| Objective To observe the effects of protective pulmonary ventilation and PCV-VG(pressure-capacity-assurance)model on respiratory mechanics,inflammatory factors and postoperative pulmonary complications in elderly patients undergoing total laparoscopic radical resection of esophageal cancer Objective to provide a reference for perioperative lung protection in elderly patients with one-lung ventilation in patients undergoing single-lung ventilation in elderly patients with thoracic surgery.Methods There were 80 patients scheduled for elective esophageal cancer resection,age> 60 years,body mass index 15-28kg/m2,of American Society of Anesthesiologists physical status grade I-III.All patients had no pulmonary infection and systemic infection within one week before surgery.No radiotherapy or chemotherapy was given.No surgery or mechanical ventilation was performed within two weeks before surgery.No severe pulmonary disease or thoracic deformity and neuromuscular disease were not included.Using the random number table method,the patients were divided into four groups : group A(lung protective ventilation group PCV-VG,n=20),group B(routine group PCV-VG,n=20),group C(lung protective ventilation group VCV,n=20)and group D(routine group VCV,n=20).Group A and B were treated with PCV-VG mode.Group C and D were treated with VCV mode.During two lung ventilation,group A and C were treated with tidal volume(VT)7ml/kg corrected body weight,PEEP 5cmH2 O,group B and D were 9ml/kg corrected body weight,without PEEP,oxygen concentration of 1,suction ratio of l: 2,respiratory rate(RR)10-12 times/min;During one lung ventilation: Group A and C were VT 5ml/kg correction Body weight,PEEP 5cmH2O;Group B and C were treated with VT 8ml/kg corrected body weight,without PEEP,RR 14-16 times/min,to maintain PETCO235-45 mmHg.Perioperative anesthesia treatment and surgical operation were performed by the same group of anesthesiologists and the same group of thoracic surgeons.The thoracoscopic surgical approach was right side into the chest.Airway peak pressure(Ppeak),mean air pressure(Pmean),lung compliance(dynamic compliance,Cdyn),breath expiratory Carbon dioxide partial pressure(PETCO2),oxygen saturation(Oxygen saturation,SpO2),tidal volume(VT),recorded every 15 minutes,then calculate the average to assess the comparison the degree of mechanical stimulation of the lungs.The mean blood pressure press(MBP),heart rate(HR)were recorded synchronously.Arterial blood gas analysis were tested at before OLV(T1),at 30 min of OLV(T2),at 20 min after re-expansion of the collapsed lung(T3),one milliliter blood samples were collected from the radial artery for calculated the pulmonary systolic rate and respiratory index,and recorded the T1-T3 respiratory mechanics and hemodynamic parameters.Three milliliter of radial artery blood samples were collected before the induction of anesthesia and T3,the supernatant was centrifuged,the concentration of neutrophil elastase(NE)was measured by ELISA.Postoperative clinical pulmonary infection score(CPIS)was recorded.Pulmonary complications such as respiratory failure,atelectasis and pulmonary infection were recorded within seven days after operation.Results During OLV,compared with group A and B,the airway pressure in group C and D was higher than that in group A and B(P <0.05).Compared with group A,the mean airway pressure in group B and D was higher(P <0.05).Compared with group A,the levels of PO2 in group B and D were lower than those in group A(P <0.05)(P<0.05).Compared with group A and group C,the levels of plasma NE were significantly higher than those of group A and C(P <0.05)(P <0.05).The clinical pulmonary infection score after one and seven days,compared with the group A,the scores of group B,C and D were higher than those of group A(P <0.05),and Compared with group B and group C,the score of group D was higher(P <0.05).Conclusion The plasma neutrophil elastase concentration in the protective lung ventilation group was superior to that in the conventional ventilation group,both in terms of intraoperative respiratory mechanics and postoperative pulmonary complications.During the one lung ventilation,the PCV-VG pattern in the protective group compared with the VCV model,which not only reduced airway peak pressure,increased lung compliance increased oxygenation,and had an advantage in reducing postoperative pulmonary complications.Protective lung ventilation combined with PCV-VG model,can reduce the total laparoscopic radical operation of esophageal cancer in elderly patients with single lung ventilation in lung injury,with a certain role in lung protection. |
