压力支持通气联合低吸入氧浓度对行机器人辅助前列腺癌根治术的老年患者全麻苏醒期肺不张的影响

Effect of pressure support ventilation combined with low inspired oxygen concentration on atelectasis during general anesthetic emergence in elderly patients undergoing robotic-assisted radical prostatectomy

目的探讨压力支持通气(PSV)联合低吸入氧浓度对行机器人辅助前列腺癌根治术的老年患者全麻苏醒期肺不张的影响。方法前瞻性随机对照研究,纳入择期全麻下行机器人辅助前列腺癌根治术老年患者144例,年龄65~80(71.4±4.4)岁。采用随机数字表法分为4组:分别于苏醒期(手术结束至气管拔管)进行PSV+40%吸入氧浓度(FiO_(2))(P40组)、PSV+80%FiO_(2)(P80组)、自主呼吸+40%FiO_(2)(S40组)、自主呼吸+80%FiO_(2)(S80组)。4组患者分别于手术结束后(T_(1))拔管后(T_(2))、进入麻醉后监测治疗室(PACU)30min后(T_(3))、术后48h(T_(4))使用超声行肺不张通气损失评分,于T_(1)~T_(4)行动脉血气分析计算氧合指数(OI),记录苏醒期内和入PACU30min内发生低氧血症(脉搏血氧饱和度<92%)的次数,并于T_(4)记录患者术后肺部并发症(PPCs)发生率。结果共有137例患者完成本研究。与P40组比较,P80组[6.0(3.0)分比4.0(2.0)分,Z=-3.733、P<0.001]、S40组[8.0(3.0)分比4.0(2.0)分,Z=-4.868、P<0.001]、S80组[9.0(3.0)分比4.0(2.0)分,Z=-6.835、P<0.001]患者在T_(2)的评分升高,且S40组[7.0(2.0)分比5.0(2.0)分.Z=-4.631、P<0.001]、S80组[9.0(2.5)分比5.0(2.0)分,Z=-6.590、P<0.001]患者在T_(3)的评分升高。4组患者在苏醒期和PACU内低氧血症发生率差异无统计学意义[苏醒期(χ^(2)=0.405,P=0.939),PACU内(χ^(2)=4.048,P=0.256)]。4组患者术后48hPPCs发生率分别为5.9%(2/34)、11.4%(4/35)、8.6%(3/35)、6.1%(2/33),差异无统计学意义(χ^(2)=0.947P=0.814)。结论PSV联合低FiO_(2)用于行机器人辅助前列腺癌根治术的老年患者苏醒期,可减少肺不张形成,降低PACU内低氧血症发生率,改善术后氧合指数。

Objective To examine the impact of pressure support ventilation(PsV)in combination with low inspired oxygen concentration on atelectasis during the emergence from general anesthesia in elderly patients undergoing robotic-assisted radical prostatectomy.Methods In this prospective randomized controlled study.a total of 144 elderly patients,aged 65-80 years(average age:71.4±4.4 years),who were undergoing elective robotic-assisted radical prostatectomy under general anesthesia,were divided into 4 groups(n=36 each)using the random number table method.The groups were as follows:PSV+40%fraction of inspiration oxygen(FiO_(2))(P40 group),PSV+80%FiO_(2)(P80 group),spontaneous breathing+40%FiO_(2)(S40 group),and spontaneous breathing+80%FiO_(2)(S80 group).These methods were used during the general anesthetic emergence,which refers to the period from the end of the operation to extubation.Atelectasis aeration loss score was measured using ultrasound,and the oxygenation index(OI)was calculated through arterial blood gas analysis.These measurements were recorded at different time points:at the end of surgery(T_(1)),after extubation(T_(2)),30 minutes after entering the post anesthesia care unit(PACU)(T_(3)).and 48 hours after surgery(T_(4)).The number of hypoxemia cases(defined as saturation of pulse oxygen<92%)during emergence and within 30 minutes of entering the PACU,as well as the incidence of postoperative pulmonary complications(PPCs)at T_(2),,were also recorded.ResultsA total of 137 patients completed the study.Compared with the P40 group,the patients in the P80 group had higher atelectasis aeration loss scores at T_(1)[6.0(3.0)scores us.4.0(2.0)scores;Z=-3.733,P<0.001],the S40 group[8.0(3.0)scores us.4.0(2.0)scores;Z=-4.868.P<0.001],and the S80 group[9.0(3.0)scores us.4.0(2.0)scores:Z=-6.835.P<0.001].At T_(3).the S40 group [7.0(2.0)scores us.5.0(2.0)scores:Z=-4.631,P<0.001]and the S80 group[9.0(2.5)scores us.5.0(2.0)scores;Z=-6.590,P<0.001]also had higher atelectasis aeration loss scores.There was no significant difference in the incidence of hypoxemia between the four groups during the recovery period(χ^(2)=0.405,P=0.939)and in PACU(χ^(2)=4.048.P=0.256).The incidence of PPCs in the four groups at 48 hours after operation was 5.9%(2/34),11.4%(4/35).8.6%(3/35).and 6.1%(2/33)respectively(χ^(2)=0.947,P=0.814).Conclusions The combination of positive end-expiratory pressure support ventilation(PSV)and low inspired oxygen concentration can effectively decrease the occurrence of atelectasis in elderly patients undergoing robotic-assisted radical prostatectomy during the emergence phase,This approach also helps in reducing the incidence of hypoxemia in the post-anesthesia care unit(PACU)and improves the postoperative oxygenation index.