Effects of Incremental PEEP Lung Recruitment Method in Lung Protective Ventilation Strategy on Respiratory Mechanics and Postoperative Pulmonary Complications in Laparoscopic Colorectal Cancer Surgery
10.3969/j.issn.1009-6604.2025.05.003
- VernacularTitle:肺保护通气策略中应用递增PEEP肺复张法对腹腔镜结直肠癌手术呼吸力学及术后肺部并发症的影响
- Author:
Qiping HUANG
1
;
Jingjia YAN
;
Yiqin LIN
Author Information
1. 泉州市第一医院麻醉科,泉州 362000
- Publication Type:Journal Article
- Keywords:
Lung protective ventilation strategy;
Pulmonary recruitment;
Respiratory mechanics;
Colorectal cancer surgery;
Postoperative pulmonary complication
- From:
Chinese Journal of Minimally Invasive Surgery
2025;25(5):268-274
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the effects of applying incremental positive end expiratory pressure(PEEP)lung recruitment method in lung protective ventilation strategy during anesthesia for laparoscopic colorectal cancer surgery on the respiratory mechanics and postoperative pulmonary complications.Methods The patients who underwent laparoscopic colorectal cancer surgery from June to December 2023 were randomly divided into two groups with 30 cases each group:the incremental PEEP lung recruitment combined with lung protective ventilation method group(RM group)and the lung protective ventilation method group(control group,C group).Both groups underwent lung protective ventilation.The RM group underwent the first lung recruitment immediately after the placement of Trendlenburg position,and then the lung recruitment was performed with the incremental PEEP method hourly thereafter.In the C group,no lung recruitment was performed throughout the procedure.The data of respiratory mechanics and oxygenation were recorded at 5 min before tracheal intubation(T0),immediately after tracheal intubation(T1),after the first pulmonary recruitment(after positioning in the C group)(T2),after the second pulmonary recruitment(60 min after positioning in the C group)(T3),after stopping the pneumoperitoneum(T4),and 30 min after extubation(T5),respectively.Postoperative pulmonary complications(PCC)were compared between the two groups.Results In terms of respiratory mechanics:the differences in peak airway pressure(Ppeak),airway plateau pressure(Pplat),driving pressure(△P),and pulmonary dynamic compliance(Cdyn)at the time point of T1 between the two groups were not significant(P＞0.05);the Ppeak,Pplat,and △P at the time points of T2 and T3 in the RM group were smaller than those in the C group(P＜0.05),and the Cdyn was larger than that in the C group(P＜0.05);the Ppeak at the time point of T4 in the RM group was smaller than that in the C group(P＜0.05),while the Pplat,△P,and Cdyn were not significant(P＞0.05).In terms of oxygenation:the differences in arterial partial pressure of oxygen(PaO2)and partial pressure of CO2(PaCO2)at the time point of T0 in the two groups were not significant(P＞0.05);the PaO2 at the time points of T3,T4,and T5 in the RM group was higher than that in the C group(P＜0.05),and the PaCO2 at the time points of T4 and T5 was lower than that in the C group(P＜0.05).In terms of postoperative pulmonary complications,the incidences of pulmonary atelectasis(5 cases vs.12 cases,P=0.045)and PPC(9 cases vs.18 cases,P=0.020)were lower in the RM group than those in the C group,while the difference of incidence of pulmonary infection and pleural effusion between the two groups was not significant(P＞0.05).There was no occurrence of respiratory failure in both groups.Conclusion Application of incremental PEEP lung recruitment in lung protective ventilation strategy can improve lung respiratory mechanics and reduce incidence of postoperative pulmonary complications in patients undergoing laparoscopic colorectal cancer surgery.
