动态肺顺应性联合肺泡无效腔量导向腹腔镜结直肠癌根治术患者术中最佳PEEP水平设置的可行性分析

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Abstract Objective To investigate the feasibility of dynamic lung compliance (Cdyn) combined with alveolar void volumetric (VD/VT) guided optimum positive end-expiratory pressure (PEEP) for improving intraoperative oxygenation in patients with laparoscopic radical resection of colorectal cancer. Methods From December 2018 to August 2020, 26 patients undergoing elective laparoscopic radical resection of colorectal cancer in Lishui Central Hospital of Zhejiang Province were selected as the research subjects. VT was set at 7 mL/kg, and volumetric increasing recruitment manoeuvre (RM) and PEEP titration were performed after the pneumopitoneum position was established. Starting from 14 cmH2O, each step decreased by 2 cmH2O and maintained for 10 min, and the end point of optimal PEEP was determined when it was reduced to 4 cmH2O. Cdyn, VD/VT, oxygenation index (OI), blood lactic acid (Lac), stroke volume variation (SVV) and other indicators in pneumoperitoneum was established for 10 min (T1) and corresponding PEEP level was established to control respiration for 20 min (T2), 30 min (T3), 40 min (T4), 50 min (T5), 60 min (T6), and 70 min (T7) were monitored. Results No significant hemodynamic fluctuations were observed in all patients undergoing PEEP titration (SVV < 13%). Compared with T1, Cdyn at T5 increased significantly (P < 0.01), and it was at the peak of titration process; OI was significantly increased (P < 0.05); VD/VT was significantly decreased at T3 and T5 (P < 0.05). Conclusion The optimal PEEP titration after RM combined with the goal oriented setting of Cdyn and VD/VT can effectively improve the oxygenation of patients during laparoscopic radical resection of colorectal cancer.

Key words： Dynamic lung compliance Positive end-expiratory pressure Recruitment manoeuvre Lung protective ventilation

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	WANG Chuanguang ZHOU Jianwei HUANG Yan YAO Yinguang WU Zhenhua YE Yonggong

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WANG Chuanguang ZHOU Jianwei HUANG Yan YAO Yinguang WU Zhenhua YE Yonggong. Feasibility analysis of optimal PEEP level setting in patients undergoing laparoscopic radical resection of colorectal cancer with dynamic lung compliance combined with alveolar void volumetric guidance#br#[J]. 中国医药导报, 2021, 18(34): 109-112.

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https://www.yiyaodaobao.com.cn/EN/ OR https://www.yiyaodaobao.com.cn/EN/Y2021/V18/I34/109

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