Effects Of Cdyn Guided Individualized PEEP On Lung Injury In Patients Undergoing Radical Prostatectomy With Robot

Objective:To evaluate the effect of cdyn guided individualized PEEP titration on lung injury in patients undergoing robot-assisted radical prostatectomy.Methods:40 cases of radical prostatectomy assisted by robot under elective general anesthesia.Age:65-79 yr,Body mass index:19-28kg/m²,ASA grade II orⅢ.The patients were divided into two groups by random number table method（n=20）:control group（group C）and PEEP group（group P）.After routine induction tracheal intubation in two groups,mechanical ventilation was performed in group C according to preset parameters,and PEEP was set by double titration method in group P after tracheal intubation and after placement combined with pneumoperitoneum.For patients of group C,serum samples of the patient’s radial artery were observe and record the HR,MAP and dynamic lung compliance（Cdyn）,collected and concentrations of Clara cell secretory protein（CC16）,lung alveolar surface active substances-D（SP-D）,TNF-αand IL-6 in the serum samples were determined by ELISA at the following 5 time points:4 min after tracheal intubation（T₁）;4 min after onset of Trendelenburg position and pneumoperitoneum（T₂）;1 hours after onset of Trendelenburg position and pneumoperitoneum（T₃）;2 hours after onset of Trendelenburg position and pneumoperitoneum（T₄）;1 min after extubation（T₅）;and 30min after extubation（T₆）.For patients of group P,all the same parameters of group C would be recorded at the following 5 time points:4 min after the first PEEP titration（T₁）;4 min after the second PEEP titration（T₂）;1 hours after the second PEEP titration（T₃）;2hours after the second PEEP titration（T₄）;1 min after extubation（T₅）;and 30 min after extubation（T₆）.Results:Compared with group C,the Cdyn of T₁^T₅ in group P was higher than that in group C（P<0.05）.Compared with T₁,the Cdyn of T₂^T₅ in the two groups decreased at each time point（P<0.05）.Compared with group C,the serum concentration of CC16of T₂^T₆ in group P was lower than that in group C,and the serum concentration of SP-D,TNF-α,IL-6 of T₃^T₆ in group P was lower than that in group C（P<0.05）.Compared with T₁,the serum concentration of CC16,IL-6 of T₂^T₆ was higher than that in group C,and the serum concentration of SP-D,TNF-αof T₃^T₆ was higher than that in group C（P<0.05）.Compared with T₁,the serum concentration of CC16 of T₃^T₆ was higher than that in group P,the serum concentration of SP-D of T₄ was higher than that in group P,and the serum concentration of IL-6 of T₅^T₆ was higher than that in group P（P<0.05）.Conclusion:For patients undergoing robotic-assisted laparoscopic radical prostatectomy in Trendelenburg position,Cdyn based individualized PEEP can decrease the serum concentration of CC16,SP-D,TNF-αand IL-6,and reduce lung injury.