解放军医学院学报2025，Vol.46Issue(6)：554-559,6.DOI:10.12435/j.issn.2095-5227.25010702
个体化呼气末正压降低患者术中机械通气的机械功率:一项随机对照研究数据的二次分析
Individualized positive end-expiratory pressure reduces mechanical power during mechanical ventilation in patients undergoing surgery:A secondary analysis of data from a randomized controlled trial
刘旭 1马晓婧 1马利彬 1付云柯 1王天竹 1朴香美 1米卫东 1张昌盛1
作者信息
- 1. 解放军总医院第一医学中心麻醉科,北京 100853
- 折叠
摘要
Abstract
Background Mechanical power(MP),as a new comprehensive index to evaluate the effect of mechanical ventilation(MV)on pulmonary respiratory mechanics,can reflect the overall energy transfer in the process of MV,and is closely related to the occurrence of lung injury and the prognosis of patients.Objective To examine the impact of individualized positive end-expiratory pressure(PEEP)guided by electrical impedance tomography(EIT)on the MP in patients undergoing robot-assisted laparoscopic surgery.Methods A secondary analysis of a previous randomized controlled study of 72 patients undergoing robotic hepatobiliary and pancreatic surgery was performed.PEEP settings of patients undergoing surgery were respectively conducted using EIT guidance(PEEPEIT group)and conventional methods(PEEP5cmH2O group).Respiratory parameters of patients 10 minutes after induction,60 minutes after PEEP titration with pneumoperitoneum and 10 minutes after deflation were screened from the data,including tidal volume(Vt),respiratory rate(f),peak airway pressure(Ppeak),plateau pressure(Pplat),respiratory compliance(Crs),driving pressure(DP),etc.MP and mechanical energy per breath(MEper breath)received by the respiratory system at different time points of both groups were calculated and compared.Results There were 48 cases in the PEEPEIT group,including 26 males and 22 females,with the mean age of 53.7±14.0 years,in the PEEP5cmH2O group,there were 24 cases,including 10 males and 14 females,with the mean age of 57.3±14.5 years.No significant difference was found in age and gender between the two groups(P＞0.05).The PEEPEIT group exhibited significantly lower MP than the PEEP5cmH₂O group at all time points:before pneumoperitoneum([4.54±1.53]J/min vs[5.49±1.23]J/min),during pneumoperitoneum([6.68±2.35]J/min vs[7.81±2.23]J/min),and after pneumoperitoneum([5.24±1.70]J/min vs[6.09±1.55]J/min)(all P<0.05).Crs was significantly higher in the PEEPEIT group compared to the PEEP5 cmH₂O group during pneumoperitoneum([44.27±11.33]mL/cmH₂O vs[31.88±6.58]mL/cmH₂O)and after pneumoperitoneum([63.56±13.06]mL/cmH₂O vs[48.13±10.59]mL/cmH₂O,both P<0.05).DP was significantly lower in the PEEPEIT group during pneumoperitoneum([11.50±2.08]cmH₂O vs[13.96±2.37]cmH₂O)and after pneumoperitoneum([7.60±1.92]cmH₂O vs[9.75±2.17]cmH₂O)(both P<0.05).Conclusion Individualized PEEP guided by EIT can reduce MP in patients undergoing robotic-assisted hepatobiliary and pancreatic surgery,which may be related to the optimization of Crs and DP.关键词
腹腔镜/呼气末正压/机械功率/肺顺应性/驱动压Key words
laparoscopy/positive end-expiratory pressure/mechanical power/lung compliance/driving pressure分类
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刘旭,马晓婧,马利彬,付云柯,王天竹,朴香美,米卫东,张昌盛..个体化呼气末正压降低患者术中机械通气的机械功率:一项随机对照研究数据的二次分析[J].解放军医学院学报,2025,46(6):554-559,6.
