开放肺入路与传统保护性通气对腹部手术肥胖患者的影响:一项随机对照试验

A. Aly, M. Medhat
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引用次数: 0

摘要

目的腹部开放手术与术后肺部并发症的风险增加相关,尤其是肥胖患者,这似乎与术中机械通气直接相关。本研究旨在比较常规保护性通气(CPV)[低潮气量和固定呼气末正压(PEEP)]与开放肺入路(OLA)(复复手法后个体化PEEP)对术后肺部并发症的影响。患者和方法入选56例在全麻下接受腹部直视手术的肥胖患者,随机分为CPV组和OLA组,CPV组接受7 ml/kg的潮气量和固定的5 cmH2O PEEP水平,而OLA组则接受肺泡扩张操作和个体化PEEP。主要结局是术后5天的早期肺部并发症。次要结局包括术中肺力学、气体交换和血流动力学、住院时间、术后肺外并发症和院内死亡率。结果CPV组术后前5 d肺部并发症明显高于OLA组。术中,OLA组的静态顺应性、PEEP、平台压力均明显高于CPV组。相反,OLA组驾驶压力明显降低。术中及术后第1、3天,OLA组氧合较好。术后第1天和第3天接受OLA的患者肺功能测试明显更好。结论OLA可作为CPV的一种可接受的替代方案,其术后肺部并发症少,术中及术后氧合良好,术后肺功能较好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Open lung approach versus conventional protective ventilation in obese patients undergoing open abdominal surgery: a randomized controlled trial
Purpose Open abdominal surgeries are associated with an increased risk of postoperative pulmonary complications, especially in obese patients, which seem to be related directly to intraoperative mechanical ventilation. The present study aimed to compare the effect of using conventional protective ventilation (CPV) [low tidal volume and fixed positive end expiratory pressure (PEEP)] with open lung approach (OLA) (recruitment maneuver followed by personalized PEEP) on postoperative pulmonary complications. Patients and methods A total of 56 obese patients undergoing open abdominal surgery under general anesthesia were enrolled and randomly assigned to either the CPV group in which they received a tidal volume of 7 ml/kg with fixed PEEP level of 5 cmH2O or the OLA group in which they had alveolar recruitment maneuver followed by individualized PEEP. The primary outcome was the early postoperative pulmonary complications during the first 5 days after surgery. Secondary outcomes included lung mechanics, gas exchange, and hemodynamics during the intraoperative period as well as length of hospital stay, postoperative extrapulmonary complications, and intrahospital mortality. Results Postoperative pulmonary complications in the first 5 days were significantly higher in the CPV than in the OLA group. During the intraoperative period, the static compliance, the PEEP, and plateau pressure were significantly higher in the OLA group than the CPV group. On the contrary, driving pressure was significantly lower in the OLA group. Better oxygenation was observed in the OLA group in the intraoperative period and postoperative days 1 and 3. Pulmonary function tests were significantly better among patients who received the OLA on the first and third postoperative days. Conclusion The OLA may be used as an acceptable alternative to CPV as it was associated with less postoperative pulmonary complications, better intraoperative and postoperative oxygenation, and better postoperative pulmonary functions.
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