胸部手术期间单肺通风中低潮量与高潮量的比较:一个倾向权重的队列研究
Rayan Braïk1, Pascal Berna2, Justine Walbecq3
1Centre Hospitalier Unversitaire d'Amiens, département d'anesthésie et de reanimation, Amiens, France. rayan.braik@aphp.fr.
Scientific reports
|September 26, 2025
概括
在单肺通风 (OLV) 期间的下潮量 (TV) 并没有减少胸部手术后的呼吸道并发症. 然而,较低的TV与手术后心房动的风险更高有关.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 临界护理医学 临界护理医学
背景情况:
- 对于胸部手术,在单肺通风 (OLV) 期间的最佳潮体积 (TV) 尚未得到充分确立.
- 以前的研究表明,肺部保护策略可能会减少术后呼吸道并发症 (PRC).
研究的目的:
- 评估手术内视频和在接受OLV胸部手术的患者中PRC的发生率之间的关联.
- 调查二次结果,包括其他主要并发症和死亡率.
主要方法:
- 一个单一中心观察队列研究 (n=1,234) 的后期分析,该研究涉及使用OLV进行选择性胸部手术的患者.
- 患者按平均手术内TV (<5毫升/千克PBW与≥5毫升/千克PBW) 分类.
- 倾向性得分重叠权重被用于调整分析,进行灵敏度分析和贝叶斯分析.
主要成果:
- 在TV<5mL/kgPBW的8.1%患者和TV≥5mL/kgPBW的5.8%患者中发生了PRC.
- 调整后的分析显示,TV<5mL/kg的PBW和减少的PRC之间没有显著的关联 (RR,1.07;95%CI,0.69-1.66).
- 视频<5mL/kg的PBW与术后心房的风险增加有关 (RR,1.50;95% CI,1.09-2.05).
结论:
- 在OLV期间手术内潮体积<5mL/kg的PBW与该队列中手术后呼吸道并发症的发病率较低无关.
- 低潮流体积可能与手术后心房的风险增加有关.
- 需要进一步的研究来确定OLV期间胸部手术的最佳电视设置.
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