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| 驱动压指导PEEP滴定对机器人辅助根治性前列腺切除术老年患者呼吸功能的影响 |
| Effect of drive pressure-guided PEEP titration on lung function in elderly patients undergoing robot-assisted radical prostatectomy |
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| DOI：10.12089/jca.2022.07.002 |
| 中文关键词: 驱动压 呼气末正压 呼吸功能 炎性因子 |
| 英文关键词: Drive pressure Positive end-expiratory pressure Lung function Inflammatory factor |
| 基金项目:山西医科大学第一医院院级基金（YD1608，YJ161709） |
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| 中文摘要: |
目的 观察驱动压（DP）指导呼气末正压（PEEP）滴定对机器人辅助根治性前列腺切除术（RARP）老年患者呼吸功能的影响。
方法 选择2020年9月至2021年9月择期全麻下行RARP的老年患者40例，年龄65～80岁，BMI 19～28 kg/m 2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：DP指导组（D组）和对照组（C组），每组20例。D组：机械通气后，PEEP从4 cmH2O开始，以1 cmH2O增幅逐渐增加，每个PEEP水平维持4 min，计算并记录4 min内最后1次呼吸循环的DP值，寻找DP最低值，此时对应的PEEP为平卧位时的最佳PEEP。屈氏体位且气腹建立后重复上述操作，滴定屈氏体位气腹下的最佳PEEP，直至手术结束。C组：以5 cmH2O的固定PEEP进行机械通气。记录平卧位最佳PEEP设置完成后（C组固定PEEP通气后）4 min （T1）、屈氏体位气腹后滴定的最佳PEEP通气（C组改变体位与建立气腹后）1 h （T2）、2 h （T3）血气分析结果、气道峰压（Ppeak）、气道平台压（Pplat）、肺动态顺应性（Cdyn），并计算肺泡动脉氧分压差（A-aDO2）、氧合指数（OI）、呼吸指数（RI）、死腔/潮气量比值（VD/VT），记录T1、T3、拔管后1 min （T4）、术后2 h （T5）血清白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）浓度。记录术后肺部并发症（PPCs）的发生情况。
结果 与C组比较，D组T1、T2、T3时PaO2、Cdyn、OI明显升高（P＜0.05），A-aDO2、RI明显降低（P＜0.05），T1、T3、T4、T5时血清IL-6、IL-8、TNF-α浓度明显降低（P＜0.05）。两组术中Ppeak、Pplat、PaCO2、VD/VT差异无统计学意义。两组均未发生PPCs。
结论 最小驱动压指导最佳呼气末正压设置能够改善机器人辅助根治性前列腺切除术老年患者术中呼吸功能，提高患者氧合。 |
| 英文摘要: |
Objective To observe the effect of drive pressure (DP)-guided positive end-expiratory pressure (PEEP) titration on pulmonary function and inflammatory factors in elderly patients with robotic-assisted radical prostatectomy (RARP).
Methods Forty elderly patients who were selected from September 2020 to September 2021, undergoing elective general anesthesia for downward RARP surgery, aged 65-80 years, BMI 19-28 kg/m 2, ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups: drive pressure guidance group(group D) and control group(group C), 20 patients in each group. Group D: after mechanical ventilation, PEEP started at 4 cmH2O and gradually increased by 1 cmH2O, and each PEEP level was maintained for 4 minutes. The DP value of the last respiratory cycle within 4 minutes was calculated and recorded until the lowest value of DP appeared when DP corresponded to the optimal PEEP in the recumbent position. The above procedure was repeated after the establishment of the pneumoperitoneum to titrate the optimal PEEP under the pneumoperitoneum until the end of the procedure. Group C: mechanical ventilation was performed with 5 cmH2O of fixed PEEP. After the optimal PEEP setting (after group C had fixed PEEP ventilation) 4 minutes (T1), optimal PEEP ventilation after titration in the pneumoperitoneum position (group C versus after pneumoperitoneum position change) at 1 hour (T2), 2 hours (T3), results of the blood gas analysis were recorded. The airway peak pressure (Ppeak), airway plateau pressure (Pplat), and pulmonary dynamic compliance (Cdyn) at T1, T2, T3 were recorded. Oxygen partial pressure difference in alveolar artery (A-aDO2), oxygenation index (OI), respiratory index (RI), and dead chamber / tidal volume ratio (VD / VT) were also calculated at T1, T2, T3. The concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) at T1, T3, 1 minute after extubation (T4), 2 hours after surgery (T5) were recorded. The incidence of postoperative pulmonary complications (PPCs) was recorded.
Results Compared with group C, PaO2, Cdyn, OI were significantly increased at T1, T2, T3 (P < 0.05), the A-aDO2 and RI were reduced (P < 0.05), IL-6, IL-8, TNF-α were decreased at T1, T3, T4, T5(P < 0.05). There were no significant differences in intraoperative Ppeak, Pplat, PaCO2, and VD / VT. There were no PPCs in both groups.
Conclusion Minimum drive pressure guiding optimal PEEP can improve intraoperative lung function, improve oxygenation, and enhance intraoperative safety and tolerance in elderly patients. |
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