Effects Of Keeping Spontaneous Breathing And Laryngeal Mask-assisted Ventilation On The Expression Of Inflammatory Factors And Postoperative Pulmonary Reexpansion In Pulmonary Bullectomy

Objective:To explore the effects of thoracoscopic pulmonary bullectomy on the expression of inflammatory factors and postoperative pulmonary reexpansion in patients with spontaneous breathing and laryngeal mask-assisted ventilation.Methods:From December 2017 to September 2018,40 patients received thoracoscopic pulmonary bullectomy in the department of Thoracic Surgery of the First Affiliated Hospital of Kunming Medical University,and were randomly divided into two groups,20 patients were categorized in to spontaneous breathing group(group S),intravenous anesthesia was performed with spontaneous breathing and laryngeal mask-assisted ventilation;20 patients were categorized into controlled breathing group(group C),intravenous anesthesia was performed with double lumen tube tracheal incubation,patients in two groups underwent paravertebral blocks and were ascertained anesthesia plane by B-ultrasound before general anesthesia inducing.Collect the venous blood from the two groups of patients before induction of anesthesia(T1),6 hours after incision(T2),and 24 hours after surgery(T3),Assaying and comparing the changes of the levels of CRP,IL-6 TNF-α at the above three moments,recording the amount of anesthetic that used during surgery.Compare the cough scores,incidences of pharyngeal discomfort and hoarseness between two group after surgery,observing lung reexpansion 24 hours after surgery and the amount of chest drainage fluid after 72 hours after surgeryResults:Compared with group C,the cumulative consumption of propofol and remifentanil during the maintenance of anesthesia was significantly reduced in group S.The incidence of postoperative cough score,pharyngeal discomfort and hoarseness in group S was significantly lower than group C.There were no significant differences in CRP,IL-6,TNF-α at T1 moment between the two groups(P>0.05).After surgical stimulation,the inflammatory factors increased in both groups,but the levels of CRP,IL-6,TNF-α in group S were significantly lower than group C(P<0.05)at T2 and T3 moment.Compared with group C,the lung reexpansion in group S was significantly better at 24 hours after operation and the amount of chest drainage fluid was significantly lower at 72 hours after operation(P<0.05).Conclusion(s):1.Retention of spontaneous breathing and laryngeal mask-assisted ventilation for pulmonary bullectomy can be used as a new alternative to clinical traditional double-lumen endotracheal intubation which is carried by single-lung isolation and single-lung ventilation,the retention of spontaneous breathing and laryngeal mask-assisted ventilation can significantly reduce airway complications caused by double-lumen endotracheal intubation.2.Laryngeal mask-assisted ventilation for pulmonary bullectomy can reduce the inflammatory responses,it is beneficial for postoperative pulmonary reexpansion.