| Objective The purpose of this study was to compare the effects of driving pressure-guided individualized PEEP and fixed PEEP（5cm H2O）in constant conventional lung-protective ventilation on respiratory function and common postoperative pulmonary complications in neurosurgery patients.Methods This study is a randomized controlled study.Totally 60 patients who underwent craniotomy in the neurosurgery department of our hospital from December2020 to December 2021,regardless of gender,had elective surgery,ASAⅠ～Ⅲ grade,BMI 18-25 kg/m2,no pulmonary complications before operation,and mechanical ventilation time was 3-5 hours.The enrolled patients were randomly divided into two groups（n=30）by digital random table method:Group P was given fixed PEEP（PEEP=5 cm H2O）,and Group D was given individualized peep（peep titration guided by driving pressure）.PCV-VG ventilation mode was adopted in both groups,with tidal volume（VT）of 7 ml/kg（ideal body weight）,inspiratory-expiratory ratio of 1:2and Fi O2of 60%.The ventilation frequency was adjusted according to the end-expiratory carbon dioxide partial pressure(PETCO2)to keep PETCO2between30-40 mm Hg.After intubation,manual lung reexpansion was performed in both groups,the ventilator was adjusted to manual ventilation mode,and the 30cm H2O airway pressure was maintained for 30 seconds in order to restore the alveolar dilation.After retension,the PEEP of group P was set to 5cm H2O,and the value of peep was determined by PEEP titration guided by driving pressure in group D.The general data（sex,age,height and weight）of the two groups before operation were recorded,and the operation time,infusion volume and urine volume were recorded after operation.At the time points of T1,T2 and T3 record the breathing parameters:airway peak pressure,lung compliance,titration PEEP value of group D,and calculate driving pressure.Serum levels of SP-A and TNF-a of lung injury factors in the two groups were detected before induction（T0）and 30 min after extubation（T4）.The common pulmonary complications such as atelectasis and pneumonia were followed up at T5.Results There was no significant difference in gender,ASA grade,age,weight,height,operation duration,fluid volume and urine volume between the two groups（P>0.05）.The individualized PEEP value guided by driving pressure in group D is6.07±0.74cm H2O,of which the maximum value is 7cm H2O and the minimum value is4cm H2O.From t1 to T3,the peak airway pressure of the two groups gradually increased with time（P<0.05）,and the peak airway pressure of group D was lower than that of group P at T3（P<0.05）.At T1-T3,the driving pressure of patients in both groups gradually increased with time（P<0.05）,and the driving pressure of group D at T1-T3 was lower than that of group P（P<0.05）.The lung compliance of patients in both groups at time T3 was lower than that at time T1（P<0.05）,while that in group D was higher than that in group P（P<0.05）.There was no significant difference in preoperative serum SP-A and TNF-αconcentrations between the two groups（P>0.05）.Intra-group comparison:The concentrations of serum SP-A and TNF-αin the two groups were significantly higher at T4 than at T0（P<0.05）;Group comparison:the concentrations of SP-A and TNF-αin group D at T4 time point were lower than those in group P（P<0.05）.No pneumonia occurred in both groups,and the incidence of atelectasis in group D was 23.33%,which was significantly lower than that in group P（56.67%,P<0.05）.Conclusion For neurosurgical patients,the individualized PEEP value guided by driving pressure is 6.07±0.74 cm H2O,which is higher than the fixed PEEP（PEEP=5cm H2O）value of the control group.Compared with the fixed PEEP,the driving pressure-guided individualized PEEP can increase the lung compliance,reduce the driving pressure,reduce the production of lung injury media,and reduce the incidence of postoperative common pulmonary complications,and has no obvious influence on the circulatory system,so it can be used for clinical guidance of individualized PEEP setting. |
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