驱动压导向个体化PEEP对俯卧位全麻脊柱手术患者肺功能的影响OA
Effects of driving pressure-guided individualized PEEP on pulmonary function in patients undergoing spinal surgery under general anesthesia in the prone position
目的 探究驱动压(DP)导向的个体化呼气末正压(PEEP)对俯卧位全麻脊柱手术患者肺功能与氧合指数的影响.方法 选择2020年10月至2021年10月大连市中心医院收治的95例行择期俯卧位全麻脊柱手术的患者,随机分为固定组(n=47)和个体化组(n=48).固定组患者设定PEEP为5 cmH2O,潮气量(VT)为6 mL/kg,无肺复张手法;个体化组患者采用DP导向的个体化PEEP,VT同固定组,无肺复张手法.比较2组患者的手术指标,入室吸氧前(T0)、机械通气后30 min(T1)、机械通气后1 h(T2)、机械通气后2 h(T3)及入麻醉复苏室后30 min(T4)的氧合指数[动脉血氧分压(PaO2)/吸入氧浓度(FiO2)].比较2组患者T1、T2、T3的肺功能[气道峰压(Ppeak)、气道平均压(Pmean)、肺顺应性(Cldyn)],T0、术后1 d(T5)、术后3 d(T6)的炎症因子指标[中性粒细胞计数(NEUT)、白细胞计数(WBC)、C反应蛋白(CRP)]及术后30 d的肺部并发症发生率.结果 2组患者手术指标与肺部并发症发生率比较,差异均无统计学意义(P>0.05).个体化组患者T2、T3、T4的PaO2/FiO2均高于固定组(P<0.05).个体化组患者T1、T2、T3的Cldyn均大于固定组(P<0.05),Ppeak、Pmean均小于固定组(P<0.05).个体化组患者T5的WBC低于固定组(P<0.05),T5、T6的CRP低于固定组(P<0.05).结论 DP导向的个体化PEEP可有效改善俯卧位全麻脊柱手术患者的氧合状态与肺功能,同时有助于减轻术后炎症反应,且不增加手术相关风险及肺部并发症发生率,可为患者提供更为有效的优化策略.
Objective To investigate the effects of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)on pulmonary function and oxygenation index in patients undergoing spinal surgery under general anesthesia in the prone position.Methods A total of 95 patients who underwent elective spinal surgery under general anesthesia in the prone position at Dalian Central Hospital from October 2020 to October 2021 were randomly divided into the fixed group(n=47)and the individualized group(n=48).Patients in the fixed group received a PEEP of 5 cmH₂O and a tidal volume(VT)of 6 mL/kg,without lung recruitment maneuvers.Patients in the individualized group received DP-guided individualized PEEP with the same VT as the fixed group and also without lung recruitment maneuvers.The surgical indicators and the oxygenation index[arterial partial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2)]before oxygen inhalation upon operating room entry(T0),30 minutes after mechanical ventilation(T1),1 hour after mechanical ventilation(T2),2 hours after mechanical ventilation(T3),and 30 minutes after admission to the post-anesthesia care unit(T4)were compared between the two groups.The pulmonary function[peak airway pressure(Ppeak),mean airway pressure(Pmean),dynamic lung compliance(Cldyn)]at T1,T2,and T3,the inflammatory factors[neutrophil count(NEUT),white blood cell count(WBC),C-reactive protein(CRP)]at T0,1 day postoperatively(T5)and 3 days postoperatively(T6),and the incidence of pulmonary complications at 30 days postoperatively were compared between the two groups.Results There was no statistically significant difference in the surgical indicators or the incidence of pulmonary complications between the two groups(P>0.05).The individualized group had higher PaO2/FiO2 ratios at T2,T3,and T4,greater Cldyn at T1,T2,and T3,and lower Ppeak and Pmean than the fixed group(P<0.05).The individualized group had lower WBC at T5,and lower CRP at T5,T6 than the fixed group(P<0.05).Conclusion DP-guided individualized PEEP can effectively improve the oxygenation status and pulmonary function in patients undergoing spinal surgery under general anesthesia in the prone position.It may also help alleviate postoperative inflammatory reactions without increasing surgical-related risks or the incidence of pulmonary complications,thereby providing more effective optimization strategies for patients.
董俊锋;蔡秋萍;刘伟;黄振基;黄洪祥
深圳市龙华区人民医院麻醉科,广东 深圳 518100大连市中心医院麻醉科,辽宁 大连 116000大连市中心医院麻醉科,辽宁 大连 116000深圳市龙华区人民医院麻醉科,广东 深圳 518100深圳市龙华区人民医院麻醉科,广东 深圳 518100
医药卫生
驱动压呼气末正压肺功能氧合指数
driving pressurepositive end-expiratory pressurepulmonary functionoxygenation index
《局解手术学杂志》 2026 (6)
478-482,5
广东省卫生健康委员会科研项目(20230676)
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