Yuce Yucel, Erkal Kutlu Hakan, Goktas Cemal, Eryildirim Bilal, Sarica Kemal
Dr. Lutfi Kirdar Training and Research Hospital, Anaesthesiology and Reanimation Department, Kartal, Istanbul.
Arch Ital Urol Androl. 2017 Mar 31;89(1):65-70. doi: 10.4081/aiua.2017.1.65.
The effects of surgical technique on respiratory mechanics, arterial oxygenation and hemodynamics in radical prostatectomy operation were investigated.
The study was planned on ASA II-III, 40-65 years old, fourty patients scheduled for radical prostatectomy under general anesthesia. They were divided into two groups: perineal and suprapubic (Group P, n = 20; Group S, n = 20). Heart rate, mean arterial blood pressure, arterial oxygen saturation (SpO2), partial pressure of end-tidal carbon dioxide (PEtCO2), Peak inspiratory pressure (PIP), plato pressure (Pplato), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2) values were evaluated at 10 minutes after induction. After the position applied for surgery in the 30.60 and 90th minutes, the Alveolar-arterial oxygen pressure gradient (P(A-a) O2), the ratio of physiologic dead space over tidal volume (VD/VT), arterial to end tidal CO2 gradient (P(a-et) CO2), static compliance (CS), dynamic compliance (CD) were assessed.
In the assessment of groups, there were not statistical differences about mean blood pressure, heart rate, SpO2, PetCO2, PaO2, plateau pressure, and P (A-a) values (p > 0.05). Peak inspiratory pressure was higher in Group P. Peak inspiratory pressure and plateau pressure increased with CO2 insufflation in Group P. PaCO2 and P(a-et) CO2 were higher statistically significantly in Group 0. There was no difference in terms of the PetCO2 values. VD/VT ratios were statistically significantly lower in the Group P.
Suprapubic surgery was shown to improve oxygenation and respiratory mechanics without causing any hemodynamic side effect in radical prostatectomy operation.
研究手术技术对根治性前列腺切除术患者呼吸力学、动脉氧合和血流动力学的影响。
本研究纳入40 - 65岁、ASA II - III级、计划在全身麻醉下进行根治性前列腺切除术的40例患者。他们被分为两组：会阴组和耻骨上组（P组，n = 20；S组，n = 20）。诱导后10分钟评估心率、平均动脉血压、动脉血氧饱和度（SpO2）、呼气末二氧化碳分压（PEtCO2）、吸气峰压（PIP）、平台压（Pplato）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）值。在手术体位摆放后第30、60和90分钟，评估肺泡 - 动脉氧分压差（P(A-a)O2）、生理死腔与潮气量之比（VD/VT）、动脉血与呼气末二氧化碳分压差（P(a-et)CO2）、静态顺应性（CS）、动态顺应性（CD）。
在两组评估中，平均血压、心率、SpO2、PetCO2、PaO2、平台压和P(A-a)值无统计学差异（p > 0.05）。P组吸气峰压较高。P组吸气峰压和平台压随二氧化碳气腹增加。0组PaCO2和P(a-et)CO2在统计学上显著更高。PetCO2值无差异。P组VD/VT比值在统计学上显著更低。
在根治性前列腺切除术中，耻骨上手术显示可改善氧合和呼吸力学，且不引起任何血流动力学副作用。
