驱动压导向个体化呼气末正压通气用于机器人辅助根治性前列腺切除术的价值

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中图分类号 R697R737.25文献标识码 A文章编号 2096-7721（2025）07-1174-07

AbstractObjective：Toanalyzetheclinicalvalueofdriving pressre（△P）-guided individualized positiveend-expiratorypreure （PEEP）inrobot-asistedradicalprostatectomy（RARP）.Method：88 prostatecancerpatientshounderwentRARPinourospialfrom June2O23 to November 2O24 were included and randomly divided into the observation group （ n =44，receiving ΔP -directedindividualized PEEP） and the control group （ n =44，receiving conventional lung-protective ventilation）. Respiratory mechanics and postoperative pulmonarycomplications （PPCs）werecomparedbetwnthetwo groups.Result： Comparisonsofairwayplateaupressre （Pplat），peak airway pressure （Ppeak）， and ΔP at timepoints T1 to T5 between the two groups showed T15>>>T4 （ P <0.05）.The Pplat，Ppeak，CdynandOIat timepoitsTtoTinthebservatiogroupwerallhighertanthoseinthecontrolgoup， and ΔP values in the observation group were all lower than those in the control group （ P <0.05）. Comparisons of FVC，PEF and FFV1 indicatorsatdifrenttimepintsinthetwogroupsshowedeforesurgery>5dysaftersurgery>3dasaftersurgery>dayfeurgery （204 （P<0.05） .Comparedwiththecontrolgroup，thelevelsofFVC，PEFandFFV1inthebservationgroupateachtimepointaftersurgerywere  all higher （ P <0.05）.The total incidence of PPCs in the observation group was lower than that in the control group （P<0.05） . Conclusion： Individualized PEEP guided by ΔP for RARP can improve the pulmonary compliance and oxygenation function of patients，enhance their pulmonary function and reduce the incidence of PPCs.

KeywordsDrivingPresureuidedInividaledPositiveEnd-expiratoryPressure;Robot-asistedSugery;rostateCaneadical Prostatectomy

机器人辅助根治性前列腺切除术（Robot-AssistedLaparoscopicRadicalProstatectomy，RARP）因其出血少、术后疼痛轻、康复快等优势被临床广泛应用[1-3]，但该术式通常需要建立 CO2 气腹并采用头低脚高位（Trendelenburg体位），易导致患者膈肌移位，引发肺不张，改变肺部力学特性，表现为气道峰压（Ppeak）及平台压（PlateauPressure，Pplat）上升，同时降低肺－胸壁系统静态顺应性，进而增加术后肺部并发症（Postoperative Pulmonary Complications，PPCs）的发生风险。（剩余9728字）