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| 肺动态顺应性指导个体化PEEP滴定对颅面重建术患儿术后肺不张的影响 |
| Effect of dynamic lung compliance-guided individualized PEEP on postoperative atelectasis in children undergoing craniofacial reconstruction |
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| DOI：10.12089/jca.2024.07.002 |
| 中文关键词: 呼气末正压 动态顺应性 肺不张 肺超声评分 肺保护性通气策略 |
| 英文关键词: Positive end-expiratory pressure Dynamic compliance Atelectasis Lung ultrasound score Lung protective ventilation strategy |
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| 中文摘要: |
目的： 探讨肺动态顺应性（Cdyn）指导个体化PEEP滴定对颅面重建术患儿术后肺不张的影响。
方法： 选择全麻下行颅面重建术患儿80例，男52例，女28例，年龄≤1岁，ASA Ⅰ或Ⅱ级，麻醉时间≥2 h。采用随机数字表法将患儿分为两组：Cdyn导向个体化PEEP组（I组）和固定PEEP组（P组），每组40例。I组在插管后5 min肺部超声评分（LUS）后进行PEEP滴定，Cdyn最高值对应的PEEP为个体化PEEP；P组PEEP固定为6 cmH2O。记录插管后5 min和手术结束时胸膜旁实变评分、B线评分、LUS总评分和肺不张发生情况。记录插管后5 min和PEEP建立后Cdyn、气道峰压（Ppeak）、HR、MAP。记录插管后5 min和手术结束时氧合指数（OI）和术后72 h肺部并发症的发生情况。
结果： I组滴定过程中Cdyn最高值时对应个体化PEEP滴定值中位数为9 cmH2O。与插管后5 min比较，两组手术结束时胸膜旁实变总评分、后胸部胸膜旁实变评分、B线总评分和前、侧、后胸部B线评分、LUS总评分均明显降低（P＜0.05）。与P组比较，I组手术结束时胸膜旁实变评分、后胸部胸膜旁实变总评分、B线总评分、后胸部B线评分、LUS总评分、肺不张发生率明显降低（P＜0.05），I组PEEP建立后Cdyn和Ppeak明显升高（P＜0.05），手术结束时OI明显升高（P＜0.05），术后72 h肺部并发症总发生率明显降低（P＜0.05）。
结论： 术中应用Cdyn指导个体化PEEP滴定能有效降低颅面重建术患儿手术结束时LUS评分和肺不张发生率，改善氧合功能，降低术后肺部并发症发生率。 |
| 英文摘要: |
Objective: To investigate the effect of dynamic lung compliance (Cdyn)-guided individualized positive end-expiratory pressure (PEEP) on postoperative atelectasis in children undergoing craniofacial reconstruction.
Methods: Eighty children under general anesthesia undergoing craniofacial reconstruction were selected, 52 males and 28 females, aged ≤1 year, ASA physical status Ⅰ or Ⅱ, anesthesia duration ≥2 hours. According to the random number table method, the children were divided into two groups: Cdyn-guided individualized PEEP group (group I) and fixed PEEP group (group P), 40 children in each group. PEEP titration was performed in group I after assessing the lung ultrasound (LUS) score 5 minutes after intubation, and the PEEP corresponding to the highest value of Cdyn was an individualized PEEP. In group P, PEEP was fixed 6 cmH2O. The parapleural consolidation score, the B-line score, the total score of LUS, and the incidence of atelectasis were recorded 5 minutes after intubation and at the end of the operation. Cdyn, Ppeak, HR and MAP were recorded 5 minutes after intubation and after PEEP was established. Oxygenation index (OI) was recorded 5 minutes after intubation and at the end of the operation. The incidence of postoperative pulmonary complications within 72 hours after operation were recorded.
Results: Median individualized PEEP with highest dynamic compliance during titration was 9 cmH2O in group I. Compared with 5 minutes after intubation, the total parapleural consolidation score, posterior thoracic parapleural consolidation score, total B-line score and anterior lateral posterior chest B-line score, and total score of LUS were significantly decreased in both groups at the end of the operation (P < 0.05). Compared with group P, the total score of parapleural consolidation, posterior chest parapleural consolidation score, total score of B-line and posterior chest B-line score, and total score of LUS, the incidence of atelectasis were significantly decreased in group I at the end of the operation (P < 0.05). Compared with group P, Cdyn and Ppeak in group I were significantly increased after PEEP establishment (P < 0.05), OI at the end of the operation was significantly increased (P < 0.05), and the incidence of postoperative pulmonary complications within 72 hours after operation was significantly decreased in group I (P < 0.05).
Conclusion: Intraoperative application of Cdyn-guided individualized PEEP can effectively reduce LUS score and atelectasis at the end of craniofacial reconstruction in children, improve oxygenation function, and reduce the incidence of postoperative pulmonary complications. |
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