Guo Jing, Liu Chu-Ling, Zhang Li-Zhen, Li Jing, Gu Xiao-Ke, Wang Tian-Shuo, Zhang Nan-Rong, Li Hong
Department of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Erheng Rd, Guangzhou, 510655, China.
Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Erheng Rd, Guangzhou, 510655, China.
Sci Rep. 2025 Jul 29;15(1):27727. doi: 10.1038/s41598-025-13213-x.
Higher intraoperative mechanical power (MP) is associated with increased postoperative pulmonary complications (PPCs). We hypothesised that periodic alveolar recruitment manoeuvres (PARM) alone, as an open-lung strategy for intraoperative protective ventilation, would reduce MP, thereby potentially mitigating PPCs. Seventy-five non-obese participants were equally allocated to either alveolar recruitment manoeuvres every 30 min alone (PARM group), or medium positive end-expiratory pressure (PEEP) of 6-8 cmHO alone (PEEP group), or a combination of medium PEEP and PARM (combination group). As a result, the median (interquartile range, IQR) MP in the PARM group was lower than in the other groups (PARM, 4.34 [3.58-5.27]; PEEP, 6.47 [5.83-7.74]; combination, 6.32 [5.16-7.36] J min; P < 0.001). The median difference (95% confidence interval, 95% CI) of MP between the PARM and control group (combined PEEP and combination) was 2.05 (1.34-2.74) J min, with a significant reduction (32.2%, P < 0.001) in the PARM group. However, no clinical benefit (such as PPCs) was observed despite these physiological improvements. In conclusion, PARM alone as an open-lung strategy for protective ventilation leads to a 32.2% reduction in MP, compared with medium PEEP alone or a combination of PARM and medium PEEP. The association between PARM and PPCs warrant further investigations.
术中较高的机械功率（MP）与术后肺部并发症（PPCs）增加相关。我们假设，作为术中保护性通气的肺开放策略，单纯的周期性肺泡复张手法（PARM）可降低MP，从而有可能减轻PPCs。75名非肥胖参与者被平均分为三组，分别为每30分钟单纯进行肺泡复张手法（PARM组）、单纯采用6 - 8 cmH₂O的中等呼气末正压（PEEP）（PEEP组）或中等PEEP与PARM联合使用（联合组）。结果显示，PARM组的MP中位数（四分位间距，IQR）低于其他组（PARM组为4.34 [3.58 - 5.27]；PEEP组为6.47 [5.83 - 7.74]；联合组为6.32 [5.16 - 7.36] J/min；P < 0.001）。PARM组与对照组（PEEP组和联合组合并）之间MP的中位数差异（95%置信区间，95%CI）为2.05（1.34 - 2.74）J/min，PARM组显著降低（32.2%，P < 0.001）。然而，尽管有这些生理改善，但未观察到临床益处（如PPCs）。总之，与单纯中等PEEP或PARM与中等PEEP联合使用相比，单纯PARM作为保护性通气的肺开放策略可使MP降低32.2%。PARM与PPCs之间的关联值得进一步研究。
