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颈动脉内膜切除术患者手动持续性膨胀与阶梯式PEEP对肺和脑部结局的影响
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游霄 编辑：王波 审校：曹莹
与 SI 相比，IP 在改善肺通气方面表现更好，血流动力学稳定性更好。 IP导致脑血流和氧合恢复较慢。
原始文献来源：Liang C, Wang T, Wang P, et al. Impact of Manual Sustained Inflation vs Stepwise PEEP on Pulmonary and Cerebral Outcomes in Carotid Endarterectomy Patients [J]. Medical Science Monitor, 2024, 30.
Impact of Manual Sustained Inflation vs Stepwise PEEP on Pulmonary and Cerebral Outcomes in Carotid Endarterectomy Patients
Background: Recruitment maneuvers (RMs) are used to reduce pulmonary atelectasis in patients under general anesthesia, but they can lead to a decrease in cerebral hemodynamics.
Material/Methods: Thirty patients undergoing carotid endarterectomy were randomized to a manual sustained inflation (SI) group or a stepwise increase in PEEP (IP) group. During both RMs, the peak airway pressure (Ppeak) was maintained at 30 cmH2O for 30 s. Electrical impedance tomography was used to evaluate pulmonary aeration changes. Mean velocity of blood flow in the middle cerebral artery (Vm) and cerebral oxygen saturation (rScO2) was monitored intraoperatively.
Results: IP improved lung aeration better at Ppeak=30 cmH2O than SI (58.2±8.4% vs 46.0±8.3%, P=0.001) and this persisted until the end of surgery. Dorsal (dependent) ventilation 30 min after extubation in the SI group was lower than that before surgery (7.7±2.6% vs 9.9±3.8%, P=0.003). Vm and rScO2 returned to baseline immediately after RM in the SI group, while it remained below baseline in the IP group (42.5±12.6 vs 50.9±18.8 cm/s, P<0.001 and 68.1±3.5% vs 70.6±3.7%, P=0.001). Heart rate declined significantly during RM only in the SI group (55.9±6.6 vs 52.2±6.9 bpm, P=0.008).
Conclusions: Compared with SI, IP performed better in improving lung aeration, with greater hemodynamic stability. IP resulted in slower recovery of cerebral blood flow and oxygenation.
