胸电阻抗断层成像引导的个体化呼气末正压对行前列腺癌根治术的老年衰弱患者术后肺部并发症的影响  

Effect of electrical impedance tomography-guided personalized positive end-expiratory pressure on postoperative pulmonary complications in elderly frail patients undergoing robot-assisted prostate cancer radical surgery

作　　者：范美含 马育蕾 任奥林 王敏[1] 朱敏敏[1] FAN Meihan;MA Yulei;REN Aolin;WANG Min;ZHU Minmin(Wuxi Second People′s Hospital Affiliated to Nanjing Medical University,Wuxi,Jiangsu 214400,China)

机构地区：[1]南京医科大学附属无锡市第二人民医院,江苏无锡214400

出　　处：《徐州医科大学学报》2025年第2期140-145,共6页Journal of Xuzhou Medical University

基　　金：江苏省医院协会项目(JSYGY-3-2024-123)。

摘　　要：目的评估胸电阻抗断层成像(EIT)引导的个体化呼气末正压(PEEP)设置对接受机器人辅助前列腺癌根治术的老年衰弱患者术后肺部并发症的影响。方法选取择期行机器人辅助前列腺癌根治术的患者66例,年龄≥65岁,衰弱评分(Fried衰弱指数)≥3分。随机分为2组:EIT引导的个体化PEEP组(I组)和固定PEEP组(P组),每组33例。I组患者根据EIT结果接受个体化PEEP设置,P组患者统一采用5 cmH 2 O(1 cmH 2 O=0.098 kPa)的PEEP设置。预充氧前(T1)、插管后5 min(T2)、气腹后30 min(T3)、1 h后(T4)及拔管后15 min(T5)抽取动脉血,检测动脉血氧分压(PaO_(2))和氧合指数(OI)。记录PEEP滴定后5 min(t1)、30 min(t2)、1.5 h(t3)以及拔管前(t4)的气道峰压、平台压、驱动压和动态顺应性。记录术后拔管时间、住院时间、术后7 d肺部并发症发生情况。结果I组术中气道峰压、平台压及动态顺应性均显著高于P组,驱动压明显低于P组(P<0.05)。I组患者T2—T4时点PaO_(2)和OI均高于P组,差异均有统计学意义(P<0.05),T5时点2组间差异无统计学意义(P>0.05)。2组术后7 d内肺部并发症的发生率及术后住院时间比较差异无统计学意义(P>0.05)。I组患者术后拔管时间比P组短,差异有统计学意义(P<0.05)。结论在老年衰弱患者机器人辅助前列腺癌根治术中,EIT引导的个体化PEEP虽未显著减少术后7 d肺部并发症的发生率,但改善了术中氧合状态和呼吸力学指标。Objective To evaluate the effect of electrical impedance tomography(EIT)-guided personalized positive end-expiratory pressure(PEEP)setting on postoperative pulmonary complications in elderly frail patients undergoing robot-assisted prostate cancer radical surgery.Methods A total of 66 patients aged≥65 years with a frailty score(Fried Frailty Index)≥3 who were scheduled for robot-assisted prostate cancer radical surgery were selected.The patients were randomly divided into two groups(n=33):an EIT-guided personalized PEEP group(group I)and a fixed PEEP group(group P).Patients in group I received personalized PEEP settings based on EIT results,while those in group P were set to a fixed PEEP of 5 cmH 2O(1 cmH 2 O=0.098 kPa).Arterial blood samples were collected before pre-oxygenation(T1),at post-intubation 5 min(T2),at post-pneumoperitoneum 30 min(T3)and 1 h(T4),and at post-extubation 15 min(T5),to measure arterial oxygen partial pressure(PaO_(2))and oxygenation index(OI).Their airway peak pressure,plateau pressure,driving pressure,and dynamic compliance were recorded at post-PEEP titration 5 min(t1),30 min(t2)and 1.5 h(t3),and before extubation(t4).The time to extubation,length of hospitalization stay,and incidence of postoperative pulmonary complications within postoperative seven days were recorded.Results During surgery,group I showed increases in airway peak pressure,plateau pressure,and dynamic compliance and decreased driving pressure,compared with group P(P<0.05).From T2 to T4,increased PaO_(2) and OI were observed in group I,compared with those in group P(P<0.05),while there was no statstical difference between the two groups at T5(P>0.05).There was no statstical difference between the two groups in the incidence of postoperative pulmonary complications or the length of postoperative hospitalization stay(P>0.05).Group I showed shorter time to extubation than group P,with statistical differences(P<0.05).Conclusions In elderly frail patients undergoing robot-assisted prostate cancer radical surgery,EIT-gui

关 键 词：电阻抗断层成像 呼气末正压 术后肺部并发症 衰弱患者 呼气末正压滴定 肺保护性通气 

分 类 号：R614.2[医药卫生—麻醉学]