基于肺超声评分评估驱动压导向呼气末正压个体化动态滴定对老年腹腔镜结直肠癌根治术患者术后肺不张的影响

To Evaluate the Effect of Individualized Dynamic Titration of Driving Pressure-directed Positive End-expiratory Pressure on Postoperative Atelectasis in Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer Based on Lung Ultrasoun Score

目的探讨肺超声评估驱动压导向呼气末正压(PEEP)个体化动态滴定在老年腹腔镜结直肠癌根治术患者中的应用效果,并使用肺超声评分评估肺不张的发生情况。方法根据PEEP滴定的不同将60例于2021年4月至2023年4月期间在医院接受腹腔镜结直肠癌根治术治疗的老年患者分为实施5 CMH2O固定PEEP的对照组(N=30)和实施驱动压导向个体化动态PEEP的试验组(N=30)。比较两组肺超声评分、肺不张发生情况、通气力学及肺损伤情况。结果拔管前及拔管后30 MIN,两组肺超声评分均高于麻醉前,但试验组均低于对照组,同时试验组肺不张发生率低于对照组,差异有统计学意义(P<0.05);PEEP后30 MIN、术毕,两组驱动压、克拉拉细胞蛋白16均高于插管后5 MIN,但试验组均低于对照组,差异有统计学意义(P<0.05)。结论驱动压导向的PEEP个体化动态滴定可减轻老年腹腔镜结直肠癌根治术患者的肺损伤,改善其术中的通气力学,降低其肺超声评分及肺不张发生率。

Objective:To investigate the application effect of individualized dynamic titration of positive end-expiratory pressure(PEEP)guided by lung ultrasound in elderly patients undergoing laparoscopic radical resection of colorectal cancer,and to evaluate the occurrence of atelectasis by lung ultrasound score.Methods:According to the different PEEP titration,60 elderly patients who underwent laparoscopic radical resection of colorectal cancer in our hospital from April 2021 to April 2023 were divided into control group(n=30)with fixed PEEP of 5cmH2O and experimental group(n=30)with individualized dynamic PEEP guided by driving pressure.The lung ultrasound score,the number of atelectasis,ventilation mechanics and lung injury were compared.Results:Before extubation and 30 min after extubation,the lung ultrasound scores of the two groups were higher than before anesthesia,the experimental group was lower than control group(P<0.05).The incidence of atelectasis in the experimental group was lower than control group(P<0.05).At 30 min after PEEP and at the end of operation,the driving pressure and Clara cell protein 16 in the two groups were higher than 5 min after intubation,the experimental group was lower than control group(P<0.05).Conclusion:The individualized dynamic titration of PEEP guided by driving pressure can reduce lung injury,improve intraoperative ventilation mechanics,and reduce the incidence of lung ultrasound score and atelectasis in elderly patients undergoing laparoscopic radical resection of colorectal cancer.