Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, 310014 Hangzhou, Zhejiang, China.
Department of Operating Room, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, 310014 Hangzhou, Zhejiang, China.
Arch Esp Urol. 2023 Jul;76(5):319-327. doi: 10.56434/j.arch.esp.urol.20237605.37.
This study aimed to explore the effect of individualized positive end-expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in elderly patients with prostate cancer undergoing general anesthesia in Trendelenburg position (low-head and high-foot position at about 45 when patients were in supine position).
The clinical data of 96 elderly patients undergoing Leonardo's robotic-assisted laparoscopic radical prostatectomy in Zhejiang Provincial People's Hospital from October 2021, to April 2023, were selected for retrospective analysis. Sixteen patients who had interrupted follow-up or did not meet the inclusion criteria were excluded, and 80 patients were finally included. The patients were divided into group A (lung-protective strategy using routine PEEP value, n = 40) and group B (lung-protective strategy using individualized PEEP value, n = 40) on the basis of different inversion methods. The PEEP value of group A was set as 5 cmHO, whereas that of group B was determined under the guidance of static lung compliance. The incidences of PPCs on postoperative day 7 were statistically analyzed, and the serum levels of interleukin (IL) 6 (IL-6) and IL-8 in both groups were measured by enzyme-linked immunoadsordent assay (ELISA).
The incidence of pulmonary complications was obviously lower in group B than in group A on postoperative day 7 ( < 0.001). Group B had lower levels of serum IL-6 and IL-8 at the end of surgery (T1) and 12 h after surgery (T2, < 0.001); Higher oxygenation index values 10 min after successful titration of individualized PEEP (A3), 1 h after individualized PEEP ventilation (A4), 2 h after individualized PEEP ventilation (A5), 10 min after recovery of supine position (A6), and 30 min after tracheal extubation (A7); And lower hospitalization time (all < 0.001) than group A.
Individualized PEEP for elderly patients with prostate cancer undergoing general anesthesia in Trendelenburg position effectively relieves the release of inflammatory factors, reduces the occurrence of PPCs, and shortens hospitalization time. Thus, it is an effective protection strategy and has certain clinical value.
本研究旨在探讨在全身麻醉下接受达芬奇机器人辅助腹腔镜前列腺根治术的老年前列腺癌患者采取特伦德伦堡位（仰卧位时头高脚低位约 45°）时，采用个体化呼气末正压（PEEP）对术后肺部并发症（PPCs）的影响。
选取 2021 年 10 月至 2023 年 4 月在浙江省人民医院接受达芬奇机器人辅助腹腔镜根治性前列腺切除术的 96 例老年患者的临床资料进行回顾性分析。排除 16 例失访或不符合纳入标准的患者，最终纳入 80 例患者。根据不同的反转方法，将患者分为 A 组（常规 PEEP 值肺保护策略，n=40）和 B 组（个体化 PEEP 值肺保护策略，n=40）。A 组的 PEEP 值设定为 5cmH2O，B 组则在静态肺顺应性的指导下确定。统计两组术后第 7 天 PPCs 的发生率，并采用酶联免疫吸附试验（ELISA）检测两组患者的血清白细胞介素（IL）6（IL-6）和 IL-8 水平。
术后第 7 天，B 组的肺部并发症发生率明显低于 A 组（<0.001）。B 组患者在手术结束时（T1）和术后 12 小时（T2）血清 IL-6 和 IL-8 水平均较低（<0.001）；在个体化 PEEP 成功滴定后 10 分钟（A3）、个体化 PEEP 通气后 1 小时（A4）、个体化 PEEP 通气后 2 小时（A5）、恢复仰卧位后 10 分钟（A6）和气管拔管后 30 分钟（A7）的氧合指数值较高；且住院时间较短（均<0.001）。
对接受全身麻醉特伦德伦堡位的老年前列腺癌患者采用个体化 PEEP，可有效缓解炎症因子的释放，降低 PPCs 的发生，缩短住院时间，是一种有效的保护策略，具有一定的临床应用价值。
