心脏手术患者低潮气量通气与氧合改善相关
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Low Tidal Volumes Are Associated With Slightly Improved Oxygenation in Patients Having Cardiac Surgery: A Cohort Analysis
背景与目的
低潮气量机械通气对非心脏手术的患者有好处；然而它是否对心脏手术的患者有好处目前不清楚。
方 法
我们回顾性研究了2010年1月至2016年8月中旬接受单腔气管插管机械通气的需要通过胸骨正中切口进行体外循环的择期心脏手术患者。分析体外循环手术期间的时间加权平均潮气量(毫升/千克预计体重[PBW])。检查潮气量与术后氧合(动脉血氧分压(PaO2)/吸入氧分数[PaO2/FiO2])、氧合受损(PaO2/FiO2<300)和临床结局的关系。
结 果
在9359名心脏手术患者中，潮气量较大与术后氧合稍差有关。术后潮气量每增加1mL/kg PBW，PaO2/FiO2下降1.05%(97.5%可信区间[CI]，−1.74至−0.37；P=0.0005)。术中潮气量的增加还与氧合受损的几率增加有关(优势比[OR；97.5%CI]：每1mL/kg PBW增加1.08[1.02-1.14]；P=0.0029)，插管时间稍长(每1mL/kg潮气量增加5%)(危险比[98.33%CI]，每1mL/kg PBW 0.95[0.93-0.98]；P<0.0001)，死亡率增加(OR[98.33%CI]，每增加1mL/kg PBW，1.34[1.06-1.70]；P=0.0144)。术中潮气量增加也与术后急性呼吸衰竭有关(OR[98.33%CI]，每增加1mL/kg PBW 1.16[1.03-1.32]；P=0.0146)，但与其他肺部并发症无关。
结 论
较低的潮气量与心脏手术患者术后氧合的改善相关。
原始文献摘要
Jia Y, Leung SM, Turan A；Low Tidal Volumes Are Associated With Slightly Improved Oxygenation in Patients Having Cardiac Surgery: A Cohort Analysis；Anesth. Analg. 2020 Jan 02;PMID：31904632；DOI：10.1213/ANE.0000000000004608
BACKGROUND:Mechanical ventilation with low tidal volumes appears to provide benefit in patients having noncardiac surgery; however, whether it is beneficial in patients having cardiac surgery is unclear.
METHODS:We retrospectively examined patients having elective cardiac surgery requiring cardiopulmonary bypass through a median sternotomy approach who received mechanical ventilation with a single lumen endotracheal tube from January 2010 to mid-August 2016. Time-weighted average tidal volume (milliliter per kilogram predicted body weight [PBW]) during the duration of surgery excluding cardiopulmonary bypass was analyzed. The association between tidal volumes and postoperative oxygenation (measured by arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen ratio [PaO2/FIO2]), impaired oxygenation (PaO2/FIO2<300), and clinical outcomes were examined.
RESULTS:Of 9359 cardiac surgical patients, larger tidal volumes were associated with slightly worse postoperative oxygenation. Postoperative PaO2/FIO2 decreased an estimated 1.05% per 1 mL/kg PBW increase in tidal volume (97.5% confidence interval [CI], -1.74 to -0.37; PBon = .0005). An increase in intraoperative tidal volumes was also associated with increased odds of impaired oxygenation (odds ratio [OR; 97.5% CI]: 1.08 [1.02-1.14] per 1 mL/kg PBW increase in tidal volume; PBon = .0029), slightly longer intubation time (5% per 1 mL/kg increase in tidal volume (hazard ratio [98.33% CI], 0.95 [0.93-0.98] per 1 mL/kg PBW; PBon < .0001), and increased mortality (OR [98.33% CI], 1.34 [1.06-1.70] per 1 mL/kg PBW increase in tidal volume; PHolm =0 .0144). An increase in intraoperative tidal volumes was also associated with acute postoperative respiratory failure (OR [98.33% CI], 1.16 [1.03-1.32] per 1 mL/kg PBW increase in tidal volume; PHolm =0 .0146), but not other pulmonary complications.
CONCLUSIONS:Lower time-weighted average intraoperative tidal volumes were associated with a very modest improvement in postoperative oxygenation in patients having cardiac surgery.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：冯玉蓉 审校：王贵龙