小儿全身麻醉中肺保护性通气策略的研究现状和困境  

Research status and dilemma of lung protective ventilation strategies in pediatric general anesthesia

作　　者：程慕樵 季海英 夏然 吕淑楠 张成密 李玮伟 石学银 Cheng Muqiao;Ji Haiying;Xia Ran;Lyu Shunan;Zhang Chengmi;Li Weiwei;Shi Xueyin(Department of Anesthesiology and Critical Care Medicine,Xinhua Hospital,Affiliated with Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学附属新华医院麻醉与重症医学科,上海200092

出　　处：《国际麻醉学与复苏杂志》2022年第9期968-972,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(81974292);上海市科委科技项目(19411966000)。

摘　　要：肺保护性通气(lung protective ventilation,LPV)策略可在一定程度上减少小儿术中机械通气肺损伤的发生。小潮气量、呼气末正压(positive end expiratory pressure,PEEP)和肺复张是小儿LPV策略的主要措施;此外,FiO_(2)、驱动压等对小儿肺保护的重要性也不容忽视。文章分析总结了有关小儿LPV策略的文献资料发现,虽然相关研究取得了阶段性的成果,但小儿LPV策略的发展远滞后于成年人,各项措施的最佳实施水平也有待确认。小儿LPV研究面临的困境主要包括理想体重(ideal body weight,IBW)的计算、机械死腔的影响、氧合和力学的矛盾平衡等,需要大量长期的临床研究进行探究,以降低术后肺部并发症(postoperative pulmonary complications,PPCs)的发生率,改善小儿预后。Lung protective ventilation(LPV)strategy can reduce the occurrence of ventilation-induced lung injury in children.Low tidal volume,positive end-expiratory pressure(PEEP),and lung recruitment are the main measures of LPV strategy in children.In addition,the importance of fraction of inspiratory oxygen(FiO_(2))and driving pressure for lung protection in children cannot be ignored.This review summarizes the literature on pediatric LPV strategies and finds that although relevant studies have achieved phased results,the development of this strategy in children lags far behind that in adults,and the best implementation level of various measures remains to be confirmed.The difficulties faced by pediatric LPV research mainly include the calculation of ideal body weight,the influence of mechanical dead cavity,and the contradictory balance of oxygenation and mechanics.A large number of long-term clinical studies are needed to explore,so as to reduce the incidence of postoperative pulmonary complications(PPCs)and improve the prognosis of children.

关 键 词：小儿 肺保护性通气策略 小潮气量 呼气末正压 肺复张 吸入氧浓度 驱动压 理想体重 机械死腔 

分 类 号：R726.1[医药卫生—儿科]