评估人工气腹压力和体位改变对机器人辅助前列腺癌根治术患者呼吸功能的影响

Evaluation effect of position change and pneumoperitoneum pressure on respiratory function in patients with DaVinci assisted radical prostatectomy

目的本研究旨在评估机器人辅助腹腔镜下前列腺癌根治术患者术中体位改变和气腹压力变化对患者呼吸系统的影响。方法选取2019年1—12月在浙江大学医学院附属第一医院手术室行机器人辅助腹腔镜下前列腺癌根治术的患者40例,将通过呼吸机记录的气道峰压、肺顺应性、气道阻力作为基础值用以后续评判呼吸功能的改变。分别记录人工气腹压为10 mmHg(1 mmHg =0.133 kPa)或15 mmHg时,5种不同体位下:头低脚高位30°、头低脚高位15°、平卧位、头高脚低位15°和头高脚低位30°,患者气道峰压、肺顺应性、气道阻力等呼吸功能的改变。结果在人工气腹压10 mmHg、头低脚高位30°时,气道峰压、肺顺应性和气道阻力分别为28.13 cmH2O、23.33 ml/cmH2O、16.06 cmH2O·L-1·s-1。调整气腹压为15 mmHg时分别为32.03 cmH2O、20.14 ml/cmH2O、17.24 cmH2O·L-1·s-1,差异有统计学意义(t值为-60.52、9.988、-19.498,P<0.01)。在人工气腹压10 mmHg,头低脚高位恢复至15°时,气道峰压、肺顺应性和气道阻力分别为26.66 cmH2O、24.95 ml/cmH2O、15.50 cmH2O·L-1·s-1,调整气腹压为15 mmHg时分别为30.61 cmH2O、20.89 ml/cmH2O、16.66 cmH2O·L-1·s-1,差异有统计学意义(t值为-43.81、24.638、-12.812,P<0.01)。结论头低脚高位时,伴随着体位角度的增大和人工气腹压的升高,气道峰压与气道阻力均随之升高,同时肺顺应性逐渐降低。此外,人工气腹压力的变化比头低脚高位角度的改变更影响术中呼吸功能的相关指标。

Objective To evaluate the effect of position change and pneumoperitoneum pressure on the respiratory system of patients undergoing DaVinci assisted laparoscopic prostate cancer surgery.Methods Peak airway pressure,lung compliance and airway resistance were recorded by ventilator as the basic values to evaluate the change of respiratory function.When the artificial pneumoperitoneum pressure was 10 mmHg or 15 mmHg,the changes of respiratory function were recorded in five different positions:trendelenburg position(head low foot height)30°,15°,supine position,anti-trendelenburg position(head high foot height)15°and 30°,peak airway pressure,lung compliance,airway resistance and so on.Results At 10 mmHg and 30°trendelenburg,peak airway pressure,lung compliance and airway resistance were 28.13 cmH2O,23.33 ml/cmH2O,16.06 cmH2O·L-1·Sec-1,respectively.When the pneumoperitoneum pressure was adjusted to 15 mmHg,peak airway pressure increased to 32.03 cmH2O,lung compliance decreased to 20.14 ml/cmH2O,and airway resistance increased to 117.24 cmH2O·L-1·Sec-1(P<0.01).At 10 mmHg and trendelenburg returned to 15°,peak airway pressure,lung compliance and airway resistance were 26.66 cmH2O,24.95 ml/cmH2O,15.50 cmH2O·L-1·Sec-1,peak airway pressure increased to 30.61 cmH2O,the lung compliance decreased to 20.89 ml/cmH2O and airway resistance increased to 16.66 cmH2O·L-1·Sec-1(t value was-43.81,24.638,-12.812,P<0.01).Conclusion With the increase of trendelenburg position angle and artificial pneumoperitoneum pressure,the peak airway pressure and airway resistance are increased,while the lung compliance decreases gradually.Compared with trendelenburg position,the change of artificial pneumoperitoneum pressure has more influence on respiratory function.