University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey.
University of Istanbul, Cerrahpasa School of Medicine, Department of Biostatistics, Turkey.
J Clin Anesth. 2017 Nov;42:31-35. doi: 10.1016/j.jclinane.2017.08.010. Epub 2017 Aug 7.
Volume controlled ventilation with low PEEP is used in neuro-anesthesia to provide constant PaCO levels and prevent raised intracranial pressure. Therefore, neurosurgery patients prone to atelectasis formation, however, we could not find any study that evaluates prevention of postoperative pulmonary complications in neurosurgery.
A prospective, randomized controlled study.
Intensive care unit in a university hospital in Istanbul.
Seventy-nine ASAI-II patients aged between 18 and 70years scheduled for elective supratentorial craniotomy were included in the study.
Patients randomized into 3 groups after surgery. The Group IS (n=20) was treated with incentive spirometry 5 times in 1min and 5min per hour, the Group CPAP (n=20) with continuous positive airway pressure 10 cmHO pressure and 0.4 FO via an oronasal mask 5min per hour, and the Group Control (n=20) 4L·minO via mask; all during the first 6h postoperatively. Respiratory functions tests and arterial blood gases analysis were performed before the induction of anesthesia (Baseline), 30min, 6h, 24h postoperatively.
The IS and CPAP applications have similar effects with respect to FVC values. The postoperative 30min FEV values were statistically significantly reduced compared to the Baseline in all groups (p<0.0001). FEV values were statistically significantly increased at the postoperative 24h compared to the postoperative 30min in the Groups IS and CPAP (p<0.0001). This increase, however, was not observed in the Group Control, and the postoperative 24h FEV values were statistically significantly lower in the Group Control compared to the Group IS (p=0.015).
Although this study is underpowered to detect differences in FEV values, the postoperative 24h FEV values were significantly higher in the IS group than the Control group and this difference was not observed between the CPAP and Control groups. It might be evaluate a favorable effect of IS in neurosurgery patients. But larger studies are needed to make a certain conclusion.
在神经麻醉中使用低呼气末正压（PEEP）容量控制通气，以提供恒定的 PaCO2 水平并防止颅内压升高。因此，神经外科患者容易发生肺不张，但我们找不到任何评估预防神经外科术后肺部并发症的研究。
前瞻性、随机对照研究。
伊斯坦布尔一所大学医院的重症监护病房。
纳入 79 例 ASAI-II 级择期幕上开颅术患者，年龄 18-70 岁。
术后随机分为 3 组。IS 组（n=20）接受激励性肺活量计 5 次，每次 1 分钟，每小时 5 分钟；CPAP 组（n=20）通过口鼻面罩持续气道正压 10cmH2O 压力和 0.4 FO，每小时 5 分钟；对照组（n=20）通过面罩 4L·minO；所有患者均在术后 6 小时内接受治疗。在麻醉诱导前（基线）、术后 30 分钟、6 小时和 24 小时进行呼吸功能测试和动脉血气分析。
IS 和 CPAP 应用在 FVC 值方面具有相似的效果。与基线相比，所有组术后 30 分钟的 FEV 值均显著降低（p<0.0001）。与术后 30 分钟相比，IS 和 CPAP 组术后 24 小时的 FEV 值显著增加（p<0.0001）。然而，对照组未观察到这种增加，与 IS 组相比，对照组术后 24 小时的 FEV 值显著降低（p=0.015）。
尽管本研究没有足够的能力检测 FEV 值的差异，但 IS 组术后 24 小时的 FEV 值明显高于对照组，CPAP 组和对照组之间没有观察到这种差异。IS 可能对神经外科患者有有益的作用。但需要更大的研究来得出确定的结论。
