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.