术内通风参数对胸部手术术术后结果的影响:基于多中心注册表的分析
Timon Marvin Schnabel1, Mark Schieren2, Carlos Daniel Cardenas Artero1
1Department of Anaesthesiology, University Witten/Herdecke, Cologne-Holweide Hospital, Cologne, Germany.
在胸部外科手术中,单肺通风 (OLV) 期间的肺保护性通风至关重要. 升高的驱动压力 (DP),最大气道压力 (pMax) 和正极端呼气压力 (PEEP) 会增加术后并发症和死亡率.
科学领域:
- 胸部外科手术 胸部外科手术
- 麻醉学 麻醉学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 一个肺通风 (OLV) 是胸部外科手术的标准.
- 它对术后结果和最佳呼吸器设置的影响需要进一步研究.
研究的目的:
- 评估手术内通风参数如何影响OLV进行胸部手术的患者的术后结果.
主要方法:
- 来自德国胸部注册表 (2017-2021) 的2922名患者的回顾性多中心队列分析.
- 操作内变量的分析:驱动压力 (DP),PEEP,最大气道压力 (pMax),每预测体重 (PBW) 的潮体积 (TV) 和通风模式.
- 主要结局:术后并发症,呼吸道并发症和住院死亡率.
主要成果:
- 术后并发症发生在28.7%的患者中.
- 升高的DP (>20 mbar),pMax (>25 mbar) 和PEEP (>8 mbar) 与更高的并发症和死亡率有关.
- 较高的TV (>5mL/kg PBW),较长的OLV (>60分钟) 和pMax>25 mbar独立预测呼吸道和整体并发症.
结论:
- 术内通风参数,特别是高DP,pMax和PEEP,增加了OLV期间的并发症和死亡风险.
- 这些发现支持肺保护性通风策略,以改善胸部外科手术的术后结果.
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