系统评价保护性肺通气在俯卧位手术的应用

目的系统评价保护性与传统肺通气在俯卧位手术的应用。方法检索Pub Med、EMbase、the Cochrane Library及万方数据库等,收集比较保护性及传统肺通气用于俯卧位手术的随机对照研究(randomized controlled trail,RCT)。根据Cochrane系统评价员手册进行文献筛选、提取数据、评价纳入研究的质量,用Rev Man软件进行数据分析。结果纳入9项RCT,共449例患者。保护性肺通气组术后肺部并发症发生率(RR 0.30,95%CI 0.12~0.73,P0.01)、气道峰压更低(MD-3.52,95%CI-6.93~-0.11,P0.05);术中俯卧位时保护性肺通气组氧合指数(PaO_2/FiO_2)更高(MD 37.28,95%CI 22.67~51.89,P0.001)、肺泡-动脉氧分压差更低(MD-45.50,95%CI-61.35~-29.65,P0.001)。结论在俯卧位手术中,低潮气量联合呼气末正压(positive end expiratory pressure,PEEP)或低潮气量同时联合PEEP及肺复张技术的保护性肺通气可减少术后肺部并发症、降低气道峰压、改善氧合,对血流动力学影响小。

A systematic evaluation of protective ventilation for surgery in the prone position

Objective To evaluate protective ventilation(PV) versus conventional ventilation(CV) for surgery in the prone position.Methods We searched PubMed, Embase, the Cochrane Library, WanFang Data and other Chinese databases to collect the randomized controlled trails (RCTs) on intraoperative PV in comparison with CV for surgery in the prone position.Two authors independently identified the studies, performed data extraction and assessed the risks of bias in the included studies according to the Cochrane Handbook for Systematic Reviews of Interventions.The reviewers conducted data analyses with RevMan software.Results A total of 9 RCTs involving 449 participants were included.The results showed that the incidence of postoperative pulmonary complications (RR 0.30, 95% CI 0.12~0.73, P<0.01) and peak pressure (MD-3.52, 95% CI-6.93~-0.11, P<0.05) were lower in the PV group.Intraoperative PaO2/FiO2 was higher (MD 37.28, 95% CI 22.67~51.89, P<0.001) and alveolar-arterial oxygen difference was lower (MD-45.50, 95% CI-61.35~-29.65, P<0.001) in the PV group.Conclusions Low tidal volume ventilation in combination with positive end-expiratory pressure (with or without recruitment maneuver) decreases postoperative pulmonary complications,reduces peak pressure and improves oxygenation for surgery in the prone position.