大多数患者在全身麻醉下可能会出现肺不张,并且Trendelenburg位置和气腹会加重腹腔镜手术中的肺不张,促进术后肺部并发症。肺复张操作已被证明可以减少围手术期肺不张,但是哪种方法是最佳的仍然存在争议。超声成像可以有助于确认肺募集动作的效果。我们的研究目的是通过超声评估超声引导下的肺泡募集操作对减少围手术期肺不张的影响,并检查在腹腔镜妇科手术中,超声引导下的募集操作(视觉和半定量)对肺不张的影响是否优于持续充气募集操作(经典和广泛使用)。
在这个随机的,控制,双盲研究,纳入接受腹腔镜妇科手术的妇女.患者被随机分配接受肺部超声引导下的肺泡募集治疗(UD组),持续充气肺泡募集动作(SI组),或没有RM(C组)使用计算机生成的随机数表。在四个预定时间点进行肺部超声检查。主要结果是手术结束时各组之间肺超声评分(LUS)的差异。
手术结束后,UD组的肺部超声评分明显低于SI组和C组(7.67±1.15比9.70±102,差异有统计学意义,-2.03[95%置信区间,-2.77至-1.29],P<0.001;7.67±1.15对11.73±1.96,差异-4.07[95%置信区间,-4.81至-3.33],P<0.001;,分别)。组间差异持续至气管拔管后30min(9.33±0.96vs11.13±0.97,-1.80[95%置信区间,-2.42至-1.18],P<0.001;9.33±0.96对10.77±1.57,差异-1.43[95%置信区间,-2.05至-0.82],P<0.001;,分别)。手术结束时SI组LUS明显低于C组(9.70±1.02比11.73±1.96,-2.03[95%置信区间,-2.77至-1.29]P<0.001),但在气管拔管后30分钟,获益并没有持续。
全身麻醉期间,超声引导下的扩张操作可以减少围手术期通气损失并改善氧合。此外,超声引导下的招募操作对肺不张的影响优于持续的通货膨胀招募操作。
Chictr.org.cn,ChiCTR2100042731,2021年1月27日注册,www.chictr.org.cn.
The majority of patients may experience atelectasis under general anesthesia, and the Trendelenburg position and pneumoperitoneum can aggravate atelectasis during laparoscopic surgery, which promotes postoperative pulmonary complications. Lung recruitment manoeuvres have been proven to reduce perioperative atelectasis, but it remains controversial which method is optimal. Ultrasonic imaging can be conducive to confirming the effect of lung recruitment manoeuvres. The purpose of our study was to assess the effects of ultrasound-guided alveolar recruitment manoeuvres by ultrasonography on reducing perioperative atelectasis and to check whether the effects of recruitment manoeuvres under ultrasound guidance (visual and semiquantitative) on atelectasis are superior to sustained inflation recruitment manoeuvres (classical and widely used) in laparoscopic gynaecological surgery.
In this randomized, controlled, double-blinded study, women undergoing laparoscopic gynecological surgery were enrolled. Patients were randomly assigned to receive either lung ultrasound-guided alveolar recruitment manoeuvres (UD group), sustained inflation alveolar recruitment manoeuvres (SI group), or no RMs (C group) using a computer-generated table of random numbers. Lung ultrasonography was performed at four predefined time points. The primary outcome was the difference in lung ultrasound score (LUS) among groups at the end of surgery.
Lung ultrasound scores in the UD group were significantly lower than those in both the SI group and the C group immediately after the end of surgery (7.67 ± 1.15 versus 9.70 ± 102, difference, -2.03 [95% confidence interval, -2.77 to -1.29], P < 0.001; 7.67 ± 1.15 versus 11.73 ± 1.96, difference, -4.07 [95% confidence interval, -4.81 to -3.33], P < 0.001;, respectively). The intergroup differences were sustained until 30 min after tracheal extubation (9.33 ± 0.96 versus 11.13 ± 0.97, difference, -1.80 [95% confidence interval, -2.42 to -1.18], P < 0.001; 9.33 ± 0.96 versus 10.77 ± 1.57, difference, -1.43 [95% confidence interval, -2.05 to -0.82], P < 0.001;, respectively). The SI group had a significantly lower LUS than the C group at the end of surgery (9.70 ± 1.02 versus 11.73 ± 1.96, difference, -2.03 [95% confidence interval, -2.77 to -1.29] P < 0.001), but the benefit did not persist 30 min after tracheal extubation.
During general anesthesia, ultrasound-guided recruitment manoeuvres can reduce perioperative aeration loss and improve oxygenation. Furthermore, these effects of ultrasound-guided recruitment manoeuvres on atelectasis are superior to sustained inflation recruitment manoeuvres.
Chictr.org.cn, ChiCTR2100042731, Registered 27 January 2021, www.chictr.org.cn .