单肺通气时胸腔硬膜外阻滞对通气-灌注匹配的影响：一项探索性研究。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-11-06 DOI:10.1016/j.jclinane.2024.111678

Yuxian Wang BS , Yilin Wei BS , Guannan Chen M.D., Ph.D , Zhiyao Wang M.D., Ph.D , Yu Fan MS , Jie Wang MS , Yuanjun Yang BS , Di Zhou M.D., Ph.D , Ming Zhong M.D., Ph.D

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引用次数: 0

摘要

目的：电阻抗断层扫描（EIT）可实现连续图像采集，便于在临床床旁对通气和灌注进行实时测量。关于使用局麻药进行胸腔硬膜外阻滞（TEB）对通气-灌注（V/Q）匹配和单肺通气（OLV）时缺氧的争议性影响的实验和临床研究并不多见。本研究旨在使用 EIT 调查 TEB 联合全身麻醉对单肺通气时肺部灌注分布和 V/Q 匹配的影响：单中心、前瞻性、非盲、随机、平行组临床试验：地点：一所大学附属教学医院的手术室：30名准备接受胸腔手术的患者被随机分配到对照组或TEB组，TEB组接受胸腔硬膜外阻滞和全身麻醉：在双肺通气（T0）、OLV（T1）后 15 分钟以及 OLV（T2）期间通过硬膜外给药给予 0.25 % 罗哌卡因或 0.9 % 生理盐水（T2）后 15 分钟，分别在侧卧位进行 EIT 测量和血气分析。记录血流动力学和呼吸参数，并根据血气分析和 EIT 图像计算死腔率、分流率和 V/Q 匹配率：两组患者从 T0 到 T1 的平均动脉压（p 2/FiO2）。硬膜外注射局麻药后，TEB 组的 PaO2/FiO2 明显降低（p 2）：根据对比增强 EIT 对肺灌注和通气的评估，TEB 似乎会诱发胸外科手术侧卧位 OLV 患者的 V/Q 失配：试验注册：ClinicalTrials.gov，NCT04730089。注册日期：2021 年 1 月 25 日。

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The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study

Objective

Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.

Design

Single-centered, prospective, unblinded, randomized, parallel-group clinical trial.

Setting

Surgical suite of a university-affiliated teaching hospital.

Patients

Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia.

Measurements

EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T₀), 15 min after OLV(T₁), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T₂). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images.

Results

Mean arterial pressure (p < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (p = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO₂/FiO₂) from T₀ to T₁ in both groups. The PaO₂/FiO₂ in the TEB group was significantly lower after epidural administration of the local anesthetic (p < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T₂ (p < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (p = 0.499).

Conclusions

Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.

Trial registration: ClinicalTrials.gov, NCT04730089. Registration on January 25th, 2021.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.