肺复张联合个体化PEEP策略对腹腔镜手术老年患者术后肺不张程度的影响  

Effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure on degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery

作　　者：王继文 庄猛 单蓓莹 吴立雪 曹亮亮 董楠[2] 张继如 Wang Jiwen;Zhuang Meng;Shan Beiying;Wu Lixue;Cao Liangliang;Dong Nan;Zhang Jiru(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,Affiliated Hospital of Jiangnan University,Wuxi 214122,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]江南大学附属医院麻醉科,无锡214125

出　　处：《中华麻醉学杂志》2024年第2期150-154,共5页Chinese Journal of Anesthesiology

基　　金：江苏省科学技术厅社会发展面上项目(BE2020634);江苏省自然科学基金面上项目(BK20191138);无锡市医疗卫生中青年拔尖人才(BJ2020049)。

摘　　要：目的评价肺复张联合个体化呼气末正压(PEEP)策略对腹腔镜手术老年患者术后肺不张程度的影响。方法择期拟行腹腔镜手术老年患者143例,性别不限,年龄≥65岁,BMI 18.5~30.0 kg/m^(2)。采用随机数字表法分为肺复张联合个体化PEEP策略组(Ⅱ组)和固定PEEP组(Ⅰ组)。手术开始后Ⅰ组维持PEEP 6 cmH_(2)O直至手术结束;Ⅱ组在麻醉诱导后进行个体化PEEP滴定。主要结局指标:气管拔管后15 min时肺部12分区超声评分,次要结局指标:术后7 d内术后肺部并发症发生率、术后第3天时15项恢复质量量表评分、非计划入住ICU率、住院时间、术中低氧血症发生率、血管活性药物使用率及术后低血压发生率。结果与Ⅰ组比较,Ⅱ组肺超声评分、驱动压和术后肺部并发症发生率降低,肺动态顺应性增加(P<0.05或0.01),其他指标差异无统计学意义(P>0.05)。结论肺复张联合个体化PEEP策略可降低腹腔镜手术老年患者术后肺不张的程度。Objective To evaluate the effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure(PEEP)on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods One hundred and forty-three elderly patients,aged≥65 yr,with body mass index of 18.5-30.0 kg/m^(2),scheduled for elective laparoscopic surgery,were assigned to either individualized PEEP combined with recruitment maneuvers(groupⅡ)or fixed PEEP(groupⅠ)using a random number table method.PEEP was maintained at 6 cmH_(2)O starting from the beginning of procedure until the end of the procedure in group I.Individualized PEEP titration was performed after induction of anesthesia in groupⅡ.The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation.Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery,Quality of Recovery-15 scale score on 3rd day after surgery,rate of unplanned admission to intensive care units,length of hospital stay,incidence of intraoperative hypoxemia,usage rate of intraoperative vasoactive drugs,and incidence of postoperative hypotension.Results Compared with groupⅠ,the lung ultrasound score,driving pressure and postoperative pulmonary complications were significantly decreased,the dynamic lung compliance was increased(P<0.05 or 0.01),and no significant changes were found in the other parameters in groupⅡ(P>0.05).Conclusions Individualized PEEP combined with recruitment maneuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.

关 键 词：呼吸 人工 正压呼吸 腹腔镜检查 肺不张 

分 类 号：R655[医药卫生—外科学]