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驱动压导向的个体化呼气末正压通气对腹腔镜手术患者的肺保护作用

Effect of individualized positive end expiratory pressureguided by driving pressure on lung protection in patients undergoing laparoscopic surgery

    摘要
  • 摘要:
      目的  探讨驱动压导向的个体化呼气末正压(PEEP)通气对腹腔镜手术患者的肺保护作用。
      方法  将40例行择期腹腔镜结直肠癌根治术的患者随机分为试验组(个体化PEEP)和对照组(PEEP 5 cmH2O)，每组20例。对照组给予5 cmH2O的PEEP，试验组PEEP按照4、6、8、10、12 cmH2O依次递增滴定，每次进行12次呼吸循环，记录各个PEEP值最后1次呼吸循环时的驱动压，滴定结束后选取产生最低驱动压的PEEP，并持续至拔管。记录2组患者气腹-Trendelenburg体位建立后即刻(T0)、PEEP给予后30 min (T1)以及术毕(T2)的潮气量(VT)、气道峰压(Ppeak)、气道平台压(Pplat)、PEEP；计算动态肺顺应性(Cdyn)；记录患者T0、T1、T2、术后24 h(T3)的动脉血氧分压pa(O2)，计算氧合指数(OI)；分别于T0、T2、T3采集患者外周静脉血，测定白细胞介素-6(IL-6)、克拉拉细胞蛋白16(CC16)浓度。
      结果  与对照组比较，试验组Cdyn在T1~T2时点增高，OI在T1~T3时点增高，差异有统计学意义(P < 0.05)；试验组IL-6浓度在T2~T3时点降低，CC16浓度在T2时点降低，差异有统计学意义(P < 0.05)。
      结论  驱动压导向的个体化PEEP通气对腹腔镜结直肠癌根治术患者具有肺保护作用。

     

    Abstract:
      Objective  To explore effect of individualized positive end expiratory pressure (PEEP) guided by driving pressure on lung protection in patients undergoing laparoscopic surgery
      Methods  Forty patients undergoing elective laparoscopic radical resection of colorectal cancer were randomly divided into experimental group (individualized PEEP) and control group (PEEP 5 cmH2O), with 20 cases in each group. The control group was given PEEP of 5 cmH2O PEEP, while the experimental group was titrated at 4, 6, 8, 10 and 12 cmH2O incrematically, 12 respiration cycles were performed each time, and the driving pressure of each PEEP value in the last respiration cycle was recorded. After titration, the PEEP with the lowest driving pressure was selected and continued until extubation. Tidal volume (VT), peak airway pressure (Ppeak), airway platform pressure (Pplat) and PEEP were recorded immediately after the establishment of pneumoperitonic-Trendelenburg position (T0), 30 minutes after administration of PEEP (T1) and the end of operation (T2); dynamic lung compliance (CDyn) was calculated. The arterial oxygen partial pressurespa(O2) of patients at T0, T1, T2 and 24 hours after surgery (T3) were recorded, and the oxygenation index (OI) was calculated; peripheral venous blood was collected at T0, T2 and T3, respectively, and the concentrations of interleukin-6 (IL-6) as well as clara cell protein 16 (CC16) were determined.
      Results  Compared with the control group, Cdyn was significantly increased from T1 to T2, and OI was significantly increased from T1 to T3(P < 0.05); the concentration of IL-6 in experimental group was significantly decreased from T2 to T3, and the concentration of CC16 was significantly decreased at T2 (P < 0.05).
      Conclusion  Individualized PEEP guided by driving pressure provides lung protection in patients undergoing laparoscopic radical resection of colorectal cancer.

     

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