Lung Protective Effect Of Driving Pressure-guided Lung Protective Ventilation Strategy Combined With PCV In Elderly Patients Undergoing Thoracoscopic Surgery

Objective:To investigate the lung protective effect of driving pressure（ΔP）-guided lung protective ventilation strategy（LPVS）combined with pressure-controlled ventilation（PCV）in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods:100 elderly patients scheduled for thoracoscopic radical resection of lung cancer from April 2021 to April 2022 in the Shanxi Province Cancer Hospital,aged 60-80 years,ASA physical statusⅠ～Ⅱ.Random number table method was used to divide them into 4groups,25 cases in each group:group A（n=25）[volume-controlled ventilation（VCV）+5cm H₂O PEEP],group B（n=25）（PCV+5cm H₂O PEEP）,group C（n=25）（VCV+ΔP-guided individualized PEEP）,and group D（n=25）（PCV+ΔP-guided individualized PEEP）.The occurrence of postoperative pulmonary complications（PPCs）within 5 d after operation was recorded.The serum concentrations of neutrophil elastase（NE）in radial artery blood samples were measured at T₀and 10 min after the end of OLV（T₃）.Blood gas analysis indexes and hemodynamic indexes were recorded before one-lung ventilation（OLV）（T₀）,30 minutes after OLV（T₁）and 60 minutes after OLV（T₂）.Results:The incidence of PPCs within 5 days after surgery in group A[36%（9/25）]was significantly higher than that in group D[4%（1/25）]（P<0.05）.The concentration of NE at T₃in group D[（160.60±13.02）ng/ml]was significantly lower than that in groups A,B and C[（202.76±9.7）,（182.52±11.97）,（180.04±10.28）ng/ml]（P<0.05）.The Pa O₂of group A and B at T₁[（135.44±49.76）,（146.02±51.06）mm Hg]and T₂[（137.01±46.22）,（142.98±47.39）mm Hg]were lower than that of group C and group D at T₁[（167.81±27.25）),（190.38±29.82）mm Hg]and T₂[（179.5±30.02）,（182.6±23.67）mm Hg]（P<0.05）.Conclusion:ΔP-guided LPVS combined with PCV can alleviate the inflammatory reaction and reduce the incidence of PPCs in elderly patients undergoing thoracoscopic radical surgery for lung cancer,which has a certain lung protective effect.In addition,individualized PEEP guided by driving pressure has certain advantages over fixed PEEP in improving intraoperative oxygenation of patients.Therefore,it may be a safer and more effective intraoperative ventilation strategy for elderly patients undergoing OLV.