收稿日期: 2025-02-27
网络出版日期: 2025-07-29
基金资助
江苏省卫生健康委科研项目(H2023083);江苏省淮安市基础研究计划（联合专项）卫生健康类科研项目(HABL2023067)
Effects of two driving pressure-based methods to set positive end-expiratory pressure on pulmonary mechanics and oxygenation in patients undergoing laparoscopic and thoracoscopic esophagectomy
Received date: 2025-02-27
Online published: 2025-07-29
目的 探究驱动压导向的递增法与递减法个体化呼气末正压（PEEP）滴定对胸腹联合腔镜食管癌根治术患者术中呼吸力学和氧合的影响。 方法 选取南京医科大学附属淮安第一医院2024年3—8月择期行胸腹联合腔镜食管癌根治术的患者60例，随机分为递减法滴定PEEP组（D组）和递增法滴定PEEP组（I组），每组30例。手术开始后两组于胸腔镜、腹腔镜时进行递减法和递增法PEEP滴定。记录预充氧前（T0）、插管后10 min（T1）、单肺通气应用PEEP 20 min（T2）、双肺通气应用PEEP 20 min（T3）、拔管前（T4）、拔管后30 min（T5）的呼吸力学、血流动力学和血气值。记录术后3 d、7 d内患者肺部并发症的发生率、住院时间和费用。 结果 与I组相比，D组患者术中的氧合指数升高、肺顺应性增加（P < 0.05）；两组在滴定后的驱动压和顺应性比滴定前均改善（P < 0.05）。 结论 驱动压导向的递增法与递减法个体化PEEP滴定方法均可以改善食管癌根治术患者术中呼吸力学和氧合，递减法对于改善患者术中呼吸力学和氧合更加有效。
朱浩文 , 徐仕杰 , 刘冉 , 洪新华 , 薛宜婷 , 田文泽 , 苏珍 . 驱动压导向的两种个体化呼气末正压滴定方法对食管癌根治术患者术中呼吸功能的影响[J]. 实用医学杂志, 2025 , 41(14) : 2217 -2223 . DOI: 10.3969/j.issn.1006-5725.2025.14.014
Objective To investigate the effects of two driving pressure-based methods to set positive end-expiratory pressure on pulmonary mechanics and oxygenation in patients undergoing laparoscopic and thoracoscopic esophagectomy. Methods Sixty patients undergoing laparoscopic and thoracoscopic esophagectomy were divided into two groups （n = 30 each）： incremental group （group I） and decremental group （group D）. PEEP titration was performed in both groups during thoracoscopy and laparoscopy. Respiratory mechanics parameters， hemodynamic parameters， and blood gas analysis were collected for analysis before preoxygenation （T0）， 10 minutes after intubation （T1）， 20 minutes after PEEP application for one-lung ventilation （T2）， 20 minutes after PEEP application for two-lung ventilation （T3）， before extubation （T4）， and 30 minutes after extubation （T5）. The postoperative pulmonary complications within 3 days and 7 days after operation， hospitalization duration， and costs were recorded. Results Compared with group I， patients in group D showed higher oxygenation index and pulmonary compliance during surgery （P < 0.05）. In both groups， driving pressure decreased and compliance increased after PEEP titration （P < 0.05）. Conclusion Both driving pressure-guided incremental and decremental titration of individualized PEEP improved intraoperative respiratory mechanics in patients undergoing laparoscopic and thoracoscopic esophagectomy， and decremental titration was more effective in improving intraoperative respiratory mechanics and oxygenation in patients during operation.
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