最佳呼吸末正压肺保护通气策略对腹腔镜下结直肠癌根治术患者氧合功能的影响

Effect of optimal positive end expiratory pressure protective mechanical ventilation strategy on oxygenation in patients undergoing laparoscopic radical resection of colorectal cancer

中文关键词: 肺动态顺应性  呼气末正压  肺复张  肺保护性通气

英文关键词: Dynamic compliance  Positive end expiratory pressure  Recruitment manoeuvres  Lung protective ventilation

中文摘要:

      
目的 探讨最佳呼吸末正压(PEEP)肺保护通气策略对腹腔镜下结直肠癌根治术患者围术期氧合功能的影响。
方法 择期行腹腔镜下结直肠癌根治术患者54例，男36例，女18例，年龄65～85岁，ASA Ⅱ或Ⅲ级。随机分为两组：传统组（T组）和保护组（P组）,每组27例。T组设置VT 9 ml/kg且无PEEP和肺复张（RMs）；P组通过肺动态顺应性（Cdyn）PEEP滴定确定患者最佳PEEP值，设置低VT 7 ml/kg联合最佳PEEP，每30分钟RMs一次。于麻醉诱导后10 min（T1）、每次RMs后30 min（T2、T3、T4）记录Cdyn及气道平台压（Pplat）、并在T1—T4、拔管后30 min（T5）及术后第3天（T6）采集动脉血样本，计算氧合指数（OI），记录术前和T6时的改良临床肺部感染评分（mCPIS）。
结果 与T组比较，T3、T4时P组Cdyn明显升高(P<0.05)，T4—T6时P组OI明显升高(P<0.05)，T6时P组mCPIS明显降低（P<0.05）。
结论 最佳PEEP联合低VT和RMs的肺保护通气策略可改善腹腔镜结直肠癌根治术患者围术期氧合，降低mCPIS。

英文摘要:

      
Ojective To explore the optimal positive end expiratory pressure (PEEP) level in patients undergoing laparoscopic colorectal cancer radical resection and to evaluate the effect of lung protective mechanical ventilation strategy on perioperative oxygenation.
Methods Fifty-four patients scheduled to undergo laparoscopic colorectal cancer radical resection, 36 males and 18 females, aged 65-85 years, falling into ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups (n = 27 in each group): traditional ventilation group (group T) and lung protective ventilation strategy (group P). Patients in group T were set the tidal volume (VT) at 9 ml/kg without PEEP and recruitment manoeuvres (RMs), patients in group P were set VT 7 ml/kg and with RMs, meanwhile, combined with optimal PEEP determined by dynamic compliance (Cdyn). Cdyn and Pplat were recorded 10 min after anesthesia induction (T1) and 30 min after every RMs (T2, T3, T4). Arterial oxygenation index were recorded at T1-T4, 30 min after extubation (T5) and 3 d after surgery (T6). Modified clinical pulmonary infection score (mCPIS) was recorded at pre operation and T6.
Results Compared with group T, the oxygenation index in group P were significantly improved at T4-T6 (P < 0.05), the Cdyn in group P were significantly improved at T3 and T4(P < 0.05), and the mCPIS in group P was significantly reduced at T6(P < 0.05).
Conclusion Optimal PEEP combined with low VT and RMs as a protective ventilation strategy can improve perioperative oxygenation and reduce mCPIS in patients undergoing laparoscopic colorectal cancer radical resection.