Effect of positive end-expiratory pressure on the incidence of atelectasis in children with congenital heart disease undergoing lateral thoracotomy under cardiopulmonary bypass
Online published: 2021-06-29
目的·应用肺超声评估侧卧位体外循环（cardiopulmonary bypass，CPB）下行先天性心脏病纠治术患儿肺不张的发生率，探讨呼气末正压（positive end-expiratory pressure，PEEP）对此类患儿肺不张发生率的影响。方法·纳入2019年10月—2020年8月于上海交通大学医学院附属上海儿童医学中心择期侧卧位CPB下行先天性心脏病纠治术的患儿60例，采用随机数字表将患儿随机分为PEEP组（P组，n=30）和对照组（C组，n=30）。P组患儿在气管插管后即刻予5 cmH2O PEEP维持，直至手术结束。C组患儿在气管插管后即刻予5 cmH2O PEEP维持，直至手术开始。分别于机械通气后1 min（T1）、手术开始前1 min（T2）、手术后即刻（T3）共3个时间点行肺超声检查。记录2组患儿的肺超声评分，比较其肺不张的发生率。结果·2组患儿在T1、T2时肺不张的发生率均无统计学意义，在T3时P组患儿肺不张发生率较C组明显降低（P=0.000）。C组患儿在T3时的肺不张发生率较T1、T2时明显升高（均P<0.05）。结论·PEEP可显著降低侧卧位CPB下行先天性心脏病纠治术患儿肺不张的发生率。
贺盼 , 孙瑛 , 杨艳艳 , 白洁 , 郑吉建 , 张马忠 . 呼气末正压对侧卧位体外循环下行先天性心脏病纠治术患儿肺不张发生率的影响[J]. 上海交通大学学报（医学版）, 2021 , 41(6) : 781 -785 . DOI: 10.3969/j.issn.1674-8115.2021.06.013
·To evaluate the incidence of atelectasis in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) by lung ultrasound, and investigate the effect of positive end-expiratory pressure (PEEP) on the incidence of atelectasis in these children.
·Sixty children undergoing selective lateral thoracotomy cardiac surgery with CPB in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from October 2019 to August 2020 were included. They were randomly divided into PEEP group (P group, n=30) and control group (C group, n=30). The P group was treated with 5 cmH2O PEEP immediately after tracheal intubation until the end of operation. The C group was treated with 5 cmH2O PEEP immediately after tracheal intubation until the beginning of operation. Lung ultrasound exam was performed three times in each patient, 1 min after starting mechanical ventilation of the lungs (T1), 1 min before the beginning of surgery (T2) and the time immediately upon completion of the surgery (T3). The lung ultrasound scores of the two groups were recorded, and the incidences of atelectasis were compared.
·There was no significant difference in the incidences of atelectasis at T1 and T2 between the two groups. The incidence of atelectasis in P group was significantly lower than that in the C group at T3 (P=0.000). The incidence of atelectasis in the C group at T3 was significantly lower than those at T1 and T2 (all P<0.05).
·PEEP can significantly reduce the incidence of atelectasis in children undergoing lateral thoracotomy cardiac surgery with CPB.
| 1 | Liu YL, Zhang HJ, Sun HS, et al. Repair of cardiac defects through a shorter right lateral thoracotomy in children[J]. Ann Thorac Surg, 2000, 70(3): 738-741. |
| 2 | Li G, Su J, Fan X, et al. Safety and efficacy of ventricular septal defect repair using a cosmetic shorter right lateral thoracotomy on infants weighing less than 5 kg[J]. Heart Lung Circ, 2015, 24(9): 898-904. |
| 3 | Sun LP, Wu L, Zhang K, et al. Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery[J]. Pediatr Pulmonol, 2020, 55(5): 1273-1281. |
| 4 | Song IK, Kim EH, Lee JH, et al. Utility of perioperative lung ultrasound in pediatric cardiac surgery: a randomized controlled trial[J]. Anesthesiology, 2018, 128(4): 718-727. |
| 5 | Cantinotti M, Ait Ali L, Scalese M, et al. Lung ultrasound reclassification of chest X-ray data after pediatric cardiac surgery[J]. Paediatr Anaesth, 2018, 28(5): 421-427. |
| 6 | Acosta CM, Maidana GA, Jacovitti D, et al. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children[J]. Anesthesiology, 2014, 120(6): 1370-1379. |
| 7 | 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): 214-222. |
| 8 | Lee JH, Choi S, Ji SH, et al. Effect of an ultrasound-guided lung recruitment manoeuvre on postoperative atelectasis in children: a randomised controlled trial[J]. Eur J Anaesthesiol, 2020, 37(8): 719-727. |
| 9 | Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia[J]. Br J Anaesth, 2003, 91(1): 61-72. |
| 10 | Bignami E, Guarnieri M, Saglietti F, et al. Mechanical ventilation during cardiopulmonary bypass[J]. J Cardiothorac Vasc Anesth, 2016, 30(6): 1668-1675. |
| 11 | 郑晓方, 徐峥嵘, 徐长庆. 体外循环手术对小儿肺表面活性物质的影响及其与肺功能的关系[J]. 哈尔滨医科大学学报, 2003, 37(6): 510-512. |
| 12 | 司翠权, 李江力. 术后肺部并发症的风险因素分析[J]. 临床合理用药杂志, 2013, 6(19): 38,45. |
| 13 | Park SH. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery[J]. Korean J Anesthesiol, 2016, 69(1): 3-7. |
| 14 | Michelet P, D'Journo XB, Roch A, et al. Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study[J]. Anesthesiology, 2006, 105(5): 911-919. |
| 15 | Lin WQ, Lu XY, Cao LH, et al. Effects of the lung protective ventilatory strategy on proinflammatory cytokine release during one-lung ventilation[J]. Chin J Cancer, 2008, 27(8): 870-873. |
| 16 | Futier E, Jaber S. Lung-protective ventilation in abdominal surgery[J]. Curr Opin Crit Care, 2014, 20(4): 426-430. |
| 17 | Rode B, Vu?i? M, Siranovi? M, et al. Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment[J]. Wien Klin Wochenschr, 2012, 124(23/24): 842-847. |
| 18 | Wu L, Hou QR, Bai J, et al. Modified lung ultrasound examinations in assessment and monitoring of positive end-expiratory pressure-induced lung reaeration in young children with congenital heart disease under general anesthesia[J]. Pediatr Crit Care Med, 2019, 20(5): 442-449. |
| 19 | 曾琼, 孟勇, 朱四海, 等. 高呼气末正压小潮气量通气对肺功能正常患者血流动力学的影响[J]. 临床麻醉学杂志, 2009, 25(2): 109-112. |
/
| 〈 |
|
〉 |