Effects Of Different Ventilation Models During One-lung Ventilation On Hemodynamics And Respiratory Mechanics

Objectives: To compare the effects of different ventilation modes on hemodynamics, respiratory mechanics and arterial blood-gas of thoracotomy in one-lung ventilation patients, in order to select the proper ventilation pattern.Methods: Forty ASA?or? patients of both sexes,aged 40⁶4 years old,BMI 18.5³0kg/m² undergoing esophageal carcinoma?the thoracotomy of left? with the same group of surgeons, were randomly divided into two groups?n=20each?: group A?low tidal volume+PEEP?, group B?PressureRegulated Volume Control?. Perioperative monitoring inclued invasive mean arterial blood pressure, heart rate, electrocardiogram, peripheral oxygen saturation, heart rate variability, PETCO₂, bispectral index, cardiac output, stroke volume and Ppeak, and so on. Anesthesia was induced with propofol 3⁵ ? g/ml, remifentanil 3⁵ng/ml? target controlled infusion, TCI?, cisatracurium 0.15mg/kg. After tracheal intubation, the patients were mechanically ventilated. When total lung ventilation: The ventilation modes were performed: VT on 8 ml/kg,I: E on 1: 1.5, oxygen flow 1.5L/min, FiO₂ on 80%, PEEP on 0cmH₂O, PETCO₂ between 30⁴0mmHg. BIS was maintained at 40⁶0 with TIVA during the operation. The one-lung ventilation modes were performed: group A?low tidal volume+PEEP?: VT on 6 ml/kg, I: E on 1:1.5, oxygen flow 1.5L/min,FiO₂ on 80%, PEEP on 5 cmH₂O, regulate RF to keep PETCO₂ between 30⁴0mmHg; group B?Pressure-Regulated Volume Control?: VT on 6 ml/kg,I: E on 1: 1.5, oxygen flow 1.5L/min,FiO₂ on 80%, PEEP on 0cmH₂O, regulate RF to keep PETCO₂ between 30⁴0mmHg, the peak voltage of air tube was undered 35cmH₂O. Recording the one-lung ventilation time, the operation time, blood loss and the infusion quantity. Recording after enter the room?T0?, before the OLV?T₁?, 30 min of OLV?T₂?, 60 min of OLV?T₃?, 90 min of OLV?T₄?, after 10 min of TLV?T₅?on the HR, MAP, SV, CO, CI, Respiratory function indicators, Artery blood gas analysis. Oxygenation index?OI?and Intrapulmonary shunt?Qs/Qt?were calculated.Results:?1? There were no significant differences in the age, gender, BMI, the one-lung ventilation time, the operation time, blood loss and infusion quantity, FEV₁/FVC in two groups?P>0.05?.?2? There were no significant differences in HR, MAP, CO, CI, SV in two groups?P>0.05?; no significant differences were found in SaO₂, PH, PaCO₂, RI?P>0.05?. Pmean was significant differences at T₁ compared A group to B group?P<0.05?, other times were no significant differences when compared A group to B group?P>0.05?. Cydn was significant differences at T₁ and T₅ compared A group to B group?P<0.05?, other times were no significant differences when compared A group to B group?P>0.05?. Ppeak was significant differences at T₁^T₅?five times?compared A group to B group?P<0.05?, other times were no significant differences when compared A group to B group?P>0.05?. Oxygenation index was significant differences at T₁, T₃, T₅,?three times?compared A group to B group?P<0.05?, other times were no significant differences when compared A group to B group?P>0.05?. PA-aO₂ was significant differences at T₁, T₅?two times?compared A group to B group?P<0.05?, other times were no significant differences when compared A group to B group?P>0.05?. PaO₂ was significant differences at T₁, T₃, T₅?three times?compared A group to B group?P<0.05?, other times were no significant differences when compared A group to B group?P>0.05?. Qs/Qt was significant differences at T₁, T₅?five times?compared A group to B group?P<0.05?, other times were no significant differences when compared A group to B group?P>0.05?.Conclusion:During OLV, there were no significant differences between PRVC model and low tidal volume+PEEP on hemodynamics, intrapulmonary shunt, Oxygenation index, but PRVC model's Ppeak was lower than low tidal volume+PEEP, maybe it could be reduce the postoperative complications of lungs better for patients.