One-lung Ventilation Under Lung Resection In Patients With Blood Flow Dynamics Of Extravascular Lung Water And Postoperative Lung Function Changes

Objective Monitor changes in EVLW by the pulse index continuous carciac output(PiCCO)system during intraoperative and postoperative stages of lung resection using one-lung ventilation, to understand the influence of one-lung ventilation (OLV) on EVLW.Methods 20 lung cancer patients undergoing pulmonary lobectomy were enrolled in the study. Invasive hemodynamic parameters were measured by transpulmonary arterial thermodilution using the PiCCO system with a femoral artery catheter. Central venous pressure(CVP),cardiac output(CO),mean artery pressure(MAP),Systemic vascular resistance index(SVRI),extravascular lung water index(EVLWI),Global enddiastolie Volume Index(GEDVI),Intrathoracic blood volume index (ITBVI),Pulmonary vascular Permeability index (PVPI)were recorded with the patient in intraoperatively after 15min,30min,60min,120min,150min, and postoperatively after 30min,1h,2h,3h,5h,7h,20h.Results The one-lung ventilation on hemodynamic parameters were not identified statistically significant differences when compared with two-lung ventilation(TLV)(P>0.05). CO increased obviously before extubation, and then remained at a high level;A upside down V variation occurred in CVP within two hours after operation;MAP increased perioperatively and decreased postoperatively, but maintain at a higher level than before;SVRI reduced preoperatively and increased intraoperatively, whereas it quickly eased back to the preoprative level after operation. Both EVLWI and PVPI depress gradually with prolongation of exposure time. While GEDVI and ITBVI remained constant throughout. Further more, EVLWI and PVPI,GEDVI had significant positive correlation. However, There were no correlation between EWLWI and CO,CVP,MAP,SVRI,ITBVI.Conclusion OLV does not appear to reflect EVLW in this study. And it is a safe Anesthesia procedure. Objective investigate the effects of one-lung ventilation on postoperative pulmonary function to understand the influence of one-lung ventilation (OLV) on EVLW.Methods 0 lung cancer patients undergoing pulmonary lobectomy were enrolled in the study. Pulmonary functions were performed in patients before and after submitted to lung exeresis. Routine methods of pulmonary functions was tested. Forced vital capacity (FVC), forced expiratory volume in 1s(FEV1), maximal mid-expiratory flow (MMEF),maximal ventilatory volume(MVV), FEV to FVC ratio(FEV 1%) were measured with the patient in Preoperatively and postoperatively at each of the visits days 1,2,3,4,5,6,7,8,9 and 10. All the indexes is expressed as percentage in predicted value(PV).Results The one-lung ventilation on pulmonary function was not identified statistically significant differences between the 2 groups (P>0.05) except for MMF % index (P<0.05). All the corresponding indexes increased with smoothly increasing altitude since the first day. Besides FEV1/FVC%, none of the indexes reached the preoperative level in the observation period Conclusion OLV does not appear to reflect postoperative pulmonary function in this study. One-lung ventilation may aggravate the incipient small airway dysfunction.