肺保护性通气与传统通气对婴幼儿腹腔镜手术期间肺不张发生率影响的比较：一项随机对照试验
A comparison of the effects of lung protective ventilation and conventional ventilation on the occurrence of atelectasis during laparoscopic surgery in young infants: a randomized controlled trial.
作者信息
Yue Kun, Wang Jingru, Wu Huangxing, Sun Yingying, Xia Yin, Chen Qi
机构信息
Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Department of Anesthesiology and Perioperative Medicine, Anhui Provincial Children's Hospital, Hefei, Anhui, China.
出版信息
Front Med (Lausanne). 2024 Oct 10;11:1486236. doi: 10.3389/fmed.2024.1486236. eCollection 2024.
OBJECTIVE
This study utilized lung ultrasound to investigate whether lung protective ventilation reduces pulmonary atelectasis and improves intraoperative oxygenation in infants undergoing laparoscopic surgery.
METHODS
Eighty young infants (aged 1-6 months) who received general anesthesia for more than 2 h during laparoscopic surgery were randomized into the lung protective ventilation group (LPV group) and the conventional ventilation group (control group). The LPV group received mechanical ventilation starting at 6 mL/kg tidal volume, 5 cmHO PEEP, 60% inspired oxygen fraction, and half-hourly alveolar recruitment maneuvers. Control group ventilation began with 8-10 mL/kg tidal volume, 0 cmHO PEEP, and 60% inspired oxygen fraction. Lung ultrasound was conducted five times-T1 (5 min post-intubation), T2 (5 min post-pneumoperitoneum), T3 (at the end of surgery), T4 (post-extubation), and T5 (prior to discharge from the PACU)-for each infant. Simultaneous arterial blood gas analysis was performed at T1, T2, T3, and T4.
RESULTS
Statistically significant differences were observed in pulmonary atelectasis incidence, lung ultrasound scores, and the PaO, PaCO, PaO/FiO ratios at T2, T3, and T4. However, at T5, no statistically significant differences were noted in terms of lung ultrasound scores (4.30 ± 1.87 vs. 5.00 ± 2.43, 95% CI: -1.67 to 0.27, = 0.153) or the incidence of pulmonary atelectasis (32.5% vs. 47.5%, = 0.171).
CONCLUSION
In infants aged 1-6 months, lung protective ventilation during laparoscopy under general anesthesia significantly reduced the incidence of pulmonary atelectasis and enhanced intraoperative oxygenation and dynamic lung compliance compared to conventional ventilation. However, these benefits did not persist; no differences were observed in lung ultrasound scores or the incidence of pulmonary atelectasis at PACU discharge.
CLINICAL TRIAL REGISTRATION
http://www.chictr.org.cn/, identifier: ChiCTR2200058653.
目的
本研究采用肺部超声来调查肺保护性通气是否能减少接受腹腔镜手术的婴儿的肺不张，并改善术中氧合。
方法
80名在腹腔镜手术期间接受全身麻醉超过2小时的1至6个月大的婴儿被随机分为肺保护性通气组（LPV组）和传统通气组（对照组）。LPV组从潮气量6 mL/kg、呼气末正压5 cmH₂O、吸入氧分数60%开始机械通气，并每半小时进行一次肺泡复张手法。对照组通气从潮气量8 - 10 mL/kg、呼气末正压0 cmH₂O和吸入氧分数60%开始。对每个婴儿进行五次肺部超声检查——T1（插管后5分钟）、T2（气腹后5分钟）、T3（手术结束时）、T4（拔管后）和T5（从麻醉后恢复室出院前）。在T1、T2、T3和T4同时进行动脉血气分析。
结果
在T2、T3和T4时，观察到肺不张发生率、肺部超声评分以及PaO₂、PaCO₂、PaO₂/FiO₂比值存在统计学显著差异。然而，在T5时，肺部超声评分（4.30 ± 1.87 vs. 5.00 ± 2.43，95% CI：-1.67至0.27，P = 0.153）或肺不张发生率（32.5% vs. 47.5%，P = 0.171）方面未观察到统计学显著差异。
结论
在1至6个月大的婴儿中，与传统通气相比，全身麻醉下腹腔镜手术期间的肺保护性通气显著降低了肺不张的发生率，并提高了术中氧合和动态肺顺应性。然而，这些益处并未持续；在麻醉后恢复室出院时，肺部超声评分或肺不张发生率没有差异。
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