【罂粟摘要】机器人辅助下腹部手术后的通气和预后：一项国际多中心观察性研究
机器人辅助下腹部手术后的通气和预后：一项国际多中心观察性研究
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
目前关于接受机器人辅助(RAS)腹部手术的患者的流行病学、通气实践和预后的国际数据仍缺乏。本研究的目的是评估RAS腹部手术术后肺部并发症(PPC)的发生率，并描述RAS腹部手术术后的呼吸机管理。
这是一项在9个国家的34个中心进行的国际性、多中心、前瞻性研究。纳入了从2017年4月至2019年3月期间接受RAS腹部手术、年龄≥18岁的患者。用加泰罗尼亚外科患者呼吸风险评估(ARISCAT)评分对PPC风险较高的患者进行分层(≥26)。主要观察指标是PPC的发生率。次要观察指标包括术前PPCs风险和呼吸机管理。
在筛查的1167名受试者中，包括905名腹部RAS患者。总体而言，590名(65.2%)患者患PPC的风险增加。同时，172例(19%)患者发生PPC，其中高危患者132例(22.4%)，低危患者40例(12.7%)(绝对风险差：12.2%[95%可信区间(CI)，6.8-17.6%]；P<0.001)。与低危患者相比，高危患者的平台压和驱动压较高，但没有通气变量与PPCs发生率增加独立相关。PPC的发展与较长的住院时间相关。
五分之一的患者出现一个或多个PPC(主要是计划外需要氧疗)，这与较长的住院时间有关。通气变量不是PPCs的独立相关变量。
原始文献来源：
Ventilation and outcomes following robotic-assisted abdominal surgery: an international, multicentre observational study[J].Br J Anaesth. 2021 Feb;126(2):533-543. doi: 10.1016/j.bja.2020.08.058.
Ventilation and outcomes following robotic-assisted abdominal surgery: an international, multicentre observational study
Background: International data on the epidemiology, ventilation practice, and outcomes in patients undergoing abdominal robotic-assisted surgery (RAS) are lacking. The aim of the study was to assess the incidence of postoperative pulmonary complications (PPCs), and to describe ventilator management after abdominal RAS.
Methods: This was an international, multicentre, prospective study in 34 centres in nine countries. Patients ≥18 yr of age undergoing abdominal RAS were enrolled between April 2017 and March 2019. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to stratify for higher risk of PPCs (≥26). The primary outcome was the incidence of PPCs. Secondary endpoints included the preoperative risk for PPCs and ventilator management.
Results: Of 1167 subjects screened, 905 abdominal RAS patients were included. Overall, 590 (65.2%) patients were at increased risk for PPCs. Meanwhile, 172 (19%) patients sustained PPCs, which occurred more frequently in 132 (22.4%) patients at increased risk, compared with 40 (12.7%) patients at lower risk of PPCs (absolute risk difference: 12.2% [95%confidence intervals (CI), 6.8-17.6%]; P<0.001). Plateau and driving pressures were higher in patients at increased risk,compared with patients at low risk of PPCs, but no ventilatory variables were independently associated with increased occurrence of PPCs. Development of PPCs was associated with a longer hospital stay.
Conclusions: One in five patients developed one or more PPCs (chiefly unplanned oxygen requirement), which was associated with a longer hospital stay. No ventilatory variables were independently associated with PPCs.