肺超声评估小儿心脏术后递增 PEEP 复张手法。

Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery.

机构信息

Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Department of Obstetrics, Zhucheng People's Hospital, Zhucheng, Shandong, China.

出版信息

Pediatr Pulmonol. 2020 May;55(5):1273-1281. doi: 10.1002/ppul.24720. Epub 2020 Mar 9.

DOI:10.1002/ppul.24720

PMID:32150673

Abstract

AIM

To explore the effect of incremental positive end-expiratory pressure recruitment maneuver (iPEEPRM) in children with congenital heart diseases (CHDs) using lung ultrasound.

METHODS

Thirty-six children aged 3 months to 5 years scheduled for cardiac surgery participated. iPEEPRM was performed with PEEP stepwise increase (0-5-10-15 cmH O) and decrease at the same rate before and after surgery. Atelectatic areas, ultrasound scores, arterial oxygen pressure (PaO ), and respiratory system dynamic compliance per kilogram body weight (CDyn/kg) were analyzed before and after iPEEPRM. The primary outcome is the incidence of atelectasis. Secondary outcomes are oxygenation, ventilation, CDyn/kg, and atelectasis area.

RESULTS

iPEEPRM was successfully applied in 92% (33/36) children before surgery and 71% (24/34) children after surgery. The incidence of atelectasis was significantly reduced by iPEEPRM from 76% to 15% before surgery and from 92% to 38% after surgery, respectively (P < .001). Before surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 32.5 (0-128.1) mm vs 0 (0-0) mm and 8 (3-12) vs 2 (0-4). PaO and CDyn/kg were significantly increased after iPEEPRM: 243 (129-275) mm Hg vs 278 (207-323) mm Hg and 0.6 (0.4-0.7) mL/cmH O/kg vs 0.8 (0.6-1.0) mL/cmH O/kg. After surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 45.7 (13.1-115.8) mm vs 0 (0-34.7) mm , and 9 (6-12) vs 3 (0-5). PaO and CDyn/kg were also significantly increased after iPEEPRM.

CONCLUSIONS

iPEEPRM effectively reduced atelectasis, improved lung aeration, oxygenation, and CDyn/kg in children undergoing cardiac surgery.

摘要

目的

应用肺超声探讨递增呼气末正压复张法（iPEEPRM）对先天性心脏病（CHD）患儿的作用。

方法

纳入 36 例年龄 3 个月至 5 岁的拟行心脏手术的患儿。在手术前和手术后，通过 PEEP 逐渐增加（0-5-10-15cmH2O）和相同速率的下降进行 iPEEPRM。分析 iPEEPRM 前后肺不张面积、超声评分、动脉血氧分压（PaO2）和每公斤体重呼吸动力学顺应性（CDyn/kg）。主要结局是肺不张的发生率。次要结局是氧合、通气、CDyn/kg 和肺不张面积。

结果

在手术前，92%（33/36）的患儿成功应用了 iPEEPRM，而手术后 71%（24/34）的患儿成功应用了 iPEEPRM。与手术前相比，iPEEPRM 使肺不张的发生率从 76%显著降低至 15%，从 92%显著降低至 38%（均 P<0.001）。手术前，iPEEPRM 显著降低肺不张面积和超声评分：32.5（0-128.1）mm 比 0（0-0）mm 和 8（3-12）比 2（0-4）。iPEEPRM 后 PaO2 和 CDyn/kg 显著升高：243（129-275）mmHg 比 278（207-323）mmHg 和 0.6（0.4-0.7）mL/cmH2O/kg 比 0.8（0.6-1.0）mL/cmH2O/kg。手术后，iPEEPRM 显著降低肺不张面积和超声评分：45.7（13.1-115.8）mm 比 0（0-34.7）mm 和 9（6-12）比 3（0-5）。iPEEPRM 后 PaO2 和 CDyn/kg 也显著升高。