反比机械通气对肥胖患者腹腔镜手术肺功能影响的meta分析

Effect of inverse ratio mechanical ventilation on pulmonary function in obese patients with laparoscopic surgery:a meta-analysis

目的评价反比通气(IRV)策略用于全身麻醉下肥胖患者腹腔镜手术对患者肺功能的影响。方法系统检索Web of Science、Cochrane Library、PubMed、Embase、中国知网、万方、维普数据库,收集所有全身麻醉下肥胖患者腹腔镜手术中使用IRV策略的随机对照试验研究文献,常规通气组采取常规容量控制的保护性肺机械通气(吸呼比为1∶2),IRV组则采用IRV(吸呼比为1∶1~2∶1)。检索时间为建库至2022年5月21日,根据纳入排除标准,运用Endnote筛选文献,采用Cochrane风险偏移评估工具评价纳入文献的质量,采用RevMan5.3软件进行meta分析。结果经过筛选最终纳入5篇文献,共312例患者,IRV组156例,常规通气组156例。IRV组吸气峰压在气腹30 min(MD=-3.06,95%CI:-3.77~-2.34,P<0.01)和气腹60 min(MD=-3.58,95%CI:-4.08~-3.07,P<0.01)时较常规通气组降低;IRV组平均气道压在气腹30 min(MD=1.95,95%CI:1.51~2.39,P<0.01)、气腹60 min(MD=1.87,95%CI:1.40~2.35,P<0.01)时较常规通气组增高,肺动态顺应性在气腹30 min(MD=2.78,95%CI:2.05~3.52,P<0.01)和气腹60 min(MD=1.87,95%CI:1.40~2.33,P<0.01)时较常规通气组也增高;IRV组氧合指数(MD=66.83,95%CI:51.11~82.54,P<0.01)和血氧饱和度(PaO_(2),MD=35.20,95%CI:28.21~42.19,P<0.01)在气腹60 min时较常规通气组增高。两组PaCO_(2)、PETCO_(2)、平均动脉压、心率、SaO_(2)、术后肩痛发生率、术后皮下气肿发生率差异无统计学意义(P>0.05)。结论IRV应用于全身麻醉下肥胖患者腹腔镜手术具有一定的肺保护作用,在临床上可作为肥胖患者机械通气模式的一种选择。

Objective To evaluate the effect of inverse ratio ventilation(IRV)strategy on the pulmonary function in obese patients with laparoscopic operation under general anesthesia.Methods The databases of Web of Science,Cochrane Library,Embase,PubMed,CNKI,Wangfang and VIP were systematically retrieved.All study literatures of randomized controlled trials of using IRV strategy in obese patients with laparoscopic operation under general anesthesia were collected.The conventional ventilation group adopted the conventional volume controlled protective pulmonary mechanical ventilation(respiratory ratio was 1∶2).The IRV group adopted IRV(respiratory ratio was 1∶1-2∶1).The retrieval time was the database establishment to May 21,2022.Based on the inclusion and exclusion standard,the Endnote was used to screen the literatures,the Cochrane risk bias evaluation tool was used to evaluate the quality of included literatures and the meta analysis was performed by using the RevMan5.3 software.Results Five articles were finally included by screening,involving 312 patients,there were 156 cases in the IRV group and 156 cases in the conventional ventilation group.The inspiratory peak pressure at pneumoperitoneum 30 min(MD=-3.06,95%CI:-3.77 to-2.34,P<0.01)and pneumoperitoneum 60 min(MD=-3.58,95%CI:-4.08 to-3.07,P<0.01)in the IRV group was decreased compared with the conventional ventilation group;the average airway pressure at pneumoperitoneum 30 min(MD=1.95,95%CI:1.51-2.39,P<0.01),pneumoperitoneum 60 min(MD=1.87,95%CI:1.40-2.35,P<0.01)was increased compared with the conventional ventilation group;the pulmonary dynamic lung compliance at pneumoperitoneum 30 min(MD=2.78,95%CI:2.05-3.52,P<0.01)and pneumoperitoneum 60 min(MD=1.87,95%CI:1.40-2.33,P<0.01)was also increased compared with the conventional ventilation group;the oxygenation index(MD=66.83,95%CI:51.11-82.54,P<0.01)and oxygen saturation(PaO_(2),MD=35.20,95%CI:28.21-42.19,P<0.01)at pneumoperitoneum 60 min in the IRV group was increased compared with the conventional ventilation group.There was no statistically significant difference in PaCO_(2),PETCO_(2),mean arterial pressure,heart rate,SaO_(2),postoperative shoulder pain incidence,and postoperative subcutaneous emphysema incidence between the two gro ups(P>0.05).Conclusion Application of IRV in the obese patients with laparoscopic surgery under general anesthesia has a certain pulmonary protective effect,which could serve as a selection for mechanic ventilation modes in obese patients in clinic.