不同PEEP水平联合PCV-VG通气模式对腹腔镜大肠癌根治术老年患者呼吸力学的影响

The effect of different PEEP levels combined with PCV-VG ventilation mode on respiratory mechanics in elderly patients undergoing laparoscopic radical resection of colorectal cancer

目的探讨不同呼气末正压(PEEP)水平联合压力控制容量保证通气模式(PCV-VG)对腹腔镜大肠癌根治术老年患者呼吸力学的影响。方法选择2019年11月至2020年11月于内蒙古自治区人民医院行腹腔镜大肠癌根治术的老年患者90例,根据随机数表法将患者分为三组,每组各30例,A组PEEP为0cmH2O,B组PEEP为5cmH2O,C组为个体化PEEP。比较三组患者于插管时(T_(1))、Trendelenburg体位后30min(T_(2))、Trendelenburg体位后60 min(T_(3))及手术结束时(T_(4))的气道平台压(Pplat)和肺动态顺应性(Cdyn);于麻醉诱导前(T_(0))、T_(3)及拔管后10 min(T_(5))采集动脉血标本,记录并比较动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))值。结果三组患者T_(2)、T_(3)、T_(4)时Cdyn低于T_(1)时,T_(4)时Cdyn高于T_(2)、T_(3)时;T_(2)、T_(3)时Pplat高于T_(1)时,T_(4)时Pplat低于T_(2)、T_(3)时,且C组T_(4)时Pplat高于T_(1);T_(3)、T_(5)时PaO_(2)显著高于T_(0)时,A组T_(5)时PaO_(2)显著低于T_(3)时;T_(3)时PaCO_(2)高于T_(0)时,差异均有统计学意义(P<0.05)。T_(2)、T_(3)和T_(4)时,C组Cdyn高于A组和B组,且T_(4)时B组Cdyn显著高于A组;T_(3)时,C组PaO_(2)显著高于A组;T_(5)时,三组患者PaO_(2)分别比较后,由高到低为C组、B组、A组,差异均有统计学意义(P<0.05)。除PaCO_(2)外,其余各指标组间比较,差异均有统计学意义(P<0.05)。结论个体化滴定的PEEP联合PCV-VG通气模式可增加腹腔镜大肠癌根治术老年患者术中Cdyn及PaO_(2),改善术中氧合,减少肺损伤。

Objective To explore the effect of different levels of positive end-expiratory pressure(PEEP)combined with pressure-controlled volume-guaranteed(PCV-VG)ventilation mode on respiratory mechanics in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods A total of 90 elderly patients who underwent laparoscopic radical resection of colorectal cancer in Inner Mongolia Autonomous Region People’s Hospital from November 2019 to November 2020 were selected and divided into three groups based on random number table method,with 30 patients in each group:Group A had a PEEP of 0 cmH2O,Group B had a PEEP of 5 cmH2O,and Group C had individualized PEEP.Comparison of the airway plateau pressure(Pplat)and pulmonary dynamic compliance(Cdyn)at the time of intubation(T_(1)),30 minutes after Trendelenburg position(T_(2)),60 minutes after Trendelenburg position(T_(3)),and at the end of surgery(T_(4))between the three groups of patients.The arterial blood samples before anesthesia induction(T_(0)),T_(3),and 10 minutes after extubation(T_(5))were collected,and the values of arterial partial pressure of oxygen(PaO_(2))and arterial carbon dioxide partial pressure(PaCO_(2))were recorded compared.Results Cdyn of the three groups of patients was lower at T_(2),T_(3),and T_(4) than at T_(1),and higher at T_(4) than at T_(2) and T_(3).Pplat was higher at T_(2) and T_(3) than at T_(1).Pplat was lower at T_(4) than at T_(2) and T_(3),and Pplat was higher at T_(4) than at T_(1) in group C.PaO_(2) was significantly higher at T_(3) and T_(5) than at T_(0),and PaO_(2) was significantly lower at T_(5) than at T_(3) in group A.PaCO_(2) was higher at T_(3) than at T_(0),with statistically significant differences(P<0.05).At T_(2),T_(3),and T_(4),the Cdyn in Group C was higher than that in Group A and Group B,and at T_(4),the Cdyn in Group B was significantly higher than that in Group A.At T_(3),the PaO_(2) in Group C was significantly higher than that in Group A.At T_(5),the three groups of PaO_(2) were compared and ranked from high to low as Group C,Group B,and Group A,with statistically significant differences(P<0.05).Except for PaCO_(2),there were differences in other indicators among all groups(P<0.05).Conclusion The individualized titration of PEEP combined with PCV-VG ventilation mode can increase intraoperative Cdyn and PaO_(2) in elderly patients undergoing laparoscopic radical resection of colorectal cancer,improve intraoperative oxygenation,and reduce lung injury.