手術中肺保護性通氣可以預防術後肺部併發症

10.6666/ClinMed.202202_89(2).0021

鄭澄寰

全身麻醉（general anesthesia） ； 肺保護性通氣（lung protective ventilation） ； 手術後肺部併發症（postoperative pulmonary complication）

臨床醫學月刊

89卷2期（2022 / 02 / 25）

113 - 117

繁體中文

手術後若發生肺部併發症，會延長住院時間並增加死亡率。肺保護性通氣（lung protective ventilation）已在重症照護中心用來治療急性呼吸窘迫症（adult respiratory distress syndrome, ARDS），但在手術室接受全身麻醉的病人，肺保護性通氣仍不是常規的作法。肺保護性通氣的實施作為包含，低潮氣量（low tidal volume），呼氣末正壓（positive end expiratory pressure, PEEP）和肺通氣補充（lung recruitment）。近年來已有相當多的研究報告指出，針對許多種手術，術中肺保護性通氣可以改善病人術後的肺功能及減少肺部併發症。本篇論文將針對此一課題，做一綜合回顧的報告。

1. Canet, J,Gallart, L,Gomar, C(2010).Prediction of postoperative pulmonary complications in a population-based surgical cohort.Anesthesiology,113,1338-1350.
2. Cheng, CD,Lin, WL,Chen, YW,Cherng, CH(2020).Effects of lung protective ventilation on postoperative pulmonary outcomes for prolonged oral cancer combined with free flap surgery.Medicine,99,e18999.
3. De, Prost, N,Costa, EL,Wellman, T(2013).Effects of ventilation strategy ondistribution of lung inflammatory cell activity.Crit Care,17,R175.
4. Determann, RM,Royakkers, A,Wolthuis, EK(2010).Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial.Crit Care,14,R1.
5. Dreyfuss, D,Saumon, G(1998).Ventilator-induced lung injury: lessons from experimental studies.Am J Respir Crit Care Med,157,294-323.
6. Fernandez-Bustamante, A,Frendl, G,Sprung, J(2017).Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the perioperative research network investigators.JAMA Surg,152,157-166.
7. Futier, E,Constantin, JM,Paugam-Burtz, C(2013).A trial of intraoperative low-tidal volume ventilation in abdominal surgery.N Engl J Med,369,428-437.
8. Gajic, O,Dara, SI,Mendez, JL(2004).Ventilatorassociated lung injury in patients without acute lung injury at the onset of mechanical ventilation.Crit Care Med,32,1817-1824.
9. Gajic, O,Frutos-Vivar, F,Esteban, A(2005).Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients.Intensive Care Med,31,922-926.
10. Gattinoni, L,Carlesso, E,Caironi, P(2012).Stress and strain within the lung.Curr Opin Crit Care,18,42-47.
11. Gu, WJ,Wang, F,Liu, JC(2015).Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials.CMAJ,187,E101-E109.
12. Gurkan, OU,O´Donnell, C,Brower, R(2003).Differential effects of mechanical ventilatory strategy on lung injury and systemic organ inflammation in mice.Am J Physiol Lung Cell Mol Physiol,285,L710-L718.
13. Lellouche, F,Dionne, S,Simard, S(2012).High tidal volumes in mechanically ventilated patients increase organ dysfunction after cardiac surgery.Anesthesiology,116,1072-1082.
14. Lionetti, V,Recchia, FA,Ranieri, VM(2005).Overview of ventilator-induced lung injury mechanisms.Curr Opin Crit Care,11,82-86.
15. Marret, E,Cinotti, R,Berard, L(2018).Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery:A double-blind randomised controlled trial.Eur J Anaesthesiol,35,1-9.
16. Pelosi, P,Negrini, D(2008).Extracellular matrix and mechanical ventilation in healthy lungs: back to baro/volotrauma?.Curr Opin Crit Care,14,16-21.
17. Petrucci, N,De Feo, C(2013).Lung protective ventilation strategy for the acute respiratory distress syndrome.Cochrane Database Syst Rev,2,CD003844.
18. Plötz, FB,Slutsky, AS,van Vught, AJ(2004).Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses.Intensive Care Med,30,1865-1872.
19. Putensen, C,Theuerkauf, N,Zinserling, J(2009).ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury.Ann Intern Med,151,566-576.
20. Schultz, MJ,Slutsky, AS(2007).What tidal volumes should be used in patients without acute lung injury?.Anesthesiology,106,1226-1231.
21. Severgnini, P,Selmo, G,Lanza, C(2013).Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function.Anesthesiology,118,1307-1321.
22. Slutsky, AS(1999).Lung injury caused by mechanical ventilation.Chest,116,9S-15S.
23. Sundar, S,Novack, V,Jervis, K(2011).Influence of low tidal volume ventilation on time to extubation in cardiac surgical patients.Anesthesiology,114,1102-1110.
24. Tao, T,Bo, L,Chen, F(2014).Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: a meta-analysis of randomized controlled trials.BMJ Open,4,e005208.
25. Tojo, K,Nagamine, Y,Yazawa, T(2015).Atelectasis causes alveolar hypoxia-induced inflammation during uneven mechanical ventilation in rats.Intensive Care Med E,3,56.
26. Tremblay, LN,Slutsky, AS(2005).Pathogenesis of ventilator-induced lung injury: trials and tribulations.Am J Physiol Lung Cell Mol Physiol,288,L596-L598.
27. Wolthuis, EK,Vlaar, AP(2009).Mechanical ventilation using noninjurious ventilation settings causes lung injury in the absence of preexisting lung injury in healthy mice.Crit Care,13,R1.
28. Wrigge, H,Pelosi, P(2011).Tidal volume in patients with normal lungs during general anesthesia: lower the better?.Anesthesiology,11,1011-1013.
29. Yang, D,Grant, MC,Stone, A(2016).Meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications is low tidal volume alone sufficient to protect healthy lungs?.Ann Surg,263,881-887.