Application of high level positive expiratory pressure ventilation combined with lung recruitment maneuvers in prone posi-tion operation of obese patients under general anesthesia
Objective To evaluate the effect of high level positive expiratory pressure ventilation(PEEP)combined with lung recruitment maneuvers(RM)in the prone position of obese patients under general anesthesia.Methods A to-tal of 60 obese patients with BMI≥28 kg/m2 who were scheduled to undergo elective lumbar and sacral surgery were selected and divided into two groups by random number table method:control group(group A)and experimental group(group B),with 30 cases in each group.PEEP=5 cmH2O was set in group A,and PEEP=10 cmH2O was set in group B combined with RM.Hemodynamic indexes,respiratory mechanics indexes,arterial blood gas analysis indexes before anesthesia(T0),mechanical ventilation in supine position for 10 min(T1),mechanical ventilation in prone position for 10 min(T2),mechanical ventilation in prone position for 1 h(T3),deoxygenation after tracheal extubation for 30 min(T4),the total lung ultrasound scores(LUS)at T0,T4,1 day after surgery(T5)and the occurrence of respiratory com-plications within 5 days after surgery were observed and recorded.Results There was no significant difference in HR and MAP between the two groups.OI in group B was significantly higher than that in group A at T2,T3 and T4,and A-aDO2 was lower than that in group A(P＜0.05).Compared with T1,Ppeak and ΔP at T2 and T3 in both groups showed an increasing trend,while Cdyn showed a decreasing trend(P＜0.05).Ppeak and Cdyn in group B were signifi-cantly higher than those in group A,while ΔP were lower than that in group A(P＜0.05).The LUS scores of group B were lower than that of group A at T4 and T5(P＜0.05);There was no significant difference in the incidence of respir-atory complications within 5 days after surgery between the two groups.Conclusion For obese patients requiring gen-eral anesthesia prone position surgery,high level PEEP combined with lung recruitment maneuvers can improve lung compliance and oxygenation status,improve patients'oxygen reserve and lung function recovery ability,but it has not been found to reduce the incidence of postoperative respiratory complications.
obesitypositive end-expiratory pressure ventilationlung recruitment maneuversprone positionrespir-atory system
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