肺复张联合个体化PEEP策略对腹腔镜手术老年患者术后肺不张程度的影响
Effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure on degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery
王继文 1庄猛 1单蓓莹 2吴立雪 2曹亮亮 2董楠 2张继如1
作者信息
- 1. 徐州医科大学麻醉学院,徐州 221004;江南大学附属医院麻醉科,无锡 214125
- 2. 江南大学附属医院麻醉科,无锡 214125
- 折叠
摘要
目的 评价肺复张联合个体化呼气末正压(PEEP)策略对腹腔镜手术老年患者术后肺不张程度的影响.方法 择期拟行腹腔镜手术老年患者143例,性别不限,年龄≥65岁,BMI 18.5～30.0 kg/m2.采用随机数字表法分为肺复张联合个体化PEEP策略组(Ⅱ组)和固定PEEP组(Ⅰ组).手术开始后Ⅰ组维持PEEP 6 cmH2O直至手术结束;Ⅱ组在麻醉诱导后进行个体化PEEP滴定.主要结局指标:气管拔管后15 min时肺部12分区超声评分,次要结局指标:术后7 d内术后肺部并发症发生率、术后第3天时15项恢复质量量表评分、非计划入住ICU率、住院时间、术中低氧血症发生率、血管活性药物使用率及术后低血压发生率.结果 与Ⅰ组比较,Ⅱ组肺超声评分、驱动压和术后肺部并发症发生率降低,肺动态顺应性增加(P＜0.05或0.01),其他指标差异无统计学意义(P＞0.05).结论 肺复张联合个体化PEEP策略可降低腹腔镜手术老年患者术后肺不张的程度.
Abstract
Objective To evaluate the effect of lung recruitment maneuvers combined with individu-alized positive end-expiratory pressure(PEEP)on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods One hundred and forty-three elderly patients,aged ≥65 yr,with body mass index of 18.5-30.0 kg/m2,scheduled for elective laparoscopic surgery,were assigned to either in-dividualized PEEP combined with recruitment maneuvers(group Ⅱ)or fixed PEEP(group Ⅰ)using a random number table method.PEEP was maintained at 6 cmH2O starting from the beginning of procedure until the end of the procedure in group Ⅰ.Individualized PEEP titration was performed after induction of anesthesia in groupⅡ.The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation.Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery,Quality of Recovery-15 scale score on 3rd day after surgery,rate of unplanned admission to inten-sive care units,length of hospital stay,incidence of intraoperative hypoxemia,usage rate of intraoperative vasoactive drugs,and incidence of postoperative hypotension.Results Compared with group Ⅰ,the lung ultrasound score,driving pressure and postoperative pulmonary complications were significantly decreased,the dynamic lung compliance was increased(P＜0.05 or 0.01),and no significant changes were found in the other parameters in group Ⅱ(P＞0.05).Conclusions Individualized PEEP combined with recruitment ma-neuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.
关键词
呼吸,人工/正压呼吸/腹腔镜检查/肺不张Key words
Respiration,artificial/Positive-pressure respiration/Laparoscopy/Pulmonary at-electasis引用本文复制引用
基金项目
江苏省科技厅社会发展面上项目(BE2020634)
江苏省自然科学基金面上项目(BK20191138)
无锡市医疗卫生中青年拔尖人才项目(BJ2020049)
出版年
2024
NETL
NSTL
万方数据