Spinazzola Giorgia, Ferrone Giuliano, Cipriani Flora, Caputo Cosimo Tommaso, Rossi Marco, Conti Giorgio
Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.
Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.
Respir Physiol Neurobiol. 2019 Jan;259:122-128. doi: 10.1016/j.resp.2018.08.012. Epub 2018 Aug 31.
It is unknown which is the best ventilatory approach in patients scheduled for gynecological robotic surgery in Deep Trendelenburg position in terms of respiratory mechanics. 40 patients were enrolled: 20 patients received a standard ventilation and 20 patients received a protective ventilation. Gas exchanges, respiratory mechanics and hemodynamic parameters were recorded. No significant differences were found between the two groups in terms of respiratory mechanics. In both groups, there was a significant reduction of static compliance between Baseline and Extubation Time (p < 0.01), and a significant increase of pulmonary pressure at the same times (p < 0.01). In both groups, a significant reduction of pH (p < 0.01) and a significant increase of PaCO (p < 0.01) were observed between Baseline and Extubation Time. At the Extubation time, PaCO was significantly higher during protective ventilation compared to standard ventilation. In this particular surgical setting, a protective ventilation strategy did not improve the respiratory mechanics compared to the standard ventilation strategy and was ineffective on post-operative gas exchanges.
就呼吸力学而言，对于计划采用深头低仰卧位进行妇科机器人手术的患者，哪种通气方式最佳尚不清楚。招募了40名患者：20名患者接受标准通气，20名患者接受保护性通气。记录气体交换、呼吸力学和血流动力学参数。两组在呼吸力学方面未发现显著差异。两组在基线和拔管时间之间静态顺应性均显著降低（p<0.01），同时肺动脉压显著升高（p<0.01）。两组在基线和拔管时间之间均观察到pH值显著降低（p<0.01）和动脉血二氧化碳分压（PaCO）显著升高（p<0.01）。在拔管时，与标准通气相比，保护性通气期间的PaCO显著更高。在这种特定的手术环境中，与标准通气策略相比，保护性通气策略并未改善呼吸力学，且对术后气体交换无效。
