| Objectives This study aims to observe the changes of serum Clara cell secretory protein(CC16),interleukin 8(IL-8),tumor necrosis factor alpha(TNF-α)levels and the oxygen index(OI)in different ventilation modes in elderly patients with open abdominal surgery.Suitable mechanical ventilation mode for elderly patients explored by us,to reduce lung injury and reduce the postoperative pulmonary complications.Methods Forty elderly patients scheduled for open abdominal surgery under general anesthesia were selected as the study subjects.All patients meet the following conditions:regardless of gender,aged from 65 to 75,American Society of Anesthesiologists(ASA)physical status Ⅱ～Ⅲ,body mass index of 19～23 kg/m2.Forty patients were divided into the lung protective ventilation strategy group(group L)and conventional mechanical ventilation strategy group(group H)by single blind and random method,20 cases in each group.In group L,VT was set as 6-8ml/kg,PEEP was set as 5cmH20,and 30 seconds of pulmonary retraction was performed every 30 minutes under pressure of 20-30 cmH2O.In the H group,VT was set as 10-12ml/kg without PEEP and pulmonary reexpansion.Inhalation oxygen concentration(FiO2)was 60%in both groups,and all patients with PETCO2 35～45mmHg were maintained by RR adjustment.Patients were all given preoperative fasting and water deprivation for 8 hours,intramuscularly injected atropine 0.5mg,30min before entering the operating room,and peripheral venous access was opened after entering the operating room.Electrocardiogram(ECG),blood pressure(BP),heart rate(HR),pulse oxygen saturation(SpO2),end-exppiratory CO2 partial pressure(PetCO2),and bispectral index(BIS)of brain were monitored.Radial artery puncture and catheterization was performed under local anesthesia.Total intravenous anesthesia was used in both groups,and the types of anesthesia induction and anesthesia maintenance were consistent.Specimen:Before anesthesia induction(T0),1h after mechanical ventilation(Ti),2h after mechanical ventilation(T2),and 30min after extubation(T3)we through radial artery artery of extraction of 5 ml,1 ml of blood gas analyzer is used to inspect PaO2,and calculate the oxygenation index(OI),4 ml preserved blood vessels to vacuum by standard serial number sent to the laboratory,the upper centrifugal after serum,label again save to-80℃ low temperature refrigerator,enzyme linked immunosorbent(ELISA)method for the determination of serum serum CC16,IL-8 and the concentration of TNF-α level.Results 1 There was no statistically significant difference in general conditions between the two groups(P>0.05).2 Comparison of OI between two groups of patients.There was no significant difference between the two groups at To time point(P>0.05).OI of group L was significantly higher than that of group H,and the differences were statistically significant(P<0.05)at time points Ti,T2 and T3.Compared with T0,there were significant decreases in 01 at T1,T2 and T3 in both groups(P<0.05).In the two groups,T3 and T2 time points had significantly increased OI,and the difference was statistically significant(P<0.05).3.Comparison of serum TNF-aconcentration between the two groups.There was no significant difference in serum TNF-aconcentration between the two groups at To and Ti time points(P>0.05).The serum TNF-aconcentration in group H at time points of T3 and T4 was significantly higher than that in group L,and the difference was statistically significant(P<0.05).Compared with To time point,the concentration of serum TNF-a in the two groups increased at Ti time point,but the difference was not statistically significant(P>0.05).The concentration of serum tnf-a in the two groups increased significantly at T2 and T3 time points,and the difference was statistically significant(P<0.05).4 Comparison of serum CC16 and IL-8 concentrations between the two groups.There was no significant difference in serum CC16 and IL-8 concentrations between the two groups at To time point(P>0.05).Compared with the L group,the serum concentrations of CC16 and IL-8 in the H group were significantly increased at T1,T2 and T3,with statistically significant differences(P<0.05).Compared with To time points,the serum concentrations of CC16 and IL-8 at T1,T2 and T3 time points were significantly higher in the two groups,and the difference was statistically significant(P<0.05).Conclusions Compared with the traditional ventilation strategy,lung protective ventilation strategy can improve oxygention and reduce inflammatory reaction in elderly patients undergoing abdominal surgery,thereby reducing lung injury.Figure 8;Table 3;Reference 117... |
PDF Full Text Request