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投稿时间：2022-08-25 网络发布日期：2022-12-20
投稿时间：2022-08-25 网络发布日期：2022-12-20
中文摘要: 目的 肺部超声（LUS）联合胃部超声评估腹腔镜前列腺癌根治术中使用等比通气(ERV)模式对患者肺形态学、胃部充气情况及喉罩通气的影响。方法 前瞻性选取2021年6月至2022年5月于南京市第一医院行腹腔镜前列腺癌根治术患者60例，采用随机数字表法分为ERV组（E组）和常规通气组(C组)，每组30例。患者常规静脉麻醉诱导后置入喉罩行机械通气，E组吸气呼气比(I∶E）为1∶1；而C组I∶E为1∶2。观察记录两组患者在麻醉诱导后(T0)、手术30min(T1)、手术60min(T2)、手术结束后10min(T3)的气道峰压（Ppeak）、气道平台压（Pplat）、气道平均压力（Pmean）、呼气末二氧化碳分压（PETCO2）和分钟通气量(MV)；同时记录两组患者手术前后的LUS评分以及胃部超声胃窦、胃底横截面积及气道并发症的发生情况。结果 E组T1、T2时Ppeak低于C组，Pmean高于C组（P＜0.05），而不同时点两组PETCO2、MV差异无统计学意义（P＞0.05）；E组患者LUS评分及肺不张的发生率低于C组（P＜0.05），胃窦、胃底横截面积差异无统计学意义（P＞0.05）；两组气道并发症发生率差异无统计学意义（30.0% vs 32.1%，χ2=0.031，P=0.860）。结论 在腹腔镜前列腺癌根治术中使用ERV通气模式可降低Ppeak，减少喉罩漏气、肺不张以及LUS评分，同时并未增加胃部充气以及喉罩相关不良并发症的发生率。
Abstract:Objective To evaluate the impacts of equal ratio ventilation(ERV) mode on lung morphology, gastric inflation and laryngeal mask airway ventilation during laparoscopic radical prostatectomy by lung ultrasound（LUS） and gastric ultrasound. Methods A prospective study was performed in 60 patients with prostate cancer undergoing laparoscopy from June 2021 to May 2022 in Nanjing First Hospital. The patients were randomly divided into ERP group(group E) and conventional ventilation group(group C,n=30, each). After induction of routine intravenous anesthesia and mechanical ventilation with laryngeal mask airway, and the ventilation mode was set as follows: the inspiratory-to-expiratory ratio in group E was 1∶1, while that in group C was 1∶2. After anesthesia induction(T0), 30 minutes after surgery begin (T1), 60 minutes after surgery begin(T2) and 10 minutes after surgery(T3), the peak airway pressure(Ppeak), airway plateau pressure(Pplat), mean airway pressure(Pmean),end-expiratory partial pressure of carbon dioxide(PETCO2) and minute ventilation(MV) were observed and compared between two groups. The LUS score, the cross-sectional area of gastric antrum and fundus and the incidence of airway complications were recorded in two groups. Results At T1 and T2, Ppeak in group E was significantly lower than that in group C(P＜0.05), and Pmean was significantly higher than that in group C(P＜0.05). There was no significant difference in PETCO2 and MV between two groups at different time points(P＞0.05). The LUS and the incidence of atelectasis in group E were statistically lower than those in group C(P＜0.05), and there was no significant difference in the cross-sectional area of gastric antrum and fundus（P＞0.05） and the incidence of airway complications（30.0% vs 32.1%，χ2=0.031，P=0.860) between two groups. Conclusion ERV mode during laparoscopic radical prostatectomy can reduce Ppeak, leakage rate of laryngeal mask, atelectasis and LUS scores without increasing the incidence of gastric inflation and laryngeal mask-related adverse complications.
keywords: Lung ultrasound Gastric ultrasound Prostate cancer Equal ratio ventilation Laryngeal mask ventilation
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谢力,施韬,刘晶晶,等.肺部联合胃部超声评估等比通气对前列腺癌腔镜手术中喉罩通气的影响[J].中国临床研究,2022,35(12):1685-1688.
谢力,施韬,刘晶晶,等.肺部联合胃部超声评估等比通气对前列腺癌腔镜手术中喉罩通气的影响[J].中国临床研究,2022,35(12):1685-1688.