低潮气量机械通气对腹腔镜下肝切除术患者出血量的影响：随机对照试验
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低潮气量机械通气对腹腔镜下肝切除术患者出血量的影响：随机对照试验
翻译：何幼芹 编辑：冯玉蓉 审校：曹莹
背景：腹腔镜肝切除术(LLR)中控制出血对患者的安全非常重要。目前尚不清楚不同潮气量的机械通气对LLR期间出血的影响。因此，本研究旨在探讨低潮气量机械通气(LTV)是否能减少LLR期间的手术出血。
方法：本研究采用前瞻性、随机、对照的临床研究方法将82例行LLR患者随机分为LTV组(6~8mL/kg)[无呼气末正压(PEEP)，并且30min膨肺1次]和常规潮气量(CTV)组(10~12mL/kg)。比较两组在肝切除术中估计的出血量和术后呼吸道并发症的发生率。
结果：LTV组患者估计失血量(中位数[四分位数间距{IQR}])较CTV组减少(301[148,402]vs 394[244，672]mL，P=0.009)；与CTV组相比，LTV组每厘米肝脏横断面失血量(5.5[4.1, 7.7]vs12.2[9.8, 14.4]mL/cm，P<0.001)和临床显著估计失血量(>800mL)的风险均降低(0/40 vs 8/40，P=0.003)。与CTV组相比，LTV组的输血量减少(5% vs 20%，P=0.043)。CTV组有2例患者由LLR转行开腹肝切除术，而LTV组则无。LTV组气道平台压低于CTV组（均数±标准差[SD]）(12.7±2.4vs17.5±3.5cmH2O，P=0.002)。
结论：LTV机械通气可减少腹腔镜下行肝脏手术患者的术中出血。
The Effect of Mechanical Ventilation With Low Tidal Volume on Blood Loss During Laparoscopic Liver Resection: A Randomized Controlled Trial.
[Abstract]
BACKGROUND:Control of bleeding during laparoscopic liver resection (LLR) is important for patient safety. It remains unknown what the effects of mechanical ventilation with varying tidal volumes on bleeding during LLR. Thus, this study aims to investigate whether mechanical ventilation with low tidal volume (LTV) reduces surgical bleeding during LLR.
METHODS:In this prospective, randomized, and controlled clinical study, 82 patients who underwent scheduled LLR were enrolled and randomly received either mechanical ventilation with LTV group (6-8 mL/kg) along with recruitment maneuver (once/30 min) without positive end-expiratory pressure (PEEP) or conventional tidal volume (CTV; 10-12 mL/kg) during parenchymal resection. The estimated volume of blood loss during parenchymal resection and the incidence of postoperative respiratory complications were compared between 2 groups.
RESULT:The estimated volume of blood loss (median [interquartile range {IQR}]) was decreased in the LTV group compared to the CTV group (301 [148, 402] vs 394 [244, 672] mL, P = .009); blood loss per cm of transected surface of liver (5.5 [4.1, 7.7] vs 12.2 [9.8, 14.4] mL/cm, P < .001) and the risk of clinically significant estimated blood loss (>800 mL) were reduced in the LTV group compared to the CTV group (0/40 vs 8/40, P = .003). Blood transfusion was decreased in the LTV group compared to the CTV group (5% vs 20% of patients , P = .043). No patient in the LTV group but 2 patients in the CTV group were switched from LLR to open hepatectomy. Airway plateau pressure was lower in the LTV group compared to the CTV group (mean ± standard deviation [SD]) (12.7 ± 2.4 vs 17.5 ± 3.5 cm H2O, P = .002).
CONCLUSIONS:Mechanical ventilation with LTV may reduce bleeding during laparoscopic liver surgery.
贵州医科大学高鸿教授课题组
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