跨肺驱动压导向通气策略对老年肠癌根治术患者的肺保护作用

Lung protection effect of transpulmonary driving pressure-guided ventilation strategy in elderly patients undergoing radical resection of colon cancer

目的 探讨跨肺驱动压导向的通气策略对行腹腔镜下肠癌根治术的老年患者的肺保护作用。方法 选择 124 例于我院行腹腔镜下肠癌根治术的老年患者,采用随机双盲对照研究的方式,按照随机数字表法将患者分为观察组( n = 62) 和对照组( n = 62) 。2 组患者术中均选择容量控制通气模式,其中观察组采用跨肺驱动压导向的通气策略,而对照组则采用传统肺保护性通气策略。收集并比较患者一般资料、手术相关指标及术中气管插管后( T0) 、气腹建立时( T1) 、气腹建立后 20 min( T2) 、气腹结束时( T3) 呼吸监测相关指标。统计术后肺部相关并发症( PPC) 发生情况,根据是否出现 PPC 将患者分为 PPC 组和非 PPC 组,采用单因素和多因素分析方法分析患者出现 PPC 的影响因素。结果 观察组和对照组患者一般资料及手术相关指标比较差异均无统计学意义( P > 0. 05) 。观察组各时间点呼气末正压( PEEP) 高于对照组,驱动压( DP) 低于对照组,观察组 T0、T3 的峰压( P) 高于对照组,差异均具有统计学意义( P < 0. 05);2 组各时间点平台压( P) 比较,差异均无统计学意义( P > 0. 05) 。单因素分析显示,PPC组与非 PPC 组患者年龄、吸烟史、手术时间及各时间点 PEEP、DP 水平比较,差异均有统计学意义( P < 0. 05);多因素 Logistic 回归分析显示,年龄越大( OR = 1. 206) 、手术时间越长( OR = 1. 125) 及 T3 的 DP 越高( OR = 55. 290) 是导致患者出现 PPC 的独立危险因素( P < 0. 05) 。结论 跨肺驱动压导向的通气策略可以通过降低术中 DP 发挥肺保护作用,从而减少 PPC 的发生。

Objective To investigate the lung protection effect of transpulmonary driving pressure-guided ventilation strategy in elderly patients undergoing laparoscopic radical resection of colon cancer. Methods A total of 124 elderly patients who underwent laparoscopic radical resection of colon cancer in our hospital were selected,and they were divided into the observation group ( n = 62) and the control group( n = 62) according to the randomized double-blind controlled study. Patients in the two groups chose the volume-controlled ventilation mode during the operation. The observation group adopted the transpulmonary driving pressure-guided ventilation strategy,while the control group adopted the traditional lung-protective ventilation strategy. The general information,surgery-related indexes,and respiratory monitoring-related data after intraoperative tracheal intubation ( T0) ,during pneumoperitoneum ( T1) ,20 minutes after pneumoperitoneum ( T2) and after pneumoperitoneum ( T3) during operation were collected and compared. The incidence of postoperative pulmonary complications ( PPC) was counted,the patients were divided into the PPC group and the non-PPC group according to whether PPC occurred. Univariate and multivariate analysis methods were used to analyze the influencing factors of PPC in patients. Results There was no significant difference in the general information or surgery-related indexes between the observation group and the control group ( P > 0. 05) . The positive end expiratory pressure( PEEP) at each time point in the observation group was higher than that in the control group,while the driving pressure ( DP) was lower than that in the control group,the peak pressure ( P) at T0 and T3 in the observation group were higher than those in the control group,with statistically significant differences ( P < 0. 05) . There was no significant difference in the plateau pressure ( P) at each time point between the two groups ( P > 0. 05) . The univariate analysis showed that there were statistically significant differences in age,smoking history,operation time ,and PEEP and DP levels at each time point between the PPC group and the non-PPC group ( P < 0. 05);the multivariate Logistic regression analysis showed that older age ( OR = 1. 206) ,longer operation time ( OR = 1. 125) and higher DP at T3 ( OR = 55. 290) were the independent risk factors for PPC ( P < 0. 05) . Conclusion Transpulmonary driving pressure-guided ventilation strategy can protect lung by reducing intraoperative DP,thereby reducing the occurence of PPC.