动态肺顺应性联合肺泡无效腔量导向腹腔镜结直肠癌根治术患者术中最佳PEEP水平设置的可行性分析  

Feasibility analysis of optimal PEEP level setting in patients undergoing laparoscopic radical resection of colorectal cancer with dynamic lung compliance combined with alveolar void volumetric guidance

作　　者：王传光[1] 周建伟[1] 黄燕 尧银光[1] 吴振华[1] 叶勇功 WANG Chuanguang;ZHOU Jianwei;HUANG Yan;YAO Yinguang;WU Zhenhua;YE Yonggong(Department of Anesthesiology,Lishui Municipal Central Hospital,Zhejiang Province,Lishui323000,China)

机构地区：[1]浙江省丽水市中心医院麻醉科,浙江丽水323000

出　　处：《中国医药导报》2021年第34期109-112,共4页China Medical Herald

基　　金：浙江省医药卫生科技计划项目(2021KY413);浙江省丽水市高层次人才培养资助项目(2019RC03)。

摘　　要：目的探讨腹腔镜结直肠癌根治术中采用动态肺顺应性(Cdyn)联合肺泡无效腔量(VD/VT)导向设置最佳呼气末正压(PEEP)对改善患者术中氧合情况的可行性。方法选择2018年12月至2020年8月浙江省丽水市中心医院择期行腹腔镜结直肠癌根治术患者26例为研究对象。设置VT为7 ml/kg,待气腹体位建立后行容量递增肺复张(RM)和PEEP滴定,从14 cmH_(2)O开始,每步降低2 cmH_(2)O且维持10 min,待降到4 cmH_(2)O时认定为滴定最佳PEEP的终点。监测气腹建立10 min(T_(1))及相应PEEP水平控制呼吸的20 min(T_(2))、30 min(T_(3))、40 min(T_(4))、50 min(T_(5))、60 min(T_(6))、70 min(T_(7))Cdyn、VD/VT、氧合指数(OI)、血乳酸(Lac)及每搏量变异(SVV)等指标。结果所有开展PEEP滴定的患者均未见明显血流动力学波动(SVV<13%)。与T_(1)比较,T_(5)时Cdyn显著升高(P<0.01),处于滴定过程的峰值;OI显著升高(P<0.05);T_(3)、T_(5)时VD/VT显著降低(P<0.05)。结论通过RM后的PEEP滴定结合Cdyn、VD/VT目标导向的最佳PEEP设定,能有效改善腹腔镜结直肠癌根治术中患者的氧合。Objective To investigate the feasibility of dynamic lung compliance(Cdyn)combined with alveolar void volumetric(VD/VT)guided optimum positive end-expiratory pressure(PEEP)for improving intraoperative oxygenation in patients with laparoscopic radical resection of colorectal cancer.Methods From December 2018 to August 2020,26 patients undergoing elective laparoscopic radical resection of colorectal cancer in Lishui Central Hospital of Zhejiang Province were selected as the research subjects.VT was set at 7 mL/kg,and volumetric increasing recruitment manoeuvre(RM)and PEEP titration were performed after the pneumopitoneum position was established.Starting from 14 cm H_(2)O,each step decreased by 2 cmH_(2)O and maintained for 10 min,and the end point of optimal PEEP was determined when it was reduced to 4 cmH_(2)O.Cdyn,VD/VT,oxygenation index(OI),blood lactic acid(Lac),stroke volume variation(SVV)and other indicators in pneumoperitoneum was established for 10 min(T_(1))and corresponding PEEP level was established to control respiration for 20 min(T_(2)),30 min(T_(3)),40 min(T_(4)),50 min(T_(5)),60 min(T_(6)),and 70 min(T_(7))were monitored.Results No significant hemodynamic fluctuations were observed in all patients undergoing PEEP titration(SVV<13%).Compared with T_(1),Cdyn at T_(5) increased significantly(P<0.01),and it was at the peak of titration process;OI was significantly increased(P<0.05);VD/VT was significantly decreased at T_(3) and T_(5)(P<0.05).Conclusion The optimal PEEP titration after RM combined with the goal oriented setting of Cdyn and VD/VT can effectively improve the oxygenation of patients during laparoscopic radical resection of colorectal cancer.

关 键 词：动态肺顺应性 呼气末正压 肺复张 肺保护性通气 

分 类 号：R614[医药卫生—麻醉学]