个体化呼气末正压通气对肥胖患者腹腔镜胃减容术后肺部并发症的影响  

Effect of individualized positive end-expiratory pressure on postoperative pulmonary complications in obese patients undergoing laparoscopic bariatric surgery

作　　者：王珺 李想 赵秋 张倩倩 刘鹤 韩园[2,4] 曹君利 WANG Jun;LI Xiang;ZHAO Qiu;ZHANG Qianqian;LIU He;HAN Yuan;CAO Junli(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学麻醉学院,221004 [2]徐州医科大学附属医院麻醉科 [3]浙江省湖州市中心医院麻醉科 [4]复旦大学附属眼耳鼻喉科医院麻醉科

出　　处：《临床麻醉学杂志》2022年第3期279-283,共5页Journal of Clinical Anesthesiology

摘　　要：目的研究个体化呼气末正压(PEEP)通气策略对肥胖患者腹腔镜胃减容术后肺部并发症(PPCs)的影响。方法选择行全身麻醉腹腔镜胃减容术的成年肥胖患者40例,男15例,女25例,年龄18~44岁,BMI 35~55 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法分为两组:个体化PEEP组(I组)和固定PEEP组(C组),每组20例。I组在诱导插管后依据肺动态顺应性(Cdyn)个体化滴定最佳PEEP并维持此PEEP进行术中通气,C组以PEEP 8 cmH_(2)O进行术中通气。记录插管后5 min、气腹后1 h的氧合指数、分流率以及气道峰压、气道平台压、驱动压、Cdyn等呼吸力学参数,记录术中低血压发生情况、输液量、血管活性药用量、机械通气时间和术后住院时间,记录术后第1天、第2天、第3天、第8天PPCs的发生情况以及术后8 d内PPCs累积发生率。结果I组PPCs累积发生率明显低于C组[13例(65%)vs 19例(95%),P<0.05]。气腹后1 h时I组氧合指数、气道峰压、气道平台压、Cdyn均明显高于C组(P<0.05),I组驱动压明显低于C组(P<0.05)。两组术中低血压发生率、输液量、去氧肾上腺素用量、机械通气时间和术后住院时间差异无统计学意义。结论个体化PEEP能够降低腹腔镜胃减容术患者PPCs发生率,并在不影响血流动力学稳定性的同时降低术中驱动压,改善氧合。Objective To explore the effect of individualized positive end-expiratory pressure(PEEP)strategy on postoperative pulmonary complications(PPCs)in patients undergoing laparoscopic bariatric surgery.Methods Forty obese adult patients who underwent laparoscopic bariatric surgery under general anesthesia,15 males and 25 females,aged 18-44 years,BMI 35-55 kg/m^(2),ASA physical statusⅡorⅢ,were randomly divided into two groups:individualized PEEP group(group I)and fixed PEEP group(group C),20 patients in each group.In group I,a standard individualized PEEP titration trial based on dynamic lung compliance(Cdyn)was conducted after anesthesia induction and intubation and this PEEP was maintained for intraoperative ventilation.In group C,patients were ventilated with a fixed PEEP of 8 cmH_(2)O.At 5 minutes after intubation and 1 hour after pneumoperitoneum,oxygenation index,intrapulmonary shunt,peak pressure,plateau pressure,driving pressure and dynamic compliance were recorded,and intraoperative hypotension,total fluid volume,vasoactive drug dosage,duration of mechanical ventilation and length of stay(LOS)were recorded.The occurrence of PPCs on day 1,day 2,day 3 and day 8 after surgery was also recorded,and the cumulative incidence of PPCs in 8 days after surgery was calculated.Results The cumulative incidence of PPCs in group I was lower than that in group C[13 patients(65%)vs 19 patients(95%),P<0.05].1 hour after pneumoperitoneum,the oxygenation index,airway peak pressure,airway plateau pressure,Cdyn of group I was respectively higher than that in group C(P<0.05),the driving pressure of group I was lower than that in group C(P<0.05).There were no significant differences between the two groups in incidence of intraoperative hypotension,total fluid,the amount of phenylephrine,the length of mechanical ventilation and LOS.Conclusion Individualized PEEP can reduce the incidence of PPCs in patients undergoing laparoscopic bariatric surgery,reduce the driving pressure and improve oxygenation during surgery without impairing

关 键 词：个体化 呼气末正压 动态顺应性 肺部并发症 胃减容手术 肥胖 

分 类 号：R614[医药卫生—麻醉学]