全身麻醉期间个体化呼气末正压研究进展

doi:10.3969/j.issn.1004-583X.2022.07.017

摘要/Abstract

摘要：

全身麻醉和机械通气会导致肺损伤和炎症因子释放。因此,围术期实施肺保护性通气策略具有重要意义。呼气末正压(positive end expiratory pressure, PEEP)的应用能增加肺顺应性,改善氧合,减少呼吸机相关肺损伤和术后肺部并发症的发生率。个体化PEEP的实施能够明显增大其肺保护效应,改善患者预后。本文就全身麻醉期间个体化PEEP的设置方法和临床应用进行综述,以期为临床提供参考。

关键词: 呼气末正压, 个体化, 滴定, 肺保护性通气, 肺顺应性

中图分类号:

R614.2

张文超, 李建立. 全身麻醉期间个体化呼气末正压研究进展[J]. 临床荟萃, 2022, 37(7): 668-672.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.07.017

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I7/668

参考文献 31

[1]	Song IK, Kim EH, Lee JH, et al. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: A randomised, controlled trial[J]. Anaesthesia, 2017, 72(2): 214-22. doi: 10.1111/anae.13713 pmid: 27804117
[2]	Williams EC, Motta-Ribeiro GC, Vidal Melo MF. Driving pressure and transpulmonary pressure: How do we guide safe mechanical ventilation?[J]. Anesthesiology, 2019, 131(1): 155-163. doi: 10.1097/ALN.0000000000002731 pmid: 31094753
[3]	Li J, Cai B, Yu D, et al. Pressure-controlled ventilation-volume guaranteed mode combined with an open-lung approach improves lung mechanics, oxygenation parameters, and the inflammatory response during one-lung ventilation: A randomized controlled trial[J]. Biomed Res Int, 2020, 2020: 1403053.
[4]	Zhang C, Xu F, Li W, et al. Driving pressure-guided individualized positive end-expiratory pressure in abdominal surgery: A randomized controlled trial[J]. Anesth Analg, 2021, 133(5): 1197-205. doi: 10.1213/ANE.0000000000005575 pmid: 34125080
[5]	张瑞, 田首元, 聂丽霞, 等. Cdyn指导PEEP滴定对机器人辅助前列腺癌根治术老年患者肺功能的影响[J]. 中华麻醉学杂志, 2019, 39(2):150-153.
[6]	Li J, Ma S, Chang X, et al. Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position[J]. J Clin Monit Comput, 2021, 36(4):1155-1164. doi: 10.1007/s10877-021-00750-9 pmid: 34448089
[7]	Yang D, Grant MC, Stone A, et al. A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications: Is low tidal volume alone sufficient to protect healthy lungs?[J]. Ann Surg, 2016, 263(5): 881-887. doi: 10.1097/SLA.0000000000001443 pmid: 26720429
[8]	Lee JH, Bae JI, Jang YE, et al. Lung protective ventilation during pulmonary resection in children: A prospective, single-centre, randomised controlled trial[J]. Br J Anaesth, 2019, 122(5): 692-701. doi: 10.1016/j.bja.2019.02.013 URL
[9]	Park SK, Yang H, Yoo S, et al. Ultrasound-guided versus conventional lung recruitment manoeuvres in laparoscopic gynaecological surgery: A randomised controlled trial[J]. Eur J Anaesthesiol, 2021, 38(3): 275-284. doi: 10.1097/EJA.0000000000001435 URL
[10]	Elshazly M, Khair T, Bassem M, et al. The use of intraoperative bedside lung ultrasound in optimizing positive end expiratory pressure in obese patients undergoing laparoscopic bariatric surgeries[J]. Surg Obes Relat Dis, 2021, 17(2): 372-378. doi: 10.1016/j.soard.2020.09.023 pmid: 33092957
[11]	Ostberg E, Thorisson A, Enlund M, et al. Positive end-expiratory pressure alone minimizes atelectasis formation in nonabdominal surgery: A randomized controlled trial[J]. Anesthesiology, 2018, 128(6): 1117-1124. doi: 10.1097/ALN.0000000000002134 pmid: 29462011
[12]	Pereira SM, Tucci MR, Morais CCA, et al. Individual positive end-expiratory pressure settings optimize intraoperative mechanical ventilation and reduce postoperative atelectasis[J]. Anesthesiology, 2018, 129(6): 1070-1081. doi: 10.1097/ALN.0000000000002435 pmid: 30260897
[13]	苑昕, 田首元, 王鑫, 等. Cydn指导PEEP滴定对机器人辅助前列腺癌根治术老年患者肺损伤的影响[J]. 中华麻醉学杂志, 2019, 39(3): 264-267.
