关注罂粟花，共同学习麻醉学最新文献！
床旁肺部超声评价儿童单肺通气期间的肺隔离：一项盲法观察可行性研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：周菁 编辑：王波 审校：曹莹
这项前瞻性盲法可行性研究纳入了40例年龄范围为0至20岁的患者。在主要麻醉团队使用FOB确认肺分离后，超声医师和听诊器（均对手术和肺分离的偏侧性不知情）进入手术室。超声医师评估胸膜肺滑动，听诊器听呼吸音。通过手术过程中肺萎陷的直接可视化明确证实了成功的肺分离。
在确认有效的单肺通气时，肺部超声的诊断准确率为95%（95%置信区间[CI]，82.7%-98.5%）。相比之下，听诊只能可靠地确认肺隔离，准确率为68%（95% CI，51.5%-80.4%）。McNemar检验显示肺部超声和听诊之间存在统计学显著差异（P <0.001）。进行超声检查的中位时间为67秒（四分位距[IQR]，46-142），进行听诊的中位时间为21秒（IQR，10-32）。
根据本研究的初步结果，肺部超声被证明是一种快速可靠的方法来验证儿科胸外科患者的单肺通气，诊断准确性高。
原始文献来源：Moharir,A. , Yamaguchi,Y. , Aldrink,J.H. , Martinez,A. , Arce-villalobos,M. , Kitio,S.A.Y. , Rice-weimer,J. ,& Tobias , J.D.(2024).Point-of-Care Lung Ultrasound to Evaluate Lung Isolation During One-Lung Ventilation in Children: A Blinded Observational Feasibility Study.Anesthesia & Analgesia,139(6),1294-1299.https://doi.org/10.1213/ANE.0000000000007155.
Point-of-Care Lung Ultrasound to Evaluate Lung
Isolation During One-Lung Ventilation in Children:
A Blinded Observational Feasibility Study
Abstract
Background: Minimally invasive thoracic surgical techniques require effective lung isolation using one-lung ventilation (OLV). Verification of lung isolation may be confirmed by auscultation,visual confirmation using fiberoptic bronchoscopy (FOB), or more recently, point-of-care ultrasound (POCUS). The aim of this study was to prospectively compare lung ultrasound with clinical auscultation to confirm OLV before thoracic surgery in pediatric patients.
Method:This prospectively blinded feasibility study included 40 patients ranging in age from 0 to 20 years. After confirmation of lung separation by the primary anesthesia team using FOB,the sonographer and the auscultator, both blinded to the laterality of surgery and lung separation, entered the operating room. The sonographer evaluated for pleural lung sliding and the auscultator listened for breath sounds. Successful lung separation was definitively confirmed by direct visualization of lung collapse during the operation.
Results:In confirming effective single-lung ventilation, lung ultrasound had a diagnostic accuracy of 95% (95% confidence interval [CI], 82.7%–98.5%). In contrast, auscultation could only reliably confirm lung isolation with 68% accuracy (95% CI, 51.5%–80.4%). The McNemar test showed a statistically significant difference between the use of lung ultrasound and auscultation (P < .001). The median time to perform ultrasonography was 67 seconds (interquartile range [IQR], 46–142) and the median time to perform auscultation was 21 seconds (IQR, 10–32).
Conclusion:Based on the initial results of our feasibility trial, lung ultrasound proved to be a fast and reliable method to verify single-lung ventilation in pediatric patients presenting for thoracic surgery with a high degree of diagnostic accuracy.
