Gao Xian, Xiong Ya, Huang Jian, Zhang Ning, Li Jianwei, Zheng Shuguo, Lu Kaizhi, Ma Daqing, Yang Bin, Ning Jiaolin
From the Department of Anesthesiology.
Department of Hepatology, Southwest Hospital, Third Military Medical University, Chongqing, China.
Anesth Analg. 2021 Apr 1;132(4):1033-1041. doi: 10.1213/ANE.0000000000005242.
Control of bleeding during laparoscopic liver resection (LLR) is important for patient safety. It remains unknown what the effects of mechanical ventilation with varying tidal volumes on bleeding during LLR. Thus, this study aims to investigate whether mechanical ventilation with low tidal volume (LTV) reduces surgical bleeding during LLR.
In this prospective, randomized, and controlled clinical study, 82 patients who underwent scheduled LLR were enrolled and randomly received either mechanical ventilation with LTV group (6-8 mL/kg) along with recruitment maneuver (once/30 min) without positive end-expiratory pressure (PEEP) or conventional tidal volume (CTV; 10-12 mL/kg) during parenchymal resection. The estimated volume of blood loss during parenchymal resection and the incidence of postoperative respiratory complications were compared between 2 groups.
The estimated volume of blood loss (median [interquartile range {IQR}]) was decreased in the LTV group compared to the CTV group (301 [148, 402] vs 394 [244, 672] mL, P = .009); blood loss per cm2 of transected surface of liver (5.5 [4.1, 7.7] vs 12.2 [9.8, 14.4] mL/cm2, P < .001) and the risk of clinically significant estimated blood loss (>800 mL) were reduced in the LTV group compared to the CTV group (0/40 vs 8/40, P = .003). Blood transfusion was decreased in the LTV group compared to the CTV group (5% vs 20% of patients, P = .043). No patient in the LTV group but 2 patients in the CTV group were switched from LLR to open hepatectomy. Airway plateau pressure was lower in the LTV group compared to the CTV group (mean ± standard deviation [SD]) (12.7 ± 2.4 vs 17.5 ± 3.5 cm H2O, P = .002).
Mechanical ventilation with LTV may reduce bleeding during laparoscopic liver surgery.
腹腔镜肝切除术（LLR）期间的出血控制对患者安全至关重要。不同潮气量的机械通气对LLR期间出血的影响尚不清楚。因此，本研究旨在探讨低潮气量（LTV）机械通气是否能减少LLR期间的手术出血。
在这项前瞻性、随机对照临床研究中，82例行择期LLR的患者入组，并在实质切除期间随机接受LTV组（6 - 8 mL/kg）机械通气并进行肺复张手法（每30分钟1次）且无呼气末正压（PEEP），或常规潮气量（CTV；10 - 12 mL/kg）通气。比较两组实质切除期间的估计失血量和术后呼吸并发症的发生率。
与CTV组相比，LTV组的估计失血量（中位数[四分位间距{IQR}]）减少（301 [148, 402] vs 394 [244, 672] mL，P = 0.009）；LTV组每平方厘米肝切面的失血量（5.5 [4.1, 7.7] vs 12.2 [9.8, 14.4] mL/cm²，P < 0.001）以及临床显著估计失血量（>800 mL）的风险低于CTV组（0/40 vs 8/40，P = 0.003）。与CTV组相比，LTV组的输血率降低（5% vs 20%的患者，P = 0.043）。LTV组无患者转为开腹肝切除术，但CTV组有2例患者转为开腹肝切除术。与CTV组相比，LTV组的气道平台压更低（均值±标准差[SD]）（12.7 ± 2.4 vs 17.5 ± 3.5 cm H₂O，P = 0.002）。
LTV机械通气可能减少腹腔镜肝手术期间的出血。
