| Study BackgroundLaparoscopic surgery,which reduces surgical trauma and promotes patients’postoperative recovery relative to traditional open surgery,has an important role in enhanced recovery after surgery,however pneumoperitoneum and Trendelenburg body position are often required in laparoscopic surgery,and pneumoperitoneum and a special body position promote diaphragmatic lifting,resulting in higher intrathoracic pressure,promoting the formation of atelectasis and aggravating lung injury in patients.Retrospective studies have found that high intraoperative driving pressure in surgical patients with normal lungs is associated with a higher incidence of postoperative pulmonary complications.However,the applicability of individualized positive end expiratory pressure（PEEP）guided by driving pressure in laparoscopic surgery and whether it can reduce lung injury during the operation and benefit patients have not been confirmed by prospective randomized controlled trial.Therefore,in our study,we intended to perform an individualized PEEP guided by the driving pressure in patients undergoing laparoscopic surgery,and to observe the effects of this PEEP setting on lung injury.PurposeTo explore effects of individualized PEEP guided by driving pressure on lung injury in patients undergoing laparoscopic surgery.MethodsThis study was a randomized controlled clinical trial,in which patients aged45-65 years,American Society of anesthesiologists（ASA）grade I-II who underwent elective laparoscopic radical colorectal cancer surgery in our hospital from January2020 to October 2020,had an operation time>3 hours,a body mass index（BMI）of18.5-24.0 kg/m2,and no history of underlying lung disease were enrolled,and 40patients were finally included.They were randomly divided into 2 groups（n=20）.Group C:conventional PEEP group（control group,all patients received PEEP with a constant level of 5 cm H2O during pneumoperitoneum）;group D:driving pressure guided individualized PEEP group（experimental group,during the pneumoperitoneum of each patient,received the PEEP that lowest the driving pressure during the titration process）.Both groups were received lung recruitment once after the establishment of the pneumoperitonic-Trendelenburg body position,and the control group were received PEEP of 5 cm H2O,while the experimental group was titrated at 4,6,8,10 and 12cm H2O incrematically,12 respiration cycles were performed each time,and the driving pressure of each PEEP value in the last respiration cycle was recorded.After titration,the PEEP with the lowest driving pressure was selected and continued until the end of surgery.Tidal volume（TV）,peak airway pressure（Ppeak）,airway platform pressure（Pplat）and PEEP were recorded immediately after the establishment of pneumoperitonic-Trendelenburg position（T0）,30 minutes after administration of PEEP（T1）and the end of surgery（T2）;and then dynamic lung compliance（Cdyn）was calculated.The arterial oxygen partial pressures（Pa O2）of patients at T0,T1,T2and 24 hours after surgery（T3）were recorded,and the oxygenation index（OI）was calculated;peripheral venous blood was collected at T0,T2 and T3,and the concentrations of interleukin-6（IL-6）as well as clara cell protein 16（CC16）were determined by ELISA.Results1.There were no significant differences between the two groups regarding the general preoperative data and the intra-operative procedure related conditions（P>0.05）.2.The comparison of dynamic lung compliance at different time points between the two groupsIntro-group comparison:compared with T0,Cdyn was increased significantly at T1、T2 in both groups（P<0.05）.Inter-group comparison:compared with group C,Cdyn was increased significantly from T1 to T2（P<0.05）.3.The comparison of lung oxygenation function at different time points between the two groupsIntro-group comparison:compared with T0,OI in both groups increased significantly at T1 and showed a decreasing trend from T1 to T3（P<0.05）.Inter-group comparison:compared with group C,OI in group D increased significantly from T1 to T3（P<0.05）.4.The comparison of serum IL-6 concentrations at different time points between the two groupsIntro-group comparison:compared with T0,the serum IL-6 concentration of patients in both groups increased significantly from T2 to T3（P<0.05）.Inter-group comparison:compared with group C,the serum IL-6 concentration of group D increased significantly from T2 to T3（P<0.05）.5.The comparison of serum CC16 concentrations at different time points between the two groupsIntro-group comparison:compared with T0,the serum CC16 concentration in both groups increased significantly at T2 and decreased at T3（P<0.05）.Inter-group comparison:compared with group C,the serum CC16 concentration of group D decreased significantly at T2（P<0.05）;at T3,the serum CC16concentration of the two groups had no significant difference（P>0.05）.6.The result of PEEP titration in the test group was 10（8-10）cm H2O（P=0.018）.ConclusionFor laparoscopic surgery,individualized PEEP guided by driving pressure,compared with the conventional PEEP of 5 cm H2O level,individualized PEEP is able to improve the dynamic lung compliance in patients,improve lung oxygenation function,reduce inflammatory reactions,alleviate patients’intraoperative lung injury. |
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