背景:术中保护性肺通气策略已被广泛推荐用于腹腔镜手术。然而,关于最佳呼气末正压(PEEP)水平及其在气腹期间的影响尚无共识.最近引入了电阻抗断层扫描(EIT)作为床边工具来实时监测肺通气。
目的:我们假设单独滴定的EIT-PEEP调整到手术干预可以改善手术期间和术后的呼吸力学。
方法:随机对照试验。
方法:解放军总医院第一医学中心,北京。
方法:75例患者在全身麻醉下接受机器人辅助腹腔镜肝胆胰手术。
方法:患者被随机分配2:1接受个性化EIT滴定PEEP(PEEPEIT;n=50)或传统PEEP5cmH2O(PEEP5cmH2O;n=25)。PEEPEIT组在气腹期间接受单独滴定的EIT-PEEP。PEEP5cmH2O组在气腹期间接受5cmH2O的PEEP。
方法:主要结果是腹腔镜手术期间的呼吸系统顺应性。次要结果是个性化PEEP水平,氧合,呼吸和血液动力学状态,术后7天内肺部并发症(PPCs)的发生。
结果:与PEEP5cmH2O相比,接受PEEPEIT的患者有更高的呼吸系统依从性(手术期间的平均值为44.3±11.3vs.31.9±6.6,mlcmH2O-1;P<0.001),较低的驱动压力(11.5±2.1vs.14.0±2.4cmH2O;P<0.001),更好的氧合(平均PaO2/FiO2427.5±28.6vs.366.8±36.4;P=0.003),术后肺不张较少(19.4±1.6vs.肺组织块46.3±14.8g;P=0.003)。两组之间的血流动力学值没有显着差异。手术期间未观察到不良反应。
结论:通过EIT进行个体化PEEP可以改善术中肺力学和氧合,而不会损害血流动力学稳定性,减少术后肺不张。
背景:中国临床试验注册中心(www.chictr.org.cn)标识符:ChiCTR2100045166。
A protective intra-operative lung ventilation strategy has been widely recommended for laparoscopic surgery. However, there is no consensus regarding the optimal level of positive end-expiratory pressure (PEEP) and its effects during
pneumoperitoneum. Electrical impedance tomography (EIT) has recently been introduced as a bedside tool to monitor lung ventilation in real-time.
We hypothesised that individually titrated EIT-PEEP adjusted to the surgical intervention would improve respiratory mechanics during and after surgery.
Randomised controlled trial.
First Medical Centre of Chinese PLA General Hospital, Beijing.
Seventy-five patients undergoing robotic-assisted laparoscopic hepatobiliary and pancreatic surgery under general anaesthesia.
Patients were randomly assigned 2 : 1 to individualised EIT-titrated PEEP (PEEPEIT; n = 50) or traditional PEEP 5 cmH2O (PEEP5 cmH2O; n = 25). The PEEPEIT group received individually titrated EIT-PEEP during
pneumoperitoneum. The PEEP5 cmH2O group received PEEP of 5 cmH2O during
pneumoperitoneum.
The primary outcome was respiratory system compliance during laparoscopic surgery. Secondary outcomes were individualised PEEP levels, oxygenation, respiratory and haemodynamic status, and occurrence of postoperative pulmonary complications (PPCs) within 7 days.
Compared with PEEP5 cmH2O, patients who received PEEPEIT had higher respiratory system compliance (mean values during surgery of 44.3 ± 11.3 vs. 31.9 ± 6.6, ml cmH2O-1; P < 0.001), lower driving pressure (11.5 ± 2.1 vs. 14.0 ± 2.4 cmH2O; P < 0.001), better oxygenation (mean PaO2/FiO2 427.5 ± 28.6 vs. 366.8 ± 36.4; P = 0.003), and less postoperative atelectasis (19.4 ± 1.6 vs. 46.3 ± 14.8 g of lung tissue mass; P = 0.003). Haemodynamic values did not differ significantly between the groups. No adverse effects were observed during surgery.
Individualised PEEP by EIT may improve intra-operative pulmonary mechanics and oxygenation without impairing haemodynamic stability, and decrease postoperative atelectasis.
Chinese Clinical Trial Registry (www.chictr.org.cn) identifier: ChiCTR2100045166.