Effect of inverse ratio mechanical ventilation on pulmonary function in obese patients with laparoscopic surgery:a meta-analysis
Objective To evaluate the effect of inverse ratio ventilation (IRV) strategy on the pulmona-ry 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 Co-chrane 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,in-volving 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 pneu-moperitoneum 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 pulmona-ry 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 (PaO2,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 PaCO2,PETCO2,mean arterial pressure,heart rate,SaO2,postoperative shoulder pain incidence,and post-operative subcutaneous emphysema incidence between the two groups (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.
inverse ratio ventilationgeneral anesthesiaobesitylaparoscopymeta analysis
万方数据
维普
