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0 cmH2O,B组PEEP为5 cmH2O,C组为个体化PEEP.比较三组患者于插管时(T1)、Trendelenburg体位后30min(T2)、Trendelenburg体位后60 min(T3)及手术结束时(T4)的气道平台压(Pplat)和肺动态顺应性(Cdyn);于麻醉诱导前(T0)、T3及拔管后10 min(T5)采集动脉血标本,记录并比较动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)值.结果 三组患者T2、T3、T4时Cdyn低于T1时,T4时Cdyn高于T2、T3时;T2、T3时Pplat高于T1时,T4时Pplat低于T2、T3时,且C组T4时Pplat高于T1;T3、T5时PaO2显著高于T.时,A组T5时PaO2显著低于T3时;T3时PaCO2高于T0时,差异均有统计学意义(P＜0.05).T2、T3和T4时,C组Cdyn高于A组和B组,且T4时B组Cdyn显著高于A组;T3时,C组PaO2显著高于A组;T5时,三组患者PaO2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PaCO2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PaO2,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(T1),30 minutes after Trendelenburg position(T2),60 minutes after Trendelenburg position(T3),and at the end of surgery(T4)between the three groups of patients.The arterial blood samples before anesthesia induction(T0),T3,and 10 minutes after extubation(T5)were collected,and the values of arterial partial pressure of oxygen(PaO2)and arterial carbon dioxide partial pressure(PaCO2)were recorded compared.Results Cdyn of the three groups of patients was lower at T2,T3,and T4 than at T1,and higher at T4 than at T2 and T3.Pplat was higher at T2 and T3than at T1.Pplat was lower at T4 than at T2 and T3,and Pplat was higher at T4 than at T1 in group C.PaO2 was significantly higher at T3 and T5 than at T0,and PaO2 was significantly lower at T5 than at T3 in group A.PaCO2 was higher at T3 than at T0,with statistically significant differences(P＜0.05).At T2,T3,and T4,the Cdyn in Group C was higher than that in Group A and Group B,and at T4,the Cdyn in Group B was significantly higher than that in Group A.At T3,the PaO2 in Group C was significantly higher than that in Group A.At T5,the three groups of PaO2 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 PaCO2,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 PaO2 in elderly patients undergoing laparoscopic radical resection of colorectal cancer,improve intraoperative oxygenation,and reduce lung injury.
刘敏;赵智慧;王晶;何金玲;白香花
内蒙古自治区妇幼保健院麻醉科,内蒙古呼和浩特 010020内蒙古自治区人民医院麻醉科,内蒙古呼和浩特 010017
临床医学
呼气末正压;腹腔镜;通气模式;呼吸力学
Positive end-expiratory pressure;Laparoscopy;Ventilation mode;Respiratory mechanics
《中国医药科学》 2024 (006)
88-91,158 / 5
内蒙古自治区自然科学基金项目(2019MS08091).
10.20116/j.issn2095-0616.2024.06.20
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