Cdyn指导的个体化PEEP对老年腰椎融合手术患者的影响

Effect of individualized PEEP guided by Cdyn on elderly patients undergoing lumbar fusion surgery

目的探索动态肺顺应性(Cdyn)指导的个体化呼气末正压(PEEP)对老年腰椎融合手术患者的影响。方法选择2019年6月至2020年10月在本院行腰椎融合手术的42例老年患者,采用随机数字表法将其分成对照组和个体化PEEP组,各21例。对照组采用固定5 cmH_(2)O PEEP,个体化PEEP组采用Cdyn指导的个体化PEEP。比较两组患者的手术时间、总入量、出血量、尿量及不同时间点的HR、MAP、OI、Cdyn、DP和IL-6、TNF-α、CC-16水平。结果两组的手术时间、总入量、出血量、尿量比较,差异无统计学意义(P>0.05)。T_(2)~T_(4)时,个体化PEEP组的OI均高于对照组,差异具有统计学意义(P<0.05);T1~T_(4)时,个体化PEEP组的Cdyn均高于对照组,DP均低于对照组,差异具有统计学意义(P<0.05)。T_(5)~T_(6)时,个体化PEEP组的IL-6、TNF-α水平均低于对照组,差异具有统计学意义(P<0.05)。结论Cdyn指导的个体化PEEP应用于老年腰椎融合手术患者中,有助于改善术中氧合,提高Cdyn,降低DP,减轻全身炎症反应。

Objective To explore the effect of individualized positive end expiration pressure(PEEP)guided by dynamic lung compliance(Cdyn)on elderly patients undergoing lumbar fusion surgery.Methods Forty-two elderly patients who underwent lumbar fusion surgery in our hospital from June 2019 to October 2020 were divided into control group and individualized PEEP group by random number table method,with 21 cases in each group.The control group was given stationary 5 cm H_(2)O PEEP,and the individualized PEEP group was given individualized PEEP guided by Cdyn.The operation time,total volume,bleeding volume,urine volume,HR,MAP,OI,Cdyn,DP,IL-6,TNF-α and CC-16 levels at different time points were compared between the two groups.Results There were no significant differences in operation time,total volume,bleeding volume or urine volume between the two groups(P>0.05).At T_(2)-T_(4),OI in the individualized PEEP group was higher than that in the control group,and the difference was statistically significant(P<0.05);at T1-T_(4),Cdyn in the individualized PEEP group was higher than that in control group,and DP was lower than that in control group,and the differences were statistically significant(P<0.05).At T_(5)-T_(6),the IL-6 and TNF-α levels in the individualized PEEP group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Individualized PEEP guided by Cdyn applied in elderly patients undergoing lumbar fusion surgery is helpful to improve intraoperative oxygenation,increase Cdyn,decrease DP and reduce systemic inflammatory response.