呼气末正压通气递增法肺复张用于胸腔镜肺切除术全麻患者中的效果  

Observation of the Effect of Incremental Positive End-Expiratory Pressure Ventilation for Lung Recruitment in Patients Undergoing Thoracoscopic Lung Resection under General Anesthesia

作　　者：尹天英 金曼 YIN Tianying;JIN Man(Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong Shaanxi 723000)

机构地区：[1]汉中市中心医院麻醉科,陕西汉中723000 [2]陕西省结核病防治院(陕西省第五人民医院)手术麻醉科,陕西西安710100

出　　处：《医学临床研究》2025年第4期619-622,共4页Journal of Clinical Research

摘　　要：【目的】探讨呼气末正压通气(PEEP)递增法肺复张用于胸腔镜肺切除术全麻患者中的效果。【方法】78例肺癌患者,随机分为观察组和对照组,每组39例,患者均行全麻下胸腔镜肺切除术。对照组行控制性肺膨胀肺复张法,观察组采取PEEP递增法进行肺复张。比较两组的肺不张评分(LUS)、氧合指数(OI)、肺动态顺应性(Cdyn)、平均动脉压(MAP)、肺功能指标[肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV _(1))、FEV _(1)/FVC、最大通气量(MVV)]、并发症发生情况。【结果】复张后,观察组OI、Cdyn、MAP和复张前比较,差异无统计学意义(P>0.05),对照组OI、Cdyn及MAP较复张前明显下降(P<0.05),观察组复张后OI、Cdyn、MAP高于对照组(P<0.05)。两组手术结束时(T _(1))LUS评分较诱导后机械通气1 min(T 0)时明显下降,入麻醉复苏室30 min(T _(2))时较T _(1)明显下降(P<0.05),且观察组在T _(1)、T _(2)时均低于对照组(P<0.05)。两组术后VC、FVC、FEV _(1)、FEV _(1)/FVC、MVV较术前均下降(P<0.05),但观察组高于对照组(P<0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。【结论】PEEP递增法在全麻胸腔镜肺切除术中能使OI、Cdyn及MAP更快恢复,增加肺含气量,促进肺功能恢复,且术后并发症发生率较少,值得临床推广应用。【Objective】This study aims to explore the effectiveness of lung recruitment using the incremental positive end-expiratory pressure(PEEP)in patients undergoing thoracoscopic lung resection under general anesthesia.【Methods】Seventy-eight lung cancer patients were randomly divided into an observation group and a control group,with 39 patients in each group.All patients underwent thoracoscopic lung resection under general anesthesia.The control group received controlled lung expansion for lung recruitment,whereas the observation group used the PEEP incremental method.The comparison between the two groups were based on lung atelectasis score(LUS),oxygenation index(OI),dynamic lung compliance(Cdyn),mean arterial pressure(MAP),and lung function indicators[vital capacity(VC),forced vital capacity(FVC),forced expiratory volume in one second(FEV _(1)),FEV _(1)/FVC and maximum voluntary ventilation(MVV)],along with the incidence of complications.【Results】After lung recruitment,there was no significant statistical difference in OI,Cdyn,and MAP in the observation group compared to before recruitment(P>0.05).In contrast,these measures after lung recruitment significantly decreased in the control group(P<0.05).After recruitment,the levels of OI,Cdyn,and MAP in the observation group were higher than those in the control group(P<0.05).The LUS scores of both groups at the end of the surgery(T _(1))were significantly lower than those at one minute after the induction of mechanical ventilation(T 0)and further decreased 30 minutes after entering the anesthesia recovery room(T _(2))(P<0.05),with the observation group showing lower LUS scores at T _(1) and T _(2) than the control group(P<0.05).Postoperatively,VC,FVC,FEV _(1),FEV _(1)/FVC,and MVV decreased in both groups compared to preoperative levels(P<0.05),with the observation group having higher values than the control group(P<0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).【Conclusion�

关 键 词：胸腔镜检查 肺切除术 肺不张 麻醉 全身 

分 类 号：R655.3[医药卫生—外科学]