驱动压导向的个体化PEEP对胃减容手术肥胖患者呼吸功能的影响  

in obese patients undergoing gastric reduction surgery

作　　者：杨海燕[1] 李佩佩 韦晓勇 袁瑞 闵红星 YANG Haiyan;LI Peipei;WEI Xiaoyong;YUAN Rui;MIN Hongxing(Department of Anesthesiology and Perioperative Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院麻醉与围术期医学科,宁夏银川750004 [2]宁夏医科大学,宁夏银川750004

出　　处：《宁夏医学杂志》2023年第11期1016-1019,共4页Ningxia Medical Journal

摘　　要：目的研究驱动压导向的个体化PEEP对胃减容手术肥胖患者全麻期间呼吸功能的影响。方法选择行腹腔镜胃减容手术的肥胖患者60例,随机分为对照组(C组)和驱动压导向组(D组),每组各30例。C组患者气管插管后以PEEP 5 cm H_(2)O维持至术毕;D组患者于气腹建立后5 min,将PEEP从2~10 cm H_(2)O逐步滴定,每个PEEP水平维持10次呼吸,记录2组患者最低气道平台压(Pplat)并计算驱动压(DP),选择驱动压最低时的PEEP值维持至术毕。记录2组患者气管插管后5 min(T_(1))、气腹后5 min(T_(2))、气腹后30 min(T_(3))、气腹后1 h(T_(4))的Pplat、DP及动态肺顺应性(Cdyn);于术前(T 0)、气腹5 min(T_(2))、气腹30 min(T_(3))、气腹1 h(T_(4))时行动脉血气分析,记录PaO_(2)、PaCO_(2),计算氧合指数(OI);记录2组患者的HR、MAP;比较2组患者一般情况、手术时间、失血量、输液量、血管活性药物的使用情况及术后住院日。结果与C组比较,D组患者在T_(3)、T_(4)时刻PaO_(2)、OI升高,差异有统计学意义(P<0.05);与C组比较,D组患者在T_(3)、T_(4)时刻DP降低,Cdyn升高,差异有统计学意义(P<0.05)。结论对于腹腔镜胃减容手术的肥胖患者,采用驱动压导向的个体化PEEP肺保护通气策略可改善患者术中氧合,降低驱动压,提高肺顺应性。Objective To investigate the effect of driven pressure-oriented individualized PEEP on respiratory function in obese patients undergoing gastric volume reduction surgery under general anesthesia.Methods 60 obese patients undergoing laparoscopic gastric volume reduction surgery were randomly divided into control group(group C,n=30)and drive pressure guided group(group D).Group C:PEEP 5 cmH_(2)O was used after endotracheal intubation until the end of operation;Group D:5min after the establishment of pneumoperitoneum,PEEP was titrated from 2~10 cmH_(2)O,and each PEEP level was maintained for 10 breaths.The lowest airway plateau pressure(Pplat)was recorded in both groups,and the driving pressure(DP)was calculated.The PEEP value at the lowest driving pressure was selected and maintained until the end of the operation.Pplat,DP and dynamic lung compliance(Cdyn)were recorded 5min after endotracheal intubation(T_(1)),5min after pneumoperitoneum(T_(2)),30 min after pneumoperitoneum(T_(3)),and 1h after pneumoperitoneum(T_(4))in two groups.Before surgery(T0),5min pneumoperitoneum(T_(2)),30 min pneumoperitoneum(T_(3)),and 1 hour pneumoperitoneum(T_(4))Blood gas analysis was performed,PaO_(2)and PaCO_(2)were recorded,and oxygenation index(OI)was calculated.The general situation,operation time,blood loss,infusion volume,use of vasoactive drugs and postoperative hospital stay of the two groups were compared.Results Compared with group C,PaO_(2)and OI in group D increased at T_(3)and T_(4),and the difference was statistically significant(P<0.05).Compared with group C,DP in group D was decreased and Cdyn was increased at T_(3)and T_(4),with statistical significance(P<0.05).Conclusion For obese patients undergoing laparoscopic gastric volume reduction surgery,the use of actuated pressure-oriented PEEP lung protective ventilation strategy can improve intraoperative oxygenation,reduce actuated pressure,and improve lung compliance.

关 键 词：肥胖 呼气末正压 驱动压 氧合 

分 类 号：R735[医药卫生—肿瘤]