围手术期肺超声在小儿心脏手术中的应用：一项随机、对照研究
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Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A Randomized Controlled Trial
背景与目的：小儿心脏病患者存在围手术期呼吸功能不全的风险。本研究的目的是评估围术期肺部超声检查在小儿心脏手术中的效用。
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方法：在这项随机对照试验中，接受心脏手术的儿童（5岁或以下）被分配到对照组（n = 61）或干预（n = 61）组。对照组在手术结束时和手术后6-12小时仅接受肺部超声检查。干预组在麻醉后、手术结束和术后6~12h根据超声检查结果，进行肺超声检查和超声引导下的肺复张。主要结果是术中和术后低氧饱和度以及术后肺部并发症。在主要的结果分析中多重比较被修正(P≤0.017)。
结果：在分析中包括的120名儿童中，术后低氧饱和度（64％对27％; P <0.001;比值比[OR]，0.210; 95 ％CI，0.097至0.456）在对照组发生更多。术中低氧饱和度的发生率（36％vs. 19％; P = 0.033; OR，0.406; 95％CI，0.176〜0.939）和术后肺部并发症（12％vs. 3％; P = 0.093; OR，0.271; 95 ％CI，0.054至1.361）两组之间相似。干预组的肺超声评分优于对照组。对照组机械通气时间长于干预组（38±43vs26±25h;平均差异的95％CI，0〜25; P = 0.048）。
结论：围手术期肺部超声检查后，超声引导下的人工操作有助于减少儿科心脏病患者的术后低氧饱和度事件并缩短机械通气时间。
Song IK1, Kim EH, Lee JH, Kang P, Kim HS, Kim JT.
Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A Randomized Controlled Trial.
Anesthesiology. Apr，2018 ;128(4):718-727. doi: 10.1097/ALN.0000000000002069.
BACKGROUND: Pediatric cardiac patients are at risk for perioperative respiratory insufficiency. The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery.
METHODS:In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12 h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12 h after surgery. Primary outcomes were incidences of intra- and postoperative desaturation, and postoperative pulmonary complications. Multiple comparisons were corrected (P ≤ 0.017) in the primary outcome analysis.
RESULTS: Of the 120 children included in the analysis, postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups. Lung ultrasound scores were better in the intervention group than in the control group. Duration of mechanical ventilation was longer in the control group than in the intervention group (38 ± 43 vs. 26 ± 25 h; 95% CI of mean difference, 0 to 25; P = 0.048).
CONCLUSIONS:Perioperative lung ultrasound examination followed by ultrasound-guided recruitment maneuver helped decrease postoperative desaturation events and shorten the duration of mechanical ventilation in pediatric cardiac patients.
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