The Pulmonary Immune Efrects And Complications Of Lung Protecti\s Ventilation In Patients Undergoing Thoracic Surgery

Background and objective:With the improvement of surgical techniques and advances in anesthesia management, thoracotomy is considered to be relatively safe. During anesthesia, inappropriate mechanical ventilation is associated with, and may even cause, lung damage in patients with or without lung disease. However, the lack of prospective randomized controlled trials made it hard to evaluate the impact of standard lung-protective ventilation strategy on the safety and intraoperative pulmonary complications. This study was performed to test the hypothesis that if protective ventilation strategies, compared with conventional ventilation strategies, could improve oxygenation, reduce lung injury and decrease the incidence of perioperative pulmonary complications and Modified Clinical Pulmonary Infection Score(m CPIS).Methods:120 undergoing lobectomy patients were randomly divided into two subgroups: control group(C, n=60) and protective lung ventilation group(P, n=60). During one-lung ventilation(OLV), tidal volume(VT) was set at 9ml/kg in group C, meanwhile VT was set at 6ml/kg, positive end-expiratory pressure(PEEP) at 5cm H2 O, continuous positive airway pressure(CPAP) at 5cm H2 O and alveolar recruitment strategy(ARS)in group P. Pplat, Ppeak and Cdyn were measured and recorded at 5 minutes before OLV(T1), 30 minutes(T2), 60 minutes after OLV(T3). Arterial blood samples were taken at T1, T2, T3 and 5 minutes after TLV(T4) for blood gas analysis. Bronchoalveolar lavage fluid(BALF) was collected at T1, T4 to determine the concentration of TNF-α and IL-6by ELISA. It was obtained for the measurements of SOD and MDA. Chest feature, chest radiographic feature and blood routine were monitored on 7 days after thoracic surgery. Modified Clinical Pulmonary Infection Score(m CPIS) was measured at days 3 after surgery.Result:Compared with TLV, Pplat and Ppeak increased significantly but Cdyn decreased during OLV. Compared with group C, Pplat, Ppeak in group P decreased significantly during T2 and T3. Compared with group C, Pa O2 and Qs/Qt decreased. Compared with group T1, concentrations of TNF-α and IL-6 increased in group T4. IL-6 concentrations of BALF collected at T4 increased significantly in group C comparing with group P.Compared with group C, complications and m CPIS reduced in group P after thoracic surgery.Conclusion:LPVS with ARS, PCV, VT at 6ml/kg, PEEP 5cm H2 O,CPAP at 5cm H2 O helped to reduce the incidence of hypoxemia thoracotomy and improve oxygenation. LPVS also could reduce lung damage, perioperative pulmonary complications and postoperative modified Clinical Pulmonary Infection Score.