高频振荡对围手术期患者肺不张减少的影响：一项前瞻性随机对照研究。

Effect of high-frequency oscillation on reduction of atelectasis in perioperative patients: a prospective randomized controlled study.

机构信息

Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China.

出版信息

Ann Med. 2023;55(2):2272720. doi: 10.1080/07853890.2023.2272720. Epub 2023 Oct 24.

DOI:10.1080/07853890.2023.2272720

PMID:37874665

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10836273/

Abstract

BACKGROUND

Atelectasis affects approximately 90% of anaesthetized patients, with laparoscopic surgery and pneumoperitoneum reported to exacerbate this condition. High-frequency oscillation therapy applies continuous positive pressure pulses to oscillate the airway, creating a pressure difference in small airways obstructed by secretions. This process helps reduce peak airway pressure, open small airways, and decrease atelectasis incidence, while also facilitating respiratory tract clearance. This study examines the efficacy of high-frequency oscillation on reduction of atelectasis in laparoscopic cholecystectomy (LC) patients under general anaesthesia, evaluated using lung ultrasound.

METHODS

Sixty-four patients undergoing laparoscopic cholecystectomy were randomly divided into a control group and a high-frequency oscillation (HFO) group. Both groups underwent total intravenous anaesthesia under invasive arterial monitoring. The HFO group received a 10-minute continuous high-frequency oscillation therapy during surgery, while the control group received no intervention. Lung ultrasound evaluations were performed three times: five minutes post-intubation (T1), at the end of the surgery (T2), and before leaving the Post-Anaesthesia Care Unit (PACU; T3). Blood gas analysis was performed twice: prior to induction with no oxygen supply and before PACU discharge (oxygen supply off).

RESULTS

The HFO group displayed a significantly lower incidence of atelectasis at T3 (57.5% vs. 90.3%, OR 6.88, 95%CI (1.74 to 27.24)) compared to the control group. Moreover, the HFO group's PaO levels remained consistent with baseline levels before PACU discharge, unlike the control group. Although there was no significant difference in LUS scores between the groups at T1 (8.56 ± 0.15 vs. 8.19 ± 0.18, = 0.1090), the HFO group had considerably lower scores at T2 (13.41 ± 0.17 vs.7.59 ± 0.17, < 0.01) and T3 (13.72 ± 0.14 vs.7.25 ± 0.21, < 0.01).

CONCLUSION

Our study indicates that high-frequency oscillation effectively reduces atelectasis in patients undergoing laparoscopic cholecystectomy. Additionally, it can mitigate the decline in oxygen partial pressure associated with atelectasis.

摘要

背景

肺不张影响约 90%的麻醉患者，腹腔镜手术和人工气腹被报道会使这种情况恶化。高频振荡治疗通过施加连续的正压脉冲来振荡气道，在被分泌物阻塞的小气道中产生压力差。这个过程有助于降低峰压，打开小气道，降低肺不张的发生率，同时也有助于呼吸道清除。本研究使用肺部超声检查评估全麻下腹腔镜胆囊切除术（LC）患者高频振荡对肺不张的疗效。

方法

64 例行腹腔镜胆囊切除术的患者随机分为对照组和高频振荡（HFO）组。两组均在有创动脉监测下接受全凭静脉麻醉。HFO 组在手术中接受 10 分钟连续高频振荡治疗，而对照组则不接受干预。进行三次肺部超声评估：插管后 5 分钟（T1）、手术结束时（T2）和离开麻醉后恢复室（PACU；T3）。进行两次血气分析：在没有氧气供应的诱导前和 PACU 出院前（氧气供应关闭）。

结果

与对照组相比，HFO 组在 T3 时肺不张的发生率显著降低（57.5%比 90.3%，OR 6.88，95%CI（1.74 至 27.24））。此外，与对照组相比，HFO 组在 PACU 出院前的 PaO 水平与基线水平保持一致。尽管两组在 T1 时的 LUS 评分无显著差异（8.56±0.15 比 8.19±0.18， = 0.1090），但 HFO 组在 T2（13.41±0.17 比 7.59±0.17， < 0.01）和 T3（13.72±0.14 比 7.25±0.21， < 0.01）时的评分明显较低。