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 pressure guided by driving pressure on lung protection in patients undergoing laparoscopic surgery

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 cmH_(2)O),每组20例。对照组给予5 cmH_(2)O的PEEP,试验组PEEP按照4、6、8、10、12 cmH_(2)O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(T_(0))、PEEP给予后30 min(T_(1))以及术毕(T_(2))的潮气量(VT)、气道峰压(P_(peak))、气道平台压(P_(plat))、PEEP;计算动态肺顺应性(Cdyn);记录患者T_(0)、T_(1)、T_(2)、术后24 h(T_(3))的动脉血氧分压[p a(O_(2))],计算氧合指数(OI);分别于T_(0)、T_(2)、T_(3)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T_(1)~T_(2)时点增高,OI在T_(1)~T_(3)时点增高,差异有统计学意义(P<0.05);试验组IL-6浓度在T_(2)~T_(3)时点降低,CC16浓度在T_(2)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。

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 cmH_(2)O),with 20 cases in each group.The control group was given PEEP of 5 cmH_(2)O PEEP,while the experimental group was titrated at 4,6,8,10 and 12 cmH_(2)O 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(P_(peak)),airway platform pressure(P_(plat))and PEEP were recorded immediately after the establishment of pneumoperitonic-Trendelenburg position(T_(0)),30 minutes after administration of PEEP(T_(1))and the end of operation(T_(2));dynamic lung compliance(CDyn)was calculated.The arterial oxygen partial pressures[p a(O_(2))]of patients at T_(0),T_(1),T_(2)and 24 hours after surgery(T_(3))were recorded,and the oxygenation index(OI)was calculated;peripheral venous blood was collected at T_(0),T_(2)and T_(3),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 T_(1)to T_(2),and OI was significantly increased from T_(1)to T_(3)(P<0.05);the concentration of IL-6 in experimental group was significantly decreased from T_(2)to T_(3),and the concentration of CC16 was significantly decreased at T_(2)(P<0.05).Conclusion Individualized PEEP guided by driving pressure provides lung protection in patients undergoing laparoscopic radical resection of colorectal cancer.