两种胸腔镜肺叶切除术个体化呼气末正压通气方法的比较  

Comparison of two methods of individualized positive end expiratory pressure in thoracoscopic lobectomy

作　　者：刘世建 卢彬[1] 江倩[1] 陈东黎 LIU Shijian;LU Bin;JIANG Qian(Department of Anesthesiology,Zigong Fourth People's Hospital,Zigong 643000,China)

机构地区：[1]自贡市第四人民医院麻醉科,四川自贡643000

出　　处：《腹腔镜外科杂志》2024年第9期652-656,661,共6页Journal of Laparoscopic Surgery

摘　　要：目的:比较肺部电阻抗断层成像(EIT)法与肺动态顺应性(Cdyn)对胸腔镜肺叶切除术个体化呼气末正压通气(PEEP)的指导价值。方法:选取2022年4月至2023年4月采用全麻胸腔镜肺叶切除术肺保护性通气治疗的124例患者,随机数字表法分为两组,EIT组采用EIT指导个体化PEEP设定,Cdyn组采用Cdyn指导个体化PEEP设定。观察两组获得个体化PEEP成功率、个体化PEEP值;比较两组个体化PEEP设置后5 min(T_(1))、30 min(T_(2))、60 min(T_(3))时平台压、驱动压及呼气末二氧化碳分压,以及两组麻醉前(T_(0))、T_(1)、T_(2)、T_(3)、拔管后10 min(T_(4))时氧合指数;统计两组拔除气管导管时间、麻醉后监测治疗室停留时间、术后肺部并发症情况。结果:排除4例患者,最终EIT组、Cdyn组各纳入60例;EIT组个体化PEEP成功率100%,高于Cdyn组的86.67%(P<0.05);EIT组个体化PEEP值为4.8(1.6,6.0)cmH_(2)O,低于Cdyn组的6.0(4.0,8.0)cmH_(2)O(P<0.05);T_(2)、T_(3)时,EIT组平台压高于Cdyn组,驱动压低于Cdyn组(P<0.05);T_(1)~T_(4)时,EIT组氧合指数均高于Cdyn组(P<0.05);T_(3)时,Cdyn组平台压低于T_(1)、T_(2)时,驱动压高于T_(1)、T_(2)(P<0.05);T_(2)~T_(4)时,EIT组氧合指数均高于T_(0)、T_(1)(P<0.05);T_(3)时,Cdyn组氧合指数高于T_(0)、T_(1)(P<0.05);T_(4)时,两组氧合指数均低于T_(3)(P<0.05);两组拔除气管导管时间、监测治疗室停留时间差异无统计学意义(P>0.05);EIT组术后肺部并发症发生率低于Cdyn组(3.33%vs.17.31%,P<0.05)。结论:EIT指导胸腔镜肺叶切除术个体化PEEP设定的价值高于Cdyn,在提升个体化PEEP成功率、降低个体化PEEP值、改善呼吸力学参数与氧合功能、减少术后肺部并发症方面更具优势。Objective:To compare the guidance value of electrical impedance tomography(EIT)and dynamic lung compliance(Cdyn)for individualized positive end expiratory pressure(PEEP)in thoracoscopic lobectomy.Methods:From Apr.2022 to Apr.2023,124 patients with lung protective ventilation after thoracoscopic lobectomy under general anesthesia were included.They were d ivided into two groups by random number table method:the EIT group used EIT to guide individual PEEP setting,and the Cdyn group used Cdyn to guide individual PEEP setting.The success rate of individualized PEEP and the value of individualized PEEP were o bserved between the two groups.The platform pressure,driving pressure and partial pressure of end-expiratory carbon dioxide at 5 min(T_(1)),30 min(T_(2))and 60 min(T_(3))after individualized PEEP settings were compared between the two groups.The oxygenation index before anesthesia(T_(0)),at T_(1),T_(2),T_(3)and 10 min after extubation(T_(4))were compared between the two groups.The time of tracheal catheter removal,stay time in postanesthesia care unit after anesthesia and postoperative pulmonary complications of the two groups were monitored.Results:A total of 4 patients were excluded,and 60 patients were included in EIT group and Cdyn group respectively.The success rate of individualized PEEP in EIT group was 100%,which was higher than 86.67%in Cdyn group(P<0.05).The individual PEEP value of EIT group was 4.8(1.6,6.0)cmH_(2)O,which was lower than 6.0(4.0,8.0)cmH_(2)O of Cdyn group(P<0.05).At T_(2)and T_(3),the platform pressure of EIT group was higher than that of Cdyn group,and the driving pressure was lower than that of Cdyn group(P<0.05).At T_(1)to T_(4),the oxygenation index of EIT group was higher than that of Cdyn group(P<0.05).At T_(3),the platform pressure of Cdyn group was lower than that at T_(1)and T_(2),and the driving pressure was higher than T_(1)and T_(2)(P<0.05).At T_(2)to T_(4),the oxygenation index of EIT group was higher than that of T_(0)and T_(1)(P<0.05).At T_(3),the oxygenation index of Cdy

关 键 词：肺叶切除术 胸腔镜检查 正压呼吸 电阻抗断层成像 肺动态顺应性 

分 类 号：R655.3[医药卫生—外科学]