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在腹腔镜手术期间评估PEEP反应的招募与膨胀比:一个生理学研究研究

Marco Covotta¹, Claudia Claroni¹, Giulia Torregiani¹

¹Department of Anesthesiology, Intensive Care and Pain Therapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

Journal of clinical anesthesia

|August 6, 2024

概括

在腹腔镜手术期间,正极端呼气压 (PEEP) 有不同的影响. 招募与通货膨胀比率 (R/I) 可以识别那些从PEEP中受益于减少肺部应变的患者.

科学领域:

麻醉学和重症监护医学
呼吸系统生理学呼吸系统生理学
手术创新在外科创新.

背景情况:

阳性末尾呼吸压力 (PEEP) 在腹腔镜手术中改善结果的作用仍然存在争议.
PEEP的好处与气膜招募有机相关,该招募通过减少肺动态应变来减轻呼吸器诱导的肺损伤.
肺上皮质膜可以诱导空气损失,对PEEP的反应在个体之间有很大的差异.

研究的目的:

为了研究肺上皮膜诱导的通风损失和PEEP诱导的肺部招募的个体间变异性.
确定招募与通胀比率 (R/I) 是否可以识别受益于PEEP减压的患者.
评估不同PEEP水平对Trendelenburg肺肺炎过程中的肺机制和应变的影响.

主要方法:

一项涉及17名患者的连续研究,这些患者在Trendelenburg肺部外皮下接受了机器人辅助前列腺切除术.
在不同PEEP水平 (0,4和12cmH2O) 上评估终呼吸肺体积 (EELV) 和呼吸机制.
使用简化压力-体积曲线方法评估肺皮引起的退聘和PEEP引起的招聘;计算R/I比率.

主要成果:

肺上皮膜显著降低了EELV和增加了动态应变,具有相当大的个体间变异性.
增加PEEP从4到12cmH2O导致了可变的招募和不一致的动态减压.
R/I比率有效地预测了PEEP诱导的动态应变减少和静态应变增加.

结论:

肺上皮炎会导致可变的肺退役,PEEP在扭转这种情况的有效性高度个性化.
高的R/I比率确定了可能经历更高PEEP的显著动态应变减压的患者.
R/I比率可以促进个性化的PEEP设置,以优化腹腔镜手术期间的肺部保护.

关键词:

膜层的招募膜层的招募这种病是Atelectasis.laparoscopic 手术拉巴洛斯科普手术是用眼镜进行的手术.对于PEEP来说,这是一个很好的方法.招聘与通货膨胀的比率是什么呼吸系统的机械学

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