[1]郝伟,张琰,录亚鹏,等.驱动压导向个体化呼气末正压对小儿腹腔镜手术中肺保护以及术后肺不张的影响研究[J].临床小儿外科杂志,2022,21(05):468-473.[doi:10.3760/cma.j.cn101785-202111021-013]
　Hao Wei,Zhang Yan,Lu Yapeng,et al.Effect of driving pressure-guided individualized positive end-expiratory pressure titration on lung pro- tection and postoperative atelectasis during laparoscopy in children[J].Journal of Clinical Pediatric Surgery,2022,21(05):468-473.[doi:10.3760/cma.j.cn101785-202111021-013]
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驱动压导向个体化呼气末正压对小儿腹腔镜手术中肺保护以及术后肺不张的影响研究

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第21卷 期数: 2022年05期 页码: 468-473 栏目: 论著 出版日期: 2022-05-01
Title:
Effect of driving pressure-guided individualized positive end-expiratory pressure titration on lung pro- tection and postoperative atelectasis during laparoscopy in children
作者:
郝伟1; 2;  张琰1;  录亚鹏1; 2;  刘洋1; 2;  钟海莲1; 2;  张荣智1;  陈亚惊3;  王迎斌1; 2
1 兰州大学第二医院麻醉科, 兰州 730030;
2 兰州大学第二临床医学院, 兰州 730030;
3 兰州大学第二医院小儿外科, 兰州 730030
Author(s):
Hao Wei1; 2;  Zhang Yan1;  Lu Yapeng1; 2;  Liu Yang1; 2;  Zhong Hailian1; 2;  Zhang Rongzhi1;  Chen Yajing3;  Wang Yingbin1; 2
1 Department of Anesthesiology, Second Hospital, Lanzhou University, Lanzhou 730030, China;
2 Second Clinical School of Medicine, Lanzhou University, Lanzhou 730030, China;
3 Department of Pediatric Surgery, Second Hospi- tal, Lanzhou University, Lanzhou 730030, China
关键词:
腹腔镜检查; 麻醉/方法; 正压呼吸; 肺通气; 肺顺应性; 肺不张; 儿童
Keywords:
Laparoscopy; Anesthesia/MT; Positive-pressure Respiration; Pulmonary Ventilation; Lung Compliance; Pulmonary Atelectasis; Child
DOI:
10.3760/cma.j.cn101785-202111021-013
摘要:
目的 探讨驱动压导向个体化呼气末正压(positive end-expiratory pressure,PEEP)对小儿腹腔镜手术中肺保护作用以及对术后肺不张的影响。方法 以兰州大学第二医院2021年6月至2021年10月行腹腔镜手术的46例患儿(年龄1~6岁)为研究对象,使用随机数字表法分为固定PEEP组和驱动压导向个体化PEEP组,每组各23例。固定PEEP组:设置5 cmH2 O (1 cmH2 O=0.098 kPa) PEEP直至手术结束;驱动压导向个体化PEEP组:PEEP从2 cmH2 O开始,每次递增1 cmH2 O,每个PEEP水平维持10次呼吸循环,直至获得最低驱动压。记录气管插管后5 min (T1)、气腹后5 min (T2)、实施PEEP后4 min (T3)、手术结束(T4)时的平台压、PEEP、驱动压、肺动态顺应性、平均动脉压和心率;记录T1、T4、T5(出恢复室)时的肺超声评分以及手术过程中气腹时长、气腹压力、机械通气时长和手术时长。结果 与T1时相比,两组T2时的肺动态顺应性均降低,驱动压均明显增高,差异具有统计学意义(P<0.05);与T2时相比,T3、T4时的肺动态顺应性和驱动压均明显改善(P<0.05)。驱动压导向个体化PEEP组较固定PEEP组在改善肺动态顺应性,降低驱动压和肺超声评分方面具有优势(P <0.05);两组不同时间点心率和平均动脉压变化差异无统计学意义(P>0.05)。结论 对于年龄1~6岁、ASAⅠ~Ⅱ级的腹腔镜手术患儿,实施驱动压导向、个体化呼气末正压通气策略可以明显改善患儿通气过程中肺动态顺应性,且能够降低驱动压和术后肺超声评分。
Abstract:
Objective To explore the influence of driving pressure-guided individualized positive end- expiratory pressure (PEEP) titration on lung protection and postoperative atelectasis in children undergoing lap- aroscopic surgery. Methods From June 2021 to October 2021, a total of 46 children undergoing laparoscopy at Second Hospital of Lanzhou University were selected as research subjects. They were divided randomly into two groups of fixed PEEP and driving pressure-guided individualized PEEP (n=23 each). Fixed PEEP group:5 cmH2 O (1 cmH2 O=0. 098 kPa) PEEP was set until end of operation. Driving pressure-guided individualized PEEP group:PEEP started from 2 cmH2 O with an increment of 1 cmH2 O and each PEEP level was maintained for 10 breathing cycles until the lowest driving pressure. There was a hourly repetition. Plateau pressure (Pplat), PEEP, driving pressure, lung dynamic compliance, mean arterial pressure (MAP) and heart rate (HR) were recorded at 5 min after tracheal intubation (T1),5 min after pneumoperitoneum (T2),4 min after PEEP (T3) and end of operation (T4);Lung Ultrasound Score (LUS) at T1,/T4/T5 (out of PACU) and intra- operative pneumoperitoneum time, pneumoperitoneum pressure, mechanical ventilation duration and operative duration were analyzed. Results As compared with T1, pulmonary dynamic compliance of two groups declined and driving pressure spiked obviously at T2. And the difference was statistically significant (P < 0. 05). As compared with T2, lung dynamic compliance and driving pressure of two groups improved markedly at T3 and T4 (P < 0. 05). As compared with fixed PEEP group, driving pressure-guided individualized PEEP group offered more advantages of improving lung dynamic compliance and reducing driving pressure and lung ultrasound score (P < 0. 05);no inter-group statistical difference existed in HR/MAP changes at different timepoints. Conclusion For ASA Ⅰ-Ⅱ children aged 1-6 years undergoing laparoscopy, driving pressure-guided individualized PEEP ventilation strategy can significantly improve lung dynamic compliance and reduce driving pressure and postoperative lung ultrasound scores.

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备注/Memo

收稿日期:2021-11-10。
基金项目:兰州大学第二医院“萃英科技创新”计划（CY2019-BJ07、CY2020-BJ10）
通讯作者:王迎斌,Email:wangyingbin6@163.com

更新日期/Last Update: 1900-01-01