The Application Research Of Individualized Positive End-expiratory Pressure In Patients Undergoing Thoracoscopic Lobectomy

Objective:To investigate the individual application level of end-expiratory positive pressure in patients undergoing thoracoscopic lobectomy and its effect on respiratory mechanics and pulmonary oxygenation.Methods:Patients who underwent elective thoracoscopic lobectomy were randomly divided into group A?n=30?and group B?n=30?.Both groups were accepted alveolar recruitment maneuver after one-lung ventilation,then group A applied the optimal PEEP followed by PEEP decrement titration,while group B directly applied 5cmH2O PEEP until the end of one-lung ventilation.Related indexes of respiratory mechanics,pulmonary oxygenation and hemodynamics were recorded after entry?T₀?,10 min after intubation?T₁?,pre-ARM?T₂?,20 min after the optimal PEEP applied?T₃?,at the end of OLV?T₄?,and at the end of surgery?T₅?.The postoperative recovery was also followed up.Results:The optimal PEEP obtained by PEEP decrement titration based on pulmonary compliance in group A was?8.8±2.4?cmH₂O,which was positively correlated with BMI?r=0.756,P<0.01?and FVC?r=0.406,P<0.05?.Group A had a higher C_PATAT than group B at T₃,T₄,T₅?P<0.05?and a lower?35?P than group B at T₃ and T₄?P<0.05?.At T₄,PaO₂ in group A was significantly higher than that in group B?P<0.05?.At T₃,SVV in group A was higher than that in group B?P<0.05?.There was no difference between the two groups in the incidence of postoperative pulmonary complications in 3 days and the length of stay?P>0.05?.Conclusion:The optimal PEEP obtained by PEEP decrement titration based on pulmonary compliance after alveolar recruitment maneuver was?8.8±2.4?cmH₂O.Individualized application of PEEP could increase lung compliance,reduce driving pressure,and improve pulmonary oxygenation in patients during one lung ventilation,with little effect on hemodynamics and postoperative recovery.