Halawa Naglaa Moustafa, El Sayed Amani Mamdouh, Ibrahim Ezzeldin Saleh, Khater Yehia H, Yassen Khaled Ahmed
Anaesthesia Department, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt.
Anaesthesia Department, Faculty of Medicine, Menoufia University, Sheeben Elkom City, Egypt.
J Anaesthesiol Clin Pharmacol. 2023 Jan-Mar;39(1):113-120. doi: 10.4103/joacp.joacp_188_21. Epub 2022 Apr 22.
Extensive surgical retraction combined with general anesthesia increase alveolar collapse. The primary aim of our study was to investigate the effect of alveolar recruitment maneuver (ARM) on arterial oxygenation tension (PaO). The secondary aim was to observe its effect on hemodynamics parameters in hepatic patients during liver resection, to investigate its impact on blood loss, postoperative pulmonary complications (PPC), remnant liver function tests, and on the outcome.
Adult patients scheduled for liver resection were randomized into two groups: ARM ( = 21) and control (C) ( = 21). Stepwise ARM was initiated after intubation and was repeated post-retraction. Pressure-control ventilation mode was adjusted to deliver a tidal volume () of 6 mL/kg and an inspiratory-to-expiratory time () ratio of 1:2 with an optimal positive end-expiratory pressure (PEEP) for the ARM group. In the C group, a fixed PEEP (5 cmHO) was applied. Invasive intra-arterial blood pressure (IBP), central venous pressure (CVP), electrical cardiometry (EC), alanine transaminase (ALT, U/L), and aspartate aminotransferase (AST, U/L) blood levels were monitored.
ARM increased PEEP, dynamic compliances, and arterial oxygenation, but reduced ventilator driving pressure compared to group C < 0.01). IBP, cardiac output (CO), and stroke volume variation were not affected by the higher PEEP in the ARM group ( > 0.05) but the CVP increased significantly ( = 0.001). Blood loss was not different between the ARM and C groups (1700 (1150-2000) mL vs 1110 (900-2400) mL, respectively and = 0.57). ARM reduced postoperative oxygen desaturation; however, it did not affect the increase in remnant liver enzymes and was comparable to group C (ALT, = 0.54, AST, = 0.41).
ARM improved intraoperative lung mechanics and reduced oxygen desaturation episodes in recovery, but not PPC or ICU stay. ARM was tolerated with minimal cardiac and systemic hemodynamic effects.
广泛的手术牵拉联合全身麻醉会增加肺泡萎陷。本研究的主要目的是探讨肺泡复张手法（ARM）对动脉氧分压（PaO）的影响。次要目的是观察其对肝切除患者肝切除术中血流动力学参数的影响，研究其对失血、术后肺部并发症（PPC）、残余肝功能检查及预后的影响。
计划进行肝切除的成年患者被随机分为两组：ARM组（n = 21）和对照组（C组）（n = 21）。插管后开始逐步进行ARM，并在牵拉后重复。压力控制通气模式调整为为ARM组输送6 mL/kg的潮气量（VT）和1:2的吸呼比（I:E），并设置最佳呼气末正压（PEEP）。C组应用固定的PEEP（5 cmH₂O）。监测有创动脉血压（IBP）、中心静脉压（CVP）、心电监测（EC）、丙氨酸转氨酶（ALT，U/L）和天冬氨酸转氨酶（AST，U/L）的血药浓度。
与C组相比，ARM增加了PEEP、动态顺应性和动脉氧合，但降低了呼吸机驱动压力（P < 0.01）。ARM组较高的PEEP对IBP、心输出量（CO）和每搏输出量变异没有影响（P > 0.05），但CVP显著升高（P = 0.001）。ARM组和C组的失血量没有差异（分别为1700（1150 - 2000）mL和1110（900 - 2400）mL，P = 0.57）。ARM降低了术后氧饱和度下降；然而，它并没有影响残余肝酶的升高，且与C组相当（ALT，P = 0.54，AST，P = 0.41）。
ARM改善了术中肺力学，减少了恢复过程中的氧饱和度下降事件，但对PPC或重症监护病房停留时间没有影响。ARM耐受性良好，对心脏和全身血流动力学影响最小。