[14]	Ahn HJ, Park M, Kim JA, et al. Driving pressure guided ventilation[J]. Korean J Anesthesiol, 2020, 73(3): 194-204. doi: 10.4097/kja.20041 pmid: 32098009
[15]	闫声明, 袁田, 高巨. 全麻机械通气期间呼气末正压影响因素与个体化实施的研究进展[J]. 临床麻醉学杂志, 2021, 37(6): 661-663.
[16]	Park M, Ahn HJ, Kim JA, et al. Driving pressure during thoracic surgery: A randomized clinical trial[J]. Anesthesiology, 2019, 130(3): 385-393. doi: 10.1097/ALN.0000000000002600 pmid: 30664548
[17]	Mini G, Ray BR, Anand RK, et al. Effect of driving pressure-guided positive end-expiratory pressure (PEEP) titration on postoperative lung atelectasis in adult patients undergoing elective major abdominal surgery: A randomized controlled trial[J]. Surgery, 2021, 170(1): 277-283. doi: 10.1016/j.surg.2021.01.047 URL
[18]	Rauseo M, Mirabella L, Grasso S, et al. Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: A physiological study[J]. BMC Anesthesiol, 2018, 18(1): 156. doi: 10.1186/s12871-018-0624-3 pmid: 30382819
[19]	Spadaro S, Grasso S, Karbing DS, et al. Physiological effects of two driving pressure-based methods to set positive end-expiratory pressure during one lung ventilation[J]. J Clin Monit Comput, 2021, 35(5): 1149-1157. doi: 10.1007/s10877-020-00582-z URL
[20]	Xu D, Wei W, Chen L, et al. Effects of different positive end-expiratory pressure titrating strategies on oxygenation and respiratory mechanics during one-lung ventilation: A randomized controlled trial[J]. Ann Palliat Med, 2021, 10(2): 1133-144. doi: 10.21037/apm-19-441 pmid: 32954753
[21]	谢阳, 杨芬, 赵李红, 等. 滴定个体化呼气末正压对全麻俯卧位脊柱手术老年患者呼吸功能的影响[J]. 临床麻醉学杂志, 2021, 37(7): 689-693.
[22]	李金路, 吴雪梅, 谢红, 等. 全麻患者肺保护性通气时个体化PEEP的确定:EIT法和Cdyn法比较[J]. 中华麻醉学杂志, 2021, 41(1): 72-75.
[23]	董兰, 刘晓梅, 李占军, 等. 基于压力-容积曲线的个体化肺保护性通气策略在肥胖患者妇科腹腔镜手术中的应用[J]. 国际麻醉学与复苏杂志, 2021, 42(5): 467-470.
[24]	Hsu HJ, Chang HT, Zhao Z, et al. Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve: A randomized trial in moderate to severe ARDS[J]. Physiol Meas, 2021, 42(1): 014002. doi: 10.1088/1361-6579/abd679 URL
[25]	Girrbach F, Petroff D, Schulz S, et al. Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: A prospective, randomised controlled clinical trial[J]. Br J Anaesth, 2020, 125(3): 373-382. doi: S0007-0912(20)30423-2 pmid: 32665059
[26]	Park SK, Yang H, Yoo S, et al. Ultrasound-guided versus conventional lung recruitment manoeuvres in laparoscopic gynaecological surgery: A randomised controlled trial[J]. European journal of anaesthesiology, 2021, 38(3): 275-284. doi: 10.1097/EJA.0000000000001435 URL
[27]	Beitler JR, Sarge T, Banner-Goodspeed VM, et al. Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial[J]. JAMA, 2019, 321(9): 846-857. doi: 10.1001/jama.2019.0555 pmid: 30776290
[28]	Piriyapatsom A, Phetkampang S. Effects of intra-operative positive end-expiratory pressure setting guided by oesophageal pressure measurement on oxygenation and respiratory mechanics during laparoscopic gynaecological surgery: A randomised controlled trial[J]. Eur J Anaesthesiol, 2020, 37(11): 1032-1039. doi: 10.1097/EJA.0000000000001204 URL
[29]	王悠然, 葛亚力, 魏海燕, 等. 个体化呼气末正压对心肺转流下瓣膜手术患者肺功能的影响[J]. 临床麻醉学杂志, 2021, 37(8): 822-827.
[30]	王悠然, 葛亚力. 个体化呼气末正压的术中滴定策略[J]. 国际麻醉学与复苏杂志, 2021, 42(8): 854-858.
[31]	Stenqvist O, Persson P, Lundin S. Can we estimate transpulmonary pressure without an esophageal balloon?-yes[J]. Ann Transl Med, 2018, 6(19): 392. doi: 10.21037/atm.2018.06.05 pmid: 30460266

