Comparison Of Effects Between Video-assisted Thoracic Surgery And Conventional Pulmonary Lobectomy On Arterial Blood Gases

Objective: by comparing the postoperative patients Arterial BloodGases changes between Video-Assisted Thoracic Surgery with Conventionalthoracotomy, clearly the influence of two different surgical procedures onpatients with arterial blood gas, in order to understand deeply significance oftotal Video-Assisted Thoracic Surgery in lobectomy.Methods: thirty-seven patients with pulmonary lobectomy wereselectedfrom single thoracic surgery treatment group of the fourth hospital ofhebei medical university between July2013and February2014,21cases ofmale,16cases of female, mean age is58.61years, Left upper lobe resection12cases, left lower lobe lung resection in7cases,10cases of resection of theupper lobe, the middle of the right lung resection in1case, the right lung loberesection in7cases,25cases of adenocarcinoma, squamous cell carcinoma7cases, gland scale cancer1case, mucous epidermoid carcinoma1case,1cases of inflammatory pseudotumor, adenocarcinoma with mucousadenocarcinoma in1case, adenocarcinoma with sarcomatoid change in1case.Video-Assisted Thoracic Surgery lobectomy20cases, of which the tumorstage for Ⅰ10case, Ⅱ period9cases, Ⅲ period1cases, left upper loberesection in7cases, left lower lobe resection in3ases,6cases of resection ofthe upper lobe, middle of the right lung resection in1case, characterized bylower lobe resection in3cases. Traditional thoracotomy lobectomy of17cases, including tumor stage for Ⅰp eriod3cases, eight Ⅱ period8cases, Ⅲperiod5cases,1cases of inflammatory pseudotumor, left upper lobe resectionin5cases, left lower lobe resection in4cases,4cases of the resection of theupper lobe of right lung resection in0, and the middle lower lobe resection in4cases, right lung in the two groups both lung resection surgery patients. All patients without oxygen in20minutes were extracted of arterial blood inthe preoperative and postoperative1days,3days,7days at rest state. Bloodgas needle is BD PresetTM2ml artery blood collector. Blood gas analyzer isRoche Roche (Switzerland) blood gas analyzer Cobas B type211. DetectingPaO2,PaCO2,pH,BE,SB as Arterial Blood Gases evaluation data. The studywas analyzed with SPSS19.0. All the datas were indicated as mean±standarddeviation(x±s). The comparison between two groups used T-test and onefactor analysis of variance SNK test between many groups, a=0.05.Results:1Statistical analysis of the two surgical groups patients preoperativearterial blood gas analysis PaO2is respectively82.57±6.88,82.72±5.68(P=0.968), PaCO2is respectively40.03±3.18,38.84±4.52(P=0.353), the pHis7.406±0.238,0.238±7.404respectively (P=0.802), BE is respectively0.085±1.959,0.0059±1.459(P=0.892), SB is24.310±1.596,1.596±24.412respectively (P=0.824), statistically (P>0.05), no statisticalsignificance between two groups.2Statistical analysis of the two surgical groups patients1days afteroperative PaO2is respectively81.31±4.05,68.28±3.18(P=0.000), PaCO2isrespectively38.54±2.48,38.14±3.02(P=0.661), the pH is7.392±0.330,0.330±7.410respectively (P=0.507), BE is respectively2.575±1.291,1.291±1.133(P=0.516), SB is respectively23.525±1.463,21.635±1.093(P=0.000), PaO2, SB statistical analysis (P<0.05, between the two groups wasstatistically significant, PaCO2、pH、BE statistically (P>0.05), no statisticalsignificance between two groups.3Statistical analysis of the two surgical groups patients3days afteroperative PaO2is respectively68.97±4.05,63.94±3.78(P=0.002), PaCO2isrespectively38.70±3.05,37.24±2.29(P=0.114), the pH is7.400±0.261,0.261±7.405respectively (P=0.531), BE is respectively0.260±2.068,2.068±1.628(P=0.954), SB is23.965±1.296,1.296±24.024respectively (P=0.892), PaO2statistical analysis (P<0.05, between the two groups havestatistical significance，PaCO2、pH,BE,SB statistically (P>0.05), no statistical significance between two groups.4Statistical analysis of the two surgical groups patients7days afteroperative PaO2are respectively80.68±4.79,78.67±3.78(P=0.171), PaCO2are respectively39.85±1.71,38.65±2.30(P=0.077), the pH is7.408±0.020,0.020±7.403respectively (P=0.552), BE are respectively0.550±1.302,0.6412±1.229(P=0.829), SB are respectively24.150±1.025,24.488±0.998(P=0.318), statistically (P>0.05), no statistical significance betweentwo groups.5Arterial blood gas data of the Video-Assisted Thoracic Surgery grouppreoperative and postoperative patients with four periods usedStudent-Newman-Keuls(SNK) test, PaO2compared between many groups,the preoperative and postoperative1days,7days arterial blood gases,P>0.05, no statistical significance. Postoperative day3PaO2and the rest ofhe group of three periods PaO2both two compared P<0.05, with statisticalsignificance. Preoperative and postoperative day3and7days BE multiplecomparison between the P>0.05, no statistical significance, Postoperativeday1BE with the rest of the group of three periods BE both two comparethe P<0.05, with statistical significance. PaCO2, pH, SB four times multiplecomparison P>0.05, no statistical significance.6Arterial blood gas data of traditional thoracotomy group ofpreoperative and postoperative patients with four periods used SNK test,preoperative and postoperative day1, day3and7days PaO2between bothtwo compare P<0.05, with statistical significance. Preoperative andpostoperative day3and7days BE multiple comparison P>0.05, nostatistical significance, postoperative day1BE with the rest of the group ofthree time BE both two compare P<0.05, with statistical significance.Preoperative and postoperative day3and7days SB multiple comparison P>0.05, no statistical significance, postoperative day1SB with the rest of thegroup of three periods SB both two compare P<0.05, with statisticalsignificance. PaCO2, pH four times multiple comparison P>0.05, nostatistical significance. Conclusion:1Video-Assisted Thoracic Surgery group and traditional thoracotomygroup, postoperative day1, day3PaO2all have varying degrees of decline,3days are the lowest. Postoperative day1metabolism of blood gas analysisindex showed that partial acid, but pH is normal. Each indicator of3daysafter postoperative are better than1days after postoperative.2Video-Assisted Thoracic Surgery group and traditional thoracotomygroup, Each indicator of postoperative day7rebounded to or close topreoperative levels.3Effects of Arterial Blood Gases Comparison Between Video-AssistedThoracic Surgery and traditional thoracotomy is small, Especially early afterthe operation Video-Assisted Thoracic surgery has significant effects onarterial blood gas less than traditional thoracotomy surgery.. There was noobvious difference in later period.