超声引导下肺复张对胸腔镜肺叶切除术后肺不张的影响

Effect of ultrasound-guided lung recruitment on postoperative pulmonary atelectasis after thoracoscopic lobectomy

中文关键词: 超声引导  肺复张  肺部超声  肺叶切除术  肺不张  呼吸参数

英文关键词: Ultrasound guidance  Lung recruitment  Lung ultrasound  Pulmonary lobectomy  Pulmonary atelectasis  Respiratory parameters

中文摘要:

      
目的：探讨超声引导下肺复张技术对胸腔镜肺叶切除术后肺不张的影响。
方法：选择2024年6—11月择期行胸腔镜肺叶切除术患者60例，男32例，女28例，年龄18～64岁，BMI 18.5～28.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：超声引导下肺复张组（U组）和手法肺复张组（C组），每组30例。两组于术前5 min、气管插管后5 min、术毕5 min及拔管后1 h行肺部超声检查，记录肺部超声评分（LUS），并在气管插管后5 min、术毕5 min分别实施超声引导下肺复张和手法肺复张，同时记录肺复张时呼吸力学相关参数：气道峰压（Ppeak）、气道平台压（Pplat）、驱动压（ΔP）、动态肺顺应性（Cdyn）及氧合指数（PaO₂/FiO₂）。记录气管插管后5 min、术毕5 min及拔管后1 h肺不张的发生情况。
结果：与术前5 min比较，气管插管后5 min和术中5 min两组LUS明显升高（P<0.05）。与气管插管后5 min比较，术毕5 min两组LUS明显降低（P<0.05）。与术毕5 min比较，拔管后1 h两组LUS明显降低（P<0.05）。与C组比较，U组术毕5 min及拔管后1 h LUS和肺不张发生率明显降低（P＜0.05），术毕5 min时Ppeak、Pplat、ΔP均明显降低（P<0.05），Cdyn及PaO₂/FiO₂均明显升高（P<0.05）。
结论：超声引导下肺复张技术可实时监测肺泡复张，有助于改善呼吸力学相关参数，减少胸腔镜肺叶切除术后肺不张的发生。

英文摘要:

      
Objective: To explore the effect of ultrasound-guided lung recruitment on postoperative pulmonary atelectasis in patients undergoing thoracoscopic lobectomy.
Methods: Sixty patients scheduled for thoracoscopic lobectomy from June to November 2024, 32 males and 28 females, aged 18-64 years, BMI 18.5-28.0 kg/m², ASA physical status Ⅰ or Ⅱ, were selected. The patients were randomly divided into two groups: ultrasound-guided lung recruitment (group U) and manual lung recruitment (group C), 30 patients in each group. Lung ultrasound examinations were performed at preoperative baseline, 5 minutes after intubation, 5 minutes after surgery, and 1 hour after extubation. Lung ultrasound scores (LUS) at each time point were recorded, and ultrasound-guided lung recruitment and manual lung recruitment 5 minutes after intubation, and 5 minutes after surgery were implemented, respectively. Respiratory mechanics parameters, including peak airway pressure (Ppeak), plateau pressure (Pplat), driving pressure (ΔP), dynamic lung compliance (Cdyn), and oxygenation index (PaO₂/FiO₂) were analyzed 5 minutes after intubation, and 5 minutes after surgery. The incidence of atelectasis 5 minutes after intubation, 5 minutes after surgery, and 1 hour after extubation were recorded.
Results: Compared with preoperative baseline, the LUS in both groups was increased significantly 5 minutes after intubation (P < 0.05). Compared with 5 minutes after intubation, LUS was decreased significantly in both groups 5 minutes after surgery (P < 0.05). Compared with 5 minutes after surgery, LUS was decreased significantly in both groups 1 hour after extubation (P < 0.05). Compared with group C, group U showed significantly lower LUS and incidence of atelectasis 5 minutes after surgery, and 1 hour after extubation (P < 0.05), significantly lower Ppeak, Pplat, and ΔP 5 minutes after surgery (P < 0.05), significantly higher Cdyn and PaO₂/FiO₂(P < 0.05), and significantly lower incidence of postoperative atelectasis (P < 0.05).
Conclusion: Ultrasound-guided lung recruitment can realize real-time monitoring of alveolar re-expansion, optimize respiratory mechanics parameters, and reduce the incidence of postoperative pulmonary atelectasis in patients undergoing thoracoscopic lobectomy.