胸部手术患者的高流量鼻与传统氧气疗法:随机对照试验
Desire T Maioli1,2, Louise M Corbellini2, Cintia L Santos2
1Programa de Pós-graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
高流量鼻 (HFNC) 氧气治疗没有显著减少胸部手术患者的术后肺并发症. 需要进一步的研究来优化HFNC在高风险人群中的使用.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 呼吸系统医学 呼吸系统医学
背景情况:
- 手术后肺部并发症 (PPC) 会增加患者的发病率和医疗费用.
- 高流量鼻腔管 (HFNC) 氧气疗法是减轻PPC的潜在干预措施.
- 在关键的外科手术期间,HFNC可以改善氧化和减少呼吸力度.
研究的目的:
- 与传统氧气疗法相比,评估HFNC的疗效.
- 为了确定HFNC是否在麻醉诱导和输出过程中降低PPC.
- 评估二次结果,包括低氧化,死亡率和ICU入院.
主要方法:
- 一个单中心随机临床试验,涉及90名接受选择性胸部手术的患者.
- 患者被随机分配,在诱导和输出过程中接受HFNC或常规氧气治疗.
- 主要结局是30天内住院PPC发生率;次要结局包括输管低氧症,30天死亡率和ICU入院.
主要成果:
- 在HFNC中,PPC发生率为20.0%,对照组为26.7% (p=0.455),没有显著差异.
- PPC的独立预测因素包括COPD,手术前的SPO2≤94%,手术>2小时和左肺通风.
- 两组之间没有观察到输管低氧症,30天死亡率或ICU入院率的显著差异.
结论:
- 在输入管和输出管期间的HFNC治疗没有显著减少选择性胸部手术患者的PPC或次要结果.
- 进一步的研究应该在高风险人群中或使用优化的协议 (例如,延长使用,变化的流速) 探索HFNC.
- 优化外科手术期间呼吸系统管理仍然是研究的关键领域.
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