Effect Of Mechanical Ventilation With Low Tidal Volume On The Pulmonary Function Of Neurosurgical Patients After Operation

ObjectiveTo compare the effects between low tidal volume ventilation and traditional tidal volume ventilation on arterial blood-gas, hemodynamics, respiratory mechanics and the complication of lung in neurosurgery patients, in order to select the proper ventilation patter.MethodOne hundred patients scheduled for elective neurosurgery were randomly divided into 2 groups: Group LV (low tidal volume ventilation, 7ml/kg), with the Rf on 12 times/min and Group TV (traditional tidal volume ventilation , 12ml/kg), Rf on 10 times/min. After intubation all patients were mechanically ventilated with IPPV model, and the blood gas analysis was determined at 30 minutes, when change the Rf for PaCO2 achieved (35±3mmHg).But ECG, blood pressure , heart rate , ET2CO2, SPO2 , airway pressure , lung compliance , and blood gas analysis were continuously monitored. Then blood gas analysis were measured at 24 and 48 hours after operation, and follow-up the patients to collect temperature, WBC numerus, cough, expectoration data. The patients were scaned by computed tomography of chest 2 hours after operation. Compare the images of 1cm above the top of the right diaphragm level.Result1.There were no significant differences in general conditions between the two groups.2. Ppeak , Pplat, Pmean and lung compliance (Cst) were significantly higher in group TV than those in group LV (P<0.05).3. PaCO₂ had no significant difference between the two groups (P>0.05), but OI,PaO2 was significantly higher and PH,RI were significantly lower in group LV during the operation (P<0.05). At 24h and 48h after operation, PH had no significant difference between the two groups(P>0.05), but OK PaO2 was signifieantly higher and PaCO₂ RI were signifieantly lower in group LV(P<0.05).4.The change of the temperature after operation had no significantly diference between the two groups .WBC numerus was remarkably increased after operation in group TV(P<0.05), the incidence rate of cough and expectoration after operation was signifieantly higher in group TV(P<0.05).5.The areas and ratios of atelectasis after intubation were remarkably increased after operation at the level of 1cm above the top of the right diaphragm .Conclusion1. The low tidal volume ventilation (7ml/kg ) can retain more lower Ppeak and Pplat, may be reduce the lung injury, can be used in the neurosurgery for its favourable venting.2. WBC numerus and the incidence rate of cough was more lower in the low tidal volume group, whitch should be more advantageous for the recovery of pulmonary function who undergoing excision of intracranial lesion.