Jung Kangha, Kim Sojin, Kim Byung Jun, Park MiHye
Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, School of Medicine, Cha University, Pocheon-si 10414, Korea.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea.
J Clin Med. 2021 Aug 30;10(17):3921. doi: 10.3390/jcm10173921.
We evaluated the pulmonary effects of two ventilator-driven alveolar recruitment maneuver (ARM) methods during laparoscopic surgery.
Sixty-four patients undergoing robotic prostatectomy were randomized into two groups: incrementally increasing positive end-expiratory pressure in a stepwise manner (PEEP group) versus tidal volume (V group). We performed each ARM after induction of anesthesia in the supine position (T1), after pneumoperitoneum in the Trendelenburg position (T2), and after peritoneum desufflation in the supine position (T3). The primary outcome was change in end-expiratory lung impedance (EELI) before and 5 min after ARM at T3, measured by electrical impedance tomography.
The PEEP group showed significantly higher increasing EELI 5 min after ARM than the V group at T1 and T3 (median [IQR] 460 [180,800] vs. 200 [80,315], = 0.002 and 280 [170,420] vs. 95 [55,175], = 0.004, respectively; PEEP group vs. V group). The PEEP group showed significantly higher lung compliance and lower driving pressure at T1 and T3. However, there was no significant difference in EELI change, lung compliance, or driving pressure after ARM at T2.
The ventilator-driven ARM by the increasing PEEP method led to greater improvements in lung compliance at the end of laparoscopic surgery than the increasing V method.
我们评估了两种呼吸机驱动的肺泡复张手法（ARM）在腹腔镜手术期间对肺部的影响。
64例行机器人前列腺切除术的患者被随机分为两组：逐步递增呼气末正压组（PEEP组）和潮气量组（V组）。我们在仰卧位麻醉诱导后（T1）、头低脚高位气腹后（T2）以及仰卧位气腹解除后（T3）分别进行每种ARM。主要结局是通过电阻抗断层扫描测量的T3时ARM前和后5分钟呼气末肺阻抗（EELI）的变化。
在T1和T3时，PEEP组在ARM后5分钟的EELI增加幅度显著高于V组（中位数[四分位间距]分别为460[180,800]对200[80,315]，P = 0.002；280[170,420]对95[55,175]，P = 0.004；PEEP组对V组）。在T1和T3时，PEEP组的肺顺应性显著更高，驱动压力更低。然而，在T2时ARM后EELI变化、肺顺应性或驱动压力方面无显著差异。
与增加潮气量方法相比，通过增加PEEP方法进行的呼吸机驱动ARM在腹腔镜手术结束时能使肺顺应性得到更大改善。