全身麻醉期间个体化呼气末正压研究进展

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 31

相关文章 10

编辑推荐

Metrics

本文评价

[1]	贾亚杰, 姚明. 限制性与开放性液体复苏对脓毒性休克患者呼吸力学及氧代谢的影响[J]. 临床荟萃, 2021, 36(9): 803-806.
[2]	霍晓霞, 李辉, 张晓岚. 急性胰腺炎治疗研究进展[J]. 临床荟萃, 2019, 34(11): 1030-1033.
[3]	赵航;葛晗明;梁战华;王琰. 帕金森病个体化诊疗的依从性与疾病进展的相关性分析[J]. 临床荟萃, 2015, 30(5): 499-502.
[4]	马孝忠. 双水平正压通气+压力支持通气模式改良叹气法在急性呼吸窘迫综合征的应用效果[J]. 临床荟萃, 2014, 29(5): 543-545546.
[5]	宋爱丽;宋慧芳;杨俊红;王美杰;曹小键;屈秀辉;闫新华. 不同腹内压水平对肺功能影响的临床研究[J]. 临床荟萃, 2012, 27(5): 427-428.
[6]	韩玉;代庆春;沈洪丽;苗晓云;回志;张晓卫. 氧合导向肺外源性急性呼吸窘迫综合征最佳呼气末正压选择与最大肺静态顺应性相关性研究[J]. 临床荟萃, 2012, 27(22): 1943-1945.
[7]	韩玉;代庆春;沈洪丽;苗晓云;回志;张晓卫. 肺复张治疗肺外源性急性呼吸窘迫综合征的效果评价[J]. 临床荟萃, 2012, 27(20): 1772-1775.
[8]	王连芹;宁海春;魏玉清;赵丽娟;王贵玲;王雪霞;何福岭;李国锋;沈惠峰;孔咏梅. 预防脑梗死再发联合治疗方案5年对照研究[J]. 临床荟萃, 2010, 25(2): 93-97.
[9]	王连芹;魏玉清;于强;宁海春;赵丽娟;孔咏梅;李国锋. 脑梗死危险分层下小剂量辛伐他汀达标预防再发对照研究[J]. 临床荟萃, 2009, 24(23): 2053-2056.
[10]	凌斌;孙洁;顾云帆;李斌;李冰沁;刘萍. 亚低温治疗时胸肺顺应性的监测及临床意义[J]. 临床荟萃, 2000, 15(12): 533-534.