术中硫酸镁输注在全身麻醉中保护 COPD 患者的氧合和肺力学。一项随机临床试验。

Intraoperative MgSO infusion protects oxygenation and lung mechanics in COPD patients during general anesthesia. A randomized clinical trial.

机构信息

Department of Anesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Department of Otorhinolaryngology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.

出版信息

Acta Anaesthesiol Scand. 2020 Nov;64(10):1460-1468. doi: 10.1111/aas.13684. Epub 2020 Aug 16.

DOI:10.1111/aas.13684

PMID:32770840

Abstract

BACKGROUND

The purpose of this study was to examine the effects of an intraoperative MgSO infusion on arterial oxygenation and lung mechanics in patients with moderate COPD undergoing cancer larynx surgery under general anesthesia (GA). Our primary outcome was arterial oxygenation determined by the PaO and PaO /FiO . The secondary outcomes were lung mechanics (peak airway pressure, airway plateau pressure, dead space, lung compliance, airway resistance) and postoperative complications.

METHODS

In this randomized controlled double-blinded trial, 40 patients with an ASA classifications II and/or III who were diagnosed with moderate COPD and who were scheduled for cancer larynx surgery under GA were randomly allocated into two equal groups, the target (Mg group) and control group (C group). In the Mg group, 30 mg/kg of 10% MgSO solution was administered intravenously for over 20 minutes as the loading dose, followed by the continuous infusion of 10 mg/kg/hr In the C group, the same loading and maintenance infusion rates were administered using 0.9% saline.

RESULTS

Unlike the C group (baseline "T0" to post-infusion "T1" interval 294 ± 97 vs 238 ± 71 mm Hg, respectively, P = .04 ± SD), the Mg group exhibited preserved intraoperative PaO (T0 to T1 interval 271 ± 89 vs 257 ± 53 mm Hg, respectively, P = .54 ± SD) and PaO /FiO (C group T0 to T1 interval 404 ± 81 vs 349 ± 84, P = .04 and Mg group 394 ± 91 vs 379 ± 95, P = .61, respectively), and these effects were modest. Further, compared to the C group, the Mg group exhibited lower airway resistance, dead space, airway plateau pressure, and peak airway pressure, and higher dynamic compliance. The postoperative PaO and PaO /FiO were higher in the Mg group compared to the C group.

CONCLUSIONS

Intraoperative infusion of MgSO in patients with moderate COPD undergoing laryngectomy surgery under GA produces mild perioperative protective effects on both arterial oxygenation and lung mechanics.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03461328; registration date: 8 March 2018.

摘要

背景

本研究旨在探讨术中硫酸镁输注对中度 COPD 患者全身麻醉（GA）下喉癌手术时动脉氧合和肺力学的影响。我们的主要结局指标是由 PaO 和 PaO/FiO 确定的动脉氧合。次要结局指标是肺力学（气道峰压、气道平台压、死腔、肺顺应性、气道阻力）和术后并发症。

方法

在这项随机对照双盲试验中，40 名 ASA 分级 II 和/或 III 级、中度 COPD 诊断明确、拟行 GA 下喉癌手术的患者被随机分为两组，即目标（Mg 组）和对照组（C 组）。在 Mg 组中，静脉注射 30mg/kg 的 10%硫酸镁溶液，持续 20 分钟作为负荷剂量，然后以 10mg/kg/hr 的速度连续输注。在 C 组中，使用 0.9%生理盐水给予相同的负荷和维持输注速度。

结果

与 C 组（基线“T0”至输注后“T1”间隔 294±97 与 238±71mmHg，P=0.04±SD）相比，Mg 组术中 PaO 得到更好的维持（T0 至 T1 间隔 271±89 与 257±53mmHg，P=0.54±SD）和 PaO/FiO（C 组 T0 至 T1 间隔 404±81 与 349±84，P=0.04；Mg 组 394±91 与 379±95，P=0.61），但效果适度。此外，与 C 组相比，Mg 组气道阻力、死腔、气道平台压和气道峰压较低，动态顺应性较高。与 C 组相比，Mg 组术后 PaO 和 PaO/FiO 更高。