Effect Of Lung Protective Ventilation On Perioperative Lung Injury In Patients Undergoing Spinal Surgery

Objective:To investigate the effect of lung protective ventilation on perioperative lung injury in patients undergoing spinal surgery.Methods:Sixty patients（28 males,32 females,40-70 years old,ASA grade II or III）undergoing selective lumbar posterior decompression and fusion and internal fixation were selected and randomly divided into two groups（n=30）:lung protective ventilation group（group P）and conventional ventilation group（group C）,group P:V_T 6 ml/kg（PBW）,RR 15 times/min,Fi O₂:50%,I:E=1:2,PEEP=4 cm H₂O,and manual lung recruitment maneuver every hour;group C:V_T 10 ml/kg（PBW）,RR 12 times/min,Fi O₂:pulmonary dynamic compliance(C_dyn)were recorded at 5 minutes after tracheal intubation（T₁）,5 minutes after prone position（T₂）,3 hours after prone position（T₃）,5 hours after prone position（T₄）,5 minutes after supine position（T₅）.Blood gas analysis were recorded at T₁-T₅.The arterial oxygen partial pressure（P_aO₂）and arterial carbon dioxide partial pressure（P_aCO₂）were recorded,the oxygenation index（OI）and Alveolar arterial oxygen differential pressure（A-a DO₂）was calculated.Peripheral venous blood samples were collected 5 minutes after tracheal intubation（T₁）,5 minutes after supine position change（T₅）,and 2 days after operation（T₆）.The concentrations of secreted protein 16（CC-16）,soluble receptor of advanced glycation end product（s RAGE）and IL-8 of Clara cells were measured by ELISA.The incidence of pulmonary complications,including pneumonia,postoperative respiratory support and sepsis,severe sepsis,septic shock and death,were recorded within 7 days after operation.Results:Compared with T₁,serum CC-16,s RAGE,and IL-8concentrations were increased in both groups at T₅（P<0.05）;compared with T₅,serum CC-16,s RAGE,and IL-8 concentrations were decreased in both groups at T₆（P<0.05）.Compared with group C,the concentrations of serum CC-16,s RAGE,and IL-8 in group P decreased at T₅（P<0.05）,and the concentrations of serum CC-16,s RAGE decreased at T₆（P<0.05）.Compared with group C,P_peak decreased in group P at T₁-T₅（P<0.05）.Compared with T₁,（P<0.05）in group P;compared with group C,C_dyn increased at T₃-T₅ in group P（P<0.05）.Compared with T₁,OI decreased and A-a DO₂ increased in both groups at T₃-T₅（P<0.05）;compared with group C,OI increased in group P at T₁-T₅（P<0.05）,and at T₂-T₅,A-a DO₂ decreased（P<0.05）.The incidence of pneumonia in group P was significantly lower than that in group C within 7days after surgery（P<0.05）.Conclusions:Lung protective ventilation can reduce perioperative lung injury,improve lung dynamic compliance and oxygenation function,and reduce the risk of perioperative pulmonary complications.