肺保护性通气策略对脊柱侧弯矫形术患儿术后肺部并发症的影响:基于倾向性评分匹配的回顾性队列研究

Effect of lung-protective ventilation strategy on postoperative pulmonary complications in pediatric patients undergoing scoliosis surgery:a retrospective propensity score-matched cohort study

回顾性收集2016年7月至2019年7月脊柱侧弯矫形术患儿的资料。根据术中通气参数分为传统通气组(传统组)和保护性通气组(保护组),通过VT/理想体重(IBW)获得标准化VT,标准化VT≥8 ml/kg且未使用PEEP者纳入传统组,VT<8 ml/kg且使用PEEP 4~8 cmH2O者纳入保护组。再通过倾向性评分匹配2组患儿基线信息和术中情况。共415例患儿接受筛选,171例匹配成功,其中传统组92例,保护组79例。与传统组比较,保护组术后30 d肺部并发症发生率和分级降低,PACU停留时间缩短,术后24 h时体温降低,VT、标准化VT和氧合指数降低,PETCO2、PEEP、通气频率和I∶E升高(P<0.05),IBW、PaCO2、术后外科并发症和麻醉相关并发症发生率、术后24 h时血浆C反应蛋白浓度和白细胞计数、住院时间和住院费用差异无统计学意义(P>0.05)。综上所述,与传统机械通气策略相比,低VT联合PEEP的肺保护性通气策略可降低脊柱侧弯矫形术患儿术后肺部并发症的发生风险,有助于改善预后。

The data of pediatric patients who underwent scoliosis surgery from July 2016 to July 2019 were collected retrospectively.The pediatric patients were divided into traditional ventilation group(T group)and lung-protective ventilation group(P group)based on the ventilator settings.Standardized tidal volume(VT)was obtained by VT/ideal body weight(IBW).Patients with standardized VT≥8 ml/kg and without positive end-expiratory pressure(PEEP)were included in group T,and patients with VT<8 ml/kg and PEEP 4-8 cmH2O were included in group P.The propensity score was used to match the baseline information and intraoperative variables in the two groups.A total of 415 pediatric patients accepted screening,and 171 cases were successfully matched,including 92 cases in group T and 79 cases in group P.Compared with group T,the incidence and grade of pulmonary complications were significantly decreased at day 30 after operation,postanesthesia care unit stay time was shortened,body temperature was decreased at 24 h after operation,VT,standardized VT and oxygenation index were decreased,PETCO2,PEEP,ventilation frequency and I∶E were increased(P<0.05),and no significant change was found in IBW,PaCO2,incidence of postoperative surgical complications and anesthesia-related complications,plasma C-reactive protein concentration and white blood cell count at 24 h after operation,hospitalization time and hospitalization cost in group P(P>0.05).In conclusion,the lung-protective ventilation strategy low VT combined with PEEP can decrease the risk of postoperation lung complications and is helpful in improving prognosis in the pediatric patients undergoing scoliosis surgery as compared with traditional mechanical ventilation strategy.