个体化呼气末正压对老年患者腹腔镜结直肠癌根治术后苏醒质量的影响

doi:10.3969/j.issn.1003-9198.2026.05.012

摘要/Abstract

摘要： 目的观察个体化呼气末正压(individualized positive end-expiratory pressure, iPEEP)对老年患者腹腔镜结直肠癌术后苏醒质量的影响。方法选择择期行腹腔镜结直肠癌根治术的老年患者60例,采用随机数表法将患者分为2组:iPEEP组(P组)和对照组(C组),每组30例。P组在插管完成即刻、气腹-屈氏体位建立即刻、气腹结束即刻行呼气末正压(PEEP)滴定试验,C组不设置 PEEP。记录气管插管后5 min(T₁),气腹-屈氏体位建立后30 min(T₂)、60 min(T₃),气腹-屈氏体位结束后10 min(T₄)时的心率 (heart rate, HR )、平均动脉压(mean arterial pressure, MAP )、视神经鞘直径(optic nerve sheath diameter,ONSD ) 、呼气末二氧化碳分压(end-tidal carbon dioxide pressure,PetCO₂ );记录术后苏醒时间(ΔT₁)、呼吸恢复时间(ΔT₂)、拔管时间(ΔT₃)、定向恢复时间(ΔT₄)以及镇静-躁动评分(sedation agitation scale, SAS);记录患者术后谵妄、术后恶心呕吐等不良反应的发生情况。结果与C组相比,P组T₃时MAP降低,ΔT₂、ΔT₄均缩短,SAS评分降低;2组患者术中ONSD比较,差异无统计学意义。C组术后第1天发生谵妄1例,2组均未发生严重认知功能障碍。结论在老年患者腹腔镜结直肠癌根治术中,采用iPEEP的肺保护通气策略可提高患者的苏醒质量且不影响患者术中颅内压。

关键词: 老年人, 结直肠癌, 个体化呼气末正压, 苏醒质量

Abstract: Objective To investigate the effect of individualized positive end-expiratory pressure (iPEEP) on quality of recovery in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods A total of sixty elderly patients undergoing laparoscopic radical resection of colorectal cancer were selected and divided into iPEEP group (group P) and control group (group C) using the random number table method, with 30 patients in each group. In group P, the patients received positive end-expiratory pressure (PEEP) titration test at immediately after intubation, immediately after establishing pneumoperitoneum and Trendelenburg position and immediately after ending pneumoperitoneum. The patients in group C received zero PEEP during procedure. The heart rate (HR), mean arterial pressure (MAP), optic nerve sheath diameter (ONSD), and end-tidal carbon dioxide pressure (PetCO₂) were recorded at 5 minutes after tracheal intubation (T₁), 30 minutes(T₂), 60 minutes (T₃)after pneumoperitoneum and Trendelenburg position establishment, and 10 minutes after the end of pneumoperitoneum and Trendelenburg position (T₄). The postoperative recovery time (ΔT₁), respiratory recovery time (ΔT₂), extubation time (ΔT₃), orientation recovery time (ΔT₄), and sedation-agitation scale (SAS) were also recorded. The occurrence of postoperative delirium(POD) and postoperative nausea and vomiting were recorded. Results Compared with group C, the MAP in group P were significantly decreased at T₃, and ΔT₂ and ΔT₄ were shortened, and the SAS score was decreased(P<0.05). There was no statistically significant difference in ONSD between the two groups during the operation. One case of POD occurred in the group C on the first day after surgery, and no severe cognitive dysfunction occurred in either group. Conclusions The lung-protective ventilation strategy with iPEEP does not affect the intracranial pressure of patients during the operation and can improve the quality of postoperative recovery in elderly patients with colorectal cancer receiving laparoscopic radical resection.

Key words: aged, colorectal cancer, individualized positive end-expiratory pressure, quality of recovery

中图分类号:

R 735.3

石进涛, 陆双伟, 申蓓. 个体化呼气末正压对老年患者腹腔镜结直肠癌根治术后苏醒质量的影响[J]. 实用老年医学, 2026, 40(5): 495-499.

SHI Jintao, LU Shuangwei, SHEN Bei. Effect of individualized positive end-expiratory pressure on quality of recovery in elderly patients undergoing laparoscopic colorectal cancer surgery[J]. Practical Geriatrics, 2026, 40(5): 495-499.

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