即刻术后 Boussignac CPAP 对胸外科术后不良肺部事件的影响：一项多中心、随机对照试验。
The effect of immediate postoperative Boussignac CPAP on adverse pulmonary events after thoracic surgery: A multicentre, randomised controlled trial.
机构信息
From the Servicio de Neumología Hospital General Universitario Gregorio Marañón (LP-M), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (LP-M, IG), Facultad de Medicina Universidad Complutense de Madrid (UCM) (LP-M, EL, JS, IG), Servicio de Anestesia Hospital General Universitario Gregorio Marañón (IG), Servicio de Anestesia Hospital General Universitario 12 de Octubre (EL), Instituto de Investigación Sanitaria 12 de Octubre (I+12) (EL, JS), Servicio de Neumología Hospital General Universitario 12 de Octubre (JS), Servicio de Anestesia Hospital General Universitario La Princesa (EA, AP), Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS La Princea) (EA, AP), Facultad de Medicina Universidad Autónoma de Madrid (UAM) (EA, AP), Servicio de Anestesia Hospital General Universitario Ramón y Cajal (DJP, MM-B), Instituto de Investigación Sanitaria Hospital Ramón y Cajal (IRICYS) (DJP, MM-B), Facultad de Medicina Universidad de Alcalá de Henares (UAH), Madrid, Spain (DJP, MM-B).
出版信息
Eur J Anaesthesiol. 2021 Feb 1;38(2):164-170. doi: 10.1097/EJA.0000000000001369.
BACKGROUND
The effectiveness of prophylactic continuous positive pressure ventilation (CPAP) after thoracic surgery is not clearly established.
OBJECTIVE
The aim of this study was to assess the effectiveness of CPAP immediately after lung resection either by thoracotomy or thoracoscopy in preventing atelectasis and pneumonia.
DESIGN
A multicentre, randomised, controlled, open-label trial.
SETTINGS
Four large University hospitals at Madrid (Spain) from March 2014 to December 2016.
PATIENTS
Immunocompetent patients scheduled for lung resection, without previous diagnosis of sleep-apnoea syndrome or severe bullous emphysema. Four hundred and sixty-four patients were assessed, 426 were randomised and 422 were finally analysed.
INTERVENTION
Six hours of continuous CPAP through a Boussignac system versus standard care.
MAIN OUTCOME MEASURES
Primary outcome: incidence of the composite endpoint 'atelectasis + pneumonia'. Secondary outcome: incidence of the composite endpoint 'persistent air leak + pneumothorax'.
RESULTS
The primary outcome occurred in 35 patients (17%) of the CPAP group and in 58 (27%) of the control group [adjusted relative risk (ARR) 0.53, 95% CI 0.30 to 0.93]. The secondary outcome occurred in 33 patients (16%) of the CPAP group and in 29 (14%) of the control group [ARR 0.92, 95% CI 0.51 to 1.65].
CONCLUSION
Prophylactic CPAP decreased the incidence of the composite endpoint 'postoperative atelectasis + pneumonia' without increasing the incidence of the endpoint 'postoperative persistent air leaks + pneumothorax'.
背景
预防性持续气道正压通气（CPAP）在胸外科手术后的效果尚不清楚。
目的
本研究旨在评估开胸或电视胸腔镜肺切除术后即刻 CPAP 预防肺不张和肺炎的效果。
设计
多中心、随机、对照、开放性试验。
地点
马德里（西班牙）的四家大型大学医院，2014 年 3 月至 2016 年 12 月。
患者
计划进行肺切除术的免疫功能正常患者，无睡眠呼吸暂停综合征或严重大疱性肺气肿的既往诊断。评估了 464 名患者，随机分配了 426 名，最终分析了 422 名。
干预
Boussignac 系统持续 6 小时 CPAP 与标准护理。
主要观察指标
主要结局：“肺不张+肺炎”复合终点的发生率。次要结局：“持续性漏气+气胸”复合终点的发生率。
结果
CPAP 组 35 例（17%）和对照组 58 例（27%）患者发生主要结局（调整后的相对风险（ARR）0.53，95%可信区间 0.30 至 0.93）。CPAP 组 33 例（16%）和对照组 29 例（14%）患者发生次要结局（ARR 0.92，95%可信区间 0.51 至 1.65）。
结论
预防性 CPAP 降低了“术后肺不张+肺炎”复合终点的发生率，而不增加“术后持续性漏气+气胸”终点的发生率。
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