麻醉后监护病房肺部超声检查结果与大手术后结局相关：高危队列中的前瞻性观察研究。

Lung Ultrasound Findings in the Postanesthesia Care Unit Are Associated With Outcome After Major Surgery: A Prospective Observational Study in a High-Risk Cohort.

机构信息

From the Department of Anesthesia and Intensive Care Medicine, Nord Hospital, and C2VN Inra, Inserm.

Department of Anesthesia and Intensive Care Medicine, Nord Hospital, Aix Marseille University, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France.

出版信息

Anesth Analg. 2021 Jan;132(1):172-181. doi: 10.1213/ANE.0000000000004755.

DOI:10.1213/ANE.0000000000004755

PMID:32224722

Abstract

BACKGROUND

Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment.

METHODS

Patients with an American Society of Anesthesiologists (ASA) score >1 and who were scheduled for major surgery of >2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models.

RESULTS

Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 [7-18] vs 8 [4-12]; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2-11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57-0.71).

CONCLUSIONS

When lung ultrasound is performed precociously <2 hours after extubation, detection of immediate postoperative alveolar consolidation and pleural effusion by lung ultrasound is associated with postoperative pulmonary complications and morbi-mortality. Further study is needed to determine the effect of ultrasound-guided intervention for patients at high risk of postoperative pulmonary complications.

摘要

背景

术后肺部并发症与发病率增加有关。识别出此类并发症风险较高的患者可能有助于进行预防性治疗。

方法

纳入了美国麻醉医师协会（ASA）评分>1 分且计划进行>2 小时的大型手术的患者，进行了一项单中心前瞻性研究。在拔管后，由 2 位经过认证的麻醉师在麻醉后护理单元中，在标准化气管拔管后中位数时间 60 分钟时进行肺部超声检查。记录术后 8 天内发生的术后肺部并发症。使用逻辑回归模型分析肺部超声结果与术后肺部并发症之间的关系。

结果

在 327 例纳入的患者中，有 69 例（19%）发生了术后肺部并发症。发生术后肺部并发症的患者的肺部超声评分更高（12 [7-18] 与 8 [4-12]；P <.001）。在肺部超声检查中发现胸腔积液的患者发生肺部并发症的比值比为 3.7（95%置信区间，1.2-11.7）。有胸腔积液的患者的住院死亡率也更高（22%比 1.3%；P <.001）。肺部超声显示肺部实变的患者术后需要机械通气的风险更高（17%比 5.1%；P =.001）。在所有患者中，预测术后肺部并发症的曲线下面积为 0.64（95%置信区间，0.57-0.71）。