肺动态顺应性指导个体化PEEP滴定对颅面重建术患儿术后肺不张的影响  

Effect of dynamic lung compliance-guided individualized PEEP on postoperative atelectasis in children undergoing craniofacial reconstruction

作　　者：施伶俐 赵龙德[1] 张莉[1] 王建设[1] SHI Lingli;ZHAO Longde;ZHANG Li;WANG Jianshe(Department of Anesthesiology,Children s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院麻醉科,210008

出　　处：《临床麻醉学杂志》2024年第7期683-687,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨肺动态顺应性(Cdyn)指导个体化PEEP滴定对颅面重建术患儿术后肺不张的影响。方法选择全麻下行颅面重建术患儿80例,男52例,女28例,年龄≤1岁,ASAⅠ或Ⅱ级,麻醉时间≥2 h。采用随机数字表法将患儿分为两组:Cdyn导向个体化PEEP组(I组)和固定PEEP组(P组),每组40例。I组在插管后5 min肺部超声评分(LUS)后进行PEEP滴定,Cdyn最高值对应的PEEP为个体化PEEP;P组PEEP固定为6 cmH_(2)O。记录插管后5 min和手术结束时胸膜旁实变评分、B线评分、LUS总评分和肺不张发生情况。记录插管后5 min和PEEP建立后Cdyn、气道峰压(Ppeak)、HR、MAP。记录插管后5 min和手术结束时氧合指数(OI)和术后72 h肺部并发症的发生情况。结果I组滴定过程中Cdyn最高值时对应个体化PEEP滴定值中位数为9 cmH_(2)O。与插管后5 min比较,两组手术结束时胸膜旁实变总评分、后胸部胸膜旁实变评分、B线总评分和前、侧、后胸部B线评分、LUS总评分均明显降低(P<0.05)。与P组比较,I组手术结束时胸膜旁实变评分、后胸部胸膜旁实变总评分、B线总评分、后胸部B线评分、LUS总评分、肺不张发生率明显降低(P<0.05),I组PEEP建立后Cdyn和Ppeak明显升高(P<0.05),手术结束时OI明显升高(P<0.05),术后72 h肺部并发症总发生率明显降低(P<0.05)。结论术中应用Cdyn指导个体化PEEP滴定能有效降低颅面重建术患儿手术结束时LUS评分和肺不张发生率,改善氧合功能,降低术后肺部并发症发生率。Objective To investigate the effect of dynamic lung compliance(Cdyn)-guided individualized positive end-expiratory pressure(PEEP)on postoperative atelectasis in children undergoing craniofacial reconstruction.Methods Eighty children under general anesthesia undergoing craniofacial reconstruction were selected,52 males and 28 females,aged≤1 year,ASA physical statusⅠorⅡ,anesthesia duration≥2 hours.According to the random number table method,the children were divided into two groups:Cdyn-guided individualized PEEP group(group I)and fixed PEEP group(group P),40 children in each group.PEEP titration was performed in group I after assessing the lung ultrasound(LUS)score 5 minutes after intubation,and the PEEP corresponding to the highest value of Cdyn was an individualized PEEP.In group P,PEEP was fixed 6 cmH_(2)O.The parapleural consolidation score,the B-line score,the total score of LUS,and the incidence of atelectasis were recorded 5 minutes after intubation and at the end of the operation.Cdyn,Ppeak,HR and MAP were recorded 5 minutes after intubation and after PEEP was established.Oxygenation index(OI)was recorded 5 minutes after intubation and at the end of the operation.The incidence of postoperative pulmonary complications within 72 hours after operation were recorded.Results Median individualized PEEP with highest dynamic compliance during titration was 9 cmH_(2)O in group I.Compared with 5 minutes after intubation,the total parapleural consolidation score,posterior thoracic parapleural consolidation score,total B-line score and anterior lateral posterior chest B-line score,and total score of LUS were significantly decreased in both groups at the end of the operation(P<0.05).Compared with group P,the total score of parapleural consolidation,posterior chest parapleural consolidation score,total score of B-line and posterior chest B-line score,and total score of LUS,the incidence of atelectasis were significantly decreased in group I at the end of the operation(P<0.05).Compared with group P,Cdyn and Ppeak

关 键 词：呼气末正压 动态顺应性 肺不张 肺超声评分 肺保护性通气策略 

分 类 号：R726.1[医药卫生—儿科]