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

Abstract

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

CLC Number:

R 735.3

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.

References

[1] 宛泉龙, 鲍杨, 张丽峰, 等. 腹腔镜手术患者苏醒期躁动的危险因素[J]. 临床麻醉学杂志, 2013, 29(3): 254-255.
[2] 武姗姗, 张宗旺. 术后谵妄神经炎症机制的研究进展[J]. 国际麻醉学与复苏杂志, 2016, 37(11): 1052-1056.
[3] 蔡玲, 朱凯敏, 沈美华, 等. 术后谵妄的研究进展[J]. 国际麻醉学与复苏杂志, 2020, 41(4): 411-416.
[4] TARAN S, WAHLSTER S, ROBBA C. Ventilatory targets following brain injury[J]. Curr Opin Crit Care, 2023, 29(2): 41-49.
[5] MELO R H, GIOLI-PEREIRA L, MACHADO F S, et al. Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure in nontraumatic neurocritically ill patients: a diagnostic accuracy systematic review and meta-analysis[J]. Neurocrit Care, 2025, 43(2): 659-670.
[6] DESIGNATION-investigators. Driving Pressure During General Anesthesia for Open Abdominal Surgery (DESIGNATION): study protocol of a randomized clinical trial[J]. Trials, 2020, 21(1): 198.
[7] 田兵, 周福波, 王丽娟, 等. 2024年视神经鞘直径超声成像和测量国际共识解读[J]. 中国卒中杂志, 2025, 20(4): 470-478.
[8] 张建锋, 于滨, 张振亚, 等. 结直肠癌术后谵妄的诊治研究进展[J]. 实用医学杂志, 2023, 39(20): 2687-2690.
[9] NEUDECKER J, SAUERLAND S, NEUGEBAUER E, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery[J]. Surg Endosc, 2002, 16(7): 1121-1143.
[10] ROBBA C, CARDIM D, DONNELLY J, et al. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods[J]. Br J Anaesth, 2016, 117(6): 783-791.
[11] SPADARO S, GRASSO S, KARBING D S, et al. Physiological effects of two driving pressure-based methods to set positive end-expiratory pressure during one lung ventilation[J]. J Clin Monit Comput, 2021, 35(5): 1149-1157.
[12] MENG L, GELB A W. Regulation of cerebral autoregulation by carbon dioxide[J]. Anesthesiology, 2015, 122(1): 196-205.
[13] CLAASSEN J A H R, THIJSSEN D H J, PANERAI R B, et al. Regulation of cerebral blood flow in humans: phsiology and clinical implications of autoregulation[J]. Physiol Rev, 2021, 101 (4):1487-1559.
[14] 刘晶晶, 斯妍娜, 唐曙华, 等. 不同气腹压力对腹腔镜妇科手术患者颅内压的影响[J]. 临床麻醉学杂志, 2019, 35(5): 478-481.
[15] GENG W, CHEN C, SUN X, et al. Effects of sevoflurane and propofol on the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery: a randomized controlled clinical studies[J]. BMC Anesthesiol, 2021, 21(1): 30.
[16] ROBBA C, BALL L, BATTAGLINI D, et al. Effects of positive end-expiratory pressure on lung ultrasound patterns and their correlation with intracranial pressure in mechanically ventilated brain injured patients[J]. Crit Care, 2022, 26(1): 31.
[17] JUN I J, KIM M, LEE J, et al. Effect of mannitol on ultrasonographically measured optic nerve sheath diameter as a surrogate for intracranial pressure during robot-assisted laparoscopic prostatectomy with pneumoperitoneum and the trendelenburg position[J]. J Endourol, 2018, 32(7): 608-613.
[18] 刘子豪. 不同呼气末二氧化碳分压对老年腹腔镜手术患者脑氧饱和度和术后谵妄的影响[D]. 张家口: 河北北方学院, 2023.

Effect of individualized positive end-expiratory pressure on quality of recovery in elderly patients undergoing laparoscopic colorectal cancer surgery

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