Department of Anesthesiology, Chengdu Fifth People's Hospital, 33 Mashi Road, Wenjiang District, Chengdu, 611130, China.
Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, 610083, China.
BMC Anesthesiol. 2022 May 2;22(1):134. doi: 10.1186/s12871-022-01664-y.
Alveolar recruitment maneuvers (ARMs) is an important part of lung-protective ventilation strategies (LPVSs), but the optimal duration and interval Remain unclear.
Patients:252 patients who underwent holmium laser lithotripsy surgery and meet inclusion criteria were included and randomized into three groups based on the duration and frequency of ARMs (Regular, one 30 s ARM (RARMs); Improved and intermittent, three 10s ARMs (IARMs); and Control (C), no ARMs).
Groups R and I received ARMs at 20 cmH2O pressures every 30 min. All patients received the same anesthesia and mechanical ventilation.
Outcomes included heart rate and mean arterial pressure changes during ARMs and postoperative pulmonary complications (PPCs) within the first 7 postoperative days.
Incidences of PPCs in groups R(7.1%) and I (5.0%)were slightly lower than those in group C (8.9%).This indicated the potential to reduce lung injury. Heart rate and mean arterial pressure fluctuations during ARMs were significantly higher in groups R and I than in group C (P < 0.01). The rate of blood pressure decrease was significantly higher in group R than in group I (P < 0.01).
IARMs can reduce cycle fluctuations than RARMs in patients Undergoing holmium laser lithotripsy surgery with laryngeal mask general anesthesia. Low tidal volume ventilation and low PEEP combined with ARM did not significantly reduce the incidence of PPCs in healthy lung patients, but tended to reduce lung injury.
The study was registered on the Chinese Clinical Trial Registry. ( ChiCTR2000030815 ,15/03/2020). This study was approved by the ethics committee of Chengdu Fifth People's Hospital with approval number(2020-005(Study)-1).
肺泡复张手法（ARMs）是肺保护性通气策略（LPVSs）的重要组成部分，但最佳持续时间和间隔仍不清楚。
患者：252 名接受钬激光碎石术且符合纳入标准的患者，根据 ARMs 的持续时间和频率分为三组：常规组，1 次 30s ARMs（RARMs）；改良组和间断组，3 次 10s ARMs（IARMs）；对照组（C 组），不进行 ARMs。
R 组和 I 组在 20cmH2O 压力下每 30min 进行 ARMs。所有患者均接受相同的麻醉和机械通气。
结果包括 ARMs 期间的心率和平均动脉压变化以及术后 7 天内的肺部并发症（PPCs）。
R 组（7.1%）和 I 组（5.0%）的 PPCs 发生率略低于 C 组（8.9%），这表明有降低肺损伤的可能。R 组和 I 组 ARMs 期间的心率和平均动脉压波动明显高于 C 组（P<0.01）。R 组血压下降率明显高于 I 组（P<0.01）。
喉罩全身麻醉下接受钬激光碎石术的患者，IARMs 可减少循环波动，优于 RARMs。低潮气量通气和低 PEEP 联合 ARM 并未显著降低健康肺患者 PPCs 的发生率，但有降低肺损伤的趋势。
本研究在中国临床试验注册中心注册（ChiCTR2000030815，15/03/2020）。本研究经成都市第五人民医院伦理委员会批准，批准号（2020-005（研究）-1）。
