Abstract：
Lung recruitment manoeuvres (RMs) during mechanical ventilation may reduce atelectasis, however, the optimal recruitment strategy for patients undergoing thoracic surgery remains unknown. Our study was designed to investigate whether ultrasound-guided lung RMs is superior to conventional RMs in reducing perioperative atelectasis during thoracic surgery with one-lung ventilation. We conducted a randomised controlled clinical trial from August 2022 to September 2022. Sixty patients scheduled for video-assisted thoracoscopic surgery (VATS) under general anaesthesia were enrolled. Subjects were randomly divided into the ultrasound-guided RMs group (manual inflation guided by lung ultrasound) or conventional RMs group (manual inflation with 30 cmH2O pressure). Lung ultrasound were performed at three predefined time points (1 min after anaesthetic induction; after RMs at the end of surgery; before discharge from postanesthesia care unit [PACU]). The primary outcome was lung ultrasound score before discharge from the PACU after extubation. In the early postoperative period, lung aeration deteriorated in both groups even after lung RMs. However, ultrasound-guided lung RMs had significantly lower lung ultrasound scores when compared with conventional RMs in bilateral lungs (2.0 [0.8-4.0] vs. 8.0 [3.8-10.3], P < 0.01) at the end of surgery, which remained before patients discharged from the PACU. Accordingly, the lower incidence of atelectasis was found in ultrasound-guided RMs group than in conventional RMs group (7% vs. 53%; P < 0.01) at the end of surgery. Ultrasound-guided RMs is superior to conventional RMs in improving lung aeration and reducing the incidence of lung atelectasis at early postoperative period in patients undergoing VATS. The study protocol was approved by the Institutional Review Board of the Fudan University Shanghai Cancer Center (No. 220,825,810; date of approval: August 5, 2022) and registered on Chinese Clinical Trial Registry (registration number: ChiCTR2200062761).
摘要：
机械通气期间的肺复张操作（RM）可以减少肺不张，然而,胸外科手术患者的最佳招募策略仍未知.我们的研究旨在研究超声引导下的肺RM在减少单肺通气胸部手术围手术期肺不张方面是否优于常规RM。我们从2022年8月至2022年9月进行了一项随机对照临床试验。纳入60例计划在全身麻醉下进行电视辅助胸腔镜手术（VATS）的患者。将受试者随机分为超声引导的RM组（由肺部超声引导的手动充气）或常规RM组（以30cmH2O压力手动充气）。在三个预定时间点（麻醉诱导后1分钟；手术结束时的RM后；从麻醉后护理室[PACU]出院前）进行肺部超声检查。主要结果是拔管后PACU出院前的肺部超声评分。在术后早期，即使在肺RM后，两组的肺通气都恶化了。然而，与双侧肺的常规RM相比，超声引导的肺RM的肺超声评分显着降低（2.0[0.8-4.0]vs.8.0[3.8-10.3]、P<0.01)在手术结束时,在患者从PACU出院之前仍然存在。因此，超声引导下的RM组肺不张的发生率低于常规RM组(7%vs.53％；P<0.01）在手术结束时。超声引导下的RM在改善VATS患者术后早期肺通气和降低肺不张的发生率方面优于常规RM。该研究方案获得了复旦大学上海癌症中心机构审查委员会的批准（编号：220,825,810；批准日期：2022年8月5日），并在中国临床试验注册中心注册（注册号：ChiCTR2200062761）。
