Department of Anesthesiology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China.
Eur Rev Med Pharmacol Sci. 2023 Jun;27(12):5459-5467. doi: 10.26355/eurrev_202306_32782.
This study aimed to evaluate the lung protection effect of an individualized protective ventilation strategy based on lung impedance tomography (EIT) technology in patients with partial pulmonary resection.
Eighty patients of any gender, American Society of Anesthesiologists (ASA) classification I-II, age 30-64 years and body mass index (BMI) 18-28 kg/m2 who underwent elective thoracoscopic partial lung resection were selected and divided into 2 groups (n=40) using the random number table method: [positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT)] PEEPEIT group (experimental group) and control group. The PEEPEIT group used volume-controlled ventilation after one-lung ventilation, setting a tidal volume of 6 ml/kg and titrating the optimal PEEP value by EIT. Group C used volume-controlled ventilation after one-lung ventilation, setting a tidal volume of 6 ml/kg and a PEEP of 5 cm H2O. Clinical data were collected and recorded at 5 min after double lung ventilation (T0), single lung ventilation, 30 min after PEEP setting (T1), 60 min after PEEP setting (T2), the end of surgery, 10 min after resumption of double lung ventilation (T3) and 10 min after removal of the tracheal tube (T4), and serum surface active substance-associated protein-A (SP-A) concentrations were measured at T0, T3 and 1 d after surgery (T5).
PEEP values were higher in the PEEPEIT group than in the control group at T1 and T2 (p-value <0.05); oxygenation index (OI) was higher in the PEEPEIT group compared to the control group at T2 and T3 (p-value <0.05); pulmonary dynamic compliance (Cdyn) was higher in the PEEPEIT group compared to the control group at T1 and T2 (p-value <0.05); intrapulmonary shunt rate (Qs/Qt) was lower in the PEEPEIT group compared to the control group at T1, T2 and at T3, the intrapulmonary shunt rate (Qs/Qt) was reduced in the PEEPEIT group compared to group C (p-value <0.05); at T5, the SP-A protein was reduced in the PEEPEIT group compared to group C. There was no statistically significant difference in the incidence of postoperative pulmonary complications between the two groups (p-value >0.05).
The EIT-guided individualized protective ventilation strategy has a lung-protective effect in patients undergoing thoracoscopic partial lung resection.
本研究旨在评估基于肺部阻抗断层成像（EIT）技术的个体化保护性通气策略对肺部分切除术患者的肺保护作用。
选择 80 名性别不限、美国麻醉医师协会（ASA）分级 I-II 级、年龄 30-64 岁、体重指数（BMI）18-28kg/m2的患者，采用随机数字表法分为 2 组（n=40）：[肺部 EIT 呼气末正压（PEEP）]PEEPEIT 组（实验组）和对照组。PEEPEIT 组在单肺通气后采用容量控制通气，潮气量 6ml/kg，并通过 EIT 滴定最佳 PEEP 值。C 组在单肺通气后采用容量控制通气，潮气量 6ml/kg，PEEP 为 5cmH2O。在双肺通气后 5 分钟（T0）、单肺通气时、PEEP 设置后 30 分钟（T1）、PEEP 设置后 60 分钟（T2）、手术结束时、恢复双肺通气后 10 分钟（T3）和拔除气管导管后 10 分钟（T4）收集和记录临床数据，并在 T0、T3 和术后 1 天（T5）测量血清表面活性物质相关蛋白-A（SP-A）浓度。
与对照组相比，实验组在 T1 和 T2 时 PEEP 值更高（p 值<0.05）；与对照组相比，实验组在 T2 和 T3 时氧合指数（OI）更高（p 值<0.05）；与对照组相比，实验组在 T1 和 T2 时肺动态顺应性（Cdyn）更高（p 值<0.05）；与对照组相比，实验组在 T1、T2 和 T3 时肺内分流率（Qs/Qt）更低，与 C 组相比，实验组的肺内分流率（Qs/Qt）降低（p 值<0.05）；与 C 组相比，实验组在 T5 时 SP-A 蛋白降低。两组术后肺部并发症发生率无统计学差异（p 值>0.05）。
EIT 指导的个体化保护性通气策略对胸腔镜肺部分切除术患者具有肺保护作用。
