Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial
Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial
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肺保护性通气策略可减少接受机器人辅助腹腔镜膀胱癌根治性膀胱切除术的患者术后肺部并发症（PPC）：一项随机双盲临床试验
DOI：
10.1016/j.jclinane.2020.110156
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发表时间：
2021-03-01
影响因子：
6.7
通讯作者：
Xie, Hong
中科院分区：
文献类型：
--
作者：
Huang, Dan;Zhou, Shujing;Xie, Hong
研究目的：评估低潮气量和呼气末正压（PEEP）通气对接受机器人辅助腹腔镜膀胱癌根治术（RARC）的患者术后肺部并发症的影响。设计：一项前瞻性随机双盲研究。地点：2017年1月至2019年1月在一家综合性三级医院进行的单中心试验。患者：总共258名接受RARC膀胱癌的患者干预措施：患者在麻醉期间被随机分配接受肺保护性通气（LPV 组）[潮气量 6 ml/kg 预计体重 (PBW) + PEEP 7 cmH2O] 或非保护性通气（对照组）（潮气量 9 ml/kg PBW，无 PEEP）。 测量：主要结果是术后 90 天内术后肺部并发症 (PPC) 的发生情况。次要结局是拔管时间、拔管后氧合指数（OI）和术后第1天血气分析。主要结果：LPV组术后第1、2和3天的PPC发生率较低[26.8% vs. 47.2%，比值比（OR）0.41，95%置信区间（CI）0.24-0.69，P = 0.0007， 21.3% vs. 43.3%，OR 0.36，95% CI，0.20-0.61，P = 0.0002，14.2% vs. 27.5%，OR0.43，95% CI，0.23-0.82，P = 0.0087，分别]，而在第 7 天和第 28 天没有观察到差异（3.9%分别为 9.4% 与 9.4%，P = 0.0788、0% 与 1.6%，P = 0.4980。术后第 90 天两组均未观察到 PPC。此外，拔管后即刻和术后第1天，LPV组的OI显着高于对照组[分别为390(337-467) vs. 343(303-420)，P = 0.0005、406.7(73.0) vs. 425.5(74.7)，P = 0.0440]。 LPV组患者术后拔管时间明显短于对照组[38（33-54）例比35（25-46）例，P = 0.0012]。结论：RARC麻醉期间LPV结合小潮气量和PEEP可降低术后肺部并发症的发生率。
Study objective: To evaluate the effects of ventilation with low tidal volume and positive end-expiratory pressure (PEEP) on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical cystectomy (RARC) for bladder cancer.Design: A prospective randomized double-blinded study.Setting: A single center trial in a comprehensive tertiary hospital from January 2017 to January 2019.Patients: A total of 258 patients undergoing RARC for bladder cancer.Interventions: Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 6 ml/ kg predicated body weight (PBW) + PEEP 7 cmH2O] or nonprotective ventilation (control group) (tidal volume 9 ml/ kg PBW without PEEP) during anesthesia.Measurements: The primary outcome was the occurrence of postoperative pulmonary complications (PPCs) during the first 90 days after surgery. The secondary outcomes were extubation time, oxygenation index (OI) after extubation and at postoperative day 1 in blood gas.Main results: The incidence of PPCs at postoperative day1, 2 and 3 were lower in LPV group [26.8% vs. 47.2%, odds ratio (OR) 0.41, 95% confidence interval (CI), 0.24-0.69, P = 0.0007, 21.3% vs. 43.3%, OR 0.36, 95% CI, 0.20-0.61, P = 0.0002, 14.2% vs. 27.5%, OR0.43, 95%CI, 0.23-0.82, P = 0.0087, respectively], while no differences were observed at day 7 and 28 (3.9% vs. 9.4%, P = 0.0788, 0% vs. 1.6%, P = 0.4980, respectively). No PPCs were observed at postoperative day 90 in both groups. Furthermore, immediately after extubating and at postoperative day 1, OI was significantly higher in LPV group compared with control group [390(337-467) vs. 343(303-420), P = 0.0005, 406.7(73.0) vs. 425.5(74.7), P = 0.0440, respectively]. Patients in LPV group had a significant shorter extubation time after operation compared with control group [38(33-54) vs. 35(25-46), P = 0.0012].Conclusion: LPV combining low tidal volume and PEEP during anesthesia for RARC may decrease the incidence of postoperative pulmonary complications.