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

doi:10.3969/j.issn.1006-5725.2025.14.014

Abstract

Abstract:

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.

Key words: driving pressure, positive end-expiratory pressure, esophageal cancer, incremental titration, decremental titration

CLC Number:

R735.1

Haowen ZHU,Shijie XU,Ran LIU,Xinhua HONG,Yiting XUE,Wenze TIAN,Zhen. SU. 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[J]. The Journal of Practical Medicine, 2025, 41(14): 2217-2223.

Figures/Tables 6

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References 26

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指标	D组	I组	t/χ² 值	P值
年龄/岁	67.30 ± 6.43	68.53 ± 6.64	-0.731	0.468
ASA 分级/例			2.308	0.129
Ⅱ	24	28
Ⅲ	6	2
性别/例			0.071	0.791
男	19	18
女	11	12
BMI/（kg/m²）	23.04 ± 1.74	22.40 ± 2.05	1.299	0.199
吸烟史/［例（%）］	7（23.33）	3（10.00）	1.920	0.166
高血压病史/［例（%）］	10（33.33）	8（26.67）	0.317	0.573
糖尿病病史/［例（%）］	2（6.67）	3（10.00）	0.218	0.640
心血管疾病史/［例（%）］	2（6.67）	5（16.67）	1.456	0.228
胸腔镜时间/min	80.80 ± 15.97	87.83 ± 18.32	-1.585	0.118
腹腔镜时间/min	31.23 ± 5.17	33.47 ± 6.39	-1.488	0.142
手术时间/min	194.73 ± 34.01	207.17 ± 46.92	-1.175	0.245
液体入量/mL	1 640.00 ± 245.79	1 660.67 ± 302.33	-0.291	0.772
尿量/mL	330.00 ± 58.13	366.67 ± 142.84	-1.302	0.198
失血量/mL	106.33 ± 32.26	117.67 ± 63.93	-0.861	0.393
血管活性药物（间羟胺）用量/mg	2.70 ± 1.60	3.05 ± 1.13	-0.972	0.335

指标	组别	T₁	T₂	T₃	T₄
PEEP	D组	5.00 ± 0.00	7.60 ± 1.07^#	7.27 ± 1.17^#	7.27 ± 1.17^#
	I组	5.00 ± 0.00	6.93 ± 0.98	6.53 ± 1.04	6.53 ± 1.04
Pplat	D组	16.67 ± 2.32	20.93 ± 1.57	20.57 ± 1.76	16.00 ± 1.76
	I组	17.23 ± 1.63	21.27 ± 2.29	20.80 ± 1.92	16.50 ± 1.48
Ppeak	D组	20.10 ± 2.44	24.10 ± 2.16	23.70 ± 2.17	19.03 ± 1.73
	I组	20.83 ± 1.82	24.76 ± 2.27	24.53 ± 2.00	19.80 ± 1.49
驱动压	D组	11.67 ± 2.32	13.33 ± 1.52^#	13.30 ± 1.29^#	8.73 ± 1.84^#
	I组	11.33 ± 1.65	14.33 ± 2.22	14.27 ± 1.51	9.96 ± 1.45
Cdyn/（mL/cmH₂O）	D组	32.32 ± 7.52	21.43 ± 3.78^#	29.01 ± 3.54^#	41.28 ± 8.28^#
	I组	30.77 ± 4.88	19.56 ± 2.94	26.88 ± 3.38	36.49 ± 4.16

