腹腔镜活体肾切除术围手术期肺超声评分评价：一项前瞻性观察性试验。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.05.013

Emre S. Bingül , Mert Canbaz , Tzevat Tefik , Mevlüt Tayfun Oktar , Meltem Savran Karadeniz

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引用次数: 0

摘要

背景：腹腔镜上腹部手术容易发生呼吸系统并发症，可能与机械通气和手术本身有关。在本研究中，我们旨在探讨在围手术期超声引导下活体供肾切除术患者肺部状况的变化。方法：对行侧位全腹腔镜手术的活体供肾切除术患者进行研究。分别在插管后（T1LUS）、拔管前（T2LUS）和拔管后30分钟（T3LUS）评估肺超声评分（LUS）。主要观察结果为T1LUS与T2LUS的比较，观察术中时间对肺部状况的影响。其次，还评估T3LUS在术后急性期是否有残留变化。观察术后肺部并发症（PPCs）的发生情况及氧合变化。结果：共有30例患者入组研究。T2LUS和T3LUS明显高于T1LUS(18[17-20.3]和11 [10-14.3]vs 7 [5-9.3]；P < 0.001)。只有4例患者（13%）在术后24小时内出现轻度肺部并发症。PPCs患者的T2LUS和T3LUS均高于无PPCs患者（分别为21 [21-22.5]vs 18[16.8-20]和16 [14.5-18.3]vs 10.5 [9.8-14]）；P < 0.05)，但动脉氧分压(PaO2)/吸入氧分数（FiO2）比值在PPCs患者和无PPCs患者之间没有差异，表明所有参与者都有足够的氧合。结论：超声检查显示，腹腔镜活体肾切除术患者术中肺部状况有一定程度的恶化。尽管发现发生PPCs的患者倾向于表现出更高的LUS，但他们的氧合水平在整个手术期间仍然足够。

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Evaluation of Perioperative Lung Ultrasound Scores in Laparoscopic Living Donor Nephrectomy Surgeries: A Prospective Observational Trial

Background

Laparoscopic upper abdominal surgeries are prone to respiratory complications, possibly due to mechanical ventilation and the surgery itself. In this study, we aimed to investigate the changes in lung condition in living donor nephrectomy patients using perioperative ultrasound guidance.

Methods

Living donor nephrectomy patients who underwent fully laparoscopic surgery in the lateral position were included in the study. The lung ultrasound score (LUS) was evaluated after intubation (T1LUS), before extubation (T2LUS), and 30 minutes after extubation (T3LUS). The primary outcome was the comparison of T1LUS and T2LUS to observe the effect of the intraoperative period on lung condition. Secondarily, T3LUS also was evaluated for any residual change remaining during the acute postoperative period. In addition, the occurrence of postoperative pulmonary complications (PPCs) and changes in oxygenation were investigated.

Results

A total of 30 patients were enrolled in the study. T2LUS and T3LUS were significantly higher than T1LUS (18 [17-20.3] and 11 [10-14.3] vs 7 [5-9.3]; P < .001). Only 4 patients (13%) experienced mild pulmonary complications in the first 24 hours postoperation. Patients with PPCs demonstrated higher T2LUS and T3LUS compared to patients without PPCs (21 [21-22.5] vs 18 [16.8-20] and 16 [14.5-18.3] vs 10.5 [9.8-14], respectively; P < .05), yet arterial oxygen partial pressure (PaO₂)/fraction of inspired oxygen (FiO₂) ratios did not differ between patients with PPCs and patients without PPCs, indicating adequate oxygenation for all participants.

Conclusion

According to the ultrasonographic examination, the intraoperative period causes some degree of deterioration in lung condition in laparoscopic living donor nephrectomy patients. Despite the finding that patients developing PPCs tended to exhibit higher LUS, their oxygenation levels remained sufficient throughout the operative period.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.