【原】【罂粟摘要】麻醉诱导时应用呼气末正压对婴儿非缺氧性呼吸暂停时间的影响：一项随机对照试验

麻醉诱导时应用呼气末正压对婴儿非缺氧性呼吸暂停时间的影响：一项随机对照试验

贵州医科大学 麻醉与电生理课题组

翻译/编辑：佟睿 审校：曹莹

背景

在麻醉诱导期间，婴儿经常会出现低氧血症。

目的

我们评估了麻醉诱导期间呼气末正压对婴儿非缺氧性呼吸暂停时间的影响。

试验设计

随机对照试验。

范围设置

2018年11月至2019年10月在三级儿童医院进行单中心试验。

受试患者

我们纳入了接受全身麻醉的1岁以下儿童。

干扰因素

我们将婴儿分为7cmH₂O或0cmH₂O呼气末正压组。麻醉诱导采用0.02 mg·kg^-1阿托品、5 mg·kg^-1硫喷妥钠和3~5%七氟醚，肌肉松弛剂采用0.6 mg·kg^-1罗库溴铵。此后经面罩给予100%氧气，容量控制通气，潮气量为6ml·kg^-1，呼气末正压为7cmH₂O或不予PEEP。通气3min后，进行气管插管，但与呼吸回路断开，当脉搏血氧饱和度达到95%时恢复通气。

主要观察指标

主要观察指标是非缺氧性呼吸暂停时间，定义为从停止通气到脉搏血氧饱和度读数为95%的时间，而次要观察指标是使用肺部超声评估的严重肺不张的发生率(合并得分≥2)。

结果

共纳入了60名患者进入了最终分析。呼气末正压7cmH₂O组呼吸暂停时间(105.2 s)较对照组(92.1s)明显延长(P=0.011，平均差值13.0s，95%CI，3.1s~22.9s)。无呼气末正压的患者全部发生了肺不张，呼气末正压为7cmH₂O的患者肺不张发生率为66.7%(P=0.019，95%CI，1.7~563.1，优势比31.2)。

结论

面罩通气麻醉诱导期间呼气末正压延长了婴儿的非缺氧性呼吸暂停时间。

原始文献来源

Eun-Hee Kim, Ji-Hyun Lee, Young-Eun Jang, et al. Effect of positive end-expiratory pressure during anaesthesia induction on non-hypoxic apnoea time in infants: A randomised controlled trial. [J]Eur J Anaesthesiol 2021; 38:1012–1018.

Effect of positive end-expiratory pressure during anaesthesia induction on non-hypoxic apnoea time in infants: A randomised controlled trial

Abstract

BACKGROUND: Hypoxaemia occurs frequently in infants during anaesthetic induction.

OBJECTIVE: We evaluated the effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants.

DESIGN: Randomised controlled trial.

SETTING: Tertiary care children’s hospital, single centre, from November 2018 to October 2019.

PATIENTS: We included patients under 1 year of age receiving general anaesthesia.

INTERVENTION: We assigned infants to a 7 cmH₂O or 0 cmH₂O positive end-expiratory pressure group. Anaesthesia was induced with 0.02 mg·kg^-1 atropine, 5 mg·kg^-1 thiopental sodium and 3 to 5% sevoflurane, and neuromuscular blockade with 0.6 mg·kg^-1 rocuronium. Thereafter, 100% oxygen was provided via face mask with volumecontrolled ventilation of 6 ml·kg^-1 tidal volume, and either 7 cmH₂O or no positive end-expiratory pressure. After 3 min of ventilation, the infants’ trachea was intubated but disconnected from the breathing circuit, and ventilation resumed when pulse oximetry reached 95%.

MAIN OUTCOME MEASURE: The primary outcome was nonhypoxic apnoea time defined as the time from cessation of ventilation to a pulse oximeter reading of 95%, whereas the secondary outcome was the incidence of significant atelectasis (consolidation score≥2) assessed by lung ultrasound.

RESULTS: Sixty patients were included in the final analysis. Apnoea time in the 7 cmH2O positive end-expiratory pressure group (105.2 s) increased compared with that in the control group (92.1 s) (P=0.011, mean difference 13.0 s, 95% CI, 3.1 to 22.9 s). Significant atelectasis was observed in all patients without positive end-expiratory pressure and 66.7% of those with 7 cmH2O positive end-expiratory pressure (P=0.019, 95% CI, 1.7 to 563.1, odds ratio 31.2).

CONCLUSION: Positive end-expiratory pressure during anaesthesia induction with face mask ventilation increased nonhypoxic apnoea time in infants.