定期肺泡复张对患儿俯卧位通气术中肺不张的影响：随机对照试验
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Effect of regular alveolar recruitment on intraoperative atelectasis in paediatric patients ventilated in the prone position: a randomised controlled trial
背景与目的
婴幼儿全身麻醉后俯卧位通气经常出现氧饱和度下降。我们旨在评估定期肺泡复张预防婴幼儿全身麻醉后俯卧位通气肺不张的效果。
方 法
全身麻醉（＞2h）后俯卧位通气的婴幼儿（＜3岁）被随机分配至定期肺泡复张组或不接受复张的标准化护理组。两组均采用超声检查确定患儿的肺泡复张情况，并均以6 ml kg-1的潮气量和7cm H2O的PEEP开始进行机械通气。机械通气过程中，干预组（定期肺泡复张组）每小时进行一次肺泡复张。在诱导麻醉和每次体位改变后进行超声检查。研究者在双盲状态下通过肺部超声检查，确定患儿拔管前是否存在明显的肺不张（任何区域肺实变评分≥2）。
结 果
共有73名患儿纳入分析（其中定期肺泡复张组37名，标准化护理组36名）。在接受每小时的干预前，定期肺泡复张组和标准化护理组的患儿在仰卧位时（两组均为83.3%，P＞0.99）和俯卧位时（88.9% vs 91.9%，P＝0.970）肺不张情况均相似。与随机分入标准化护理组患儿的47.1%的肺不张发生率相比，接受定期肺泡复张的患儿在拔管前肺不张的发生率更低（8.1%）（绝对风险降低39.1%[95%CI：20.6%－57.6%]；P＜0.001）。
结 论
3岁以下的婴幼儿在接受全身麻醉后俯卧位通气时，定期肺泡复张可以降低手术结束时肺不张发生率。
原始文献来源及摘要
Jang YE, Ji SH, Kim EH, et al. Effect of regular alveolar recruitment on intraoperative atelectasis in paediatric patients ventilated in the prone position: a randomised controlled trial.[J].Br J Anaesth 2020,pii: S0007-0912(20)30085-4.
Abstract
Background: Desaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position.
Methods: Children (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg-1 and PEEP of 7 cm H2O. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score>2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation.
Results: Seventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P=0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6%-57.6%); P<0.001).
Conclusions: Regular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：佟睿 编辑：冯玉蓉 审校：曹莹