重庆医学2024，Vol.53Issue(7)：1064-1069,6.DOI:10.3969/j.issn.1671-8348.2024.07.020
不同肺保护性通气策略在老年腹腔镜结直肠手术患者中的应用效果及安全性分析
Analysis on application effect and safety of different lung protective ventilation strategies in elderly patients undergoing laparoscopic colorectal surgery
摘要
Abstract
Objective To explore the application effect and safety of different lung protective ventilation strategies in elderly patients undergoing laparoscopic colorectal surgery.Methods A total of 100 elderly pa-tients undergoing laparoscopic colorectal surgery in this hospital from June 2022 to May 2023 were prospec-tively selected as the research subjects and divided into the observation group and control group according to the random number table method in a ratio of 1∶1,50 cases in each group.The observation group adopted the driven pressure-oriented individualized positive end expiratory pressure(PEEP)model,while the control group adopted the traditional PEEP model.The hemodynamic indicators(mean arterial pressure,heart rate),lung compliance,gas exchange indicators[partial pressure of oxygen in arterial blood(PaO2),oxygenation in-dex(OI),alveola-arterial oxygen partial pressure difference(A-aDO2),dead space/tidal volume ratio(Vd/Vt),at 5 min after endotracheal intubation(T1),5 min after pneumoperitoneum(T2),1,2 h after operation(T3,T4),and after abdominal closure(T5),the levels of lung injury markers[interleukin-6(IL-6),clara cell protein 16(CC16)]before anesthesia and at T5,and the incidence rate of postoperative pulmonary complica-tions(PPCS)were compared between the two groups.Results There was no statistically significant differ-ences in mean arterial pressure and heart rate at T1,T2,T3,T4 and T5 between the two groups(P＞0.05).The lung compliance at T1,T2,T3,T4 and T5 in the observation group was higher than that in the control group(P＜0.05).PaO2 and OI at T1,T2,T3,T4 and T5 in the observation group were higher than those in the control group,while A-aDO2 and Vd/Vt in the observation group were lower than those in the control group(P＜0.05).A-aDO2 at T3,T4 and T5 in the control group was higher than that at T1,while A-aDO2 at T4 in the observation group was only higher than that at T1(P＜0.05).The levels of serum IL-6 and CC16 at T5 in the two groups were higher than those before anesthesia,but the observation group was significantly lower than the control group(P＜0.05).The incidence rate of PPCS in the observation group was significantly low-er than that in control group(P＜0.05).Conclusion In the elderly patients with laparoscopic colorectal sur-gery,driven pressure-oriented individualized PEEP model could improve the lung dynamic compliance and gas exchange,reduce the inflammatory response and intraoperative lung injury,reduce the incidence rate of PPCS,and give full play to the lung protective effect of PEEP.关键词
肺保护性通气/驱动压/呼气末正压通气/老年人/腹腔镜术Key words
lung protective ventilation/driving pressure/positive end-expiratory pressure ventilation/aged/laparoscopy分类
医药卫生引用本文复制引用
郑艺,潘宗怀,卓谦..不同肺保护性通气策略在老年腹腔镜结直肠手术患者中的应用效果及安全性分析[J].重庆医学,2024,53(7):1064-1069,6.基金项目
温州市科研项目(Y20220953). （Y20220953）
