成年人体外循环心脏手术术中通气管理临床实践:区域性调查研究

Clinical practice of intraoperative ventilation management in adult patients undergoing cardiac surgery:a regional survey

目的调查四川省成年人CPB心脏手术术中通气管理现状。方法采用横断面问卷调查方法,在2021年8月—2021年10月向四川省12家医院(心脏手术量>100台/年)的麻醉医师发送电子调查问卷,并对调查结果进行分析。结果共回收有效问卷187份,回复率65.3%。在非CPB期间,实际联合使用"小潮气量(tidal volume,V_(T))、呼气末正压(positive end-expiratory pressure,PEEP)及肺复张(alveolar recruitment maneuver,ARM)"作为肺保护性通气(lung protective ventilation,LPV)策略的麻醉医师有114人(61.0%),176人(94.1%)采用6~8 ml/kg的小V_(T)通气,174人(93.0%)使用PEEP,95人(50.8%)PEEP设置水平<5 cmH_(2)O(1 cmH_(2)O=0.098 kPa),129人(69.0%)常规实施ARM,170人(90.9%)采用手控肺活量法。在CPB期间,172人(92.0%)不进行肺通气,164人(87.7%)会在手术操作需要时实施ARM。结论四川省大多数麻醉医师会联合使用"小V_(T)、PEEP及ARM"作为LPV策略,除小V_(T)的应用较为一致,其他通气参数设置在临床实践中存在差异。

Objective To investigate the intraoperative management of ventilation in adult patients undergoing cardiac surgery with cardiopulmonary bypass(CPB)in Sichuan province.Methods This was a cross‑sectional survey.Electronic questionnaires were sent to anesthesiologists in 12 hospitals with more than 100 annual cardiac operations in Sichuan province from August 2021 to October 2021.The questionnaire results were analyzed.Results A total of 187 replies were collected with a response rate of 65.3%.Actually,61.0%(n=114)of respondents performed the combination of low tidal volume(V_(T)),positive end‑expiratory pressure(PEEP)and alveolar recruitment maneuver(ARM)as the lung protective ventilation(LPV)strategy.176 respondents(94.1%)ventilated patients with the V_(T)of 6‒8 ml/kg.93.0%(n=174)of respondents applied PEEP,among those 50.8%(n=95)set a PEEP level less than 5 cmH_(2)O(1 cmH_(2)O=0.098 kPa).129 respondents(69.0%)routinely used intraoperative ARM and 170 respondents(90.9%)used manual ARM.During the CPB,92.0%(n=172)of respondents withdrew mechanical ventilation,while 87.7%(n=164)of respondents would perform ARM when required by surgeons.Conclusion A majority of anesthesiologists adopted the LPV strategy of“low V_(T),PEEP and ARM”in Sichuan province.Except V_(T),the intraoperative ventilator parameters vary widely.