Setak-Berenjestanaki Mostafa, Bagheri-Nesami Masoumeh, Gholipour Baradari Afshin, Mousavinasab Seyed Nouraddin, Ghaffari Rahman, Darbeheshti Manijeh
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Med J Islam Repub Iran. 2018 Mar 10;32:20. doi: 10.14196/mjiri.32.20. eCollection 2018.
The use of positive end-expiratory pressure (PEEP) can have an important role as one of the ways to prevent and treat atelectasis, but it seems that there is still no consensus about its beneficial level. The aim of this study was to determine the effect of different levels of PEEP on the incidence of atelectasis after heart surgery. This is a double-blind randomized controlled trial that was adopted from a research project recorded in the Iranian Registry of Clinical Trials. This paper is the result of a research project undertaken at Fatemeh Zahra Hospital (Mazandaran Heart Center) in 2015. 180 patients underwent open heart surgery were selected and were divided randomly into three groups: control, PEEP=8, and PEEP=10 (60 in each group). The patients in the two PEEP8 and PEEP10 intervention groups separately received 8 cm H2O and 10 cm H2O PEEP, respectively, 30 minutes after admission to the ICU for 4 hours and then received 5 cm H2O PEEP until extubation. Atelectasis was examined two hours after the extubation and on the third day after surgery. The incidence rates of atelectasis two hours after extubation on the first day of surgery were 22 (36.7%), 20 (33.3%) and 10 (16.7%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were statistically significant among the three groups (p=0.035). The incidence rates of atelectasis on the third day after surgery were 39 (65%), 36 (60%) and 21 (35%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were also statistically significant among the three groups (p=0.003). The use of 10 cm H2O PEEP can lead to a reduction in the incidence of atelectasis, intubation time at the ICU and length of ICU and hospital stay. Given that this level of PEEP is effective, this method is recommended to be used in postoperative care of patients.
使用呼气末正压通气（PEEP）作为预防和治疗肺不张的方法之一可发挥重要作用，但关于其有益水平似乎仍未达成共识。本研究的目的是确定不同水平的PEEP对心脏手术后肺不张发生率的影响。这是一项双盲随机对照试验，采用了伊朗临床试验注册中心记录的一个研究项目。本文是2015年在法蒂玛·扎赫拉医院（马赞德兰心脏中心）开展的一个研究项目的结果。选取180例行心脏直视手术的患者并随机分为三组：对照组、PEEP = 8组和PEEP = 10组（每组60例）。两个PEEP干预组的患者分别在入住重症监护病房（ICU）30分钟后接受8 cm H₂O和10 cm H₂O的PEEP，持续4小时，然后接受5 cm H₂O的PEEP直至拔管。在拔管后两小时及术后第三天检查肺不张情况。手术第一天拔管后两小时，对照组、PEEP8组和PEEP10组的肺不张发生率分别为22例（36.7%）、20例（33.3%）和10例（16.7%）。三组之间差异具有统计学意义（p = 0.035）。术后第三天，对照组、PEEP8组和PEEP10组的肺不张发生率分别为39例（65%）、36例（60%）和21例（35%）。三组之间差异也具有统计学意义（p = 0.003）。使用10 cm H₂O的PEEP可降低肺不张发生率、ICU插管时间以及ICU和住院时间。鉴于该水平的PEEP有效，建议在患者术后护理中使用此方法。
