EIT指导个体化PEEP设定对机器人辅助前列腺癌根治术老年患者低氧血症发生率的影响  

Effect of EIT-guided individualized PEEP setting on the incidence of hypoxemia in elderly patients undergoing robot-assisted radical prostatectomy

作　　者：潘丽丽 高玲玲 杨礼 潘丛侠 殷曰昊 朱赟 张军 Pan Lili;Gao Lingling;Yang Li;Pan Congxia;Yin Yuehao;Zhu Yun;Zhang Jun(Department of Anesthesiology,Fudan University Shanghai Cancer Center Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院麻醉科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华医学杂志》2022年第47期3727-3733,共7页National Medical Journal of China

基　　金：上海市科委医学创新项目(20Y11906200)。

摘　　要：目的探讨胸部电阻抗断层成像(EIT)指导个体化呼气末正压(PEEP)设定对机器人辅助前列腺癌根治术老年患者在麻醉后监护室(PACU)内低氧血症发生率的影响。方法选取2020年9月至2021年10月复旦大学附属肿瘤医院择期全身麻醉下行机器人辅助前列腺癌根治术老年患者60例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,采用最小随机化分组方法将纳入受试者分为两组:EIT-PEEP组(EP组,n=30)和固定PEEP组(FP组,n=30)。在完成气管插管、气腹-屈式体位建立后,EP组用EIT指导个体化PEEP设定,FP组PEEP设置为5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)至术毕。术中机械通气采用压力调节容量控制通气模式。记录两组患者在PEEP设置后5 min(T_(1))、30 min(T_(2))、60 min(T_(3))和气管导管拔除后(T_(4))时的驱动压、肺动态顺应性(Cdyn)、氧合指数(PaO_(2)/FiO_(2))和血流动力学等参数。主要研究终点为患者拔管后在PACU内低氧血症的发生率。结果EP组患者拔管后低氧血症发生率为3.3%(1/30),低于FP组的26.7%(8/30)(P=0.030);两组患者驱动压在T_(2)[(13.1±2.4)比(14.9±2.9)cmH_(2)O,P=0.012]、T_(3)[(12.7±2.4)比(15.6±2.8)cmH_(2)O,P<0.001]时差异均有统计学意义;与FP组相比,EP组的Cdyn在T_(2)[(38.4±7.2)比(31.9±5.2)ml/cmH_(2)O,P=0.006]、T_(3)[(37.5±9.0)比(30.4±5.9)ml/cmH_(2)O,P=0.001]时改善;EP组的PaO_(2)/FiO_(2)在T_(1)[(465.7±84.5)比(383.5±58.0)mmHg,1 mmHg=0.133 kPa,P<0.001]、T_(2)[(504.7±105.8)比(418.9±73.7)mmHg,P=0.001]、T_(3)[(520.7±92.2)比(423.2±90.7)mmHg,P<0.001]、T_(4)[(368.7±42.0)比(339.5±54.9)mmHg,P=0.024]时升高。结论EIT指导的个体化PEEP设定可降低机器人辅助前列腺癌根治术老年患者在PACU内低氧血症的发生率。Objective To investigate the effect of individualized positive end expiratory pressure(PEEP)setting guided by chest electrical impedance tomography(EIT)on the incidence of hypoxemia in elderly patients undergoing robot-assisted radical prostatectomy in the post anesthesia care unit(PACU).Methods From September 2020 to October 2021,sixty elderly patients,with the American Association of Anesthesiologists(ASA)of GradeⅠtoⅢ,who underwent selective robot-assisted radical prostatectomy under general anesthesia in the Cancer Hospital Affiliated to Fudan University were selected.The participants were divided into two groups by the minimum randomized grouping method:EIT-PEEP group(EP group,n=30)and fixed PEEP group(FP group,n=30).After completion of tracheal intubation and establishment of pneumoperitoneum flexion posture,the individualized PEEP setting was guided by EIT in EP group,and the PEEP setting in FP group was 5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)to the end of operation.During the operation,the ventilation mode of pressure regulation volume control was adopted.The driving pressure,dynamic lung compliance(Cdyn),oxygenation index and hemodynamics were recorded at 5 min(T_(1)),30 min(T_(2)),60 min(T_(3))after PEEP setting and at the time of tracheal catheter removal(T_(4))in both groups.The primary end point was the incidence of hypoxemia in PACU after extubation.Results The incidence of hypoxemia after extubation was 3.3%(1/30)in EP group and 26.7%(8/30)in FP group(P=0.030).The difference of driving pressure between the two groups at T_(2)[(13.1±2.4)cmH_(2)O vs(14.9±2.9)cmH_(2)O,P=0.012],T_(3)[(12.7±2.4)cmH_(2)O vs(15.6±2.8)cmH_(2)O,P<0.001]was statistically significant.In EP group,Cdyn was improved at T_(2)[(38.4±7.2)ml/cmH_(2)O vs(31.9±5.2)ml/cmH_(2)O,P=0.006]and T_(3)[(37.5±9.0)ml/cmH_(2)O vs(30.4±5.9)ml/cmH_(2)O,P=0.001].In EP group,PaO_(2)/FiO_(2)increased at T_(1)[(465.7±84.5)mmHg vs(383.5±58.0)mmHg,1 mmHg=0.133 kPa,P<0.001],T_(2)[(504.7±105.8)mmHg vs(418.9±73.7)mmHg,P=0.001],T_(3)[(520.7±92.2)mmH

关 键 词：低氧血症 电阻抗断层成像 呼气末正压 机器人辅助前列腺癌根治术 

分 类 号：R737.25[医药卫生—肿瘤]