Objective To explore the effect of continuous positive airway pressure(CPAP)on oxygenation and intrapulmonary shunt in patients with one-lung ventilation by meta-analysis.Methods PubMed,Embase,VIP,CNKI,Wanfang Data and other databases were searched by computer.The search time was from the inception to 31 December 2020.Randomized controlled trials(RCTs)on the effect of CPAP administered on the non-ventilated side during one-lung ventilation on patients′ oxygenation status and intrapulmonary shunt were collected.Two independent researchers screened and extracted relevant literature,and evaluated the quality of literature following the inclusion and exclusion criteria.Finally,RevMan 5.3 software was used to conduct a meta-analysis on the included RCTs.Results A total of 11 RCTs and 346 patients were included.Intrapulmonary shunt volume in CPAP group(one-lung ventilation 30 min:SMD=-1.08,95%CI=-1.37 to -0.79, P<0.000 01;one-lung ventilation for 60 min: SMD=-0.47,95%CI=-0.83 to -0.12, P=0.009)was lower than that of the control group,and arterial partial oxygen pressure(one-lung ventilation for 30 min: SMD=0.97,95%CI=0.73-1.20, P<0.000 01;one-lung ventilation for 60 min: SMD=0.72,95%CI=0.30-1.13,P=0.0007),and the differences were statistically significant(P<0.05).There was no significant difference in the partial pressure of carbon dioxide between the two groups(one-lung ventilation for 30 min: SMD=0.02,95%CI=-0.24 to -0.29, P=0.87;one-lung ventilation for 60 min: SMD=-0.18,95%CI=-0.70-0.35, P=0.51).Conclusion CPAP can significantly improve the oxygenation status and intrapulmonary shunt in patients with one-lung ventilation.
刘树杰;高 婕;王 宇;杨世杰;闫玉荣. 持续气道正压对单肺通气患者氧合及肺内分流影响的meta分析[J]. 中国当代医药, 2021, 28(24): 16-20.
LIU Shu-jie; GAO Jie; WANG Yu ;YANG Shi-jie; YAN Yu-rong. A meta-analysis of the effect of continuous positive airway pressure on oxygenation and intrapulmonary shunt in patients with one-lung ventilation. 中国当代医药, 2021, 28(24): 16-20.
Kim YD,Ko S,Kim D,et al.The effects of incremental continuous positive airway pressure on arterial oxygenation and pulmonary shunt during one-lung ventilation[J].Korean J Anesthesiol,2012,62(3):256-259.
[13]
Campos JH.Effects of oxygenation during selective lobar versus total lung collapse with or without continuous positive airway pressure[J].Anesth Analg,1997,85(3):583-586.
[14]
Fischer GW,Cohen E.An update on anesthesia for thoracoscopic surgery[J].Curr Opin Anaesthesiol,2010,23(1):7-11.
[15]
Lumb AB,Slinger P.Hypoxic pulmonary vasoconstriction:physiology and anesthetic implications[J].Anesthesiology,2015,122(4):932-946.
[16]
Campos JH,Feider A.Hypoxia During One-Lung Ventilation-A Review and Update[J].J Cardiothorac Vasc Anesth,2018,32(5):2330-2338.
[17]
Magnusson L,Spahn DR.New concepts of atelectasis during general anaesthesia[J].Br J Anaesth,2003,91(1):61-72.
[18]
Licker M,Diaper J,Villiger Y,et al.Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery[J].Crit Care,2009,13(2):R41.
[19]
Choi YS,Bae MK,Kim SH,et al.Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position[J].Yonsei Med J,2015,56(5):1421-1427.
[20]
Capan LM,Turndorf H,Patel C,et al.Optimization of arterial oxygenation during one-lung anesthesia[J].Anesth Analg,1980,59(11):847-851.
[21]
Sentürk M,Layer M,Pembeci K,et al.A comparison of the effects of 50% oxygen combined with CPAP to the nonventilated lungvs.100% oxygen on oxygenation during one-lung ventilation[J].Anasthesiol Intensivmed Notfallmed Schmerzther,2004,39(6):360-364.