全麻拔管前肺复张对腹腔镜妇科手术患者恢复室内肺部并发症的影响
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摘要
<正>肺复张是指对于机械通气的患者,间断给予高于常规平均气道压的压力并维持一定时间,使萎陷的肺泡重新复张。全身麻醉患者在机械通气期间因分泌物聚积、氧气吸收等因素会出现终末小肺泡的阻塞和萎陷,增加患者术后发生肺不张、肺部感染等并发症的风险[1-3]。对于腹腔镜下妇科手术的患者,气腹的建立会使膈肌上抬、胸腔受压,加之头低位加重了这两项改变,此类患者发生肺泡萎陷的比率特别高[4-6]。有研究表明术中采用保护性通气策略,包括低潮气量、增加呼气末正压(positive end expiratory pressure,PEEP)和间断肺复张,可以降低腹部手术和腹腔镜手术患者术后肺部并发症发生率[7-9]。但间断肺复张的时机尚无定论,特别是拔除气
引文
1 Wirth S,Baur M,Spaeth J,et al.Intraoperative positive end-expiratory pressure evaluation using the intratidal compliance-volume profile[J].Br J Anaesth,2015,114(3):483-490.
2 Wirth S,Kreysing M,Spaeth J,et al.perative compliance profiles and regional lung ventilation improve with increasing positive endexpiratory pressure[J].Acta Anaesthesiol Scand,2016,60(9):1241-1250.
3 Spaeth J,Daume K,Goebel U,et al.Increasing positive end-expiratory pressure(re-)improves intraoperative respiratory mechanics and lung ventilation after prone positioning[J].Br J Anaesth,2016,116(6):838-846.
4 Terragni PP,Rosboch GL,Lisi A,et al.How respiratory system mechanics may help in minimising ventilator-induced lung injury in ARDS patients[J].Eur Respir J Suppl,2003,42:15s-21s.
5 Hartland BL,Newell TJ,Damico N.Alveolar recruitment maneuvers under general anesthesia:a systematic review of the literature[J].Respir Care,2015,60(4):609-620.
6 Wirth S,Biesemann A,Spaeth J,et al.Pneumoperitoneum deteriorates intratidal respiratory system mechanics:an observational study in lung-healthy patients[J].Surg Endosc,2017,31(2):753-760.
7 TuncalB,Erol V,Zeyneloglu P.Effects of volume-controlled equal ratio ventilation with recruitment maneuver and positive endexpiratory pressure in laparoscopic sleeve gastrectomy:a prospective,randomized,controlled trial[J].Turk J Med Sci,2018,48(4):768-776.
8 Ferrando C,Tusman G,Suarez-Sipmann F,et al.Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy:a feasibility study[J].Acta Anaesthesiol Scand,2018,62(5):608-619.
9 Park SJ,Kim BG,Oh AH,et al.Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery:prospective,randomized and controlled trial[J].Surg Endosc,2016,30(10):4598-4606.
10 Choi ES,Oh AY,In CB,et al.Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy:A randomised single-blinded trial[J].PLoS One,2017,12(9):e0183311.
11 Russell GB,Graybeal JM.Hypoxemic episodes of patients in a postanesthesia care unit[J].Chest,1993,104(3):899-903.
12 Michael Dunham C,Hileman BM,Hutchinson AE,et al.Evaluation of operating room reverse Trendelenburg positioning and its effect on postoperative hypoxemia,aspiration,and length of stay:a retrospective study of consecutive patients[J].Perioper Med(Lond),2017,6:10.
13 Ahn S,Byun SH,Chang H,et al.Effect of recruitment maneuver on arterial oxygenation in patients undergoing robot-assisted laparoscopic prostatectomy with intraoperative 15 cm H(2)O positive end expiratory pressure[J].Korean J Anesthesiol,2016,69(6):592-598.
14 Fernandez-Bustamante A,Frendl G,Sprung J,et al.Postoperative Pulmonary Complications,EarlyMortality,and Hospital Stay Following Noncardiothoracic Surgery:A Multicenter Study by the Perioperative Research Network Investigators[J].JAMA Surg,2017,152(2):157-166.
15 Rady MY,Ryan T,Starr NJ.Early onset of acute pulmonary dysfunction after cardiovascular surgery:risk factors and clinical outcome[J].Crit Care Med,1997,25(11):1831-1839.
16 Mitchell CK,Smoger SH,Pfeifer MP,et al.Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery[J].Arch Surg,1998,133(2):194-198.
