机器人妇科手术患者低潮气量通气时低和高呼气末正压的比较：一项随机对照试验。
Comparison of low and high positive end-expiratory pressure during low tidal volume ventilation in robotic gynaecological surgical patients using electrical impedance tomography: A randomised controlled trial.
机构信息
From the Department of Anaesthesiology and Pain Medicine, College of Medicine, Ewha Womans University (HJB), Department of Anaesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine (EHC), and Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea (HM, KJ).
出版信息
Eur J Anaesthesiol. 2019 Sep;36(9):641-648. doi: 10.1097/EJA.0000000000001047.
BACKGROUND
The appropriate level of positive end-expiratory pressure (PEEP) during intra-operative mechanical ventilation remains unclear.
OBJECTIVE
The aim of this study was to investigate the effects of different levels of PEEP with low tidal volume (low-VT) ventilation in a steep Trendelenburg position (30°) and pneumoperitoneum on oxygenation, respiratory mechanics and ventilation distribution using electrical impedance tomography.
DESIGN
A randomised controlled trial.
SETTING
Single university secondary care centre, conducted from January 2017 to December 2017.
PATIENTS
Forty female patients, aged 20 to 60 years, and of American Society of Anesthesiologists' (ASA) physical status 1 or 2, undergoing elective robotic gynaecological surgery were included.
INTERVENTION
Forty patients were allocated randomly to a PEEP4 (PEEP 4 cmH2O) group or a PEEP8 (PEEP 8 cmH2O) group.
MAIN OUTCOME MEASURES
The primary outcomes were respiratory mechanics. The secondary outcomes included changes in ventilation distribution across the ventral and dorsal regions of interest and postoperative pulmonary complications (PPCs) using a modified clinical pulmonary infection score.
RESULTS
There was no difference in PaO2 at any time point. The peak inspiratory pressure (PIP) and mean airway pressure (MPAW) of the PEEP4 group were lower than those of the PEEP8 group (P < 0.001). The oxygenation factor in the PEEP4 group was higher than that in the PEEP8 group during mechanical ventilation at all times. There was no difference in the fractional distribution of end-expiratory ventilation according to region of interest between the two groups.
CONCLUSION
Both 4 and 8 cmH2O of PEEP with low-VT ventilation can be used for robotic gynaecological surgery that requires a steep Trendelenburg position and pneumoperitoneum. However, 8 cmH2O of PEEP had no benefit over 4 cmH2O of PEEP with respect to oxygenation and improvement of dorsal regional ventilation.
TRIAL REGISTRATION
The trial was registered at the Clinical Trial Registry of Korea (KCT0002255). https://cris.nih.go.kr.
背景
术中机械通气时合适的呼气末正压（PEEP）水平仍不清楚。
目的
本研究旨在使用电阻抗断层成像术（EIT）研究在 30°头高脚低位和气腹时低潮气量（low-VT）通气时不同 PEEP 水平对氧合、呼吸力学和通气分布的影响。
设计
随机对照试验。
设置
2017 年 1 月至 2017 年 12 月，单所大学二级保健中心进行。
患者
40 名年龄在 20 至 60 岁之间的女性患者，美国麻醉医师协会（ASA）身体状况 1 或 2 级，接受择期机器人妇科手术。
干预
40 名患者随机分配至 PEEP4（PEEP 4cmH2O）组或 PEEP8（PEEP 8cmH2O）组。
主要观察指标
主要观察指标为呼吸力学。次要观察指标包括腹侧和背侧感兴趣区域通气分布的变化以及使用改良临床肺部感染评分（CPIS）的术后肺部并发症（PPC）。
结果
任何时间点的 PaO2 均无差异。PEEP4 组的吸气峰压（PIP）和平均气道压（MPAW）均低于 PEEP8 组（P<0.001）。PEEP4 组在机械通气的所有时间点的氧合因子均高于 PEEP8 组。两组间根据感兴趣区域的呼气末通气的分数分布无差异。
结论
在需要头高脚低位和气腹的机器人妇科手术中，低-VT 通气时使用 4 和 8cmH2O 的 PEEP 都可以使用。然而，与 4cmH2O 的 PEEP 相比，8cmH2O 的 PEEP 并不能改善氧合和背侧区域通气。
试验注册
该试验在韩国临床试验注册中心（KCT0002255）注册。https://cris.nih.go.kr.
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