低氧流量和高氧流量联合肺保护性通气对腹部手术后肺部并发症的影响：随机对照试验
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低氧流量和高氧流量联合肺保护性通气对腹部手术后肺部并发症的影响：随机对照试验
翻译：吴学艳 编辑：冯玉蓉 审校：曹莹
研究目的：术中肺保护性通气策略已被推荐用于减少术后肺部并发症(PPCs)，然而，吸入氧浓度(FiO2)在这种通气策略中的作用仍不明确，我们旨在评估术中低FiO2(30%)和高FiO2(80%)联合肺保护性通气策略对腹部手术患者PPCs的影响。
设计：前瞻性、平行随机对照试验。
机构：中国高等专科医院。
受试者：年龄≥18岁、ASA I~III级、计划在全身麻醉下行择期腹部手术的252例患者。
干预措施：患者术中被随机分配接受30%或80%的FiO2。所有患者均采用容量控制机械通气的肺保护通气方案，包括预测体重潮气量为8ml/ kg，PEEP水平6~8cm H2O，以及反复肺复张通气。
测量指标：主要结果是术后7天内的综合肺部并发症，包括呼吸道感染、呼吸衰竭、支气管痉挛、肺不张、胸腔积液、气胸和吸入性肺炎。PPCs的严重程度作为一个重要的次要指标进行测量。
主要结果：251例患者完成了试验。125例接受30%FiO2的患者中有43例（34.4%）发生PPCs，而126例接受80%FiO2的患者中有59例（46.8%）发生PPCs(相对风险0.74，97.5%CI 0.51-1.02，p=0.045，>0.025)。低FiO2组(FiO2 30%）术后7天内PPCs的严重程度明显减轻(p=0.001)。
结论：在全麻腹部手术患者中，30% FiO2与80% FiO2联合术中肺保护通气策略并没有降低PPCs的发生率，但使用30% FiO2可减少严重的肺部并发症。
原始文献来源: Li XF, Jiang D, Jiang YL, et al.Comparison of low and high inspiratory oxygen fraction added to lung-protective ventilation on postoperative pulmonary complications after abdominal surgery: A randomized controlled trial.[J].J Clin Anesth 2020 Aug 21;67.
Comparison of low and high inspiratory oxygen fraction added to lung-protective ventilation on postoperative pulmonary complications after abdominal surgery: A randomized controlled trial
Abstract
Study objective:Intraoperative lung-protective ventilation strategy has been recommended to reduce postoperative pulmonary complications (PPCs). However, the role of inspiratory oxygen fraction (FiO2) in this protection remains highly uncertain. We aimed to evaluate the effect of intraoperative low (30%) versus high (80%) FiO2 in the context of lung-protective ventilation strategy on PPCs in patients undergoing abdominal surgery.
Design:Prospective, two-arm, randomized controlled trial.
Setting:Tertiary university hospital in China.
Patients:A total of ASA I-III 252 patients aged ≥18, who were scheduled for elective abdominal surgery under general anesthesia were included in the study.
Intervention:Patients were randomly assigned to receive either 30% or 80% FiO during the intraoperative period. All patients received volume-controlled mechanical ventilation with lung-protective ventilation approach, which included a tidal volume of 8 ml kg of predicted body weight, a positive end-expiratory pressure level of 6-8 cmH2O, and repeated recruitment maneuvers.
Measurements:The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, consisting of respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, and aspiration pneumonitis. The severity grade of PPCs was measured as a key secondary outcome.
Main results:Two hundred and fifty-one patients completed the trial. PPCs occurred in 43 of 125 (34.4%) patients assigned to receive 30% FiO compared with 59 of 126 (46.8%) patients receiving 80% FiO (relative risk 0.74, 97.5% confidence interval, 0.51-1.02, p = 0.045, > 0.025). The severity of PPCs within the first 7 days following surgery was attenuated significantly in the low (30%) FiO group (p = 0.001).
Conclusions:Among patients undergoing abdominal surgery under general anesthesia, an intraoperative lung-protective ventilation strategy with 30% FiO compared with 80% FiO did not reduce the incidence of PPCs. And the use of 30% FiO resulted in less severe pulmonary complications.
贵州医科大学高鸿教授课题组
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