目的 调查我国心脏手术麻醉医师在成人体外循环(cardiopulmonary bypass,CPB)心脏手术中通气管理的临床实践,分析肺保护性通气(lung-protective ventilation,LPV)策略的临床应用与理论认识之间是否存在差距.方法 采用横断面问卷调查的方法,在2021年9月-2022年2月向中国30家医院(心脏手术量＞1000台/年)的心脏手术麻醉医师发送电子调查问卷.结果 共回收问卷323份,有效问卷297份,有效率92.0％.在非CPB期间,联合使用小潮气量(tidal volume,VT)、呼气末正压(positive end expiratory pressure,PEEP)和肺复张手法(alveolar recruitment maneuver,ARM)的麻醉医师占 84.8％(252/297);90.6％(269/297)的麻醉医师采用小VT 通气(6～8 mL/kg);92.3％(274/297)设置 PEEP,其中 PEEP 水平＜5 cm H2O 占 57.9％(172/297);67.3％(200/297)常规实施ARM,其中86.2％(256/297)采用手控ARM.在CPB期间,89.9％(267/297)的麻醉医师不实施肺通气,29.6％(88/297)主动实施ARM.结论 在中国成人CPB心脏手术通气管理中,大多数麻醉医师应用联合小VT、PEEP和ARM的LPV策略,除小VT的应用较一致外,其他通气参数的设置在麻醉医师之间存在差异.同时,LPV的临床实践与理论认识也存在差距.
Clinical practice of intraoperative ventilation management in cardiac surgery:A nationwide survey in China
Objective To investigate the current status of routine practice and perspective of anesthesiologists regarding ventilation strategies during cardiac surgery,and to analyze whether there is a gap between the clinical application and theoretical understanding of lung-protective ventilation(LPV)strategies.Methods We conducted a multi-institutional cross-sectional survey of anesthesiologists working at high-volume(＞1 000 cardiac procedures each year)Chinese hospitals.The electronic questionnaire was designed and distributed from September 2021 to February 2022.Results A total of 323 replies were collected and 297(92.0％)replies were valid.Among the respondents,84.8％(252/297)performed the combination of low tidal volume(VT),positive end-expiratory pressure(PEEP)and alveolar recruitment maneuver(ARM)during non-CPB period.The vast majority of respondents(90.6％,269/297)ventilated patients with the VT of 6-8 mL/kg.92.3％(274/297)of respondents applied PEEP,among those 57.9％(172/297)set a PEEP level＜5 cm H2O.Most of the respondents(67.3％,200/297)performed intraoperative ARM,and manual ARM was used by 86.2％(256/297)of anesthesiologists.During CPB,89.9％(267/297)of respondents withdrew mechanical ventilation,and 29.6％(88/297)performed ARM.Conclusion This national survey in China showed that the majority of anesthesiologists adopted LPV strategy with the combination of low VT,PEEP and ARM during cardiac surgery.Except VT,the intraoperative ventilator settings varied widely from one anesthesiologist to another.Meanwhile,there is a gap between the clinical practice and theoretical understanding of LPV.
Questionnaire surveylung-protective ventilationcardiopulmonary bypasscardiac surgery
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