指标	组别	T₀	T₁	T₂	T₃	T₄	T₅
MAP/mmHg	D组	93.23 ± 8.73	78.03 ± 5.93	78.30 ± 7.41	81.37 ± 8.38	84.40 ± 7.37	86.93 ± 5.03
	I组	89.87 ± 6.90	77.63 ± 5.22	75.73 ± 5.14	79.00 ± 4.18	79.87 ± 3.75	84.80 ± 3.62
HR/（次/min）	D组	79.00 ± 7.11	72.87 ± 7.48	78.97 ± 9.27	73.07 ± 8.26	76.17 ± 7.07	82.07 ± 5.56
	I组	80.57 ± 10.09	70.97 ± 8.80	76.40 ± 9.34	74.60 ± 9.77	77.73 ± 4.56	80.17 ± 4.57
PaO₂/mmHg	D组	82.00 ± 10.26	332.30 ± 67.51	228.13 ± 67.80^#	295.47 ± 68.00^#	343.90 ± 74.84^#	110.43 ± 18.65
	I组	82.67 ± 9.76	335.50 ± 57.75	189.17 ± 58.41	252.83 ± 86.08	300.13 ± 91.73	112.37 ± 20.40
PaCO₂/mmHg	D组	40.07 ± 3.68	39.57 ± 4.10	52.03 ± 8.15^#	46.80 ± 6.30	40.40 ± 3.71^#	41.23 ± 4.68
	I组	38.67 ± 2.67	37.73 ± 3.18	56.60 ± 7.53	45.80 ± 4.94	42.63 ± 3.11	41.93 ± 3.73
pH	D组	7.43 ± 0.04	7.42 ± 0.03	7.35 ± 0.04^#	7.36 ± 0.04	7.40 ± 0.03	7.41 ± 0.04
	I组	7.44 ± 0.03	7.40 ± 0.05	7.30 ± 0.05	7.35 ± 0.04	7.39 ± 0.04	7.39 ± 0.03
Hb	D组	12.69 ± 1.22	12.29 ± 1.16	12.09 ± 1.14	11.55 ± 1.18	11.70 ± 1.23	12.24 ± 1.42
	I组	12.42 ± 1.44	11.95 ± 1.55	11.47 ± 1.56	10.97 ± 1.41	11.42 ± 1.73	12.19 ± 1.66
SPO₂/%	D组	96.70 ± 1.51	99.90 ± 0.53	98.33 ± 1.18	99.53 ± 0.78	99.60 ± 0.56	98.03 ± 1.22
	I组	96.37 ± 0.96	99.80 ± 0.31	98.37 ± 1.54	99.73 ± 0.52	99.80 ± 0.41	98.63 ± 1.16
OI /mmHg	D组	390.47 ± 48.87	415.40 ± 84.38	285.20 ± 84.76^#	492.44 ± 113.32^#	573.17 ± 124.74^#	380.81 ± 64.31
	I组	393.66 ± 46.48	419.40 ± 72.20	236.48 ± 73.01	421.38 ± 143.47	500.22 ± 152.89	387.47 ± 70.34

指标	胸腔镜期间		腹腔镜期间
指标	D组	I组	D组	I组
Pplat
滴定前	15.73 ± 1.48	16.70 ± 2.32	15.77 ± 1.41	16.53 ± 1.61
滴定后	20.93 ± 1.57^#	21.27 ± 2.29^#	23.70 ± 2.17^#	20.80 ± 1.92^#
Ppeak
滴定前	18.87 ± 1.72	19.93 ± 2.59	19.00 ± 1.68	20.20 ± 1.67
滴定后	24.10 ± 2.16^#	24.77 ± 2.27^#	23.70 ± 2.17^#	24.53 ± 2.00^#
驱动压
滴定前	15.73 ± 1.48	16.70 ± 2.32	15.77 ± 1.41	16.53 ± 1.61
滴定后	13.33 ± 1.52^#	14.33 ± 2.22^#	13.30 ± 1.29^#	14.27 ± 1.51^#
Cdyn/（mL/cmH₂O）
滴定前	18.58 ± 2.43	17.50 ± 2.65	25.12 ± 3.50	23.89 ± 2.64
滴定后	21.43 ± 3.78^#	19.56 ± 2.94^#	29.01 ± 3.54^#	26.88 ± 3.38^#

指标	D组	I组	t/χ² /Z值	P值
3 d内PPCs发生率	10（33.33）	12（40.00）	0.287	0.592
7 d内PPCs发生率	12（40.00）	13（43.33)	0.069	0.793
住院时间（x ± s）/d	20.53 ± 2.94	21.03 ± 3.67	-0.582	0.563
住院费用[M(P₂₅，P₇₅ ）]/元	93 838.44（88 973.71，100 142.18）	100 489.50（90 932.61，108 962.68）	-1.981	0.048

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

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