Celebi Serdar, Köner Ozge, Menda Ferdi, Omay Oguz, Günay Ilhan, Suzer Kaya, Cakar Nahit
Department of Anesthesiology and Intensive Care, Baskent University, Turkey.
Anesth Analg. 2008 Aug;107(2):614-9. doi: 10.1213/ane.0b013e31817e65a1.
The aim of our study was to evaluate the pulmonary effects of noninvasive ventilation (NIV) with or without recruitment maneuver (RM) after open heart surgery.
One-hundred patients undergoing coronary artery bypass surgery were randomized into four groups after the operation: 1) RM with sustained inflation during mechanical ventilation postoperatively (RM group, n = 25); 2) RM combined with NIV applied for 1/2-h periods every 6 h in the first postoperative day after tracheal extubation (RM-NIV group, n = 25); 3) NIV after tracheal extubation (NIV group, n = 25); and 4) a control group consisting of patients receiving neither RM nor NIV (control group, n = 25). Pulmonary function tests, oxygenation index, and atelectasis on chest radiograph were evaluated and compared among the groups.
RM provided higher arterial oxygen levels during mechanical ventilation and after tracheal extubation compared to other interventions. Oxygenation was better in the RM-NIV and NIV groups than in the control group (P = 0.02 and P = 0.008, respectively) at the end of the study. The postoperative atelectasis score of the control group (median: 1) was higher than those of the RM (1; P = 0.03), RM-NIV (0; P < 0.01) and NIV (0; P < 0.01) groups. Pulmonary function of the NIV groups on postoperative day 2 was better than in the other groups, whereas the tests were similar among the groups on postoperative day 7.
NIV associated with RM provided better oxygenation both during and after the mechanical ventilation period. NIV either alone or in combination with RM provided lower atelectasis scores and better early pulmonary function tests compared to the control group, without a significant difference regarding the duration of mechanical ventilation, intensive care unit stay, and the length of hospitalization. NIV combined with RM is recommended after open heart surgery to prevent postoperative atelectasis and hypoxemia.
我们研究的目的是评估心脏直视手术后无创通气（NIV）联合或不联合肺复张手法（RM）对肺部的影响。
100例行冠状动脉搭桥手术的患者术后被随机分为四组：1）术后机械通气期间采用持续膨肺的肺复张手法（肺复张手法组，n = 25）；2）气管拔管后术后第1天每6小时应用肺复张手法联合无创通气1/2小时（肺复张手法-无创通气组，n = 25）；3）气管拔管后应用无创通气（无创通气组，n = 25）；4）既不采用肺复张手法也不采用无创通气的对照组（对照组，n = 25）。对各组的肺功能测试、氧合指数及胸部X线片上的肺不张情况进行评估和比较。
与其他干预措施相比，肺复张手法在机械通气期间及气管拔管后能提供更高的动脉血氧水平。研究结束时，肺复张手法-无创通气组和无创通气组的氧合情况优于对照组（P值分别为0.02和0.008）。对照组的术后肺不张评分（中位数：1）高于肺复张手法组（1；P = 0.03）、肺复张手法-无创通气组（0；P < 0.01）和无创通气组（0；P < 0.01）。术后第2天无创通气组的肺功能优于其他组，而术后第7天各组间测试结果相似。
联合肺复张手法的无创通气在机械通气期间及之后能提供更好的氧合。与对照组相比，单独或联合肺复张手法的无创通气能降低肺不张评分并改善早期肺功能测试结果，在机械通气时间、重症监护病房停留时间及住院时间方面无显著差异。建议心脏直视手术后采用无创通气联合肺复张手法以预防术后肺不张和低氧血症。
