胸腔镜手术单肺通气期间潮气量对血管外肺水含量的影响：一项随机对照试验

Effect of tidal volume on extravascular lung water content during one-lung ventilation for video-assisted thoracoscopic surgery: a randomised, controlled trial.

作者信息

Qutub Hatem, El-Tahan Mohamed R, Mowafi Hany A, El Ghoneimy Yasser F, Regal Mohamed A, Al Saflan AbdulHadi A

机构信息

From the Department of Critical Care & Pulmonary Medicine, Department of Medicine (H-Q), Department of Anaesthesia and Surgical ICU (MR-ET, HA-M, AA-AS), and Department of Cardiothoracic Surgery (YF-EG, MA-R), King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.

出版信息

Eur J Anaesthesiol. 2014 Sep;31(9):466-73. doi: 10.1097/EJA.0000000000000072.

DOI:10.1097/EJA.0000000000000072

PMID:24690891

Abstract

BACKGROUND

The use of low tidal volume during one-lung ventilation (OLV) has been shown to attenuate the incidence of acute lung injury after thoracic surgery.

OBJECTIVE

To test the effect of tidal volume during OLV for video-assisted thoracoscopic surgery on the extravascular lung water content index (EVLWI).

DESIGN

A randomised, double-blind, controlled study.

SETTING

Single university hospital.

PARTICIPANTS

Thirty-nine patients scheduled for elective video-assisted thoracoscopic surgery.

INTERVENTIONS

Patients were randomly assigned to one of three groups (n = 13 per group) to ventilate the dependent lung with a tidal volume of 4, 6 or 8 ml kg(-1) predicted body weight with I:E ratio of 1:2.5 and PEEP of 5 cm H2O.

MAIN OUTCOME MEASURES

The primary outcomes were perioperative changes in EVLWI and EVLWI to intrathoracic blood volume index (ITBVI) ratio. Secondary outcomes included haemodynamics, oxygenation indices, incidences of postoperative acute lung injury, atelectasis, pneumonia, morbidity and 30-day mortality.

RESULTS

A tidal volume of 4 compared with 6 and 8 ml kg(-1) after 45 min of OLV resulted in an EVLWI of 4.1 [95% confidence interval (CI) 3.5 to 4.7] compared with 7.7 (95% CI 6.7 to 8.6) and 8.6 (95% CI 7.5 to 9.7) ml kg(-1), respectively (P < 0.003). EVLWI/ITBVI ratios were 0.57 (95% CI 0.46 to 0.68) compared with 0.90 (95% CI 0.75 to 1.05) and 1.00 (95% CI 0.80 to 1.21), respectively (P < 0.05). The incidences of postoperative acute lung injury, atelectasis, pneumonia, morbidity, hospitalisation and 30-day mortality were similar in the three groups.

CONCLUSION

The use of a tidal volume of 4 ml kg during OLV was associated with less lung water content than with larger tidal volumes of 6 to 8 ml kg(-1), although no patient developed acute lung injury. Further studies are required to address the usefulness of EVLWI as a marker for the development of postoperative acute lung injury after the use of a low tidal volume during OLV in patients undergoing pulmonary resection.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT01762709.

摘要

背景

单肺通气（OLV）期间采用低潮气量已被证明可降低胸外科手术后急性肺损伤的发生率。

目的

测试OLV期间用于电视辅助胸腔镜手术的潮气量对血管外肺水含量指数（EVLWI）的影响。

设计

一项随机、双盲、对照研究。

地点

单一大学医院。

参与者

39例计划接受择期电视辅助胸腔镜手术的患者。

干预措施

患者被随机分配到三组之一（每组n = 13），以预测体重4、6或8 ml·kg⁻¹的潮气量对非通气肺进行通气，吸呼比为1:2.5，呼气末正压为5 cmH₂O。

主要观察指标

主要结局为围手术期EVLWI及EVLWI与胸腔内血容量指数（ITBVI）比值的变化。次要结局包括血流动力学、氧合指数、术后急性肺损伤、肺不张、肺炎的发生率、发病率及30天死亡率。

结果

OLV 45分钟后，与6和8 ml·kg⁻¹相比，4 ml·kg⁻¹潮气量组的EVLWI为4.1[95%置信区间（CI）3.5至4.7]，而6和8 ml·kg⁻¹潮气量组分别为7.7（95%CI 6.7至8.6）和8.6（95%CI 7.5至9.7）ml·kg⁻¹（P < 0.003）。EVLWI/ITBVI比值分别为0.57（95%CI 0.46至0.68），而6和8 ml·kg⁻¹潮气量组分别为0.90（95%CI 0.75至1.05）和1.00（95%CI 0.80至1.21）（P < 0.05）。三组术后急性肺损伤、肺不张、肺炎的发生率、发病率、住院时间及30天死亡率相似。