肺保护性通气策略对降低膀胱癌患者行机器人辅助腹腔镜根治性膀胱切除术后肺部并发症（PPCs）的影响：一项随机、双盲临床试验。

Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial.

机构信息

Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.; Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.

Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.

出版信息

J Clin Anesth. 2021 Aug;71:110156. doi: 10.1016/j.jclinane.2020.110156. Epub 2021 Mar 1.

DOI:10.1016/j.jclinane.2020.110156

PMID:33662902

Abstract

STUDY OBJECTIVE

To evaluate the effects of ventilation with low tidal volume and positive end-expiratory pressure (PEEP) on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical cystectomy (RARC) for bladder cancer.

DESIGN

A prospective randomized double-blinded study.

SETTING

A single center trial in a comprehensive tertiary hospital from January 2017 to January 2019.

PATIENTS

A total of 258 patients undergoing RARC for bladder cancer.

INTERVENTIONS

Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 6 ml/ kg predicated body weight (PBW) + PEEP 7 cmHO] or nonprotective ventilation (control group) (tidal volume 9 ml/ kg PBW without PEEP) during anesthesia.

MEASUREMENTS

The primary outcome was the occurrence of postoperative pulmonary complications (PPCs) during the first 90 days after surgery. The secondary outcomes were extubation time, oxygenation index (OI) after extubation and at postoperative day 1 in blood gas.

MAIN RESULTS

The incidence of PPCs at postoperative day1, 2 and 3 were lower in LPV group [26.8% vs. 47.2%, odds ratio (OR) 0.41, 95% confidence interval (CI), 0.24-0.69, P = 0.0007, 21.3% vs. 43.3%, OR 0.36, 95% CI, 0.20-0.61, P = 0.0002, 14.2% vs. 27.5%, OR0.43, 95%CI, 0.23-0.82, P = 0.0087, respectively], while no differences were observed at day 7 and 28 (3.9% vs. 9.4%, P = 0.0788, 0% vs. 1.6%, P = 0.4980, respectively). No PPCs were observed at postoperative day 90 in both groups. Furthermore, immediately after extubating and at postoperative day 1, OI was significantly higher in LPV group compared with control group [390(337-467) vs. 343(303-420), P = 0.0005, 406.7(73.0) vs. 425.5(74.7), P = 0.0440, respectively]. Patients in LPV group had a significant shorter extubation time after operation compared with control group [38(33-54) vs. 35(25-46), P = 0.0012].

CONCLUSION

LPV combining low tidal volume and PEEP during anesthesia for RARC may decrease the incidence of postoperative pulmonary complications.

摘要

研究目的

评估小潮气量和呼气末正压（PEEP）通气对膀胱癌行机器人辅助腹腔镜根治性膀胱切除术（RARC）患者术后肺部并发症的影响。

设计

前瞻性随机双盲研究。

地点

2017 年 1 月至 2019 年 1 月在一家综合三级医院进行的单中心试验。

患者

共 258 例膀胱癌行 RARC 患者。

干预

患者随机分为肺保护性通气（LPV 组）[潮气量 6ml/kg预测体重（PBW）+PEEP 7cmH2O]或非保护性通气（对照组）（潮气量 9ml/kg PBW 无 PEEP）麻醉期间。

测量

主要结局是术后 90 天内发生的术后肺部并发症（PPCs）。次要结局为拔管时间、拔管后和术后第 1 天血气中的氧合指数（OI）。

主要结果

LPV 组术后第 1、2 和 3 天 PPCs 的发生率较低[26.8%比 47.2%，比值比（OR）0.41，95%置信区间（CI）0.24-0.69，P=0.0007，21.3%比 43.3%，OR0.36，95%CI0.20-0.61，P=0.0002，14.2%比 27.5%，OR0.43，95%CI0.23-0.82，P=0.0087]，而第 7 天和第 28 天无差异[3.9%比 9.4%，P=0.0788，0%比 1.6%，P=0.4980]。两组均未发生术后第 90 天的 PPCs。此外，LPV 组拔管后即刻和术后第 1 天的 OI 明显高于对照组[390（337-467）比 343（303-420），P=0.0005，406.7（73.0）比 425.5（74.7），P=0.0440]。LPV 组患者术后拔管时间明显短于对照组[38（33-54）比 35（25-46），P=0.0012]。