围术期肺部超声在小儿心脏外科学中的应用：一项随机对照试验。

Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A Randomized Controlled Trial.

机构信息

From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (I.-K.S.); and the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (E.-H.K., J.-H.L., P.K., H.-S.K., J.-T.K.).

出版信息

Anesthesiology. 2018 Apr;128(4):718-727. doi: 10.1097/ALN.0000000000002069.

DOI:10.1097/ALN.0000000000002069

PMID:29309282

Abstract

BACKGROUND

Pediatric cardiac patients are at risk for perioperative respiratory insufficiency. The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery.

METHODS

In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12 h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12 h after surgery. Primary outcomes were incidences of intra- and postoperative desaturation, and postoperative pulmonary complications. Multiple comparisons were corrected (P ≤ 0.017) in the primary outcome analysis.

RESULTS

Of the 120 children included in the analysis, postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups. Lung ultrasound scores were better in the intervention group than in the control group. Duration of mechanical ventilation was longer in the control group than in the intervention group (38 ± 43 vs. 26 ± 25 h; 95% CI of mean difference, 0 to 25; P = 0.048).

CONCLUSIONS

Perioperative lung ultrasound examination followed by ultrasound-guided recruitment maneuver helped decrease postoperative desaturation events and shorten the duration of mechanical ventilation in pediatric cardiac patients.

VISUAL ABSTRACT

An online visual overview is available for this article at http://links.lww.com/ALN/B682.

摘要

背景

儿科心脏患者存在围手术期呼吸功能不全的风险。本研究旨在评估肺超声检查在儿科心脏手术中的应用价值。

方法

在这项随机对照试验中，接受心脏手术的儿童（5 岁或以下）被分为对照组（n = 61）和干预组（n = 61）。对照组仅在手术结束时和手术后 6 至 12 小时进行肺超声检查。干预组在麻醉诱导后、手术结束时和手术后 6 至 12 小时根据超声结果进行肺超声检查和超声引导下的复张手法。主要结局为术中及术后低氧血症的发生率和术后肺部并发症。在主要结局分析中，对多重比较进行了校正（P ≤ 0.017）。

结果

在纳入分析的 120 名儿童中，对照组术后发生低氧血症（64%比 27%；P < 0.001；优势比[OR]，0.210；95%置信区间，0.097 至 0.456）的比例更高。术中低氧血症（36%比 19%；P = 0.033；OR，0.406；95%置信区间，0.176 至 0.939）和术后肺部并发症（12%比 3%；P = 0.093；OR，0.271；95%置信区间，0.054 至 1.361）的发生率在两组间相似。干预组的肺超声评分优于对照组。对照组机械通气时间长于干预组（38 ± 43 比 26 ± 25 小时；95%置信区间差值，0 至 25；P = 0.048）。