全麻开腹手术中高与低呼气末正压通气对术后肺量计检查的影响：一项随机临床试验。

Ventilation with high versus low peep levels during general anaesthesia for open abdominal surgery does not affect postoperative spirometry: A randomised clinical trial.

机构信息

From the Department of Anesthesiology, Düsseldorf University Hospital, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany (TAT, MS, JK, BB, PK, BP), The Department of Anesthesiology, The Academic Medical Center, Amsterdam, The Netherlands (SNH), The Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany (MGA), The Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy (PP) and the Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), and the Department of Intensive Care, The Academic Medical Center, Amsterdam, The Netherlands (MJS) for the PROVE Network Investigators.

出版信息

Eur J Anaesthesiol. 2017 Aug;34(8):534-543. doi: 10.1097/EJA.0000000000000626.

DOI:10.1097/EJA.0000000000000626

PMID:28306591

Abstract

BACKGROUND

Invasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function.

OBJECTIVE

We investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry.

DESIGN

This was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial.

SETTING

University hospital from November 2011 to January 2013.

PATIENTS

Nonobese patients scheduled for major abdominal surgery at a high risk of postoperative pulmonary complications (PPCs).

INTERVENTION

Intraoperative low tidal volume ventilation with PEEP levels of 12 cmH2O and RM (the high PEEP group) or with PEEP levels of 2 cmH2O or less without RM (the low PEEP group).

MAIN OUTCOME MEASURES

Time-weighted averages (TWAs) of the forced expiratory volume in 1 s (FEV1) and the forced vital capacity (FVC) up to postoperative day five.

RESULTS

Thirty-one patients were allocated to the high PEEP group and 32 to the low PEEP group. No postoperative spirometry test results were available for 6 patients. In both groups, TWA of FEV1 and FVC until postoperative day five were lower than preoperative values. Postoperative spirometry test results were not different between the high and low PEEP group; Data are median [interquartile range], TWA FVC 1.8 [1.6 to 2.4] versus 1.7 [1.2 to 2.4] l (P = NS) and TWA FEV1 1.2 [1.1 to 2.5] versus 1.2 [0.9 to 1.9] l (P = NS). Patients who developed PPCs had lower FEV1 and FVC on postoperative day five; 1.1 [0.9 to 1.6] versus 1.6 [1.4 to 1.9] l (P = 0.001) and 1.6 [1.2 to 2.6] versus 2.3 [1.7 to 2.6] l (P = 0.036), respectively.

CONCLUSION

Postoperative spirometry is not affected by PEEP and RM during intraoperative ventilation for open abdominal surgery in nonobese patients at a high risk of PPCs, but rather is associated with the development of PPCs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01441791.

摘要

背景

全身麻醉下进行的侵袭性机械通气通常会导致肺不张，并损害术后肺功能。

目的

我们研究术中高呼气末正压（PEEP）通气和复张手法（RM）对术后肺活量测定的影响。

设计

这是一项国际多中心随机对照试验（PROVHILO 试验）的预先计划的单中心亚研究。

地点

2011 年 11 月至 2013 年 1 月期间的大学医院。

患者

非肥胖患者，计划接受腹部大手术，术后肺部并发症（PPCs）风险高。

干预

术中低潮气量通气，PEEP 水平为 12cmH2O 和 RM（高 PEEP 组）或 PEEP 水平为 2cmH2O 或更低，无 RM（低 PEEP 组）。

主要观察指标

术后第 5 天的 1 秒用力呼气量（FEV1）和用力肺活量（FVC）的时间加权平均值（TWA）。

结果

31 名患者被分配到高 PEEP 组，32 名患者被分配到低 PEEP 组。6 名患者术后未进行肺活量测定试验。两组患者术后第 5 天的 FEV1 和 FVC 的 TWA 均低于术前值。高 PEEP 组和低 PEEP 组之间的术后肺活量测定结果无差异；数据为中位数[四分位数范围]，TWA FVC 1.8[1.6 至 2.4]与 1.7[1.2 至 2.4]L（P=NS）和 TWA FEV1 1.2[1.1 至 2.5]与 1.2[0.9 至 1.9]L（P=NS）。发生 PPCs 的患者术后第 5 天的 FEV1 和 FVC 较低；1.1[0.9 至 1.6]与 1.6[1.4 至 1.9]L（P=0.001）和 1.6[1.2 至 2.6]与 2.3[1.7 至 2.6]L（P=0.036）。