Comparison Of Pressure Controlled Ventilation And Volume Controlled Ventilation In Artificial Pneumothorax Surgery

Objective:The minimally invasive oesophagectomy takes a long time for artificial pneumothorax,and long-term CO2 pneumothorax and relatively high airway pressure will inevitably affect the normal respiratory circulatory system.In this study,two different ventilation modes,the volume controlled ventilation(VCV)and the pressure controlled ventilation(PCV),were used to evaluate the respiratory,hemodynamic,lung tissue damage and postoperative complications in patients undergoing artificial pneumothorax in thoracolaparoscopic oesophagectomy The impact provides a theoretical basis for seeking a more reasonable ventilation pattern.Methods:We select 36 esophagus cancer patients who undergoing artificial pneumothorax in thoracolaparoscopic oesophagectomy.Then divided them into 2 group(n=18):volume controlled ventilation group(group V),pressure controlled ventilation group(group P).Preoperative clinical data were collected.In the operating room,routine monitoring was performed.Anesthesia was induced with midazolam,fentanyl,cis-atracurium and etomidate.Intubation with a single-lumen endotracheal tube.After tracheal intubation,PetCO2 monitoring were performed.Anesthesia was maintained with sevoflurane,propofol,and remifentanil.Group V used a volume controlled ventilation model.Group P used pressure controlled ventilation mode.PetCO2 maintained at between 30-50 mmHg.Anesthesia operation time and establishment of artificial pneumothorax time were recorded.Patient-related vital signs and respiratory parameters(HR,MAP,SPO2,Pmax,Pmean)were recorded before establishment of artificial pneumothorax(TO)and every 15 minutes during the establishment of artificial pneumothorax(T1.T2.T3.T4.T5).Respectively before the establishment of pneumothorax(T0),after the establishment of pneumothorax 1h(T4)and before the end of artificial pneumothorax(T6),analyzed and recorded the arterial blood gas.Before the establishment of pneumothorax(T0),2h after surgery(T7)and 6h after surgery(T8),enzyme-linked immunosorbent assay(ELISA)was used to quantitatively detect alveolar surface protein in serum pulmonary surfactant-associated protein D(SP-D)and Clara cell protein-16(CC16)concentrations.Patients were followed up for 48 hours after surgery and before discharge.Recording the results of breath-holding test 48 hours after operation,postoperative days of hospitalization and postoperative complications.Results:There was no significant difference in sex,age,body mass index,operation time,establishment of artificial pneumothorax time between the two groups(P>0.05).In group P,the value of MAP at T1 point was lower than that of this group at TO point,and the difference was statistically significant(P<0.05).In group P,the value of MAP at T1 point was lower than that of group V at T1 point,and the difference was statistically significant(P<0.05).The Pmax at each time of T1-T5 in the two groups was higher than the Pmax at the time of T0,and the difference was statistically significant(P<0.05).There was no significant difference in the Pmean between the two groups of patients at T0～T5(P>0.05).There was significant difference in the pH between TO and T4/T6 in the two groups(P<0.05).There was significant difference in the PaO2 between TO and T4/T6 in the two groups(P<0.05).There was significant difference in the PaCO2 between TO and T4/T6 in the two groups(P<0.05).There was significant difference in the PaCO2 between the T4 and T6 in the two groups(P<0.05).The concentration of serum CC16 and SP-D in the two groups of patients at T8 point was higher than that of TO and T7,and the difference was statistically significant(P<0.05)..Conclusions:In minimally invasive oesophagectomy procedures,the effect of artificial pneumothorax on the physiological state of the patients is serious,which can decrease PaO2 and increase PaCO2 by increase the pulmonary shunt.A minimally invasive oesophagectomy assisted by artificial pneumothorax may lead to a higher level of serum specific lung injury markers.There is no obvious advantage of PCV compared with VCV in minimally invasive oesophagectomy.