Effect of individualized PEEP combined with regular lung recruitment maneuvers on atelectasis after laparoscopic radical resection of colorectal cancer in elderly patients

doi:10.11958/20230235

Abstract

Abstract:

Objective To evaluate the effect of driving pressure (ΔP)-guided individualized positive end-expiratory pressure (PEEP) combined with regular lung recruitment maneuvers (RMs) on atelectasis in elderly patients undergoing laparoscopic surgery in the Trendelenburg position using lung ultrasound. Methods A total of 62 patients aged 65-85 years old and classified by ASA status Ⅰ-Ⅲ undergoing laparoscopic radical resection of colorectal cancer were included and randomly divided into the experimental group (n=31) and the control group (n=31). Both groups received one RM after the beginning of pneumoperitoneum, followed immediately by titration of individualized PEEP with the lowest ΔP, and both groups received another RM after the end of pneumoperitoneum. The experimental group received additional RM every 30 min from the beginning of pneumoperitoneum, while the control group received no intervention. Recording time points for observation were: before induction of anesthesia (T₀), 30 min after pneumoperitoneum (T₁), 90 min after pneumoperitoneum (T₂), at the end of surgery (T₃) and 45 min after entering the postanesthesia care unit (PACU, T₄). Lung ultrasound score (LUS) was recorded at T₀, T₃ and T₄. Dynamic lung compliance (Cdyn) was recorded at T₁-T₃. Oxygenation index (OI), mean arterial pressure (MAP) and heart rate (HR) were recorded at T₀-T₄. Hypotension during RM, hypoxic saturation events in PACU and the incidence of pulmonary complications (POPC) within the first 7 days after surgery were recorded. Results Compared with the control group, LUSs at T₃ and T₄were significantly decreased in the experimental group (P < 0.05), and OI and Cdyn at T₂ and T₃ were significantly increased (P < 0.05). In addition, the incidence of hypoxia saturation events in PACU was lower in the experimental group than that in the control group (P < 0.05). There were no significant differences in the incidence of hypotension during lung recruitment and the incidence of POPC within 7 days after surgery between the two groups. Conclusion The individualized PEEP combined with regular RMs can effectively reduce the atelectasis observed by lung ultrasound immediately after laparoscopic radical resection of colorectal cancer and in PACU in elderly patients.

Key words: pulmonary atelectasis, laparoscopes, aged, individualized positive end-expiratory pressure, driving pressure

CLC Number:

R563.4

Figures/Tables 10

References 23

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组别	n	年龄/岁	性别（男/女）	BMI/（kg/m²）	吸烟史
对照组	31	72（67，76）	20/11	23.7±2.7	15/14/2
试验组	31	74（70，79）	15/16	23.5±2.4	19/11/1
Z、χ²或t		1.637	1.640	0.345	1.243

组别	n	年龄/岁	性别（男/女）	BMI/（kg/m²）	吸烟史
对照组	31	72（67，76）	20/11	23.7±2.7	15/14/2
试验组	31	74（70，79）	15/16	23.5±2.4	19/11/1
Z、χ²或t		1.637	1.640	0.345	1.243

组别	n	高血压	糖尿病	FEV1/FVC	Hb/（g/L）	ASA分级（Ⅰ/Ⅱ/Ⅲ）	ARISCAT评分（26~44/>44）
对照组	31	13（41.9）	4（12.9）	74.9±7.9	120.8±14.4	4/24/3	8/23
试验组	31	16（51.6）	7（22.6）	77.6±8.0	117.5±12.9	3/23/5	11/20
Z、χ²或t		0.583	0.995	1.316	0.939	0.728	0.683

组别	n	高血压	糖尿病	FEV1/FVC	Hb/（g/L）	ASA分级（Ⅰ/Ⅱ/Ⅲ）	ARISCAT评分（26~44/>44）
对照组	31	13（41.9）	4（12.9）	74.9±7.9	120.8±14.4	4/24/3	8/23
试验组	31	16（51.6）	7（22.6）	77.6±8.0	117.5±12.9	3/23/5	11/20
Z、χ²或t		0.583	0.995	1.316	0.939	0.728	0.683

组别	n	PEEP/ cmH₂O	气腹时间/ min	手术时间/ min	苏醒时间/ min	手术类型（直肠癌/结肠癌）	输液量/ mL	估计失血量/ mL	尿量/ mL
对照组	31	9（8，10）	162（137，185）	201（183，221）	13.9±3.5	16/15	2 000（1 600，2 300）	150（100，150）	350（200，550）
试验组	31	9（7，10）	180（145，209）	211（180，238）	13.4±3.5	13/18	2 000（1 500，2 500）	150（100，200）	420（200，620）
Z、χ²或t		0.857	1.352	0.514	0.647	0.583	0.542	0.670	0.789