Perioperative Research And Application Of Spontaneous Ventilation Thoracoscopic Surgery

Chaper Ⅰ Comparison of spontaneous ventilation and tracheal intubation anesthesia on the incidence of postoperative pulmonary complications after thoracoscopic surgery more than 3 hours:A propensity matching analysisObjective:To compare the difference between the two anesthesia methods on postoperative pulmonary complications(PPC)after thoracic surgery more than 3 hours.Methods:A retrospective analysis of 440 VATS patients with surgery time of more than 3 hours from The First Affiliated Hospital of Guangzhou Medical University from January 1，2018 to December 31,2018.Analysis and comparison of PPC and postoperative recovery in spontaneous ventilation group(S)and tracheal intubation group(1).The statistical method of propensity matching analysis(PSM)is used to reduce confounding biasResults:After PSM,the incidence of PPC in group Ⅰ was higher than that in group S.There were 9 postoperative respiratory failures in group I,5 of which developed ARDS,but none in group S.Conclusion:Compared with tracheal intubation anesthesia,spontaneous ventilation anesthesia has a lower incidence of postoperative pulmonary complications after thoracoscopic surgery for more than 3 hours.Chaper Ⅱ Effects of 4 hours of spontaneous ventilation and mechanical ventilation on lung injury of rabbits with one-lung ventilationObjective:Compare the effects of spontaneous ventilation and mechanical ventilation for 4 hours on rabbit one-lung ventilation(OLV)lung injury.Methods:Establish a rabbit OLV model.Grouping:control group(C),spontaneous ventilation group(S),mechanical ventilation group(M).During the experiment,the vital signs and blood gas analysis changes were monitored.After OLV 4h,lung tissues on the ventilated side were taken to to detect its pathological changes,W/D ratio,expression of inflammatory cytokines IL-6,IL-8,TNF-α and MMPs,and the degradation of glycoaminoglycan(GAGS)of extracellular matrix(ECM).Results:Pathological examination after 4h OLV revealed lung injury on the ventilated side in both group S and group M,and the injury in group M was more serious.Compared with group S,MMPs,IL-6 and TNF-α in group M were increased,and the extraction contents of Total glycoaminoglycans(total-GAGs)and heparin sulfate glycoaminoglycans(hs-GAGs)in group M were increased.Conclusion:Both spontaneous ventilation and mechanical ventilation with OLV for 4 hours caused lung damage in the ventilated side of the experimental rabbits.The injury was more serious in the mechanical ventilation group.The mechanism may be related to the degradation and remodeling of GAGs in ECM caused by more MMPs activated by mechanical ventilation OLV.Chaper Ⅲ The comparison of thoracic paravertebral block and internal intercostal nerve block in spontaneous ventilation anesthesia for video-assisted thoracic surgeryObjective:To compare the safety and feasibility of thoracic paravertebral blockade(TPVB)and internal intercostal nerve block(IINB)for spontaneous ventilation anesthesia video-assisted thoracic surgery(SV-VATS).Methods:Thirty-four patients who underwent SV-VATS from April 2016 to May 2017 were retrospectively reviewed and divided into two groups consecutively according to local analgesia treatment,of which 20 patients received TPVB(P group)and the remaining 14 received ⅡNB(I group).A Propensity Score Matching(PSM)analysis was performed to control the selection bias due to nonrandom assignment.Results:There was no difference in clinical characteristics between the two groups after PSM.Blood-gas analysis 15 minutes after opening the chest showed significantly lower PaCO2 in the P group compared to the I group.The consumption of propofol from anesthesia induction to 15 minutes after opening the chest was also lower in the P group compared with the I group.There were no significant differences in the duration of surgery and visual analogue scale(VAS)pain scores between the two groups.Conclusion:TPVB can provide safe and reliable local anesthesia for SV-VATS.