Clinical Observation Of Pulmonary Protective Ventilation Strategy In Laparoscopic Intestinal Tumor 0Peration

Purpose:To investigate patients undergoing laparoscopic intestinal tumors,during routine anesthesia,The effect of conventional ventilation mode and pulmonary protective ventilation strategy(small tidal volume 6-8ml/kg（ideal weight）,moderate positive end expiratory pressure（5cmH₂O）intermittent lung recruitment on the patient’s respiratory dynamics,postoperative pulmonary complications,and length of hospital stay.Evidence is provided to provide appropriate ventilation strategies for patients undergoing laparoscopic intestinal tumor surgery.Methods:A total of 60 patients with laparoscopic intestinal tumor surgery（colon cancer and rectal cancer）were selected from the hospital of Yan’an University from December 2017to December 2018,the ASAI-III grade,was divided into two groups by random number table method:Conventional ventilation group,Lung protective ventilation group.The patient entered the room,after repeated verification by the three parties,routine monitoring of ECG,pulse oximetry,non-invasive blood pressure of the upper limbs,radial artery catheterization to monitor upper extremity invasive arterial blood pressure,and monitoring of patient anesthesia depth（BIS）,end-tidal carbon dioxide Partial pressure(P_ETCO₂),muscle relaxation（TOF value）.After establishing the central venous access,preoperative drugs were given before anesthesia:atropine 0.5 mg,tropisetron 5mg,and dextrozine 5 mg.Anesthesia induction:All patients received oxygen in a regular mask,and anesthesia was induced according to the patient’s corrected body weight midazolam 0.05 mg/kg,sufentanil citrate 0.5 ug/kg,propofol 1 mg/kg,Shun A Tricuronium 0.15mg/kg,assisted ventilation for about 5 minutes,followed by endotracheal intubation connected to anesthesia machine for mechanical ventilation.Maintenance of anesthesia:maintenance by intravenous anesthesia,adjustment of micro-pump remifentanil 0.2-0.3ug/（kg·h）,propofol injection 2-6 mg/（kg·h）,cis-atracurium 0.08⁰.10mg/（kg·h）,maintain hemodynamic stability,make blood pressure heart rate fluctuate by±20%,intraoperative anesthesia depth BIS is maintained at 40-60,TOP<25%,stop 30 minutes before surgery The muscle relaxant,the anesthetic was stopped 5 minutes before the surgery.Intravenous administration of flurbiprofen axetil injection to relieve postoperative pain,parallel controlled intravenous analgesia（PCIA）.The mechanical ventilation strategies of the two groups were as follows:the two groups used volume ventilation mode（VCV）,the ratio of suction to breath（I:E）was 1:2,and the abdominal pressure was maintained at 11-13 mmHg.Conventional ventilation group:VT is 10-12mL/kg（ideal weight）,respiratory rate is 10-12 times/min;lung protective ventilation group:VT:6-8mL/kg（ideal weight）,respiratory rate is 16²0Times/min,PEEP was maintained at 5cmH₂O,and regular alveolar recruitment was performed after intraoperative pneumoperitoneum,immediately after changing body position,1 hour after changing body position,2 hours after changing body position,after restoring body position,and pneumoperitoneum（controlled lung expansion method）).Observe and record the Ppeak at 5 time points after 10 minutes（T1）after tracheal intubation,10 minutes（T2）after pneumoperitoneum,1 h（T3）after pneumoperitoneum,2 h（T4）after pneumoperitoneum,and after pneumoperitoneum（T5）.,Pmean,lung compliance（Cdyn）respiratory mechanics index and blood gas index PH,PaCO₂,PaO₂;observed and recorded after entering the room（T0）,T1,T2,T3,T4,T5,tracheal extubation（T6）time point Patients with SpO₂;observed and recorded new pulmonary complications and postoperative hospital stay within 72 hours after surgery.Secondary observations were general data,time of surgery,time of anesthesia,duration of pneumoperitoneum,and scores of risk factors for postoperative pulmonary complications.Results:1.Comparison of general data of patients There was no significant difference between the two groups（P>0.05）.2.Comparison of blood gas indexes between two groups of patients at different time points PH:There was no significant difference in the PH values of T1,T2 and T3between the two groups（P>0.05）.The T4 and T5 were compared between groups.The conventional ventilation group was 0.04 and 0.05 higher than the lung protection group（P<0.001）.).PaO₂:There was no significant difference in oxygen partial pressure between T1,T2 and T3 in the two groups（P>0.05）.The oxygen partial pressure in the T4and T5 lung protection groups was significantly higher than that in the conventional ventilation group（46.41 mmHg,40.82 mmHg（P<0.001）.PaCO₂:There was no significant difference in the PH values of T1,T2 and T3 between the two groups（P>0.05）.The lung protection group was 1.96 mmHg and 1.85 mmHg higher than the conventional group（P<0.05）.Compared with the time points in the two groups,PaCO₂gradually increased with the prolongation of the operation time.Comparison of pulse oximetry There was no difference between the two groups in the T0,T1,T2,T3,T4,T5,and T6 time points,there were differences between the operation and the forward and postoperative（P<0.05）.3.Compared with pulse oximetry in the two groups There were no differences between the two groups in the T0,T1,T2,T3,T4,T5,and T6 time points.SpO₂ was higher at each time point than before and after surgery（P<0.05）.4.Comparison of respiratory mechanics at different time points between the two groups Ppeak:There was no significant difference between the two groups at T1 and T2（P>0.05）.At T3,T4 and T5,the lung protection group was 1.76 cmH₂0（P=0.004）、1.82cmH₂0（P<0.001）and 1.17 cmH₂0（P=0.035）lower than the conventional ventilation group.Pmean:In the T1 and T5 groups,P>0.05,the two groups were compared between T2,T3 and T4.The lung protection group was 2.59 cmH20,2.67 cmH₂0 and 3.08 cmH₂0higher than the conventional group（P<0.05）.）.Pulmonary compliance:There was no significant difference in lung compliance between the two groups at T1 and T4（P>0.05）.The lung compliance of the T2,T3,and T5 lung protection groups was higher than that of the conventional group2.67 L/cmH₂O,2.02 L/cmH₂O,4.55 L/cmH₂O（P<0.05）.5.Comparison of postoperative hospital stay The postoperative hospital stay was compared with the lung protection group by 1.39 days（P<0.05）.6.Postoperative pulmonary complications The cough、WBC counts in the lung protection group were statistically significant compared with the conventional group（P<0.05）.Conclusion:In mechanical ventilation,the correct choice of ventilation strategy is critical to avoid lung damage in patients.The application of pulmonary protective ventilation strategy is superior to conventional ventilation.In laparoscopic intestinal tumor surgery,the patient’s respiratory mechanics can be improved,the patient’s oxygen and function can be increased,the postoperative pulmonary complications can be reduced,and postoperative hospitalization can be shortened.This is beneficial for the rapid recovery of patients.Therefore,it can be said that the lung protective ventilation strategy is more suitable for patients with long-term laparoscopic surgery.