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摘要译文(供参考)

呼气末正压对机器人辅助腹腔镜前列腺根治术患者肺顺应性和肺部并发症的影响：一项随机对照试验

背景：

观察不同呼气末正压通气策略对机器人辅助腹腔镜前列腺手术患者肺部顺应性和并发症的影响。

方法：

共120名美国麻醉医师协会身体状况I级或II级患者接受了择期机器人辅助腹腔镜前列腺切除术。

我们将患者随机分为三组，每组40名患者：PEEP0、PEEP5或PEEP10。

麻醉医师在术中使用容量控制通气和术中深度肌肉松弛策略。

在6个时间点记录呼吸力学指标：麻醉诱导后10分钟、气腹建立后立即、30分钟、60分钟、90分钟和气腹结束时。

麻醉诱导后10分钟、气腹后60分钟和气管拔管后进行动脉血气分析和氧合指数计算。

还记录了术后肺部并发症。

结果：

气腹后，峰值吸气压力（Ppeak）、平台压力（Pplat）、平均压力（Pmean）、驱动压力（ΔP）和气道阻力（Raw）显著增加，肺顺应性（Crs）下降，并在气腹期间持续存在。

在气腹建立后即刻、30分钟、60分钟和90分钟之间，10cmH2OPEEP组的肺顺应性高于5cmH2OPEEP（P<0.05）和0cmH2OPEEP各组（P<0.05）。

10cmH2OPEEP组在气腹建立后即刻、30分钟、60分钟和90分钟的驱动压力（ΔP）低于5cmH2OPEEP（P<0.05）和0cmH2OPEEP两组（P<0.05）。

气腹和气管拔管后60min，三组PaCO2无显著差异（P>0.05）。

气腹后60分钟和气管拔管后，PEEP5组的氧合指数（PaO2/FiO2）高于PEEP0和PEEP10组，具有统计学意义（P<0.05）。

在术后肺部并发症中，PEEP0组肺不张的发生率高于PEEP5组和PEEP10组，具有统计学显著性差异（p<0.05）。

结论：

在RARP期间使用5cmH2O PEEP可提高肺顺应性，改善术中氧合指数，减少术后肺不张。

试验注册：

本研究于2020年5月30日在中国临床试验注册中心注册（注册号：ChiCTR2000033380）。

关键词：

呼气末正压；肺顺应性；机器人辅助腹腔镜前列腺根治术。

原文摘要

Effect of positive end-expiratory pressure on pulmonary compliance and pulmonary complications in patients undergoing robot-assisted laparoscopic radical prostatectomy: a randomized control trial

Background: To observe the effects of different positive end-expiratory pressure (PEEP) ventilation strategies on pulmonary compliance and complications in patients undergoing robotic-assisted laparoscopic prostate surgery.

Methods: A total of 120 patients with the American Society of Anesthesiologists Physical Status Class I or II who underwent elective robotic-assisted laparoscopic prostatectomy were enrolled. We randomized the patients divided into divided into three groups of 40 patients each: PEEP0, PEEP5, or PEEP10. Master Anesthetist used volume control ventilation intraoperatively with an intraoperative deep muscle relaxation strategy. Respiratory mechanics indexes were recorded at six time-points: 10 mimuts after anaesthesia induction, immediately after pneumoperitoneum establishment, 30 min, 60 min, 90 min, and at the end of pneumoperitoneum. Arterial blood gas analysis and oxygenation index calculation were performed 10 mimuts after anaesthesia induction, 60 mimuts after pneumoperitoneum, and after tracheal extubation. Postoperative pulmonary complications were also recorded.

Results: After pneumoperitoneum, peak inspiratory pressure (Ppeak), plateau pressure (Pplat), mean pressure (Pmean), driving pressure (ΔP), and airway resistance (Raw) increased significantly, and pulmonary compliance (Crs) decreased, persisting during pneumoperitoneum in all groups. Between immediately after pneumoperitoneum establishment, 30 min, 60 min, and 90 min, pulmonary compliance in the 10cmH2OPEEP group was higher than in the 5cmH2OPEEP (P < 0.05) and 0cmH2OPEEP groups(P < 0.05). The driving pressure (ΔP) immediately after pneumoperitoneum establishment, at 30 min, 60 min, and 90 min in the 10cmH2OPEEP group was lower than in the 5cmH2OPEEP (P < 0.05) and 0cmH2OPEEP groups (P < 0.05). Sixty min after pneumoperitoneum and tracheal extubation, the PaCO2 did not differ significantly among the three groups (P > 0.05). The oxygenation index (PaO2/FiO2) was higher in the PEEP5 group than in the PEEP0 and PEEP10 groups 60 min after pneumoperitoneum and after tracheal extubation, with a statistically significant difference (P < 0.05). In postoperative pulmonary complications, the incidence of atelectasis was higher in the PEEP0 group than in the PEEP5 and PEEP10 groups, with a statistically significant difference (p < 0.05).

Conclusion: The use of PEEP at 5cmH2O during RARP increases lung compliance, improves intraoperative oxygenation index and reduces postoperative atelectasis.

Trial registration: This study was registered in the China Clinical Trials Registry on May 30, 2020 (Registration No. ChiCTR2000033380).

Keywords: Positive end-expiratory pressure; Pulmonary compliance; Robot-assisted laparoscopic radical prostatectomy.