局解手术学杂志2026，Vol.35Issue(6)：478-482,5.DOI:10.11659/jjssx.11E025059
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
Effects of driving pressure-guided individualized PEEP on pulmonary function in patients undergoing spinal surgery under general anesthesia in the prone position
摘要
Abstract
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.关键词
驱动压/呼气末正压/肺功能/氧合指数Key words
driving pressure/positive end-expiratory pressure/pulmonary function/oxygenation index分类
医药卫生引用本文复制引用
董俊锋,蔡秋萍,刘伟,黄振基,黄洪祥..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[J].局解手术学杂志,2026,35(6):478-482,5.基金项目
广东省卫生健康委员会科研项目(20230676) （20230676）
