Nakano Shoko, Nakahira Junko, Sawai Toshiyuki, Kuzukawa Yosuke, Ishio Junichi, Minami Toshiaki
Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
BMC Anesthesiol. 2016 Jul 7;16(1):32. doi: 10.1186/s12871-016-0197-y.
Intravascular fluid shifts, mechanical ventilation and inhalational anesthetic drugs may contribute to intraoperative lung injury. This prospective observational study measured the changes in respiratory impedance resulting from inhalational anesthesia and mechanical ventilation in adults undergoing transurethral resection of bladder tumors. The components of respiratory impedance (resistance and reactance) were measured using the forced oscillation technique (FOT).
Respiratory resistance at 5 Hz (R5) and 20 Hz (R20), respiratory reactance at 5 Hz (X5), resonant frequency (Fres) and area of low reactance (ALX) were measured before and immediately after surgery in 30 adults. In addition, preoperative vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1.0) were evaluated using spirometry. All patients were intubated with an endotracheal tube and were mechanically ventilated, with anesthesia maintained with sevoflurane. Pre- and postoperative FOT measurements were compared using Wilcoxon paired rank tests, and the relationships between FOT measurements and preoperative spirometry findings were determined by Spearman's rank correlation analysis.
Twenty-six patients were included in the final analysis: postoperative FOT could not be performed in four because of postoperative restlessness or nausea. The mean duration of surgery was 47 min. All components of respiratory resistance deteriorated significantly over the course of surgery, with median increases in R5, R20, and R5-R20 of 1.67 cmH2O/L/s (p < 0.0001), 1.28 cmH2O/L/s (p < 0.0001) and 0.46 cmH2O/L/s (p = 0.0004), respectively. The components of respiratory reactance also deteriorated significantly, with X5 decreasing 1.7 cmH2O/L/s (p < 0.0001), Fres increasing 5.57 Hz (p < 0.0001) and ALX increasing 10.51 cmH2O/L/s (p < 0.0001). There were statistically significant and directly proportional relationships between pre- and postoperative X5 and %VC, %FEV1.0 and %FVC, with inverse relationships between pre- and postoperative Fres and ALX.
All components measured by FOT deteriorated significantly after a relatively short period of general anesthesia and mechanical ventilation. All components of resistance increased. Of the reactance components, X5 decreased and Fres and ALX increased. Pre- and postoperative respiratory reactance correlated with parameters measured by spirometry.
JMA-IIA00136 .
血管内液体转移、机械通气和吸入性麻醉药物可能导致术中肺损伤。这项前瞻性观察性研究测量了接受经尿道膀胱肿瘤切除术的成年人在吸入麻醉和机械通气过程中呼吸阻抗的变化。使用强迫振荡技术（FOT）测量呼吸阻抗的组成部分（阻力和电抗）。
在30名成年人手术前和手术后立即测量5Hz（R5）和20Hz（R20）时的呼吸阻力、5Hz（X5）时的呼吸电抗、共振频率（Fres）和低电抗面积（ALX）。此外，术前使用肺活量计评估肺活量（VC）、用力肺活量（FVC）和第1秒用力呼气量（FEV1.0）。所有患者均经气管插管并进行机械通气，使用七氟醚维持麻醉。使用Wilcoxon配对秩和检验比较术前和术后的FOT测量值，并通过Spearman秩相关分析确定FOT测量值与术前肺活量计检查结果之间的关系。
最终分析纳入了26名患者：4名患者因术后烦躁或恶心无法进行术后FOT测量。手术平均持续时间为47分钟。在手术过程中，呼吸阻力的所有组成部分均显著恶化，R5、R20和R5-R20的中位数增加分别为1.67cmH2O/L/s（p<0.0001）、1.28cmH2O/L/s（p<0.0001）和0.46cmH2O/L/s（p=0.0004）。呼吸电抗的组成部分也显著恶化，X5降低1.7cmH2O/L/s（p<0.0001），Fres增加5.57Hz（p<0.0001），ALX增加10.51cmH2O/L/s（p<0.0001）。术前和术后X5与%VC、%FEV1.0和%FVC之间存在统计学上显著的正比关系，术前和术后Fres与ALX之间存在反比关系。
在相对较短的全身麻醉和机械通气时间后，FOT测量的所有组成部分均显著恶化。所有阻力组成部分均增加。在电抗组成部分中，X5降低，Fres和ALX增加。术前和术后呼吸电抗与肺活量计测量的参数相关。
JMA-IIA00136 。
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