不同浓度氧吸入对机械通气患儿肺不张的影响：随机对照研究

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Effect of different fraction of inspired oxygen on development of atelectasis in mechanically ventilated children A randomized controlled trial

背景与目的

高浓度的吸入氧浓度（FiO₂）会导致直接的肺毒性以及肺部并发症，本研究的目的是通过肺部超声来评估术中不同FiO₂对机械通气患儿发生肺不张的影响。

方  法

86名小于6周岁择期在全麻下行非心脏手术的患儿被随机分为两组：高FiO₂组和低FiO₂组。低FiO₂组吸入30%的空氧混合气体，高FiO₂组吸入100%纯氧。设定潮气量为8 mL/kg，PEEP 5cm H₂O，呼吸次数15-40次/分，使EtCO₂ 维持在35‐45 mmHg。主要指标：术后肺超声检查中严重肺不张的发生率。次要指标：术前严重肺不张、术中及术后（24小时内）低氧（SpO₂<95%）、术后发热（24小时内体温≧37.5°C），以及术后24小时内的肺部并发症的发生情况。

结 果  

低FiO₂组术后严重肺不张的发生率为28%，而高FiO₂组的发生率为37%，两者之间没有统计学差异 (28% vs 37%;P =0.357; OR= 1.531; 95% CI: 0.617‐3.800) 。两组间术前肺超声的显著肺不张发生率也相似（12%vs9%；；P=0.725；OR= 0.779；95%CI:0.194–3.125）。其余指标无统计学差异。

结 论

吸入不同浓度的氧并不会对机械通气的患儿严重肺不张的发生产生影响。

原始文献摘要

Song IK, Jang YE, Lee JH,et al;Effect of different fraction of inspired oxygen on development of atelectasis in mechanically ventilated children A randomized controlled trial;Paediatr Anaesth. 2019 Oct;29(10):1033-1039. doi: 10.1111/pan.13718.

Background: The use of high fraction of inspired oxygen (FIO₂) can cause direct pulmonary toxicity and pulmonary complications. The purpose of this study was to evaluate the effect of different FIO₂ on development of intraoperative atelectasis in mechanically ventilated children using lung ultrasound.

Methods: In this randomized, controlled, patient- and sonographer-blinded trial, 86 children (≤6 yr) undergoing non-cardiac surgery were allocated into a low (n=43) or high (n=43) FIO₂ group. The low FIO₂ group consistently received 30% air–oxygen mixture during preoxygenation, ultrasound-guided  recruitment maneuver, and mechanical ventilation. The high FIO₂ group received 100% oxygen during preoxygenation and ultrasound-guided recruitment maneuver and 60% air–oxygen mixture during mechanical ventilation. Positive end-expiratory pressure of 5 cm H₂O was applied in both groups. Lung ultrasound was performed one minute after the start of mechanical ventilation and at the end of surgery in both groups. Primary outcome was significant atelectasis incidence (consolidation score of ≥ 2 in any region) on the postoperative lung ultrasound. Secondary outcomes included significant atelectasis incidence on the preoperative lung ultrasound, incidences of intra- and postoperative desaturation, incidences of postoperative fever and postoperative pulmonary complications.

Results: Significant atelectasis incidence on the postoperative lung ultrasound was similar between the low and high FIO₂ groups (28% vs. 37%; Pearson chi-square value=0.847; P=0.357; OR 1.531; 95% CI 0.617–3.800). Significant atelectasis incidence on the preoperative lung ultrasound was also similar between the groups (12% vs. 9%; Pearson chi-square value=0.124; P=0.725; OR 0.779; 95% CI 0.194–3.125). There were no statistically significant differences in the other secondary outcomes.

Conclusions: FIO₂ did not affect significant atelectasis formation in mechanically ventilated children who received ultrasound-guided recruitment maneuver and positive end-expiratory pressure.

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翻译：王贵龙  编辑：何幼芹  审校：王贵龙