Objective:To compare the guidance value of electrical impedance tomography(EIT)and dynamic lung compliance(Cdyn)for individualized positive end expiratory pressure(PEEP)in thoracoscopic lobectomy.Methods:From Apr.2022 to Apr.2023,124 patients with lung protective ventilation after thoracoscopic lobectomy under general anesthesia were included.They were divided into two groups by random number table method:the EIT group used EIT to guide individual PEEP setting,and the Cdyn group used Cdyn to guide individual PEEP setting.The success rate of individualized PEEP and the value of individualized PEEP were observed between the two groups.The platform pressure,driving pressure and partial pressure of end-expiratory carbon dioxide at 5 min(T1),30 min(T2)and60 min(T3)after individualized PEEP settings were compared between the two groups.The oxygenation index before anesthesia(T0),at T1,T2,T3 and 10 min after extubation(T4)were compared between the two groups.The time of tracheal catheter removal,stay time in postanesthesia care unit after anesthesia and postoperative pulmonary complications of the two groups were monitored.Results:A total of 4 patients were excluded,and 60 patients were included in EIT group and Cdyn group respectively.The success rate of individualized PEEP in EIT group was100%,which was higher than86.67%in Cdyn group(P<0.05).The individual PEEP value of EIT group was4.8(1.6,6.0)cmH2 O,which was lower than 6.0(4.0,8.0)cmH2 O of Cdyn group(P<0.05).At T2 and T3,the platform pressure of EIT group was higher than that of Cdyn group,and the driving pressure was lower than that of Cdyn group(P<0.05).At T1 to T4,the oxygenation index of EIT group was higher than that of Cdyn group(P<0.05).At T3,the platform pressure of Cdyn group was lower than that at T1 and T2,and the driving pressure was higher than T1 and T2(P<0.05).At T2 to T4,the oxygenation index of EIT group was higher than that of T0 and T1(P<0.05).At T3,the oxygenation index of Cdyn group was higher than that of T0 and T1(P<0.05).At T4,the oxygenation index of both groups was lower than T3(P<0.05).There was no significant difference in the time of tracheal catheter removal and stay time in postanesthesia care unit between the two groups(P>0.05).The incidence of postoperative pulmonary complications in EIT group was 3.33%,which was lower than that in Cdyn group(17.31%,P<0.05).Conclusions:Compared with Cdyn,the value of EIT in guiding individual PEEP setting in patients with thoracoscopic lobectomy is higher,EIT has more advantages in improving the success rate of individualized PEEP,reducing the value of individualized PEEP,improving respiratory parameters and oxygenation function,and reducing postoperative pulmonary complications.
维普
万方数据