The Effect Of Permissive Hypercapnia On Peripheral Inflammatory Cytokines In Patients Undergoing Laparoscopic Radical Resection Of Rectal Cancer

Objective:To evaluate the application value of permissive hypercapnia in laparoscopic radical resection of rectal cancer and to observe the effect of it on peritoneal inflammatory mediators.Methods:Fifty patients aged 45 to 75 years old undergoing laparoscopic radical resection of rectal cancer were randomly provided into the control group(group C)with normal blood gas and the permissive hypercapnia group(group P)with 25 patients in each group.Group C adopted the conventional ventilation strategy,maintaining PaCO2 between 35 and 45 mmHg and pH between 7.35 and 7.45.Permissive hypercapnia ventilation strategy was adopted in group P to maintain PaCO2 between 46~55mmHg and pH greater than 7.25.The mean arterial pressure(MAP),heart rate(HR),airway peak pressure,lung compliance,and blood gas analysis results were recorded before anesthesia(T1),1h after carbon dioxide pneumoperitoneum(T2),1h after operation(T3),and 24 h after operation(T4),and the concentrations of C-reactive protein(CRP),tumour necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10((IL-10)in peripheral venous blood were measured at the corresponding time points,as well as the incidence of adverse events.Results: There were no statistically significant differences between the two groups in age,height,weight,operation time,pneumoperitoneum time and other general conditions(P>0.05),and no serious adverse events of circulatory and respiratory system occurred during the operation.Compared with the control group,at T2~T4 points,the concentrations of CRP,TNF-α and IL-6 in serum in the permissive hypercapnia group were significantly decreased,while the concentration of IL-10 in serum were relatively high(P>0.05).In addition,the permissive hypercapnia group had lower airway peak pressure and better pulmonary dynamic compliance(P<0.05),and there was no significant difference in hemodynamic changes between the two groups(P>0.05).Conclusion: In laparoscopic radical resection of rectal cancer,permissive hypercapnia ventilation strategy can reduce the release of peripheral inflammatory mediators,improve lung function to a certain extent,and no adverse reactions occur,which may be a more appropriate ventilation strategy.