Regli A, Habre W, Saudan S, Mamie C, Erb T O, von Ungern-Sternberg B S
Department of Anaesthesia, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Anaesthesia. 2007 May;62(5):451-5. doi: 10.1111/j.1365-2044.2007.05030.x.
Trendelenburg positioning, a head-down tilt, is routinely used in anaesthesia when inserting a central venous catheter to increase the calibre of the jugular or subclavian veins and to prevent an air embolism. We investigated the impact of Trendelenburg positioning on functional residual capacity and ventilation homogeneity as well as the potential reversibility of these changes by repositioning and/or a recruitment manoeuvre in children with congenital heart disease. Functional residual capacity and ventilation homogeneity were assessed in 20 anaesthetised children between the ages of 3 months and 8 years who required central venous catheterisation before undergoing cardiac surgery. Functional residual capacity was measured (1) in the supine position, (2) in the Trendelenburg position, (3) after repositioning supine and (4) after a recruitment manoeuvre to total lung capacity which was performed by manually elevating the airway pressure to 40 cmH(2)O for ten consecutive breaths. Adopting the Trendelenburg position led to a significant decrease in functional residual capacity (median [range]- 12 (6-21)%) and increase in lung clearance index (12 (2-19)%). Baseline values were not reached after repositioning supine in any patient until after a standardised recruitment manoeuvre was performed.
特伦德伦伯卧位（头低脚高位）在麻醉中插入中心静脉导管时经常使用，以增加颈静脉或锁骨下静脉的管径并防止空气栓塞。我们研究了特伦德伦伯卧位对功能残气量和通气均匀性的影响，以及在先天性心脏病患儿中通过重新摆放体位和/或采用肺复张手法这些改变的潜在可逆性。对20名年龄在3个月至8岁之间、在心脏手术前行中心静脉置管的麻醉患儿评估了功能残气量和通气均匀性。在（1）仰卧位、（2）特伦德伦伯卧位、（3）重新摆放为仰卧位后以及（4）通过手动将气道压力提升至40 cmH₂O并连续呼吸十次使肺容量达到总肺容量的肺复张手法后测量功能残气量。采用特伦德伦伯卧位导致功能残气量显著降低（中位数[范围] - 12（6 - 21）%），肺清除指数增加（12（2 - 19）%）。在进行标准化肺复张手法之前，任何患者重新摆放为仰卧位后均未达到基线值。
