驱动压导向最佳PEEP的肺保护通气策略对腹腔镜下前列腺癌根治术患者围术期氧合功能的影响  

作　　者：王武[1] 周建伟[1] 吴绍芳[1] 王传光[1] 

机构地区：[1]浙江省丽水市中心医院,323000

出　　处：《浙江临床医学》2023年第6期900-902,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY413)。

摘　　要：目的探讨驱动压导向最佳呼气末正压(PEEP)的肺保护通气策略对腹腔镜下前列腺癌根治术患者围术期氧合功能的影响。方法择期腹腔镜下前列腺癌根治术患者66例,年龄65~85岁,ASA I~III级。随机分为两组(n=33):常规通气组(C组)和驱动压导向最佳PEEP通气组(P组),设置VT为7 mL/kg,初始PEEP为5 cmH2O。C组常规通气并鼓肺(RMs)1次/30 min;P组经驱动压滴定探寻不同患者最佳PEEP值,并鼓肺1次/30 min。于麻醉诱导后10 min(T_(1))、RMs后30 min(T_(2)、T_(3)、T_(4))时记录动态顺应性(Cdyn),于T_(1)~T_(4)、拔管后30 min(T5)及术后第3天(T6)时采集动脉血,测氧合指数(OI),记录术前(T_(0))及T6时的改良肺部感染评分(mCPIS)。结果与C组比较,P组T_(3)~T6时氧合指数升高,T_(4)时Cdyn升高,T6时mCPIS降低(P<0.05)。结论驱动压导向最佳PEEP的肺保护通气策略可改善腹腔镜前列腺癌根治术患者围术期氧合。Objective To investigate the effect of the lung protective ventilation strategy by the driven pressure guided optimal PEEP on perioperative oxygenation in patients with laparoscopic prostate cancer.Methods Sixty-six laparoscopic prostate cancer patients,aged 65~85yr,with American Society of Anesthesiologists physical status I-III,scheduled for elective laparoscopic prostate cancer were divided into 2 groups(n=33 in each group)using a random number table method:the conventional ventilation group(group C)and the driven pressure guided optimal PEEP of protective ventilation group(group P).The 7 mL/kg tidal volume(VT)with PEEP 5 cmH2O were set in both groups before pneumoperitoneum in laparoscopy being established.Routine ventilation and manoeuvres(RMs)per 30 mins were received in the group C,while optimal PEEP determined by driven pressure and RMs per 30 mins were set in the group P.The dynamic compliance(Cdyn)at 10 mins after anesthesia induction(T_(1)),30 mins after every RMs(T_(2),T_(3),T_(4))were recorded.Arterial oxygenation index was recorded at T_(1)~T_(4),30 mins after extubation(T5)and 3 days after surgery(T6).Modified clinical pulmonary infection score(mCPIS)was recorded at preoperative(T_(0))and T6.Results Compared with the group C,the oxygenation index was significantly increased at T_(3)~T6,the Cdyn was significantly improved at T_(4),the mCPIS was significantly decreased at T6 in the group P(P<0.05).Conclusion The lung protective ventilation strategy by the driven pressure guided optimal PEEP can improve perioperative oxygenation in patients undergoing laparoscopic radical prostatectomy.

关 键 词：驱动压 呼气末正压 肺保护性通气 

分 类 号：R737.25[医药卫生—肿瘤]