17 Costa Leme A,Hajjar LA,Volpe MS,et al.Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications:ARandomized Clinical Trial[J].JAMA,2017,317(14):1422-1432.
18 SabatéS,Mazo V,Canet J.Predicting postoperative pulmonary complications:implications for outcomes and costs[J].Curr Opin Anaesthesiol,2014,27(2):201-209.
19 Langeron O,Carreira S,le SachéF,et al.Postoperative pulmonary complications updating[J].Ann Fr Anesth Reanim,2014,33(7-8):480-483.(:)
2 Wirth S,Kreysing M,Spaeth J,et al.perative compliance profiles and regional lung ventilation improve with increasing positive endexpiratory pressure[J].Acta Anaesthesiol Scand,2016,60(9):1241-1250.
3 Spaeth J,Daume K,Goebel U,et al.Increasing positive end-expiratory pressure(re-)improves intraoperative respiratory mechanics and lung ventilation after prone positioning[J].Br J Anaesth,2016,116(6):838-846.
4 Terragni PP,Rosboch GL,Lisi A,et al.How respiratory system mechanics may help in minimising ventilator-induced lung injury in ARDS patients[J].Eur Respir J Suppl,2003,42:15s-21s.
5 Hartland BL,Newell TJ,Damico N.Alveolar recruitment maneuvers under general anesthesia:a systematic review of the literature[J].Respir Care,2015,60(4):609-620.
6 Wirth S,Biesemann A,Spaeth J,et al.Pneumoperitoneum deteriorates intratidal respiratory system mechanics:an observational study in lung-healthy patients[J].Surg Endosc,2017,31(2):753-760.
7 TuncalB,Erol V,Zeyneloglu P.Effects of volume-controlled equal ratio ventilation with recruitment maneuver and positive endexpiratory pressure in laparoscopic sleeve gastrectomy:a prospective,randomized,controlled trial[J].Turk J Med Sci,2018,48(4):768-776.
8 Ferrando C,Tusman G,Suarez-Sipmann F,et al.Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy:a feasibility study[J].Acta Anaesthesiol Scand,2018,62(5):608-619.
9 Park SJ,Kim BG,Oh AH,et al.Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery:prospective,randomized and controlled trial[J].Surg Endosc,2016,30(10):4598-4606.
10 Choi ES,Oh AY,In CB,et al.Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy:A randomised single-blinded trial[J].PLoS One,2017,12(9):e0183311.
11 Russell GB,Graybeal JM.Hypoxemic episodes of patients in a postanesthesia care unit[J].Chest,1993,104(3):899-903.
12 Michael Dunham C,Hileman BM,Hutchinson AE,et al.Evaluation of operating room reverse Trendelenburg positioning and its effect on postoperative hypoxemia,aspiration,and length of stay:a retrospective study of consecutive patients[J].Perioper Med(Lond),2017,6:10.
13 Ahn S,Byun SH,Chang H,et al.Effect of recruitment maneuver on arterial oxygenation in patients undergoing robot-assisted laparoscopic prostatectomy with intraoperative 15 cm H(2)O positive end expiratory pressure[J].Korean J Anesthesiol,2016,69(6):592-598.
14 Fernandez-Bustamante A,Frendl G,Sprung J,et al.Postoperative Pulmonary Complications,EarlyMortality,and Hospital Stay Following Noncardiothoracic Surgery:A Multicenter Study by the Perioperative Research Network Investigators[J].JAMA Surg,2017,152(2):157-166.
15 Rady MY,Ryan T,Starr NJ.Early onset of acute pulmonary dysfunction after cardiovascular surgery:risk factors and clinical outcome[J].Crit Care Med,1997,25(11):1831-1839.
16 Mitchell CK,Smoger SH,Pfeifer MP,et al.Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery[J].Arch Surg,1998,133(2):194-198.
17 Costa Leme A,Hajjar LA,Volpe MS,et al.Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications:ARandomized Clinical Trial[J].JAMA,2017,317(14):1422-1432.
18 SabatéS,Mazo V,Canet J.Predicting postoperative pulmonary complications:implications for outcomes and costs[J].Curr Opin Anaesthesiol,2014,27(2):201-209.
19 Langeron O,Carreira S,le SachéF,et al.Postoperative pulmonary complications updating[J].Ann Fr Anesth Reanim,2014,33(7-8):480-483.(:)