de Souza Alda Paiva, Buschpigel Márcia, Mathias Ligia Andrade Silva Telles, Malheiros Carlos Alberto, Alves Vera Lucia dos Santos
Departamento de Recuperação Pós-anestésica, UTI do Departamento de Cirurgia e UTI - Neurocirurgia da ISCMSP.
Rev Bras Anestesiol. 2009 Mar-Apr;59(2):177-86. doi: 10.1590/s0034-70942009000200005.
BACKGROUND AND METHDS: Alveolar recruitment maneuver (ARM) is indicated in the treatment of intraoperative atelectasis. The objective of the present study was to compare two techniques of ARM using the response of the PaO2/FiO2 ratio and [PaO2 + PaCO2] in patients with grade III obesity.
This was an open prospective study with adult patients with grade III obesity who underwent bariatric surgery under volume-controlled mechanical ventilation with positive end-expiratory pressure (PEEP) of 5 cmH2O, divided in three groups: G CONT: PEEP of 5 cmH2O; G ARM10/15/20 after suture of the aponeurosis: progressive increase in PEEP to 10, 15, and 20 cmH2O with a 40-second pause and maintaining each level of PEEP for 2 minutes; and G ARM30 after suture of the aponeurosis: sudden increase in PEEP to 30 cmH2O with a 40-second pause and maintaining a PEEP of 30 for 2 minutes. Heart rate, mean arterial pressure, systolic and diastolic blood pressure, mean (P AW) and plateau (P PLAT) airways pressure, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/FiO2 ratio (inspired fraction of oxygen), and [PaO2 + PaCO2] were analyzed.
The following parameters showed statistically significant differences among the study groups: P PLAT, P AW, PaO2, PaO2/FiO2 ratio, and [PaO2 + PaCO2] (p < 0.0001). Comparing the groups two by two, the following parameters showed statistically significant differences: for P PLAT and P AW: G CONT x G2ARM10/15/20 and G CONT x G ARM30; and for PaO2/FiO2 ratio and [PaO2 + PaCO2]: G CONT x G ARM30.
Alveolar recruitment maneuver with sudden increase of PEEP to 30 cmH2O showed a better response of the PaO2/FiO2 ratio.
背景与方法：肺泡复张手法（ARM）适用于术中肺不张的治疗。本研究的目的是比较在III级肥胖患者中使用两种ARM技术时，动脉血氧分压/吸入氧分数值（PaO2/FiO2）比值和[PaO2 + PaCO2]的反应。
这是一项开放性前瞻性研究，纳入接受减重手术的成年III级肥胖患者，在容量控制机械通气下进行，呼气末正压（PEEP）为5 cmH2O，分为三组：G CONT组：PEEP为5 cmH2O；G ARM10/15/20组：在腱膜缝合后，PEEP逐步增加至10、15和20 cmH2O，每次增加后暂停40秒，并在每个PEEP水平维持2分钟；G ARM30组：在腱膜缝合后，PEEP突然增加至30 cmH2O，暂停40秒，并维持PEEP为30 cmH2O 2分钟。分析心率、平均动脉压、收缩压和舒张压、平均气道压（P AW）和平台气道压（P PLAT）、氧分压（PaO2）、二氧化碳分压（PaCO2）、PaO2/FiO2比值（吸入氧分数）和[PaO2 + PaCO2]。
以下参数在研究组之间显示出统计学显著差异：P PLAT、P AW、PaO2、PaO2/FiO2比值和[PaO2 + PaCO2]（p < 0.0001）。两两比较各研究组，以下参数显示出统计学显著差异：对于P PLAT和P AW：G CONT组与G ARM10/15/20组以及G CONT组与G ARM30组；对于PaO2/FiO2比值和[PaO2 + PaCO2]：G CONT组与G ARM30组。
将PEEP突然增加至30 cmH2O的肺泡复张手法显示出更好的PaO2/FiO2比值反应。
