驱动压指导的肺保护性通气策略对老年结直肠手术后肺部并发症的影响

doi:10.3969/j.issn.1003-9198.2024.04.014

摘要/Abstract

摘要： 目的探讨驱动压指导的肺保护性通气策略(lung protective ventilation strategy,LPVS)对老年结直肠手术病人术后肺部并发症(postoperative pulmonary complications,PPCs)的影响。方法选择择期行结直肠手术的80例老年病人,按随机数表法将病人分为2组:固定呼气末正压(positive end-expiratory pressure,PEEP)组(C组)和驱动压指导PEEP滴定组(T组),每组40例。C组病人通气期间采用5 cmH₂O固定PEEP的LPVS,T组采用驱动压指导的LPVS。采用床旁超声评估病人的肺超声评分(lung ultrasound score,LUS)。对比2组病人术后7 d内PPCs的发生情况及术中术后的LUS、驱动压、氧合指数。结果 C组术后7 d内PPCs发生率为32.5%,T组为12.5%,差异有统计学意义(P＜0.05)。与C组比较,T组病人在手术开始后2 h和手术结束时的驱动压降低,氧合指数上升,在手术开始后2 h 至术后1 d 的LUS降低(P＜0.05)。结论与5 cmH₂O的固定PEEP比较,驱动压指导的LPVS可获得个体化、适宜的PEEP,进而降低机械通气和手术创伤引起的肺损伤。

关键词: 老年人, 结直肠手术, 术后肺部并发症, 肺保护性通气策略, 驱动压, 肺超声

Abstract: Objective To explore the effects of driving pressure-guided lung protective ventilation strategy (LPVS) on postoperative pulmonary complications (PPCs) in the elderly patients undergoing colorectal surgery. Methods A total of 80 elderly patients scheduled to undergo elective colorectal surgery were randomly divided into fixed positive end-expiratory pressure (PEEP) group (group C) and driving pressure-guided PEEP titration group (group T), with 40 cases in each group. After induction of general anesthesia, all patients received volumetric ventilation with a tidal volume of 6 mL/kg. Group C was treated with a PEEP of 5 cmH₂O LPVS during ventilation after the initial recruitment manoeuvre (RM). Group T was treated with driving pressure-guided LPVS. Lung ultrasonography was used to evaluate the score of lung ultrasound at 12 regions of bilateral lung. The score of each region was accumulated as lung ultrasound score (LUS). The occurrence of PPCs within 7 days after surgery and driving pressure, oxygenation index, LUS during and after operation were compared between the two groups. Results The incidence rate of PPCs within 7 days was 32.5% in group C and 12.5% in group T, with statistically significant difference (P <0.05). Compared with group C, driving pressure decreased, oxygenation index increased at the time of 2 hours from surgery beginning and at the end of surgery, and LUS decreased from 2 hours after the beginning of surgery to 1 day after operation in group T (P<0.05). Conclusions Compared with 5 cmH₂O PEEP, the elderly patients undergoing driving pressure-guided LPVS can obtain individualized, appropriate PEEP values, which can reduce lung injury induced by mechanical ventilation and surgical trauma.

Key words: aged, colorectal surgery, postoperative pulmonary complications, protective lung ventilation strategy, driving pressure, pulmonary ultrasound

中图分类号:

R 614.1

沈珀, 冯悦, 钟艺, 郭姚邑, 姜帆, 马明涛, 胡玉萍, 史宏伟, 斯妍娜. 驱动压指导的肺保护性通气策略对老年结直肠手术后肺部并发症的影响[J]. 实用老年医学, 2024, 38(4): 386-391.

SHEN Po, FENG Yue, ZHONG Yi, GUO Yaoyi, JIANG Fan, MA Mingtao, HU Yuping, SHI Hongwei, SI Yanna. Effects of driving pressure-guided lung protective ventilation strategy on postoperative pulmonary complications in elderly patients undergoing elective colorectal surgery[J]. Practical Geriatrics, 2024, 38(4): 386-391.

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