体外循环期间通气策略对心脏手术后术后肺部并发症的影响：一项随机临床试验。
Effect of ventilation strategy during cardiopulmonary bypass on postoperative pulmonary complications after cardiac surgery: a randomized clinical trial.
机构信息
Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, China.
Department of Anesthesiology, The Third People's Hospital of Chengdu, Chengdu, 610041, China.
出版信息
J Cardiothorac Surg. 2021 Oct 30;16(1):319. doi: 10.1186/s13019-021-01699-1.
BACKGROUND
To determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO) had an impact on the occurrence of postoperative pulmonary complications (PPCs).
METHODS
A total of 413 adult patients undergoing elective cardiac surgery with CPB were randomly assigned into three groups: 138 in the NoV group (received no mechanical ventilation during CPB), 138 in the LOV group (received a tidal volume (V) of 3-4 ml/kg of ideal body weight with the respiratory rate of 10-12 bpm, and the positive end-expiratory pressure of 5-8 cmHO during CPB; the FiO was 30%), and 137 in the HOV group (received the same ventilation parameters settings as the LOV group while the FiO was 80%).
RESULTS
The primary outcomes were the incidence and severity of PPCs during hospitalization. The composite incidence of PPCs did not significantly differ between the NoV (63%), LOV (49%) and HOV (57%) groups (P = 0.069). And there was also no difference regarding the incidence of PPCs between the non-ventilation (NoV) and ventilation (the combination of LOV and HOV) groups. The LOV group was observed a lower proportion of moderate and severe pulmonary complications (grade ≥ 3) than the NoV group (23.1% vs. 44.2%, P = 0.001).
CONCLUSION
Maintaining ventilation during CPB did not reduce the incidence of PPCs in patients undergoing cardiac surgery.
TRIAL REGISTRATION
Chinese Clinical Trial Registry ChiCTR1800015261. Prospectively registered 19 March 2018. http://www.chictr.org.cn/showproj.aspx?proj=25982.
背景
为了确定在体外循环（CPB）期间使用不同吸入氧分数（FiO2）维持通气是否会对术后肺部并发症（PPCs）的发生产生影响。
方法
共纳入 413 例接受 CPB 择期心脏手术的成年患者，随机分为三组：NoV 组（CPB 期间不接受机械通气，138 例）、LOV 组（CPB 期间给予 3-4 ml/kg 理想体重潮气量，呼吸频率 10-12 bpm，呼气末正压 5-8 cmHO；FiO2 为 30%，138 例）和 HOV 组（CPB 期间给予 LOV 组相同的通气参数设置，同时 FiO2 为 80%，137 例）。
结果
主要结局是住院期间 PPCs 的发生率和严重程度。NoV（63%）、LOV（49%）和 HOV（57%）三组之间 PPCs 的复合发生率无显著差异（P=0.069）。非通气（NoV）和通气（LOV 和 HOV 组合）两组之间 PPCs 的发生率也无差异。LOV 组中度和重度肺部并发症（≥3 级）的比例低于 NoV 组（23.1%比 44.2%，P=0.001）。
结论
CPB 期间维持通气并不能降低心脏手术患者 PPCs 的发生率。
试验注册
中国临床试验注册中心 ChiCTR1800015261。前瞻性注册于 2018 年 3 月 19 日。http://www.chictr.org.cn/showproj.aspx?proj=25982。
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