【罂粟摘要】婴儿全麻诱导期间自主呼吸对肺不张的影响：一项前瞻性随机对照试验
婴儿全麻诱导期间自主呼吸对肺不张的影响：一项前瞻性随机对照试验
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
肺不张常见于儿童，尤其是婴儿的全身麻醉诱导过程中。
假设维持自主通气可以减少麻醉诱导期间婴儿肺不张的形成。比较自主通气和手动正压通气在婴儿肺不张形成中的作用。
随机对照研究。
招募了60名1岁以下接受全身麻醉的儿童，其中56人完成了研究。排除标准为既往全身麻醉期间有低氧血症史、1个月内出现呼吸道感染、目前插管或气管造口插管、需要快速顺序插管、早产、年龄在孕后60周内以及有罗库溴铵或硫喷妥钠禁忌症。
患者被随机分配到“自主呼吸”组或“手动正压通气”组。在预给氧期间，“自主呼吸”组维持自主通气，而“手动正压通气”组则维持常规的面罩通气。预给氧5min后，进行肺超声检查，比较两组肺不张形成情况。
预给氧后“自主呼吸”组26例中有7例(26.9%)出现肺不张，“手动正压通气”组30例中有22例(73.3%)出现肺不张(P=0.001)。“自主呼吸”组肺不张的相对危险度为0.39(95%CI为0.211~0.723)。在实变的超声图像上，“自主呼吸”肺部各分区的实变得分和总分均显著低于“手动正压通气”组(P值分别为0.007和0.001)。
在全麻诱导期间保持自主通气对1岁以下婴儿肺不张有预防作用，特别是在肺的前、侧、后分区部分。
原始文献来源：
Ji SH, Jang HS, Jang YE,et,al.Effect of spontaneous breathing on atelectasis during induction of general anaesthesia in infants[J].Eur J Anaesthesiol. 2020 Dec;37(12):1150-1156. doi: 10.1097/EJA.0000000000001327.
BACKGROUND Atelectasis occurs commonly during induction of general anaesthesia in children, particularly infants.
OBJECTIVES We hypothesised that maintaining spontaneous ventilation can reduce atelectasis formation during anaesthetic induction in infants. We compared spontaneous ventilation and manual positive-pressure ventilation in terms of atelectasis formation in infants.
DESIGN Randomised controlled study.
SETTING Single tertiary hospital in Seoul, Republic of Korea,from November 2018 to December 2019.
PATIENTS We enrolled 60 children younger than 1 year of age undergoing general anaesthesia, of whom 56 completed the study. Exclusion criteria were history of hypoxaemia during previous general anaesthesia, development of a respiratory tract infection within 1 month, current intubation or tracheostomy cannulation, need for rapid sequence intubation, preterm birth, age within 60 weeks of the postconceptional age and the presence of contraindications for rocuronium or sodium thiopental.
INTERVENTION Patients were allocated randomly to either the 'spontaneous’ group or 'controlled’ group. During preoxygenation, spontaneous ventilation was maintained in the 'spontaneous’ group while conventional bag-mask ventilation was provided in the 'controlled’ group. After 5 min of preoxygenation, a lung ultrasound examination was performed to compare atelectasis formation in the two groups.
RESULTS Atelectasis after preoxygenation was seen in seven (26.9%) of 26 patients in the 'spontaneous’ group and 22 (73.3%) of 30 patients in the 'controlled’ group (P=0.001). The relative risk of atelectasis in the 'spontaneous’ group was 0.39 (95% CI 0.211 to 0.723). Regarding ultrasound pictures of consolidation, the total score and sum of scores in the dependent regions were significantlylowerin the 'spontaneous’ group than in the 'controlled’ group (P=0.007 and 0.001, respectively).
CONCLUSION Maintaining spontaneous ventilation during induction of general anaesthesia has a preventive effect against atelectasis in infants younger than 1 year of age,particularly in the dependent portions of the lungs.