不同呼气末正压对腹腔镜腹部手术患者术后肺部并发症的影响  

作　　者：郑彩虹 翟雯[3] 刘金涛 陈嘉宝 周振锋 

机构地区：[1]浙江中医药大学,310053 [2]杭州市妇产科医院,310008 [3]浙江省人民医院,310009

出　　处：《浙江临床医学》2024年第2期269-271,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020KY032)。

摘　　要：目的评价不同呼气末正压(PEEP)对腹腔镜腹部手术患者术后肺部并发症(PPC)的影响。方法择期气管插管全身麻醉下拟行腹腔镜腹部手术患者72例,ARISCAT风险评分≥26分,根据术中采用不同呼气末正压(PEEP)随机分为较高PEEP肺通气组(处理组,PEEP=6~8 cmH_(2)O)和低PEEP肺通气组(对照组,PEEP=0~2 cmH_(2)O),每组各36例。主要观察指标为术后7 d内PPC的发生率。结果处理组术后7 d内呼吸道感染的发生率明显低于对照组(16.7%VS.41.7%,P=0.02)。两组间术后7 d内PPC的发生率、术后第7天mCPIS评分、手术并发症的严重程度,术后住院时间及入住重症监护病房(ICU)发生率的比较差异均无统计学意义(P>0.05)。结论气管插管全身麻醉下行腹腔镜腹部手术患者,采用较高PEEP的术中机械通气策略能降低呼吸道感染的发生率,但并未明显改善其术后肺部并发症的发生率。Objective To explore the effect of different positive end expiratory pressure(PEEP)on postoperative pulmonary complications(PPC)in patients undergoing laparoscopic abdominal surgery.Methods A total of 72 patients undergoing laparoscopic abdominal surgery under selective tracheal intubation and general anesthesia.ARISCAT Score was≥26.Subjects were randomized and divided into two groups for parallel control:the high PEEP group(the treatment group,PEEP=6~8 cmH_(2)O)and the low PEEP group(the control group,PEEP=0~2 cmH_(2)O).The primary outcome was the incidence of PPC within 7 days after operation.Results The incidence of respiratory tract infections within 7 days after surgery in the treatment group was significantly lower than that in the control group(16.7%VS.41.7%,P=0.02).There was no statistically significant difference in the incidence of PPC within 7 days after surgery,the modified clinical pulmonary infection score(mCPIS)on the 7th day after surgery,severity of surgical complications,the length of postoperative hospitalization,and the incidence of hospitalization in the intensive care unit(ICU)between the two groups(P>0.05).Conclusion This study shows that the intraoperative mechanical ventilation strategy with higher PEEP showed no improvement in postoperative pulmonary complications,however,it can lower the incidence of respiratory tract infections in patients undergoing laparoscopic abdominal surgery under general anesthesia for endotracheal intubation.

关 键 词：腹腔镜 腹部手术 呼气末正压 肺部并发症 

分 类 号：R614[医药卫生—麻醉学]