肺超声监测PEEP递增肺复张对老年人腹腔镜结直肠癌根治术后肺不张的影响  

Effect of pulmonary ultrasonography monitoring of PEEP increasing lung recruitment on atelectasis in elderly patients after laparoscopic radical resection of colorectal cancer

作　　者：陈琼仪 马楚洲[1] 罗秀芝 郑良杰[1] 吴萍[1] CHEN Qiongyi;MA Chuzhou;LUO Xiuzhi;ZHENG Liangjie;WU Ping(Department of Anesthesiology,Shantou Central Hospital,Shantou,Guangdong 515000,China)

机构地区：[1]广东省汕头市中心医院麻醉科,515000

出　　处：《重庆医学》2023年第12期1800-1805,共6页Chongqing medicine

基　　金：广东省科技专项资金项目(210713176903514);广东省汕头市科技计划项目(191215225264184)。

摘　　要：目的比较术毕肺超声监测呼气末正压(PEEP)递增肺复张与传统正压膨肺对老年人腹腔镜结直肠癌根治术后肺不张发生率的影响。方法选择拟行腹腔镜结直肠癌根治术患者104例(年龄≥65岁,ASA分级Ⅰ~Ⅲ级),所有患者均遵循肺保护策略,并随机分为两组,Lu组(n=52)为肺超声实时监测PEEP递增肺复张法组,术毕在肺超声实时监测下,采用PEEP递增法对老年患者行肺复张;Tr组(n=52)为传统正压膨肺组,在拔管前挤压球囊膨肺,最大气道压力为40 cmH 2O,保持40 s。记录两组患者术后48 h肺不张发生率,插管前、拔管前、拔管后20 min、术后48 h肺通气评分,复苏室低氧血症的发生率,复张时低血压的发生率、复苏室停留时间、术后肺炎发生率、住院时间。结果术后48 h,Lu组和Tr组分别有4例(8.2%)和11例(24.4%)患者发生肺不张(RR=0.82;95%CI:0.68~0.99;P=0.031);拔管后20 min,Lu组和Tr组分别有5例(10.2%)和14例(31.1%)患者发生肺不张(RR=0.77;95%CI:0.62~0.95;P=0.012);Lu组肺超声评分明显低于Tr组(P<0.05)。Lu组和Tr组复苏室低氧血症发生率分别为14.3%和33.3%(RR=0.78;95%CI:0.62~0.99;P=0.028);Lu组在复苏室停留时间短于Tr组(P<0.05)。复张时,Lu组和Tr组低血压发生率分别为8.2%和26.7%(RR=0.80;95%CI:0.66~0.97;P=0.015)。事后敏感性分析显示术毕采用肺超声监测PEEP递增肺复张法有利于减少术后肺不张。两组患者术后肺功能与术前相比仍然有所下降,相比传统正压膨肺法下降幅度小(P<0.05)。两组患者在术后肺炎发生率和住院时长方面差异无统计学意义(P>0.05)。结论术毕肺超声实时监测PEEP递增肺复张可能比传统正压膨肺更能有效减少老年人腹腔镜结直肠癌根治术后肺不张,减少低氧血症发生率,并且对血流动力学影响不明显。Objective To compare the effects of pulmonary ultrasonography monitoring of PEEP increasing lung recruitment and traditional positive pressure manual hyperinflation on the incidence of atelectasis in elderly patients after laparoscopic radical resection of colorectal cancer.Methods A total of 104 patients aged≥65 years old with ASA gradeⅠ-Ⅲwere selected for laparoscopic radical resection of colorectal cancer.All patients followed the lung protection strategy and were randomly divided into two groups with 52 cases in each group.The Lu group was the PEEP increasing lung recruitment for real-time monitoring of lung ultrasound.After the operation,the PEEP increasing method was used for lung recruitment in elderly patients under real-time monitoring of lung ultrasound.The Tr group was the traditional positive pressure manual hyperinflation group.Before extubation,the balloon was squeezed to dilate the lung.The maximum airway pressure was 40 cmH 2O and maintained for 40 s.The incidence of atelectasis in 48 hours after operation,pulmonary ventilation score before intubation,before extubation,20 minutes after extubation and 48 hours after operation,and the incidence of hypoxemia in resuscitation room,the incidence of hypotension in lung recruitment,length of stay in resuscitation room,incidence of postoperative pneumonia and length of stay in hospital were recorded in the two groups.Results 48 hours after operation,the incidence of atelectasis in the Lu group(4 cases)and the Tr group(11 cases)was 8.2%and 24.4%,respectively[risk ratio(RR)=0.82;95%CI:0.68-0.99;P=0.031].20 minutes after extubation,the incidences of atelectasis in the Lu group and the Tr groups were 10.20%and 31.10%,respectively(RR=0.77;95%CI:0.62-0.95;P=0.012).The pulmonary ultrasound score in the Lu group was significantly lower than that in the Tr group(P<0.05).The incidence of hypoxemia in the resuscitation room in the Lu group and the Tr group was 14.3%and 33.3%,respectively(RR=0.78;95%CI:0.62-0.99;P=0.028).The stay in the resuscitation room in th

关 键 词：肺超声 肺复张 腹腔镜手术 老年患者 肺不张 

分 类 号：R614.2[医药卫生—麻醉学]