The effect of positive end-expiratory pressure on the respiratory function in obese patients undergoing laparoscopic radical resection of colon cancer.

doi:10.3877/cma.j.issn.2095-9605.2021.04.006

Abstract

Abstract:

Objective

To compare the effects of different levels of positive end expiratory pressure (PEEP) ventilation on the perioperative respiratory function of obese patients undergoing laparoscopic radical resection of colon cancer.

Methods

A total of 80 obese patients who underwent laparoscopic radical resection of colon cancer at Huizhou Central People's Hospital from January 2020 to May 2021 were randomly divided into two groups: PEEP 10 cmH₂O group (high ventilation group) and PEEP 5 cm H₂O group (hypoventilation group), 40 cases in each group. Record P_ETCO₂, peak airway pressure (P_peak) and airway plateau pressure (P_plat) after intubation, establishment of pneumoperitoneum and PEEP, 2 hours of pneumoperitoneum; record blood gas analysis at different time points, and improve lung ventilation score; record all patients Pulmonary complications occurred within 7 days after operation.

Results

There was no statistically significant difference in operation time, pneumoperitoneum pressure, intraoperative bleeding, and norepinephrine usage in patients in the hyperventilation group and the hypoventilation group (P>0.05); but the different time between the two groups There was no significant difference in the levels of HR, SBP, and DBP at points (P>0.05). The levels of P_peak and P_plat in the high-ventilation group were significantly higher in the pneumoperitoneum and PEEP, and the pneumoperitoneum 2 h level was significantly higher than that in the hypoventilation group (P<0.05) However, there was no statistically significant difference in Acidity (pH), arterial oxygen partial pressure (PaO₂), carbon dioxide partial pressure (PaCO₂) and oxygenation index (OI) levels between the two groups at different time points (P>0.05), and there was no significant difference in the incidence of postoperative lung-related complications between the two groups (P>0.05).

Conclusions

High PEEP ventilation in obese patients undergoing laparoscopic radical colon cancer surgery can improve the level of perioperative lung ventilation, but it fails to improve the patient’s respiratory function and reduce the incidence of postoperative lung-related complications.

Key words: Horizontal positive end expiratory pressure, Obesity, Laparoscopy, Colon cancer, Respiratory function

Xiaoxu Yin, Jing Li. The effect of positive end-expiratory pressure on the respiratory function in obese patients undergoing laparoscopic radical resection of colon cancer.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(04): 250-254.

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References 14

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组别	n	性别		年龄（岁）	BMI （kg/m²）	ASA分级（Ⅰ/Ⅱ）	基础疾病		手术部位（左半/右半）
组别	n	男	女	年龄（岁）	BMI （kg/m²）	ASA分级（Ⅰ/Ⅱ）	高血压	2型糖尿病	手术部位（左半/右半）
高通气组	40	25	15	56.2±4.3	32.4±1.3	14/26	28	16	31/9
低通气组	40	21	19	57.5±4.8	32.2±1.5	18/22	24	21	28/12
统计值		0.818		1.276	0.637	0.833	0.879	1.257	0.518
P值		0.366		0.206	0.526	0.361	0.348	0.262	0.446

组别	n	性别		年龄（岁）	BMI （kg/m²）	ASA分级（Ⅰ/Ⅱ）	基础疾病		手术部位（左半/右半）
组别	n	男	女	年龄（岁）	BMI （kg/m²）	ASA分级（Ⅰ/Ⅱ）	高血压	2型糖尿病	手术部位（左半/右半）
高通气组	40	25	15	56.2±4.3	32.4±1.3	14/26	28	16	31/9
低通气组	40	21	19	57.5±4.8	32.2±1.5	18/22	24	21	28/12
统计值		0.818		1.276	0.637	0.833	0.879	1.257	0.518
P值		0.366		0.206	0.526	0.361	0.348	0.262	0.446

组别	n	手术时间（min）	气腹压力（mmHg）	术中出血（mL）	去甲肾上腺素用量（μg）
高通气组	40	186.3±14.7	11.9±0.5	30.6±8.1	925±114
低通气组	40	189.6±12.6	11.7±0.4	29.4±7.2	894±126
统计值		1.078	1.975	0.486	1.154
P值		0.284	0.052	0.700	0.446

组别	n	手术时间（min）	气腹压力（mmHg）	术中出血（mL）	去甲肾上腺素用量（μg）
高通气组	40	186.3±14.7	11.9±0.5	30.6±8.1	925±114
低通气组	40	189.6±12.6	11.7±0.4	29.4±7.2	894±126
统计值		1.078	1.975	0.486	1.154
P值		0.284	0.052	0.700	0.446

指标	组别	麻醉诱导前	插管后	气腹及PEEP建立	气腹2 h	手术结束时
HR（次/min）	高通气组（n=40）	82±6	71±5^*	66±6^*	64±5^*	73±6^*
HR（次/min）	低通气组（n=40）	80±7	70±4^*	67±8^*	63±4^*	74±5^*
SBP（mmHg）	高通气组（n=40）	141±18	132±17^*	127±14^*	123±16^*	138±17
SBP（mmHg）	低通气组（n=40）	139±21	131±16^*	129±15^*	122±15^*	136±16
DBP（mmHg）	高通气组（n=40）	85±9	81±7^*	76±7^*	74±9^*	82±11
DBP（mmHg）	低通气组（n=40）	84±11	80±8^*	75±8^*	73±10^*	81±13

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