Department of Anesthesiology, Chengdu Second Peoples Hospital, Chengdu, 610021, Sichuan Province, China.
Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
BMC Anesthesiol. 2022 Jul 1;22(1):200. doi: 10.1186/s12871-022-01742-1.
Atelectasis is the primary cause of hypoxemia during general anesthesia. This study aimed to evaluate the impact of the combination of recruitment maneuvers (RM) and positive end-expiratory pressure (PEEP) on the incidence of atelectasis in adult women undergoing gynecologic laparoscopic surgery using pulmonary ultrasound.
In this study, 42 patients with healthy lungs undergoing laparoscopic gynecologic surgery were randomly divided into the recruitment maneuver group (RM group; 6 cm HO PEEP and RM) or the control group (C group; 6 cm HO PEEP and no RM), 21 patients in each group. Volume-controlled ventilation was used in all selected patients, with a tidal volume of 6-8 mL·kg of ideal body weight. When atelectasis was detected, patients in the RM group received ultrasound-guided RM, while those in the C group received no intervention. The incidence and severity of atelectasis were determined using lung ultrasound scores.
A total of 41 patients were investigated. The incidence of atelectasis was lower in the RM group (40%) than in the C group (80%) 15 min after arrival in the post-anesthesia care unit (PACU). Meanwhile, lung ultrasound scores (LUSs) were lower in the RM group compared to the C group. In addition, the differences in the LUS between the two groups were mainly due to the differences in lung ultrasound scores in the posterior regions. However, this difference did not persist after 24 h of surgery.
In conclusion, the combination of RM and PEEP could reduce the incidence of atelectasis in patients with healthy lungs 15 min after arrival at the PACU; however, it disappeared within 24 h after surgery.
(Prospectively registered): ChiCTR2000033529 . Registered on 4/6/2020.
在全身麻醉期间，肺不张是低氧血症的主要原因。本研究旨在评估肺复张（RM）联合呼气末正压通气（PEEP）对接受妇科腹腔镜手术的成年女性肺不张发生率的影响，采用肺部超声进行评估。
本研究将 42 例肺健康的拟行腹腔镜妇科手术患者随机分为肺复张组（RM 组；6cmH2O PEEP 和 RM）和对照组（C 组；6cmH2O PEEP 且无 RM），每组 21 例。所有入选患者均采用容量控制通气，潮气量为 6-8ml·kg 理想体重。当出现肺不张时，RM 组患者接受超声引导下 RM，C 组患者不接受干预。采用肺部超声评分评估肺不张的发生率和严重程度。
共纳入 41 例患者。RM 组患者（40%）在到达麻醉后监护病房（PACU）后 15min 时的肺不张发生率低于 C 组（80%）。同时，RM 组患者的肺部超声评分（LUS）低于 C 组。此外，两组间 LUS 的差异主要是由于后区肺部超声评分的差异。然而，这种差异在手术后 24h 内不再存在。
综上所述，RM 联合 PEEP 可降低 PACU 后 15min 时肺健康患者的肺不张发生率，但在手术后 24h 内消失。
（前瞻性注册）：ChiCTR2000033529。注册于 2020 年 4 月 6 日。
