The Influence Of PCV-VG And VCV Model To Lung Injury For Patients Of Retroperitoneal Laparoscopic Surgery

Objective:To comparethe effectsofthepressurecontrolledventilation-volume guaranteed?PCV-VG?mode and the traditional volume controlied?VCV?ventilation mode on lung injury in patients with retroperitoneal laparoscopic surgery.Methods:60 patients with retroperitoneal laparoscopic surgery from August 2017 to December 2017 in the First Affiliated Hospital of Shanxi Medical University?ASA grade I-II,chest X-ray and electrocardiogram showed normal,20⁶0 years of age,body mass index<30?were divided into two groups according to random number double blind method:Pressure controlled ventilation-volume guarantee group?PCV-VG??P group?and volume controlled ventilation group?VCV??V group?,with 30 cases in each group.Two groups of patients be ventilated according to the preset parameters,respectively record peak airway pressure?Ppeak?,mean airway pressure?Pmean?and end tidal carbon dioxide pressure?PetCO₂?at T1-T4?5min after tracheal intubation,30min after pneumoperitoneum,90min after pneumoperitoneum,30min after the end of pneumoperitoneum?,calculating lung compliance?Cd?at T1-T4,pumping arterial blood to monitor the plasma concentration of interleukin-6?IL-6?,tumor necrosis factor-??TNF-??and soluble intercellular adhesion molecule-1?s ICAM-1?at T1-T4.The changes of the respiratory mechanics parameters and the plasma concentration of the IL-6,TNF-?and sICAM-1 were compared between the two groups.Results:Ppeak and Pmean in two groups increased after pneumoperitoneum,but the level of Ppeak and Pmean in PCV-VG group is lower than VCV group,the difference was statistically significant?P<0.05?.Dynamic compliance of the lung in two groups decreased at T2?T3,but PCV-VG group in the lower degree compared with group VCV,the difference was statistically significant?P<0.05?.The PetCO₂ in group PCV-VG at T2was lower than that of the VCV group,and the difference was statistically significant?P<0.05?,there was no statistical difference between the two groups at the rest of the time?P>0.05?.After the pneumoperitoneum began,the plasma concentrations of IL-6,TNF-?and sICAM-1 increased in all two groups,and increased with the increase of the pneumoperitoneum time.But the plasma concentrations of IL-6,TNF-?and sICAM-1 at T2,T3 and T4 at the time of PCV-VG were lower than those in the VCV group,and the difference was statistically significant?P<0.05?.Conclusion:The PCV-VG mode can reduce the peak airway pressure and mean airway pressure of the patients with retroperitoneal laparoscopic surger,increase the dynamic compliance of the lung,reduce the plasma concentration of IL-6,TNF-?and sICAM-1,and reduce the occurrence of lung injury to some extent.