两种肺复张手法与常规通气对小儿腹腔镜手术中肺不张效果的比较-一项前瞻性随机对照试验。

Comparison of the effect of two recruitment manoeuvres to conventional ventilation on lung atelectasis in paediatric laparoscopic surgery- a prospective randomised controlled trial.

机构信息

Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.

Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

BMC Anesthesiol. 2024 Jun 22;24(1):211. doi: 10.1186/s12871-024-02596-5.

DOI:10.1186/s12871-024-02596-5

PMID:38909220

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11193267/

Abstract

BACKGROUND

There is a high incidence of pulmonary atelectasis during paediatric laparoscopic surgeries. The authors hypothesised that utilising a recruitment manoeuvre or using continuous positive airway pressure may prevent atelectasis compared to conventional ventilation.

OBJECTIVE

The primary objective was to compare the degree of lung atelectasis diagnosed by lung ultrasound (LUS) using three different ventilation techniques in children undergoing laparoscopic surgeries.

DESIGN

Randomised, prospective three-arm trial.

SETTING

Single institute, tertiary care, teaching hospital.

PATIENTS

Children of ASA PS 1 and 2 up to the age of 10 years undergoing laparoscopic surgery with pneumoperitoneum lasting for more than 30 min.

INTERVENTION

Random allocation to one of the three study groups: CG group: Inspiratory pressure adjusted to achieve a TV of 5-8 ml/kg, PEEP of 5 cm HO, respiratory rate adjusted to maintain end-tidal carbon dioxide (ETCO) between 30-40 mm Hg with manual ventilation and no PEEP at induction. RM group: A recruitment manoeuvre of providing a constant pressure of 30 cm HO for ten seconds following intubation was applied. A PEEP of 10 cm HO was maintained intraoperatively. CPAP group: Intraoperative maintenance with PEEP 10 cm HO with CPAP of 10 cm HO at induction using mechanical ventilation was done.

OUTCOME MEASURES

Lung atelectasis score at closure assessed by LUS.

RESULTS

Post induction, LUS was comparable in all three groups. At the time of closure, the LUS for the RM group (8.6 ± 4.9) and the CPAP group (8.8 ± 6.8) were significantly lower (p < 0.05) than the CG group (13.3 ± 3.8). In CG and CPAP groups, the score at closure was significantly higher than post-induction. The PaO/FiO ratio was significantly higher (p < 0.05) for the RM group (437.1 ± 44.9) and CPAP group (421.6 ± 57.5) than the CG group (361.3 ± 59.4) at the time of pneumoperitoneum.

CONCLUSION

Application of a recruitment manoeuvre post-intubation or CPAP during induction and maintenance with a high PEEP leads to less atelectasis than conventional ventilation during laparoscopic surgery in paediatric patients.

TRIAL REGISTRY

CTRI/2019/08/02058.

摘要

背景

小儿腹腔镜手术中肺不张的发生率较高。作者假设，与常规通气相比，使用募集手法或持续气道正压通气（CPAP）可能预防肺不张。

目的

主要目的是比较三种不同通气技术在小儿腹腔镜手术中通过肺超声（LUS）诊断的肺不张程度。

设计

随机、前瞻性三臂试验。

地点

单机构、三级护理、教学医院。

患者

ASA PS 1 和 2 级的儿童，年龄在 10 岁以下，行腹腔镜手术，气腹时间超过 30 分钟。

干预

随机分配到三组研究之一：CG 组：吸气压力调整至实现 TV 5-8 ml/kg，PEEP 5 cm HO，呼吸频率调整至维持呼气末二氧化碳（ETCO ）在 30-40 mm Hg 之间，手动通气，诱导时无 PEEP。RM 组：在插管后给予持续 10 秒 30 cm HO 的募集手法。术中维持 10 cm HO 的 PEEP。CPAP 组：诱导时使用机械通气，CPAP 为 10 cm HO，PEEP 为 10 cm HO，术中持续 CPAP。

观察指标

LUS 评估关闭时的肺不张评分。

结果

诱导后，三组的 LUS 均相似。在关闭时，RM 组（8.6±4.9）和 CPAP 组（8.8±6.8）的 LUS 明显低于 CG 组（13.3±3.8）（p<0.05）。CG 和 CPAP 组在关闭时的评分明显高于诱导后。RM 组（437.1±44.9）和 CPAP 组（421.6±57.5）的 PaO/FiO 比值明显高于 CG 组（361.3±59.4）在气腹时。