基于肺开放策略的个体化PEEP滴定对经尿道前列腺激光切除术老年患者术中胸腔液体水平的影响  

Effect of individualized PEEP titration based on open-lung strategy on intraoperative thoracic fluid content in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy

作　　者：马娟 张扬 王梓 张婷婷 黄天丰 葛亚丽 王存金 高巨 Ma Juan;Zhang Yang;Wang Zi;Zhang Tingting;Huang Tianfeng;Ge Yali;Wang Cunjin;Gao Ju(Department of Anesthesiology,Subei People′s Hospital Affiliated to Yangzhou University Clinical Medical College,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院麻醉科,扬州225001

出　　处：《中华麻醉学杂志》2024年第2期140-144,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(82172190,82101299);江苏省卫生健康委员会医学科研项目面上项目(M2021105);扬州市麻醉学重点实验室(YZ2021148)。

摘　　要：目的评价基于肺开放策略的个体化PEEP滴定对经尿道前列腺激光切除术(TULIP)老年患者术中胸腔液体水平(TFC)的影响。方法择期行TULIP患者86例,年龄65~80岁,BMI 18~28 kg/m^(2),ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=43):固定PEEP组(C组)和个体化PEEP滴定组(P组)。C组患者行常规机械通气后设置PEEP为4 cmH_(2)O;P组患者术中采用肺复张联合个体化PEEP滴定。分别于气管插管后5 min(T_(0))、PEEP滴定并通气30 min(T_(1))、手术结束前5 min(T_(2))及出恢复室前(T_(3))时,采用无创心输出量监测仪测定TFC;于T_(0)-T_(2)时记录CO、CI和SVI,同时行动脉血气分析,并记录气道峰压及肺动态顺应性,计算氧合指数。记录PACU滞留时间和术后7 d内肺部并发症发生情况、住院时间。结果最终纳入83例患者,C组42例,P组41例。与C组比较,P组T_(1)-T_(3)时TFC降低,T_(1)时CI、CO及SVI降低,T_(1)和T_(2)时肺动态顺应性、PaO2和氧合指数升高,PaCO_(2)降低,术后肺部并发症发生率降低,PACU滞留时间和术后住院时间缩短(P<0.05)。结论基于肺开放策略的个体化PEEP滴定可有效降低TULIP老年患者TFC,改善术中氧合及预后。Objective To evaluate the effect of individualized positive end-expiratory pressure(PEEP)titration based on open-lung strategy on the intraoperative thoracic fluid content(TFC)in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy(TULIP).Methods Eighty-six American Society of Anesthesiologists Physical Status classificationⅡorⅢ,patients,aged 65-80 yr,with body mass index of 18-28 kg/m^(2),scheduled for elective TULIP,were divided into 2 groups(n=43 each)by the random number table method:fixed PEEP group(group C)and individualized PEEP titration group(group P).PEEP was set at 4 cmH_(2)O after routine mechanical ventilation in group C.Patients underwent pulmonary recruitment maneuvers combined with individualized PEEP titration during surgery in group P.TFC was measured using a non-invasive cardiac output monitor at 5 min after tracheal intubation(T_(0)),30 min after PEEP titration and ventilation(T_(1)),5 min before surgery(T_(2)),and 5 min before leaving the recovery room(T_(3)).Cardiac output,oxygenation index and stroke volume index were recorded from T_(0)-T_(2),arterial blood gas analysis was simultaneously performed to record peak airway pressure and dynamic lung compliance,and oxygenation index was calculated.The duration of postanesthesia care unit stay,pulmonary complications within 7 days after surgery,and length of hospital stay were also recorded.Results Eighty-three patients were finally included,with 42 in group C and 41 in group P.Compared with group C,TFC was significantly decreased at T_(1)-T_(3),cardiac index,cardiac output and stroke volume index were decreased at T_(1),dynamic lung compliance,PaO_(2) and oxygenation index were increased at T_(1) and T_(2),PaCO_(2) was decreased,the incidence of postoperative pulmonary complications was reduced,and the duration of postanesthesia care unit stay and postoperative length of hospital stay were shortened in group P(P<0.05).Conclusions Individualized PEEP titration based on open-lung strategy can effectively dec

关 键 词：正压呼吸 老年人 经尿道前列腺切除术 胸腔液体水平 

分 类 号：R614[医药卫生—麻醉学]