Effect Of Protective Lung Ventilation Strategy On Lung Protection And Inflammatory Factors In Patients With Oral Cancer

Objective To investigate the effects of protective lung ventilation strategy on lung protection and inflammatory factors in patients with oral cancer.Methods Fifty patients（ASA I grade orⅡgrade）who underwent elective radical resection of oral cancer combined with skin flap repair（ventilation duration>6h）were randomly divided into conventional ventilation group（CV group）and protective lung ventilation group（PV group）,with 25 patients in each group.All patients underwent volume controlled ventilation mode（VCV）,oxygen flow was 2L/min,oxygen concentration was set at 60%,and inhalation/respiration ratio was 1:2.Two groups of patients developed different ventilation methods:PV group:VT:6ml/kg+5cm H₂OPEEP（positive end-expiratory pressure ventilation）+pulmonary manipulation retensioning every 30min（LRM,pressure 30mm Hg,duration 30S）;CV group:VT:10ml/kg,no PEEP,no pulmonary manipulation reopening.Arterial blood was extracted preoperatively（T1）,3 hours of ventilation（T3）,10 minutes before the end of surgery（T4）,and 24 hours after surgery（T5）for blood gas analysis.PaO₂（arterial oxygen partial pressure）and P（A-a）DO₂（alveolar artery oxygen partial pressure difference）were recorded at T1,T3,T4,and T5 in each group,and the oxygenation index（OI）was calculated.The contents of IL-6（interleukin-6）,TNF-α（tumor necrosis factorα）and HMGB-1（high migration rate group protein B1）were determined,and the correlation between postoperative oxygenation indexes and inflammatory factors was studied.ΔP（driving pressure）at 15min（T2）,T3,and T4 of mechanical ventilation was recorded,and CL（dynamic pulmonary compliance）was calculated.The white blood cells（WBC）at T1 and T5 were recorded,and the incidence of postoperative pulmonary complications in each group was recorded.Results 1.There was no statistical difference in general condition between the two groups（P>0.05）.2.There were no statistical differences in PaO₂,P（A-a）DO₂ and OI between 2 groups before surgery（P>0.05）.P（A-a）DO₂ in both groups at T3,T4 and T5 was higher than that at T1,and the increase was more obvious in the CV group than in the PV group,with statistical significance（P<0.05）.PaO₂ at T3 and T4 in 2 groups was significantly higher than that at T1,and the increase was more obvious in PV group（P<0.05）.OI in both groups showed a decreasing trend over time,and the decrease was more obvious in CV group than in PV group,with statistical significance（P<0.05）.3.Inoperative PV groupΔP was significantly lower than that of CV group,while CL was significantly higher than that of CV group,the difference was statistically significant（P<0.05）.4.Compared with preoperation,the levels of IL-6 and HMGB-1 at T3,T4and T5 in the PV group increased,and the levels of TNF-αincreased with statistical significance（P<0.05）.The levels of IL-6,TNF-αand HMGB-1 in the CV group increased significantly at T3,T4 and T5.There was statistical significance（P<0.05）.The concentrations of IL-6,TNF-αand HMGB-1 in CV group were significantly higher than those in PV group at T3 and T4,with statistical significance（P<0.05）.5.Postoperative P（A-a）DO₂ was moderately correlated with the levels of inflammatory factors IL-6 and TNF-α（r=0.56,r=0.51,P<0.05）.6.The postoperative WBC,pulmonary infection score（m CIPS）,incidence of postoperative pulmonary complications and postoperative hospitalization days in the PV group were significantly lower than those in the CV group.（P<0.05）Conclusion Compared with the conventional ventilation mode,the application of protective lung ventilation strategy can significantly improve the lung oxygenation function,reduce the intraoperative driving pressure,and reduce the release of inflammatory factors.It still has a protective effect on the lung of patients with long mechanical ventilation（ventilation time>6h）.