The Effects Of Low Tidal Volume And The Positive End-expiratory Pressure Combined With Alveolar Recruitment Maneuvers On The Pulmonary Function Of Elderly Patients

Objective To observe the effect of low tidal volume and moderate positive end-expiratory pressure ventilation on the intraoperative hemodynamics,perioperative pulmonary function and postoperative complications in elderly patients undergoing general anesthesia.Methods Sixty elderly patients undergoing unilateral knee replacement were randomly divided into standard ventilation group?tidal volume 8-10 ml/kg?and protective ventilation group?tidal volume 6-8 ml/kg,5 cmH₂O PEEP,alveolar recruitment maneuvers?,30 cases in each group.Anesthesia was performed on general anesthesia with composite femoral nerve and sciatic nerve block.Postoperative analgesia was performed around the femoral nerve to ensure that the patient's pain visual analogue scale?VAS?was<3 points.Patients were encouraged to get out of bed early and get functional exercise,Use antibiotics to prevent infection near the incision and in the lungs.The arterial partial pressure of oxygen,partial pressure of carbon dioxide,airway pressure and end-tidal carbon dioxide in the two groups were detected and recorded at different time points?preoperative and postoperative?,and the intraoperative hemodynamic changes,postoperative respiratory system complications and other complications,the use of pulmonary function test before and after 1,3,5 days lung function.Results There was no significant difference in preoperative PaO₂ between the two groups,but postoperative PaO₂ was significantly lower than those in the preoperative,but the protective ventilation group was significantly higher than the standard ventilation group[?80.2±3.4?mmHg?1 mmHg=0.133 kPa?74.1±2.6 mmHg],the difference was statistically significant?P<0.05?.The end-tidal carbon dioxide in the protective ventilation group was significantly higher than that in the standard ventilation group[?42.4±2.1?mmHg vs?38.1±1.4?mmHg]?P<0.05?.There was no significant difference in airway pressure and PaCO₂ before and after operation between two groups?P>0.05?.There was no significant difference in pulmonary function between the two groups before operation?P>0.05?.In the standard ventilation group,FEV₁ percentage of predicted value,percentage of predicted value of FVC,FEV₁/FVC were decreased at 1,3 and 5 days after operation?P<0.05?.In the protective ventilation group,FEV₁percentage of predicted value,percentage of predicted value of FVC,FEV₁/FVC were decreased at 1,3 and 5 days after operation?P<0.05?.However,the protective ventilation group was significantly higher than the standard ventilation group,the difference was statistically significant?P<0.05?.Intraoperative hemodynamic changes and postoperative respiratory complications and other comorbidities compared:two groups of intraoperative hemodynamic changes and postoperative complications no significant difference?P>0.05?.Conclusion Intraoperative pulmonary protective ventilation strategy can reduce the postoperative pulmonary complications.The reduction of postoperative pulmonary complications can reduce the medical and nursing costs.Conversely,postoperative pulmonary complications are associated with increased resource utilization,cost of care,and high mortality associated with respiratory failure.Intraoperative application of low tidal volume,moderate positive end expiratory pressure combined with alveolar recruitment maneuvers can improve postoperative respiratory function in elderly patients,with a protective effect.