驱动压导向的个体化呼气末正压通气在胸腔镜下肺叶切除术患者中的应用效果

Application Effect of Driving Pressure-Oriented Individualized Positive End-Expiratory Pressure in Patients Undergoing Thoracoscopic Lobectomy of Lung

目的:探讨驱动压导向的个体化呼气末正压通气(PEEP)在胸腔镜下肺叶切除术患者中的应用效果。方法:选取2022年1月—2024年2月于黔南州人民医院行胸腔镜下肺叶切除术的患者80例作为研究对象,随机分为对照组和观察组,各40例。两组均行胸腔镜下肺叶切除术,术中观察组实施驱动压导向的个体化PEEP,对照组给予常规PEEP。比较两组手术效果。结果:两组手术时间、麻醉时间比较,差异无统计学意义(P>0.05);观察组复苏室观察时间、ICU住院时间短于对照组,差异有统计学意义(P<0.05)。PEEP设置完成后10 min(T_(1))时,两组动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))比较,差异无统计学意义(P>0.05);手术60 min(T_(2))、手术120 min(T_(3))、拔管前5 min(T_(4))时,观察组PaO_(2)高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。T_(1)、T_(4)时,两组驱动压、平台压(Pplat)比较,差异无统计学意义(P>0.05);T_(2)、T_(3)时,观察组驱动压、Pplat低于对照组,差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:驱动压导向的个体化PEEP在胸腔镜下肺叶切除术患者中的应用效果显著,可改善患者术中血流指标、呼吸指标,促进患者康复。

Objective:To explore the application effect of driving pressure-oriented individualized positive end-expiratory pressure(PEEP)in patients undergoing thoracoscopic lobectomy of lung.Methods:A total of 80 patients undergoing thoracoscopic lobectomy of lung at Qiannan People's Hospital from January 2022 to February 2024 were selected as the study subjects.They were randomly divided into control group and observation group with 40 cases in each group.Both groups underwent thoracoscopic lobectomy of lung.During surgery,the observation group implemented driving pressure-oriented individualized PEEP and the control group implemented conventional PEEP.The surgical effects were compared between two groups.Results:There was no significant difference in operation time and anesthesia time between the two groups(P>0.05).The observation time in resuscitation room and the length of ICU stay in the observation group were shorter than those in the control group,and the difference was statistically significant(P<0.05).At 10 min after the completion of PEEP setting(T_(1)),there was no significant difference in arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))between the two groups(P>0.05).At 60 min of surgery(T_(2)),120 min of surgery(T_(3))and 5 min before extubation(T_(4)),the PaO_(2) in the observation group was higher than that in the control group,and the PaCO_(2) in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in driving pressure and plateau pressure(Pplat)between the two groups at T_(1) and T_(4)(P>0.05).At T_(2) and T_(3),the driving pressure and Pplat in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion:The application of driving pressure-oriented individualized PEEP in patients undergoing thoracoscopic lobectomy of lung has significant effects,which can improve the intraoperative blood flow indexes and respiratory indexes,and promote the recovery of patients.