超声引导下肺复张对腹腔镜前列腺癌根治术后肺不张的影响

Effect of recruitment manoeuvres under lung ultrasound-guidance on postoperative atelectasis in laparoscopic radical prostatectomy

目的探究围手术期在肺超声可视化指导下进行肺复张对腹腔镜前列腺癌根治术后肺不张发生率的影响。方法选取2021年5月至2022年8月湖州市第一人民医院腹腔镜前列腺癌根治术患者76例,电脑随机数字表法将患者分为两组:对照组(C组,n=38)与肺复张组(I组,n=38)。两组患者分别于气管插管后5min(T_(1))、手术结束时(T_(2))及拔除气管导管后20min(T_(3))进行肺超声检查。I组患者若在T_(1)、T_(2)超声检查时遇肺不张,则在肺超声可视化指导下进行肺复张,C组暂不做处理。记录两组各时间点肺不张发生率、肺超声评分及低氧血症发生率[氧合指数=动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))/吸入氧浓度(fraction of inspiration O_(2),FiO_(2))<300mmHg (1mmHg=0.133kPa)]。结果T_(1)时点两组患者肺不张发生率差异无统计学意义(2.6%vs.7.9%,P=0.615);T_(2)时点两组患者肺不张发生率差异无统计学意义(73.7%vs. 65.8%,P=0.454);T_(3)时点I组患者肺不张发生率较C组显著降低(15.8%vs.60.5%,P<0.001);低氧血症发生率I组显著低于C组(5.3%vs.23.7%,P=0.047);氧合指数I组明显改善[(368.9±41.4)vs.(335.0±53.8),P=0.003]。拔管后肺超声评分I组较C组显著下降(P<0.05)。结论腹腔镜前列腺癌根治手术结束时在肺超声指导下肺复张可有效降低术后肺不张和低氧血症发生率,并改善肺通气。

Objective To explore the effect of recruitment manoeuvres under lung ultrasound-guidance on postoperative atelectasis in laparoscopic radical prostatectomy.Methods A total of 76 patients undergoing laparoscopic radical prostatectomy in the First People’s Hospital of Huzhou from May 2021 to August 2022,were randomly divided into two groups,control group(C group,n=38)and intervention group(I group,n=38)through computer table of random numbers.Lung ultrasound examination was carried out at 3 predetermined time points in each group:5 minutes after intubation(T_(1)),at the end of surgery(T_(2))and 20 minutes after extubation(T_(3)).Patients with atelectasis on the sonogram in I group received lung ultrasound-guided recruitment manoeuvres at point T_(1) and T_(2),with C group had no processed.The incidence of postoperative atelectasis,lung ultrasound score and incidence of hypoxemia[oxygenation index=arterial partial pressure of oxygen(PaO_(2))/fraction of inspiration O_(2)(FiO_(2))<300mmHg(1mmHg=0.133kPa)]were recorded at each time point in the two groups.Results The incidence of postoperative atelectasis at T_(1) was not significantly different between the two groups(2.6%vs.7.9%,P=0.615).At T2,there was no significant difference in the incidence of atelectasis between the two groups(73.7%vs.65.8%,P=0.454).At T_(3),the incidence of postoperative atelectasis in I group was significantly lower than that in C group(15.8%vs.60.5%,P<0.001).The incidence of hypoxemia was significantly lower in I group than that in C group(5.3%vs.23.7%,P=0.047).The oxygenation index was significantly improved in I group[(368.9±41.4)vs.(335.0±53.8),P=0.003].The lung ultrasound score in I group was significantly lower than that in C group(P<0.05).Conclusion In patients undergoing laparoscopic radical prostatectomy,recruitment manoeuvres under lung ultrasound-guidance at the end of the operation can reduce the incidence of postoperative atelectasis and hypoxemia,and improve pulmonary ventilation effectively.