| Objective:With the continuous development of the retroperitoneallaparoscopy, the impact on the pathological and physiological of patients afterlaparoscopic caused has become more apparent, retroperitoneal laparoscopycompared with laparoscopic operation is easier to reduce pulmonarycompliance and increased the content of carbon dioxide in theblood,aggravating the effect on pulmonary function of patients.CC16is aprotein secreted by lung clara cells,the present study find that the changes ofCC16protein in blood can be used as a peripheral maker of acute lung injurycaused by mechanical ventilation.This test is through recorded during peakairway pressure,measured the pressure of carbon dioxide in arterial atdifferent time points and the changes of CC16proteins in plasma to comparethe influence of different modes of mechanical ventilation in theretroperitoneal laparoscopic partial nephrectomy operation on the respiratorysystem in order to guide clinical anesthesia and reduce pulmonarycomplications.Methods:45patients undergoing retroperitoneal laparoscopic partialnephrectomy operation, ASA grade ⅠorⅡ, from18to60years old, bodymess index between18kg/m2-30kg/m2, preoperative pulmonary function testswere normal. Fourty-five patients were randomly divided into three groups tovolume control ventilation under120ml/kg in one minute, in which therespiratory rate and tidal volume were set: Group A were set to respiratoryrate12times/min, tidal volume10ml/kg; Group B respiratory rate15times/min, tidal volume8ml/kg; Group C set respiratory rate20times/min,tidal volume6ml/kg. Patients into the operation room,monitoring the ECG,pulse,blood pressure before arterial puncture under local nanesthesia,and then start the induction of anesthesia.The drugs aremidazolam0.1～0.15mg/kg, propofol1.5～2mg/kg,astracurium0.4～0.6mg/kg, fentanyl3～6μg/kg. When the drugs reach the effective concentration,tracheal intubation. According to the group of the patient for mechanicalventilation.Oxygen concentration has been maintained at around50%andrecord the start time of the mechanical ventilation.Application thepropofol,remifentanil and atracurium to maintain the anesthesia.Use the BISmonitoring the depth of anesthesia,keep the BIS value between40～60.Recording the airway pressure at the time of after trachealintubation,positioned,at the start of pneumoperitoneum,5min,30min,1h,2h after the start of pneumoperitoneum and at the end of mechanicalventilation.Blood gas analyzer is used to measure the arterial blood gas at thetime of after punctured,at the beginning of pneumoperitoneum,30min,1h,2hafter the start of pneumoperitoneum,at the end of pneumoperitoneum and atthe end of mechanical ventilation.Using enzyme-linked immunosorbentassay,measure the concentration of CC16in plasma at the time of afterpunctured, at the beginning of pneumoperitoneum,1h,2h after the start ofpneumoperitoneum and at the end of mechanical ventilation.Results:The patients in the experiment, there were not significantlydifferent among the ages, BMI, the during time of mechanical ventilation, timeof the operation and time of pneumoperitoneum. The process of surgery andanesthesia are all smoothly. There was no complication come out.There were not significantly different among CC16concentrations ofthree groups of the same time(P＞0.05).There were not significantly differenttoo in the same group at different time points (P＞0.05）. Observation theresults show that with the time going on the concentration of CC16graduallydecrease, compared the time of “mechanical ventilation at the end” and “afterarterial puncture” in group A,group B and group C.“Mechanical ventilation atthe end” accounted for “after arterial puncture” are97.5%,98.5%and97.3%.Analysis the results of the pressure of arterial carbon dioxide. In group A,group B, group C, except the time of “after arterial puncture” point there was not significantly different (P＞0.05), at other time points there weresignificantly different (P＜0.05).In the same group at different points exceptthe time of “after arterial puncture” point compared with the time point of “atthe beginning of pneumoperitoneum”in group C,there were not significantlydifferent (P＞0.05),at other time points,there were significantly different (P＜0.05).Three sets of results of arterial carbon dioxide were increased,the mostsignificantly is group C, next is group B.In the experiment,afterpneumoperitneum, the pressure of carbon in each group was53.12±6.01mmHg,67.96±9.08mmHg,84.44±10.77mmHg.At the end ofmechanical ventilation the results in each group was38.53±4.12mmHg,49.80±6.49mmHg,69.26±10.09mmHg.During the operation, the highestresult was95mmHg,appeared in group C.The results of the peak airway pressure were all increase at the time of“positioned” compare with the time point of “after tracheal intubation”.Atdifferent time points in the same group, compared with the time point of“positioned” and “after tracheal intubation” there were significantly different(P＜0.05), there were significantly different in the time of “afterpneumoperitoneum” and “positioned”(P＜0.05).Compared the time fromthe begin of the pneumoperitoneum to the end of pneumopertoneum therewere not significantly different (P＞0.05).When the pneumoperitoneumend,the peak airway pressure decreased.During the mechanical ventilationthe highest peak pressure was31cmH2O,occurred in the group A.Comparewith the airway pressure at the same time there were significantly different ingroup A, group B and group C,(P＜0.05).Conclusion:①I n theretroperitoneal laparoscopic partial nephrectomyoperation three ventilation modes were not cause damage to the health lungs.②Low tidal volume mechanical ventilation (6ml/kg) is mot suitable for theretroperitoneal laparoscopic partial nephrectomy operation.③In the normalfunction of lung tissue even because of pneumoperitoneum and posturereducing lung compliance, moderate increase the amount of tidal volume willnot significantly increase airway pressure.④i n theretroperitoneal laparoscopic partial nephrectomy operation can not blindly increase thebreathing rate to increase effective ventilation. |
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