| Background and purposeLaparoscopic surgery has the advantages of small invasiveness,small scar and short hospital stay,which is the current trend of surgical development.During laparoscopic surgery,the establishment of artificial pneumoperitoneum often leads to an increase in the intra-abdominal pressure of the patient,which causes the diaphragm to lift and restrict the activity,which has a certain effect on the respiratory function;when the colon cancer is operated,the lower body position causes the diaphragm to be lifted up passively.Further aggravating its activity,the volume of the thoracic cavity is reduced,and the amount of pulmonary functional residual gas is reduced,resulting in the formation of partial atelectasis.These effects may lead to an increase in the incidence of postoperative pulmonary complications and prolonged hospital stay.A large number of clinical trials have shown that[1,2],the use of lung protective ventilation strategy can reduce the incidence of postoperative inflammatory response and improve lung function.In the relevant section of the 2017 edition of the Chinese Anesthesiology Guide and the Expert Consensus on the rational application of muscle relaxants,Yu Yonghao et al.pointed out that during general anesthesia,moderate muscle blockage,when the pneumoperitoneum pressure reaches 12-15 mmHg,Although there is a satisfactory surgical field and sufficient operating space,when the pneumoperitoneum pressure is higher than the portal pressure,it may have a certain effect on the venous return of the internal organs of the surgical patients,causing ischemia and reperfusion injury of the internal organs and systemic inflammation.The reaction takes place.Therefore,it is recommended to use deep muscle relaxation in laparoscopic surgery.therefore,it is recommended to use deep muscle block in laparoscopic surgery to reduce intra-abdominal pressure to reduce intra-abdominal ischemia-reperfusion injury and systemic inflammatory response and pressure injury to the abdominal wall.but attention should be paid to the diagnosis and treatment of residual muscle relaxant.The residual muscle relaxant will increase the incidence of atelectasis in patients[3],causing reflux and error during recovery.Risks such as suction and hypoxemia increase.In addition,the residual of other general anesthetics during general anesthesia will synergize with muscle relaxants,which may lead to more serious consequences,increase the incidence of postoperative complications and mortality,and affect the prognosis of patients[4].Laparoscopic radical resection of colorectal cancer is longer and requires more physical position.The application of lung protection ventilation strategy combined with deep muscle relaxation may reduce lung injury and benefit patients.In this study,we compared the pulmonary protective ventilation strategy of deep muscle Panasonic during the pneumoperitoneum and the occurrence of pulmonary complications during routine ventilation,in order to explore the most favorable anesthesia program for laparoscopic surgery and reduce the incidence of postoperative complications.Accelerate the recovery of patients after surgery.MethodsThis study was a prospective randomized controlled study.65 patients who underwent laparoscopic radical resection of colorectal cancer from July 2018 to January 2019 were included.Among them,35 were males and 30 were females,aged 40-65 years old,ASA grade Ⅰ～Ⅱ.The patients were randomly divided into T group(deep muscle relaxation lung protection ventilation group)and C group(deep muscle relaxation routine ventilation group).All patients were treated with intravenous anesthesia,with intraoperative oxygen concentration of 40%,tidal volume of 6-8ml/kg,and respiratory rate of 12-20 times/min.PTC<3 was maintained by muscle relaxation monitoring.PEEP and manual reinfusion were used in the T group,respectively,before and after pneumoperitoneum for 30min,1h,2h,and 3h.Blood gas analysis was performed by PACU at 1h after surgery,and blood gas results were recorded.Intraoperative respiratory parameters,operation time,postoperative follow-up,complications,hospital stay,outcomes,et.al.Arterial blood was extracted before pneumoperitoneum and lh after surgery to detect IL-8 and TNF-a,and respiratory function of the two groups were compared.ResultsThere were no significant differences in gender,age,height,weight,BMI,smoking history,operation time,ASA classification and complications between the two groups.Heart rate of the T group was slightly higher than that of the C group at each time point,but there was no statistical difference in other time points.The number of patients using vasoactive drugs in the two groups was higher than that in the control group,P<0.05,the difference was statistically significant.Comparison of respiratory indicators showed that PaO2 and OI values in group T were higher than those in group C at T6,whilePA-aDO2 and Qs/QT values were lower than those in group C,showing statistical difference.At T2,T3 and T4,the airway pressure of group T was slightly higher than that of group C,with statistical difference.The number of days of postoperative hospitalization in group T was less than that in group C,with statistical difference.There was no significant difference between the two groups in statistical analysis of the other indicators at each time.For patients undergoing laparoscopic colorectal cancer surgery with deep muscle Panasonic,compared with the traditional small tidal volume ventilation group,the PPEAK and PPLAT were higher than the control group in the lung protection ventilation strategy,but they were all within the normal range.The patients with PA-aDO2 and Qs/QT were lower than the control group,and the oxygen partial pressure and oxygenation index were higher than the control group.The postoperative hospital stay,the lung protective ventilation group was also less than the control group,but the vasoactive drugs.The probability of use is greater than the control group.ConclusionsThe lung protective ventilation strategy of deep muscle Panasonic can be used in laparoscopic surgery for colorectal cancer,and is conducive to the improvement of postoperative oxygenation of patients,but has no significant effect on postoperative pulmonary complications. |
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