驱动压导向呼气末正压滴定对腹腔镜直肠癌手术患者呼吸动力学及肺部并发症的影响  

Impact of driving pressure-guided PEEP titration on respiratory dynamics and pulmonary complications in patients undergoing laparoscopic rectal cancer surgery

作　　者：张振 池元龙 林葆 ZHAN-Zhen;CHI Yuanlong;LIN Bao(Department of Anesthesiology,Affiliated Sanming First Hospital of Fujian Medical University,Sanming,Fujian 365000,China;Department of Gastrointestinal Surgery,Affiliated Sanming First Hospital of Fujian Medical University,Sanming,Fujian 365000,China)

机构地区：[1]福建医科大学附属三明第一医院麻醉科,三明365000 [2]福建医科大学附属三明第一医院胃肠外科,三明365000

出　　处：《福建医药杂志》2025年第2期21-25,共5页Fujian Medical Journal

摘　　要：目的探讨驱动压导向呼气末正压(PEEP)滴定对腹腔镜直肠癌根治手术患者呼吸动力学及肺部并发症的影响。方法回顾性分析2020年3月至2023年5月143例直肠癌手术患者的临床资料,分析比较对照组(n=75,采用常规麻醉)和滴定组(n=68,采用PEEP滴定)的围手术期指标、呼吸动力学指标、气体交换指标、血清炎症指标及术后肺部并发症发生情况。结果滴定组在T_(2)、T_(3)、T_(4)时间点氧合指数(OI)、肺动态顺应性(Cdyn)、动脉血氧分压(PaO_(2))均高于对照组,而驱动压(ΔP)、血清炎症指标IL-6和TNF-α低于对照组,差异均有统计学意义(P<0.05);对照组和滴定组术后肺部并发症的发生率分别为26.7%、10.3%,差异有统计学意义(P<0.05)。结论在腹腔镜直肠癌根治手术患者中,驱动压导向个体化PEEP滴定有助于改善术中氧合,提高肺动态顺应性,降低术后肺部并发症的发生率。Objective To investigate the impact of driving pressure-guided PEEP(positive end expiratory pressure)titration on respiratory dynamics and pulmonary complications in patients undergoing laparoscopic rectal cancer surgery.Methods A retrospective analysis was conducted on the clinical data of 143 patients undergoing rectal cancer surgery from March 2020 to May 2023.Perioperative indexes,respiratory dynamics indexes,gas exchange indexes,serum inflammatory indexes,and postoperative pulmonary complications were analyzed and compared between the control group(accepting routine anesthesia)and the titration group(accepting PEEP titration).Results Oxygenation index(OI),dynamic lung compliance(Cdyn)and arterial partial pressure of oxygen(PaO_(2))in the titration group were higher than those in the control group at T_(2),T_(3)and T_(4),while driving pressure(ΔP),serum inflammatory indexes IL-6 and TNF-αwere lower than those in the control group,with statistical significance(P<0.05).The incidence of postoperative pulmonary complications in the control group and the titration group was 26.7%and 10.3%,respectively,and the difference was statistically significant(P<0.05).Conclusion In patients undergoing laparoscopic rectal cancer surgery,individualized PEEP titration guided by driving pressure helps to improve intraoperative oxygenation,increase lung dynamic compliance,and reduce the incidence of postoperative pulmonary complications.

关 键 词：驱动压 呼气末正压滴定 呼吸动力学 肺部并发症 直肠癌 

分 类 号：R614.2[医药卫生—麻醉学]