摘要
目的评价驱动压导向个体化呼吸末正压(PEEP)通气对机器人辅助前列腺癌根治术(RALP)老年患者脑血流动力学和局部脑氧饱和度(rSO_(2))的影响。方法择期全麻RALP老年患者80例,年龄65~80岁,体质量指数19~28 kg/m^(2),ASA分级Ⅰ-Ⅲ级。采用随机数字表法分为传统肺保护性通气组(A组,n=40)和驱动压导向个体化PEEP通气组(B组,n=40)。A组Trendelenburg位调整完成后10 min予以固定5 cmH_(2)O PEEP进行小潮气量肺保护通气;B组则在气腹体位建立、平卧位后分别进行PEEP滴定。两组均以上述PEEP通气至拔除气管导管。分别于麻醉诱导前即刻(T_(0))、气管插管后5 min(T_(1))、CO_(2)气腹建立后5 min(T_(2))、气腹⁃Trendelenburg位后5 min(T_(3))、PEEP滴定后5 min(T_(4),对应A组加用PEEP通气后10 min)、呼气末正压滴定后60 min(T_(5))、手术结束后5 min(T_(6))记录平均动脉压(MAP),测量大脑中动脉收缩期血流速度(VS)、舒张期血流速度(VD)及平均血流速度(VM)、搏动指数(PI),计算脑灌注压(CPP);记录T_(1⁃6)肺顺应性(Cdyn)、动脉氧分压(PaO_(2))及动脉二氧化碳分压(PaCO_(2));记录T_(0⁃6)rSO_(2);记录术后1周肺部并发症。结果与A组比较,B组T_(5⁃6)时Cdyn和PaO_(2)升高,术后肺部并发症(PPCs)发生率明显降低(P<0.05),两组之间MAP、CPP、rSO_(2)差异无统计学意义(P>0.05)。结论驱动压导向个体化PEEP应用于RALP中是安全有效的,可以改善术中肺氧合功能和顺应性,降低术后肺部并发症发生率,并且不会对脑血流动力学和rSO_(2)产生明显影响。
Objective To evaluate the effect of driving pressure⁃guided individualized positive end⁃expira⁃tory pressure(PEEP)on intracranial pressure and regional cerebral oxygen saturation(rSO_(2))in elderly patients undergoing robot⁃assisted laparoscopic radical prostatectomy(RALP).Methods Eighty patients with elective general anesthesia for RALP,aged 65 to 80 years,with BMI 19 to 28 kg/m^(2),and ASA classification Ⅰ toⅢ,were selected.A randomized number table method was used to divide the patients into conventional pulmonary protective ventilation(group A)and individualized PEEP with driving pressure guidance(group B).In group A,5 cmH_(2)O PEEP was fixed 10 minutes after the Trendelenburg position was adjusted for low tidal volume lung protection venti⁃lation;In group B,PEEP titration was performed after the establishment of pneumoperitoneum position and supine position.The air was ventilated with the PEEP until the tracheal tube was removed.The mean arterial pressure(MAP)was recorded immediately before anesthesia induction(T_(0)),5 minutes after endotracheal intubation(T_(1)),5 minutes after CO_(2)pneumoperitoneum establishment(T_(2)),5 minutes after pneumoperitoneum Trendelenburg position(T_(3)),5 minutes after positive end⁃expiratory pressure titration(T_(4),10 minutes after PEEP ventilation in group A),60 minutes after positive end⁃expiratory pressure titration(T_(5)),and 5 minutes after surgery(T_(6)).Systolic blood flow velocity(VS),blood flow velocity diastolic period(VD),mean blood flow velocity(VM),and pulsation index(PI)of the middle cerebral artery were measured,and cerebral perfusion pressure(CPP)were calculated;T_(1⁃6) lung compliance(Cdyn),arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))and T_(0⁃6) rSO_(2)were recorded;Pulmonary complications were recorded one week after operation.Results Compared with group A,group B had higher Cdyn and PaO_(2)at T_(5⁃6) and a significantly lower incidence of pulmonary complications(P<0.05),with n
作者
辛超
高巨
葛亚丽
吴可汀
陈小萍
XIN Chao;GAO Ju;GE Yali;WU Keting;CHEN Xiaoping(Department of Anesthesiology,Clinical Medical College of Yangzhou University,Northern Jiangsu People′s Hospital,Yangzhou 225000,China)
出处
《实用医学杂志》
CAS
北大核心
2023年第12期1524-1528,1535,共6页
The Journal of Practical Medicine
基金
江苏省青年医学重点人才项目(编号:QNRC2016337)。
关键词
驱动压
呼气末正压
机器人辅助前列腺癌根治术
脑血流动力学
脑氧饱和度
老年人
driving pressure
positive end⁃expiratory pressure
robot⁃assisted laparoscopic radical prostatectomy
cerebral hemodynamics
regional cerebral oxygen saturation
elderly patients
