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, VT）、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VT通气，174人（93.0%）使用PEEP，95人（50.8%）PEEP设置水平<5 cmH2O（1 cmH2O=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VT、PEEP及ARM”作为LPV策略，除小VT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 (VT), 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 VT 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 cmH2O(1 cmH2O=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 VT, PEEP and ARM” in Sichuan province. Except VT, the intraoperative ventilator parameters vary widely.
Cited
)
