The Effect of PEEP Titration Guided by Lung Compliance on Oxygenation and Postoperative Delirium in Elderly Patients Undergoing Radical Surgery for Lung Cancer
Objective To observe the effect of positive end expiratory pressure(PEEP)titration on perioperative im-provement of pulmonary oxygenation and postoperative delirium(POD)in patients undergoing radical resection of lung cancer.Methods A total of 110 elderly patients who underwent thoracoscopic radical lung cancer surgery under general anesthesia from December 2023 to May 2024 were selected and divided into group G(optimal PEEP group guided by dynamic lung com-pliance)and group R(do not set PEEP group)by random number table method,with 55 cases in each group.Respiratory parameters of the two groups were set as follows:tidal volume6-8 mL/kg,I:E=1:2;Respiratory parameters of single lung ventilation(OLV)were set as follows:tidal volume5 mL/kg,I:E=1:2;The PEEP of group G was titrated after lung re-expansion in lateral position,and the PEEP value was taken when the lung compliance was maximum and maintained until the end of OLV.The control group did not set PEEP,that is,OLV was performed after pulmonary reexpansion.Intraoperative maintenance The mean arterial pressure was±20％at baseline and the heart rate was 50-100/min with vasoactive drugs and anesthesia drugs;By adjusting the respiratory rate to maintain the end-respiratory carbon dioxide partial pressure at 35-45 mmHg,pulse oxygen saturation(SpO2)and arterial oxygen partial pressure(PaO2)were recorded at different time points during the operation,oxygenation index(OI)was calculated,and POD occurrence was evaluated with the 3min delirium as-sessment scale 3 and 5 days after the operation.The levels of interleukin-6(IL-6)in peripheral blood before and after opera-tion and lung ultrasound scores(LUS)at 24 and 48 h after operation were recorded in the 2 groups,and the changes of respir-atory and circulatory function before and after PEEP titration were recorded.Results Compared with R group,SpO2 and PaO2 were significantly increased and OI was significantly improved in G group at the end of single lung ventilation(P<0.05).Compared with R group,POD incidence in G group was significantly decreased at 3 and 5 days after surgery,LUS score and IL-6 level at 24 h after surgery were also significantly decreased(P<0.05).There was no significant difference in LUS score 48 h after operation between the two groups(P>0.05).Conclusion Individualized PEEP titration guided by lung compliance is helpful to improve intraoperative oxygenation,reduce inflammatory response and prevent POD in elderly pa-tients undergoing thoracoscopic radical lung cancer surgery.
Lung cancerPositive end expiratory pressureElderlyThoracoscopySingle lung ventilationPostop-erative deliriumInterleukin-6
国家科技期刊平台
NSTL
万方数据
