肺动态顺应性导向的个体化呼气末正压通气对行腹腔镜腹部手术的老年患者呼吸功能的影响  

Effect of Pulmonary Dynamic Compliance-Guided Individualized Positive End Expiratory Pressure on Respiration Function in the Aged Patients Undergoing Laparoscopic Major Abdominal Surgery

作　　者：梁敏[1] 苏少琼 李艳珍[1] 林颖仡 陈鹭[1] LIANG Min;SU Shaoqiong;LI Yanzhen;LIN Yingyi;CHEN Lu(Department of Anesthesiology,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Anesthesiology,Nan an Municipal Hospital,Nan an 362300,China)

机构地区：[1]福建医科大学附属第一医院麻醉科,福州350005 [2]南安市医院麻醉科,南安362300

出　　处：《福建医科大学学报》2023年第2期122-129,共8页Journal of Fujian Medical University

基　　金：福建医科大学启航基金项目(2020QH1027)。

摘　　要：目的 评价肺动态顺应性(Cdyn)导向的个体化呼气末正压通气(PEEP)对行腹腔镜腹部手术的老年患者呼吸功能的影响。方法 选取2019年9月-2021年12月130例行腹腔镜腹部手术的老年患者,采用电脑随机数法将患者随机分为2组,分为接受Cdyn导向个体化PEEP组(A组)和无PEEP组(B组)。分别于入室(T_(0))、插管后(T_(1))、PEEP建立(T_(2))、气腹1 h(T_(3))、气腹2 h(T4)、手术结束(T_(5))时记录心率(HR)和平均动脉压(MAP);于T_(1)~T_(5)记录并计算Cdyn、肺静态顺应性(Clst)、呼气末二氧化碳分压(P_(ET)CO_(2))、气道峰压(PIP)、气道平台压(Pplat)和驱动压(DP);于T_(1)、T_(3)、T_(5)行血气分析,记录氢离子浓度指数(pH值)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO_(2))、肺泡-动脉血氧分压差(A-aDO_(2))、死腔与潮气量比值(VD/VT)和氧合指数(OI);记录术后7 d内呼吸困难、低氧血症、肺不张、肺炎、胸腔积液和呼吸功能不全等肺部并发症的发生率。结果 与B组比较,A组在T_(2)~T_(4)时PIP较高,在T_(2)~T_(5)时Cdyn、Clst较高,而DP较低(P<0.05);在T_(3)和T_(5)时A-aDO2和VD/VT较低,而PaO_(2)和OI较高(P<0.05);A组术后呼吸困难、低氧血症和肺不张的发生率较低(P<0.05),其他循环、呼吸功能、血气分析和不良事件指标比较,差别均无统计学意义(P>0.05)。结论 Cdyn导向的个体化PEEP有利于改善行腹腔镜腹部手术的老年患者的呼吸功能,减少术后肺部并发症。Objective To evaluate the effect of pulmonary dynamic compliance(Cdyn)-guided individualized positive end expiratory pressure(PEEP)on respiration function in the aged patients undergoing laparoscopic major abdominal surgery.Methods From September 2019 to December 2021,130 elderly patients undergoing elective major abdominal surgery under laparoscopy were selected.The patients were randomly divided into Cdyn-guided individualized PEEP group(group A)and non-PEEP group(group B)by computer random number method.Heart rate(HR)and mean arterial pressure(MAP)were recorded at entry(T 0),after intubation(T_(1)),PEEP establishment(T_(2)),pneumoperitoneum 1 hour(T_(3)),pneumoperitoneum 2 hours(T_(4)),and the end of operation(T 5).Cdyn,static lung compliance(Clst),partial pressure of end-tidal carbon dioxide(P ET CO_(2)),peak airway pressure(PIP),plateau pressure(Pplat),driving pressure(DP)were recorded and calculated at T_(1)-T_(5).Blood gas analysis was performed at T_(1),T_(3),and T_(5),and the hydrogen ion concentration(pH value),partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),alveolar-artery oxygen partial pressure gradient(A-aDO_(2)),physiological dead cavity to tidal volume ratio(VD/VT),oxygenation index(OI)were recorded.Pulmonary complications such as dyspnea,hypoxemia,atelectasis,pneumonia,pleural effusion and respiratory insufficiency were recorded within 7 days after operation.Results Compared with group B,PIP in group A was significantly higher at T_(2)-T_(4),while Cdyn and Clst in group A were significantly higher at T_(2)-T_(5)(P<0.05).In contrast,DP in group A was significantly lower,comparing with group B(P<0.05).Additionally,compared with group B,A-aDO_(2) and VD/VT in group A were significantly lower,while PaO_(2) and OI in group A were significantly higher at T_(3) and T_(5)(P<0.05).The incidence of postoperative dyspnea,hypoxia and atelectasis were significantly lower in group A,comparing with group B(P<0.05).There were no significant differences in the other circulatory,re

关 键 词：肺动态顺应性 呼气末正压 呼吸功能 腹腔镜 腹部手术 老年 

分 类 号：R614[医药卫生—麻醉学]