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

Abstract

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

CLC Number:

R 614.1

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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Effects of driving pressure-guided lung protective ventilation strategy on postoperative pulmonary complications in elderly patients undergoing elective colorectal surgery

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