The Combined Protective Ventilation Strategy Of The Laryngeal Mask Reduces Postoperative Pulmonary Complications In Elderly Patients

ObjectiveTo investigate the effect of laryngeal mask airway combining lung protective ventilation strategy reduces postoperative pulmonary complications in old patients after laparotomy.Methods100 patients with elective open surgery in our hospital from December 2016 to July 2017,operation time of 2⁶h,ASAⅡ^Ⅲ,age≥65,Were randomly divided into four groups:endotracheal intubation conbined conventional ventilation group（group A）,endotracheal intubation conbined protective ventilation group（group B）,laryngeal mask conbined conventional ventilation group（group C）,and laryngeal mask conbined lung protective ventilation group（group D）,each group had 25 cases.The endotracheal tube was used in IH and IP groups,while the LMA was used in LH and LP groups.The mechanical ventilation parameters in IH and LH groups were tidal volume（VT）8¹0ml/kg,without positive end-expiratory pressure（PEEP）or intermittent recruitment maneuvers（RMs）.On the contrast,the parameters in IP and LP groups were VT 6⁸ml/kg with PEEP 5cmH₂O and RMs every 30 minutes.Postoperation pulmonary complications were observed during 7 days after surgery.Heart rate（HR）,mean arterial pressure（MAP）were recorded at the time before intubation（T0）,the time of induction/laryngeal mask immediately（T1）,ventilation for five minutes（T2）,ventilation for 2h（T3）,extubation immediately（T4）.Arterial blood was collected at T0,T3,T4.Arterial partial pressure of oxygen（PaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）were recorded.At T2 and T3 airway peak pressure（Ppeak）was recorded.New symptoms,including temperature>38℃,heart rate>100 BPM,cough,sputum,intubation complications was recorded during postoperative 3 days.The length of hospital stay and patient satisfaction were compared in four groups.In T0,T3,T5collected 5 ml artery blood at each time point,after centrifugal supernatant on return through Elisa to detect surfactant protein A（SP-A）and human high mobility group protein B1（HMGB-1）,interleukin 6（IL-6）,interleukin 8（IL-8）.Results100 patients were observed in the trial.In group D,the rate of PPCs was less than the other three groups,and the difference was statistically significant（P<0.05）.The new symptoms included temperature>38℃,heart rate>100 BPM,the incidence of cough,sputum of group D were significantly less than the other three groups in three days after surgery（P<0.05）.There was no statistically significant difference between the four groups（P>0.05）at T0.Compared with T0 time point,the HR and MAP of group A and group B at T1 time were significantly increased（P<0.05）.Compared with T0 time point,there was no significant difference between groups C and D at T1（P>0.05）.Compared with T3,HR and MAP of group A and group B at T4 were significantly increased（P<0.05）.Compared with T3,there was no statistically significant difference between C and D at T4（P>0.05）.There was no significant difference in HR and MAP of the four groups（P>0.05）.There was no statistical differences significance（P>0.05）about Ppeak of group A,group B,group C and group D at T2 and T3.There was no statistical differences significance about PaO₂ and PaCO₂ of four groups at T0,T3,T4（P>0.05）.There were no difference about intubation complications,patient satisfaction and hospitalization days in the four groups（P>0.05）.There was no statistically significant difference in SP-A,HMGB-1,TNF-α,IL-6,IL-8 of groups A,B,C and D in the T0 time points（P>0.05）.Compared with T0 time point,there was no significant difference in SP-A of group A,B,C and D in T3 time point（P>0.05）.There was no significant difference in SP-A in group A,B,C and D in T3 time point（P>0.05）.Compared with T0 time point,the difference of SP-A in A,B and C in T5 time point was statistically significant（P<0.05）,and the difference between group D and T0 time was not statistically significant（P>0.05）.In T5 time point,SP-A of group A,B,C,D the difference was statistically significant（P<0.05）,group A compared with group D statistically significant（P<0.05）,while the rest of the two groups had no statistical difference.Compared with T0 time point,there was no significant difference in HMGB-1 of group A,B,C and D in T3 time point（P>0.05）.There was no significant difference in HMGB-1 in group A,B,C and D in T3 time point（P>0.05）.Compared with T0 time point,the difference of HMGB-1 in A,B and C in T5 time point was statistically significant（P<0.05）,and the difference between group D and T0 time was not statistically significant（P>0.05）.In T5 time point,HMGB-1 of group A,B,C,D the difference was statistically significant（P<0.05）,group A compared with group D statistically significant（P<0.05）,while the rest of the two groups had no statistical difference.Compared with T0 time point,there was no significant difference in TNF-αof group A,B,C and D in T3 time point（P>0.05）.There was no significant difference in TNF-αin group A,B,C and D in T3 time point（P>0.05）.Compared with T0 time point,the difference of TNF-αin A,B,C and D in T5 time point was statistically significant（P<0.05）.In T5 time point,TNF-αof group A,B,C,D the difference was statistically significant（P<0.05）,group A compared with group D statistically significant（P<0.05）,while the rest of the two groups had no statistical difference.Compared with T0 time point,there was statistically significant in IL-6 of group A,B,C and D in T3 time point（P<0.05）.There was statistically significant in IL-6 in group A,B,C and D in T3 time point（P<0.05）,group A compared with group D statistically significant（P<0.05）,while the rest of the two groups had no statistical difference.Compared with T0 time point.The difference of IL-6 in A,B,C and D in T5time point was statistically significant（P<0.05）.In T5 time point,IL-6 of group A,B,C,D the difference was statistically significant（P<0.05）,group A compared with group D statistically significant（P<0.05）,while the rest of the two groups had no statistical difference.Compared with T0 time point,there was statistically significant in IL-8 of group A,B,C and D in T3 time point（P<0.05）.There was statistically significant in IL-8 in group A,B,C and D in T3 time point（P<0.05）,group A compared with group D statistically significant（P<0.05）,while the rest of the two groups had no statistical difference.Compared with T0 time point.The difference of IL-8 in A,B,C and D in T5time point was statistically significant（P<0.05）.In T5 time point,IL-8 of group A,B,C,D the difference was statistically significant（P<0.05）,group A compared with group D statistically significant（P<0.05）,while the rest of the two groups had no statistical difference.ConclusionLaryngeal mask combined lung protective ventilation can reduce postoperative pulmonary complications in elderly patients undergoing laparotomy with more stable hemodynamics.It can reduce the release of inflammatory factor:SP-A,HMGB-1,TNF-α,IL-6 and IL-8.It is worthy of clinical popularization and application.