Clinical Study Of Different Ventilation Models During One Lung Ventilation Anesthesia

Objective:To investigate the effects of different ventilation mode on inflammtory mediators,arterial blood-gas,airway pressure and lung tissue in one lung ventilation patients,in order to select the proper ventilation patter.Method:Forty ASAⅡpatients with lung caner aged 20-65yr weighting 45-80 kg undergoing lung resection were randomly divided into 4 groups with 10 subjects in each group.After intubation all patients were mechanically ventilated with IPPV model,When TLV:VT on 10ml/kg,Rf on 10 times/min,PEEP on 0,I∶E on 1∶2,Fio2 on 100%, Oxygen flow on 2L/min.After Olv:group A,VT on 10 ml/kg,Rf on 10 times/min,PEEP on 0;group B,VT on 6 ml/kg,Rf on 17 times/min, PEEP on 0;group C,VT on 6 ml/kg,Rf on 17 times/min,PEEP on 5cmH2O;group D,VT on 6 ml/kg,Rf on 17 times/min,PEEP on 10cmH2O.Blood gas analysis was determined 30 min after TLV(T0),30 min(T1),60 min(T2),90 min(T3)after OLV and 30 min after re-TLV (T4).At the same time HR,MAP,Ppeak and Pplat were drawn.Blood samples were colleted from peripheral vein at different time points including T0,T1,T2 and T3.The serums were stored by refrigerator under -20℃and were used for measuring TNF-a,IL-8 and IL-10 concentration.Five patients were randomly selected from each group and lung specimen was taken from the operated lung for light microscope examination.Result:1.There were no significant differences in general conditions in all the groups.There were no significant differences in HR,MAP,pH and PaCO2 in all the groups.2.The changes of Ppeak,Pplat,OI and Qs/Qt:(1)There were significant increase of Ppeak and Pplat during OLV.Contrast to group D, there were significant increase in groups A,B and C at T1,T2 and T3. (2)OI in groups A,B,D were obviously decreasing after OLV,but group C was decreased only at T1 obviously then they increased gradually. Compared with group C,groups A,Band D were obviously decreasing at T2 and T3.(3)Qs/Qt in all groups were increased obviously during OLV, then they decreased gradually after re-TLV.Groups A,B and D were higher obviously at T4 than T0,but there were no significant differences in group C at T4 and T0.Contrast to group C,groups A,B and D were increased obviously at T1,T2 and T3.3.The changes of TNF-a,IL-8 and IL-10:(1)TNF-a in all groups was significant increased during OLV.Groups A and D were higher than groups B and C at T1,T2 and T3 significantly.(2)IL-8 was increasing gradually after OLV in all groups,groups A,B and D were increased obviously at T2,group C were increased obviously at T3.Contrast to group C,there were significant increase in groups A,B and D at T2 and T3.(3)IL-10 was increasing gradually after OLV in all groups,Group C was began at T1 obviously,groups A,B and D were began at T2 obviously.Compared with groups A,B and D,there were significant increase in group C at T1,T2 and T3.4.The changes of light microscopic:There were no significant differences before and after of OLV in all the groups.Conclusion:1.One lung ventilation with tide volume 6ml/kg and PEEP 5 cmH2O can effectively improve systemic oxygenation,and inhabit the level of serum TNF-a and IL-8,and increase the release of IL-10.2.One lung ventilation with tide volume 6ml/kg and PEEP 10 cmH2O can induce higher Ppeak and Pplat,aggravate lung injury...