基于肺开放策略的个体化PEEP滴定对经尿道前列腺激光切除术老年患者术中胸腔液体水平的影响
Effect of individualized PEEP titration based on open-lung strategy on intraoperative thoracic fluid content in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy
马娟 1张扬 1王梓 1张婷婷 1黄天丰 1葛亚丽 1王存金 1高巨1
作者信息
- 1. 扬州大学附属苏北人民医院麻醉科,扬州 225001
- 折叠
摘要
目的 评价基于肺开放策略的个体化PEEP滴定对经尿道前列腺激光切除术(TULIP)老年患者术中胸腔液体水平(TFC)的影响.方法 择期行TULIP患者86例,年龄65～80岁,BMI 18～28 kg/m2,ASA分级Ⅱ或Ⅲ级.采用随机数字表法分为2组(n=43):固定PEEP组(C组)和个体化PEEP滴定组(P组).C组患者行常规机械通气后设置PEEP为4 cmH2O;P组患者术中采用肺复张联合个体化PEEP滴定.分别于气管插管后5 min(T0)、PEEP滴定并通气30 min(T1)、手术结束前5 min(T2)及出恢复室前(T3)时,采用无创心输出量监测仪测定TFC;于T0-T2时记录CO、CI和SVI,同时行动脉血气分析,并记录气道峰压及肺动态顺应性,计算氧合指数.记录PACU滞留时间和术后7 d内肺部并发症发生情况、住院时间.结果 最终纳入83例患者,C组42例,P组41例.与C组比较,P组T1-T3时TFC降低,T1时CI、CO及SVI降低,T1和T2时肺动态顺应性、PaO2和氧合指数升高,PaCO2降低,术后肺部并发症发生率降低,PACU滞留时间和术后住院时间缩短(P＜0.05).结论 基于肺开放策略的个体化PEEP滴定可有效降低TULIP老年患者TFC,改善术中氧合及预后.
Abstract
Objective To evaluate the effect of individualized positive end-expiratory pressure(PEEP)titration based on open-lung strategy on the intraoperative thoracic fluid content(TFC)in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy(TULIP).Methods Eighty-six American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ,patients,aged 65-80 yr,with body mass index of 18-28 kg/m2,scheduled for elective TULIP,were divided into 2 groups(n=43 each)by the random number table method:fixed PEEP group(group C)and individualized PEEP titration group(group P).PEEP was set at 4 cmH2O after routine mechanical ventilation in group C.Pa-tients underwent pulmonary recruitment maneuvers combined with individualized PEEP titration during sur-gery in group P.TFC was measured using a non-invasive cardiac output monitor at 5 min after tracheal intu-bation(T0),30 min after PEEP titration and ventilation(T1),5 min before surgery(T2),and 5 min be-fore leaving the recovery room(T3).Cardiac output,oxygenation index and stroke volume index were recor-ded from T0-T2,arterial blood gas analysis was simultaneously performed to record peak airway pressure and dynamic lung compliance,and oxygenation index was calculated.The duration of postanesthesia care u-nit stay,pulmonary complications within 7 days after surgery,and length of hospital stay were also recorded.Results Eighty-three patients were finally included,with 42 in group C and 41 in group P.Compared with group C,TFC was significantly decreased at T1-T3,cardiac index,cardiac output and stroke volume index were decreased at T1,dynamic lung compliance,PaO2 and oxygenation index were increased at T,and T2,PaCO2 was decreased,the incidence of postoperative pulmonary complications was reduced,and the dura-tion of postanesthesia care unit stay and postoperative length of hospital stay were shortened in group P(P＜0.05).Conclusions Individualized PEEP titration based on open-lung strategy can effectively decrease TFC and improve intraoperative oxygenation and prognosis in elderly patients undergoing TULIP.
关键词
正压呼吸/老年人/经尿道前列腺切除术/胸腔液体水平Key words
Positive-pressure respiration/Aged/Transurethral resection of prostate/Thorac-ic fluid content引用本文复制引用
基金项目
国家自然科学基金(82172190)
国家自然科学基金(82101299)
江苏省卫生健康委医学科研面上项目(M2021105)
扬州市麻醉学重点实验室项目(YZ2021148)
出版年
2024
NETL
NSTL
万方数据