一项关于无瓣膜套管针在机器人根治性膀胱切除术中对呼吸力学影响的前瞻性、随机临床试验：一项初步研究。

A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy: A Pilot Study.

作者信息

Covotta Marco, Claroni Claudia, Torregiani Giulia, Naccarato Alessia, Tribuzi Susanna, Zinilli Antonio, Forastiere Ester

机构信息

From the *Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy; and †Research Institute on Sustainable Economic Growth of the National Research Council of Italy, Italy.

出版信息

Anesth Analg. 2017 Jun;124(6):1794-1801. doi: 10.1213/ANE.0000000000002027.

DOI:10.1213/ANE.0000000000002027

PMID:28452822

Abstract

BACKGROUND

Prolonged pneumoperitoneum and Trendelenburg positioning for robot-assisted radical cystectomy (RARC) are essential for optimizing visualization of the operative field, although they worsen hemodynamic and respiratory function. Our hypothesis is that the use of a valveless trocar (VT) may improve respiratory mechanics.

METHODS

In this prospective, 2-arm parallel trial, patients ASA II to III undergoing RARC were randomly assigned into 2 groups: in the VT group, the capnoperitoneum was maintained with a VT; in the control group, the capnoperitoneum was maintained with a standard trocar (ST group). Inspiratory plateau pressure (Pplat), static compliance (Cstat), minute volume (MV), tidal volume (Vt), and carbon dioxide (CO2) elimination rate were recorded at these times: 15 minutes after anesthesia induction (T0), 10 minutes (T1) and 60 minutes (T2) after first robot docking, 10 minutes before first undocking (T3), 10 minutes (T4) and 60 minutes (T5) after second docking, 10 minutes before second undocking (T6), and 10 minutes before extubation (T7). The primary end point of the study was the assessment of Pplat mean value from T1 to T6.

RESULTS

A total of 56 patients were evaluated: 28 patients in the VT group and 28 in the ST group. VT group had lower Pplat (means and standard error, VT group 30 [0.66] versus ST group 34 [0.66] cm H2O, with estimated mean difference and 95% confidence interval, -4.1 [-5.9 to -2.2], P < .01), lower MV (means and standard error, VT group 8.2 [0.22] versus ST group 9.8 [0.21] L min, P < .01), lower CO2 elimination rate (means and standard error, VT group 4.2 [0.25] versus ST group 5.4 [0.24] mL kg min, P < .01), lower end-tidal CO2 (ETCO2) (means and standard error, VT group 28.8 [0.48] versus ST group 31.3 [0.46] mm Hg, P < .01), and higher Cstat (means and standard error, VT group 26 [0.9] versus ST group 22.1 [0.9] mL cm H2O, P < .01). Both groups had similar Vt (P = .24).

CONCLUSIONS

During RARC, use of a VT was associated with a significantly lower Pplat and improvement in other respiratory parameters.

摘要

背景

机器人辅助根治性膀胱切除术（RARC）中长时间气腹和头低脚高位对于优化手术视野至关重要，尽管这会恶化血流动力学和呼吸功能。我们的假设是使用无阀套管针（VT）可能会改善呼吸力学。

方法

在这项前瞻性双臂平行试验中，将接受RARC的美国麻醉医师协会（ASA）II至III级患者随机分为两组：在VT组中，使用VT维持气腹；在对照组中，使用标准套管针维持气腹（ST组）。在以下时间记录吸气平台压（Pplat）、静态顺应性（Cstat）、分钟通气量（MV）、潮气量（Vt）和二氧化碳（CO2）清除率：麻醉诱导后15分钟（T0）、首次机器人对接后10分钟（T1）和60分钟（T2）、首次解对接前10分钟（T3）、第二次对接后10分钟（T4）和60分钟（T5）、第二次解对接前10分钟（T6）以及拔管前10分钟（T7）。该研究的主要终点是评估T1至T6期间的Pplat平均值。

结果

共评估了56例患者：VT组28例，ST组28例。VT组的Pplat较低（均值和标准误，VT组为30[0.66]cmH2O，ST组为34[0.66]cmH2O，估计平均差值和95%置信区间为-4.1[-5.9至-2.2]，P<.01），MV较低（均值和标准误，VT组为8.2[0.22]L/min，ST组为9.8[0.21]L/min，P<.01），CO2清除率较低（均值和标准误，VT组为4.2[0.25]mL·kg/min，ST组为5.4[0.24]mL·kg/min），呼气末二氧化碳分压（ETCO2）较低（均值和标准误，VT组为28.8[0.48]mmHg，ST组为31.3[0.46]mmHg，P<.01），Cstat较高（均值和标准误，VT组为26[0.9]mL/cmH2O），ST组为22.1[0.9]mL/cmH2O，P<.01）。两组的Vt相似（P = 0.24）。