个体化呼气末正压对胸腔镜肺癌手术患者苏醒期呼吸力学、氧合及术后并发症的影响:基于EIT技术  

Effects of individualized PEEP on respiratory mechanics during recovery,oxygenation and postoperative complications in patients undergoing thoracoscopic lung cancer surgery:based on EIT

作　　者：江倩[1] 李强[1] 刘世建 JIANG Qian;LI Qiang;LIU Shijian(Department of Anesthesiology,Zigong Fourth People's Hospital/Chongqing Medical University Teaching Hospital,Zigong 643000,China)

机构地区：[1]自贡市第四人民医院/重庆医科大学教学医院麻醉科,四川自贡643000

出　　处：《分子影像学杂志》2025年第3期371-378,共8页Journal of Molecular Imaging

基　　金：医疗质量循证管理持续改进研究项目(YLZLXZ22G041);自贡市科技计划项目(2023YLWS22)。

摘　　要：目的 基于电阻抗断层成像(EIT)技术的个体化呼气末正压(PEEP)对胸腔镜肺癌手术患者苏醒期呼吸力学、氧合及术后并发症的影响。方法 纳入2022年10月~2024年10月于本院行胸腔镜肺癌手术治疗的84例患者,采用随机数字表法将其分为对照组和试验组,42例/组,分别应用常规PEEP-吸入氧浓度表法及EIT技术指导个体化PEEP滴定来行肺保护性通气。比较两组患者苏醒期不同时间点[进入苏醒室时(T1)、机械通气30 min(T2)、苏醒后(T3)]呼吸力学、氧合功能、血流动力学的差异,比较两组的术后康复相关指标及1周内并发症发生率。结果 试验组术中及苏醒室内最佳PEEP值均高于对照组(P<0.05);治疗后,T1时两组动态肺顺应性(Cdyn)、气道峰压(P_(peak))、平台压(P_(plat))、ΔP、氧合指数(OI)的差异无统计学意义(P>0.05);T2、T3时两组Cdyn、OI均高于同组T1时,且试验组高于对照组(P<0.05),两组P_(peak)、P_(plat)、ΔP低于同组T1时,且试验组低于对照组(P<0.05);T1~T3时两组动脉血二氧化碳分压、平均动脉压、中心静脉压、心率的差异均无统计学意义(P>0.05)。试验组拔管时间、苏醒时间、住院时间均短于对照组(P<0.05);术后1周试验组低氧血症、呼吸机相关性肺损伤及肺部并发症的发生率低于对照组(P<0.05)。结论 将基于EIT技术的个体化PEEP用于胸腔镜肺癌手术患者能有效改善苏醒期呼吸力学及氧合功能,减少术后相关并发症的发生,提高苏醒期质量,但对血流动力学无明显影响。Objective To explore the effects of individualized positive end expiratory pressure(PEEP)based on electrical impedance tomography(EIT)on respiratory mechanics during recovery,oxygenation and postoperative complications in patients undergoing thoracoscopic lung cancer surgery.Methods According to random number table method,84 patients undergoing thoracoscopic lung cancer surgery in the hospital were divided into control group(routine PEEP-fraction of inspired oxygen)and experimental group(individualized PEEP titration based on EIT)between October 2022 and October 2024,including 42 cases per group.The differences in respiratory mechanics,oxygenation function and hemodynamics at different time points during recovery[immediately after entering the recovery room(T1),30min of mechanical ventilation(T2),after awaking(T3)],postoperative rehabilitation indexes and incidence of complications within 1 week were compared between the two groups.Results The intraoperative PEEP and optimal PEEP in recovery room in experimental group were higher than those in control group(P<0.05).At T1,there was no significant difference in dynamic compliance(Cdyn),peak airway pressure(P_(peak)),plateau pressure(P_(plat)),ΔP or oxygenation index(OI)between the two groups(P>0.05).Compared with T1,Cdyn and OI were increased in both groups at T2 and T3,which were higher in experimental group than control group(P<0.05),while P_(peak),P_(plat) andΔP were decreased,which were lower in experimental group than control group(P<0.05).From T1-T3,there was no significant difference in partial pressure of carbon dioxide,mean arterial pressure,central venous pressure or heart rate between the two groups(P>0.05).The extubation time,awaking time and length of hospital stay in experimental group were shorter than those in control group(P<0.05).Within 1 week after surgery,incidence of hypoxemia,ventilator-associated lung injury and postoperative pulmonary complications in experimental groups was lower than that in control group(P<0.05).Conclusion Individualize

关 键 词：肺癌 胸腔镜肺癌根治术 电阻抗断层成像技术 呼气末正压 呼吸力学 氧合指数 并发症 

分 类 号：R47[医药卫生—护理学]