非心胸手术成年患者术中通气管理的临床实践:一项区域问卷调查研究

Clinical practice of intraoperative ventilation management of adult patients undergoing non-cardiothoracic surgery:a regional questionnaire survey

目的问卷调查四川省非心胸手术成年患者术中通气管理的临床实践情况。方法2020年12月至2021年1月,向四川省29家大型三甲综合医院的麻醉医生发送电子调查问卷。结果共回收有效问卷1264份,回复率78.50%。术中采用小VT通气的麻醉医生比率为90.43%;采用呼气末正压(PEEP)通气的麻醉医生比率为70.73%,PEEP水平控制在1~5 cmH2O的麻醉医生最多,在腔镜和非腔镜手术中比率分别为77.4%和88.4%。术中实施肺复张手法(ARM)的麻醉医生比率为82.28%。将小VT、PEEP及ARM联合使用的麻醉医生比率为37.03%。98.10%的麻醉医生认为"小VT、适当PEEP或ARM的使用"属于"术中肺保护性通气(LPV)策略"。而对于其他通气参数的设置,如吸入氧浓度、通气频率及通气模式等,临床实践存在差异。结论四川省大型三甲综合医院的麻醉医生较为认可的LPV策略包括小VT、PEEP及ARM,但LPV策略的实际应用情况与理论认识存在差距。

Objective To investigate the development of clinical practice of intraoperative ventilation management of the adult patients undergoing non-cardiothoracic surgery using surveys and questionnaires.Methods From December 2020 to January 2021,an electronic questionnaire was sent to the anesthesiologists in twenty-nine tertiary general hospitals in Sichuan province.Results A total of 1264 valid questionnaires were received with a response rate of 78.50%.The proportion of anesthesiologists who utilized low tidal volume(VT)during surgery was 90.43%.The proportion of anesthesiologists who utilized positive end-expiratory pressure(PEEP)during surgery was 70.73%,and the level of PEEP was controlled at 1-5 cmH2O by most of the anesthesiologists(77.4%in laparoscopic surgery and 88.4%in non-cardiothoracic surgery).The proportion of anesthesiologists who performed alveolar recruitment maneuvers(ARM)was 82.28%.The proportion of anesthesiologists who used a combination of low VT,PEEP and ARM was 37.03%.The proportion of anesthesiologists who considered"low VT,appropriate use of PEEP or ARM"as"intraoperative lung-protective ventilation(LPV)strategy"was 98.10%.However,the other ventilation settings such as the fraction of inspired oxygen,respiratory rate and ventilation mode varied among anesthesiologists in clinical practice.Conclusion LPV strategy recognized by anesthesiologists in the large-scale tertiary general hospitals in Sichuan province includes low VT,PEEP and ARM,however,there is a gap between clinical practice and theoretical cognition.