个体化呼气末正压对老年脊柱手术患者的影响  

Effect of Individualized Positive End-Expiratory Pressure on Elderly Patients Undergoing Spinal Surgery

作　　者：龚瑶[1] 吴畏 何崎[1] 张莉 Gong Yao;Wu Wei;He Qi;Zhang Li(Department of Anesthesiology,Affiliated Sport Hospital of Chengdu Sport University,Chengdu 610041,China;Department of Anesthesia and Pain,General Hospital of Western Theater Command PLA,Chengdu 610083,China)

机构地区：[1]成都体育学院附属体育医院麻醉科,成都610041 [2]西部战区总医院麻醉疼痛科,成都610083

出　　处：《成都医学院学报》2025年第1期88-92,97,共6页Journal of Chengdu Medical College

基　　金：四川省保健委员会干部保健普及应用项目(No:川干研2022-1301);成都市卫生健康委员会医学科研项目(No:2024004)。

摘　　要：目的探讨驱动压(DP)滴定个体化呼气末正压(PEEP)对老年脊柱手术患者的影响。方法选取2022年10月至2023年10月于成都体育学院附属体育医院择期在全麻下行俯卧位脊柱手术的137例老年患者为研究对象,采用随机数字表法,将其分为PEEP滴定组(V_(T)=6 mL/kg,DP滴定PEEP,肺复张,n=46)、固定组(V_(T)=6 mL/kg,PEEP=5 cmH_(2)O,肺复张n=45)和常规组(V_(T)=8 mL/kg,无PEEP,无肺复张,n=46)。比较3组入室(T0)、插管后5 min(T1)、俯卧后5 min(T2)、手术1 h(T3)、拔管前(T4)、出室(T5)的血流动力学指标;比较3组T1、T2、T3、T4呼吸力学指标;比较3组T0、T3、T4血气分析指标;比较3组T0、术后1 d(T6)、出院前(T7)炎症因子指标;比较3组术后30 d肺部并发症(PPCs)发生率及严重程度;比较3组住院时间和住院费用。结果纳入患者共发生PPCs 22例,其中PEEP滴定组6例、固定组5例、常规组11例。3组PPCs发生率、严重程度、住院费用比较,差异无统计学意义(P>0.05)。PEEP滴定组T2、T4的PEEP水平低于T1(P<0.05)。与常规组相比,PEEP滴定组和固定组在T1、T2、T3、T4驱动压更低(P<0.01);在T3、T4动脉血CO_(2)分压较高,在T4氧合指数较高(P<0.05)。与常规组相比,PEEP滴定组C-反应蛋白在T6更低,住院时间更短(P<0.05)。结论驱动压滴定PEEP可降低老年脊柱手术患者驱动压,减少炎症反应、改善氧合情况,但对术后肺部并发症发生率无明显影响。Objective To investigate the effect of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)titration on elderly patients undergoing spinal surgery.Methods A total of 137 elderly patients who were scheduled for spinal surgery in prone position under general anesthesia in the Affiliated Sport Hospital of Chengdu Sport University between October 2022 and October 2023 were selected as the study objects.The patients were randomly divided into a titrated PEEP group[tidal volume(VT)=6 mL/kg,titrated PEEP by DP,with intraoperative pulmonary resuscitation,n=46],a fixed PEEP group(VT=6 mL/kg,PEEP=5 cmH2O,with intraoperative pulmonary resuscitation,n=45)and a conventional ventilation group(VT=8 mL/kg,no PEEP,no pulmonary resuscitation,n=46)by random number table method.Hemodynamic indices on admission to the operating room(T0),5 min after tracheal intubation(T1),5 min after position placement(T2),1 h after the begining of surgery(T3),before extubation(T4)and exit from the operating room(T5)were compared.Respiratory mechanics indicators at T1,T2,T3 and T4 were compared.Blood gas analysis indicators at T0,T3 and T4 were compared.Inflammatory factor indicators at T0,1 d after surgery(T6),and before discharge(T7)were compared.The incidence and severity of postoperative pulmonary complications(PPCs)30 d after surgery were compared.The length of stay and total hospital costs were compared.Results A total of 22 patients suffered from PPCs were included,including 6 patients in the PEEP titrated group,5 patients in the fixed PEEP group and 11 patients in the conventional ventilation group.There was no significant difference in the incidence and severity of PPCs,and total hospital costs among the three groups(P>0.05).The PEEP levels at T2 and T4 in the titrated PEEP group were lower than that at T1(P<0.05).Compared with the conventional ventilation group,the titrated and fixed PEEP groups had lower DP at T1,T2,T3 and T4,higher arterial partial pressure of carbon dioxid(PaCO2)at T3 and T4,and higher oxygen

关 键 词：脊柱退行性病变 脊柱手术 肺保护性通气 术后肺部并发症 驱动压 俯卧位通气 

分 类 号：R614[医药卫生—麻醉学]