机器人辅助前列腺癌根治术的麻醉管理

Anesthesia management of robot-assisted laparoscopic radical prostatectomy

目的探讨达芬奇机器人辅助前列腺癌根治术的麻醉管理经验及注意要点。方法回顾性分析2015年8月至2021年10月在北京和睦家医院就诊的40例择期在全身麻醉下行机器人辅助腹腔镜下前列腺癌根治术患者的麻醉过程及临床资料。比较气管插管后即刻(T0)、机械臂对接(docking)完成即刻(T1)、docking后1h(T2)、docking后2h(T3)、docking后3h(T4)、关气腹前即刻(T5)和拔除气管插管前即刻(T6)的呼气末二氧化碳分压、气道峰压、呼吸频率和潮气量。记录手术时间、气腹时间、麻醉时间、拔管时间、术后住院时间。记录术中出入量,包括出血量、入液量(晶体液和胶体液)和尿量,以及肌肉松弛药用量(mg/kg)。结果与T0时的基础值比较,呼气末二氧化碳分压、呼吸频率在T1~T6时间点均高于基础值,气道峰压在T1~T4均显著高于T0、T6、T5。潮气量在各个时间点差异无统计学意义。手术时间为(257.4±43.4)min,气腹时间为(222.3±40.8)min,麻醉时间为(297.2±56.7)min,拔管时间为(18.3±5.5)min,肌肉松弛药用量(1.1±0.2)mg/kg,无围手术期严重并发症,术后住院时间为(6.5±2.4)d。结论达芬奇机器人辅助腹腔镜下前列腺癌根治术中由于气腹和极度头低位而引发呼吸循环等问题,需要麻醉管理更为精细化,从而保证患者快速康复。

Objective To explore the experience and key points of anesthesia management in Da Vinci robot-assisted laparoscopic radical prostatectomy(RALP)surgery.Methods The anesthesia process and clinical data of 40 patients undergoing robot-assisted laparoscopic radical prostatectomy under general anesthesia from August 2015 to October 2021 were retrospectively analyzed.The end expiratory pressure of carbon dioxide(PETCO2),peak airway pressure(PIP),respiratory rate(RR),and tidal volume(VT)was compared after endotracheal intubation(T0),time of robotic arm docking(T1),1h after docking(T2),2h after docking(T3),3h after docking(T4),time of abdomen closure(T5),and time before endotracheal intubation removal(T6).The duration of surgery,pneumoperitonium,anesthesia,extubation process and postoperative hospital stay were recorded.Intraoperative volumes were recorded,including blood loss,fluid intake(crystal and colloidal),urine volume,and muscle relaxant dosage(mg/kg).Results Compared with the basal values at T0,the partial end expiratory carbon dioxide pressure(PETCO2)and respiratory rate(RR)were higher than the basal values at T1-T6,and the peak airway pressure(PIP)at T1-T4 was significantly higher than that at T0,T6 and T5.There was no significant difference in tidal volume at each time point.The duration of surgery was(257.4±43.4)min,the duration of pneumoperitoneum was(222.3±40.8)min,the duration of anesthesia was(297.2±56.7)min,the duration of extubation was(18.3±5.5)min,the dosage of muscle relaxant was(1.1±0.2)mg/kg,and there were no perioperative serious complications.Postoperative hospitalization time was(6.5±2.4)d.Conclusions The respiratory circulation and other problems caused by pneumoperitoneum and extreme head-down position in Da Vinci robot-assisted laparoscopic radical prostatectomy require more precise anesthesia management,so as to ensure the rapid recovery of patients.