以肺顺应性为导向的PEEP滴定法对肺癌根治术老年患者术中氧合和术后谵妄的影响  

The Effect of PEEP Titration Guided by Lung Compliance on Oxygenation and Postoperative Delirium in Elderly Patients Undergoing Radical Surgery for Lung Cancer

作　　者：陈紫琪 何怡达 纪尚实 李锋 CHEN Ziqi;HE Yida;JI Shangshi;LI Feng(Department of Anesthesiology,Yancheng Clinical College,Xuzhou Medical University,Yancheng,Jiangsu 224000,China;Department of Anesthesiology,Yancheng First People's Hospital,Yancheng,Jiangsu 224000,China)

机构地区：[1]徐州医科大学附属盐城临床学院麻醉科,江苏盐城224000 [2]盐城市第一人民医院麻醉科,江苏盐城224000

出　　处：《转化医学杂志》2024年第8期1225-1230,共6页Translational Medicine Journal

基　　金：江苏省中医药科技发展计划(MS2024103);江苏省老年健康科研项目(LKM2024048)。

摘　　要：目的观察呼气末正压(PEEP)滴定法对肺癌根治术患者围术期肺氧合改善和术后谵妄(POD)发生率的影响。方法选取2023年12月至2024年5月择期行全麻胸腔镜下肺癌根治术的老年患者110例,采取随机数字表法分为G组(以动态肺顺应性指导最佳PEEP组)和R组(不设置PEEP组),每组55例。2组双肺通气呼吸参数设置:潮气量6~8 mL/kg,I∶E=1∶2;单肺通气(OLV)呼吸参数设置:潮气量5 mL/kg,I∶E=1∶2;G组摆好侧卧位行肺复张后PEEP滴定,当肺顺应性最大时取该PEEP值维持至OLV结束;对照组不设置PEEP,即在肺复张后进行OLV。术中通过血管活性药物和麻醉药物将平均动脉压维持在基线±20%,心率50~100/min;通过调整呼吸频率维持呼吸末二氧化碳分压在35~45 mmHg,记录患者术中不同时间点脉搏血氧饱和度(SpO2)、动脉血氧分压(PaO2),计算氧合指数(OI),术后3、5 d患者3 min谵妄评估量表评估患者POD发生情况,术前和术后2组外周血白细胞介素-6(IL-6)水平以及术后24、48 h肺部超声评分(LUS),同时记录PEEP滴定前后呼吸循环功能变化。结果与R组相比,G组单肺通气结束时SpO2、PaO2明显增加,OI明显改善(P<0.05)。与R组相比,G组术后3、5 d POD发生率明显降低,术后24 h单肺LUS评分、术后IL-6水平也明显降低(P<0.05)。2组术后48 h LUS评分比较无统计学差异(P>0.05)。结论以肺顺应性为指导的个体化PEEP滴定用于老年胸腔镜下肺癌根治术患者,有利于改善术中氧合、降低炎症反应,对POD有一定预防作用。Objective To observe the effect of positive end expiratory pressure(PEEP)titration on perioperative im⁃provement of pulmonary oxygenation and postoperative delirium(POD)in patients undergoing radical resection of lung cancer.Methods A total of 110 elderly patients who underwent thoracoscopic radical lung cancer surgery under general anesthesia from December 2023 to May 2024 were selected and divided into group G(optimal PEEP group guided by dynamic lung com⁃pliance)and group R(do not set PEEP group)by random number table method,with 55 cases in each group.Respiratory parameters of the two groups were set as follows:tidal volume 6⁃8 mL/kg,I∶E=1∶2;Respiratory parameters of single lung ventilation(OLV)were set as follows:tidal volume 5 mL/kg,I∶E=1∶2;The PEEP of group G was titrated after lung re⁃expansion in lateral position,and the PEEP value was taken when the lung compliance was maximum and maintained until the end of OLV.The control group did not set PEEP,that is,OLV was performed after pulmonary reexpansion.Intraoperative maintenance The mean arterial pressure was±20%at baseline and the heart rate was 50⁃100/min with vasoactive drugs and anesthesia drugs;By adjusting the respiratory rate to maintain the end⁃respiratory carbon dioxide partial pressure at 35⁃45 mmHg,pulse oxygen saturation(SpO2)and arterial oxygen partial pressure(PaO2)were recorded at different time points during the operation,oxygenation index(OI)was calculated,and POD occurrence was evaluated with the 3min delirium as⁃sessment scale 3 and 5 days after the operation.The levels of interleukin⁃6(IL⁃6)in peripheral blood before and after opera⁃tion and lung ultrasound scores(LUS)at 24 and 48 h after operation were recorded in the 2 groups,and the changes of respir⁃atory and circulatory function before and after PEEP titration were recorded.Results Compared with R group,SpO2 and PaO2 were significantly increased and OI was significantly improved in G group at the end of single lung ventilation(P<0.05).Compared with

关 键 词：肺癌 呼气末正压 老年 胸腔镜 单肺通气 术后谵妄 白细胞介素-6 

分 类 号：R734.2[医药卫生—肿瘤]