个体化呼气末正压通气指导下的驱动压通气对机器人辅助腹腔镜前列腺根治术患者氧合的影响：一项随机对照临床试验。
Effects of driving pressure-guided ventilation by individualized positive end-expiratory pressure on oxygenation undergoing robot-assisted laparoscopic radical prostatectomy: a randomized controlled clinical trial.
机构信息
Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, No 58, Zhongshan 2 Road, Guangzhou, 510080, China.
Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
出版信息
J Anesth. 2023 Dec;37(6):896-904. doi: 10.1007/s00540-023-03251-y. Epub 2023 Sep 14.
PURPOSE
Patients with robot-assisted laparoscopic radical prostatectomy (RALP) need to be placed in Trendelenburg position, which results in cranial displacement of the diaphragm and decreases functional residual capacity and pulmonary compliance. Positive end-expiratory pressure (PEEP) can increase ventilation in the dorsal area, reduce the occurrence of atelectasis and improve oxygenation. However, due to individual differences, inappropriate PEEP will cause lung injury and even hemodynamic instability. Therefore, our study is to evaluate the efficacy of individualized PEEP in RALP.
METHODS
We randomly recruited 48 patients and divided them into driving pressure-guided individualized PEEP group (P group, individualized PEEP) or traditional lung-protective ventilation strategy group (C group, tidal volume 8 mL/kg combined with PEEP of 5cmHO). The primary outcome was the PaO/FiO before extubation. The secondary outcomes included individualized PEEP values in the P group, the results of arterial blood gas analysis, respiratory mechanics parameters and vital sign parameters. Other measurements included intraoperative vasoactive drug dosage, length of stay, postoperative SpO, leukocyte count, temperature, serum inflammatory factors and soluble receptor for advanced glycation end products (sRAGE).
RESULTS
Individualized PEEP improved the PaO/FiO before extubation (P = 0.034) and decreased driving pressure (P = 0.011). The PEEP valued in the P group was 14 [10-14] cmHO. The lung compliance of the P group was significantly higher than that in the C group (P = 0.013). There was no significant difference in other measurements.
CONCLUSIONS
Individualized PEEP could improve PaO/FiO in patients who underwent RALP and do not increase the dosage of intraoperative vasoactive drug and the release of inflammatory factors.
TRIAL REGISTRATION
www.chictr.org.cn (registration no. ChiCTR2100047271).
目的
机器人辅助腹腔镜前列腺根治术（RALP）的患者需要采用头高脚低位，这会导致膈肌上抬，降低功能残气量和肺顺应性。呼气末正压（PEEP）可以增加背部区域的通气，减少肺不张的发生，改善氧合。然而，由于个体差异，不合适的 PEEP 会导致肺损伤，甚至血流动力学不稳定。因此，我们的研究旨在评估 RALP 中个体化 PEEP 的疗效。
方法
我们随机招募了 48 名患者，并将其分为驱动压指导的个体化 PEEP 组（P 组，个体化 PEEP）或传统肺保护性通气策略组（C 组，潮气量 8 mL/kg 并加用 5cmH₂O 的 PEEP）。主要结局是拔管前的 PaO/FiO₂。次要结局包括 P 组中的个体化 PEEP 值、动脉血气分析结果、呼吸力学参数和生命体征参数。其他测量包括术中血管活性药物剂量、住院时间、术后 SpO₂、白细胞计数、体温、血清炎症因子和可溶性晚期糖基化终产物受体（sRAGE）。
结果
个体化 PEEP 可改善拔管前的 PaO/FiO₂（P=0.034）和降低驱动压（P=0.011）。P 组的 PEEP 值为 14[10-14]cmH₂O。P 组的肺顺应性明显高于 C 组（P=0.013）。其他测量无显著差异。
结论
个体化 PEEP 可改善 RALP 患者的 PaO/FiO₂，且不会增加术中血管活性药物剂量和炎症因子释放。
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