的手术内呼吸器策略:叙述性审查
Silvia Coppola1,2, Bruno Pastene3, Isabella Fratti4
1Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudinì 9, Milan, Italy. silvia_coppola@libero.it.
Advances in therapy
|September 19, 2025
概括
视频辅助胸部手术 (VATS) 和机器人辅助胸部手术 (RATS) 的最佳机械通风设置仍然不清楚. 目前的证据表明,保护性肺透气可能不会减少术后的肺部并发症,这凸显了进一步研究的必要性.
科学领域:
- 胸部外科手术 胸部外科手术
- 麻醉学 麻醉学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 视频辅助胸部手术 (VATS) 和机器人辅助胸部手术 (RATS) 是流行的手术技术.
- 手术后的肺部并发症 (PPC) 影响了接受这些手术的患者中高达10%.
研究的目的:
- 审查关于VATS和RATS机械通风策略的现有证据.
- 评估正极呼气压 (PEEP),潮体积 (VT) 和通风模式对患者结果的影响.
- 评估胸部外科手术中双肺通风的可行性.
主要方法:
- 2007年1月至2025年2月期间发表的研究的叙述性综述.
- 在MEDLINE/PubMed搜索中使用了"VATS"或"RATS"和"通风"的术语.
- 出版物按标题或摘要进行选,并根据方法质量进行分析.
主要成果:
- 在单肺通风 (OLV) 期间的保护性肺通风 (VT 5-8 mL/kg PBW,PEEP 5-8 cmH2O) 并没有降低PPC发生率.
- 定位PEEP可能会改善氧化和减少肺炎,但证据有限.
- 双肺通风显示,最近对特定程序的积极评价没有增加并发症.
- 在VATS/RATS中,通风装置的总体证据水平较低.
结论:
- 目前用于VATS/RATS的手术内通风策略缺乏减少PPC的有力证据.
- 进一步的大型随机对照试验 (RCT) 对于建立最佳的通风设置至关重要.
- 两肺通风的可行性需要继续调查.
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