Effects Of The Lung Recruitment Maneuvers On Pulmonary Oxygenation And Compliance In Patients Undergoing Laparoscopic Radical Resection Of Cervical Cancer

Objective:To investigate whether the different lung recruitment maneuvers during laparoscopic radical resection of the cervical cancer can improve pulmonary oxygenation capacity and compliance in patients.Methods:Seventy patients,scheduled for elective laparoscopic radical resection of cervical cancer,were selected and divided into either the manual lung recruitment maneuver group(group M)or the pressure-controlled lung recruitment maneuver group(group P)by random number table method,with 35 patients in each group.Intraoperatively,all patients were treated with volume-controlled ventilation(VCV)except lung recruitment process,and the fresh gas flow was 2 L/min,the fraction of inspired oxygen(FiO2)was 30%-50%,the tidal volume(VT)was 6-8 mL/kg,the positive end-expiratory pressure(PEEP)was 5 cmH2O,the inspiration and expiration ratio(I:E)was 1:2.The respiratory parameters were adjusted during surgery,in order to maintain the pulse oxygen saturation(SpO2)≥95%,the end-tidal carbon dioxide partial pressure(PetCO2)between 35-45 mmHg.Both groups received the lung recruitment maneuver when the creation of pneumoperitoneum and every 60 min passed,as well as the end of surgery.The lung recruitment maneuver of group M:when lung recruitment maneuver was conducted,the ventilator were set up with manual-controlled ventilation(MCV),the adjustable pressure limiting valve was turned to 40 cmH2O,FiO2 was 50%,the breathing bag was squeezed for 15 s,in order to increase the airway pressure to 35 cmH2O,and then turned back to VCV,the respiratory parameters were recovered to the former state.The lung recruitment maneuver of group M:when lung recruitment maneuver was conducted,the ventilator were set up with pressure-controlled ventilation(PCV),the respiratory rate(RR)was 8 times/min,FiO2 was 50%,the maximal airway pressure(Pmax)was 40 cmH2O,the inspiration pressure(IP)was 35 cmH2O,PEEP was was 15 cmH2O,PCV was conducted in 2 min,then turned back to VCV,and the respiratory parameters were recovered to the former state.Data collection was proceed at the prior to intubation(To),2 min after creation of pneumoperitoneum(T1),45 min(T2),90 min(T3),the end of surgery(T4),30 min after extubation(T5).At T0,T2,T3,T4,T5,the arterial blood gas analysis was observed,and arterial partial pressure of oxygen(PaO2)was recorded,and the oxygenation index(OI=PaO2/FiO2)was calculated.At T1,T2,T3,T4,the peak airway pressure(Ppeak),the plateau airway pressure(Pplat),and the pulmonary dynamic compliance(Cdyn)were recorded.The extubation time,the rate of hypoxemia after extubation,the rate of pulmonary complications and hospital stays after surgery were compared in two groups.Results:1.Sixty-eight patients successfully completed the study and two were excluded.None of the adverse reaction occurred in the two groups during the lung recruitment.2.There was no significant difference in age,body mass index(BMI),ASA classification,the preoperative hemoglobin value between the two groups(P>0.05).3.There was no significant difference in surgery time,pneumoperitoneum time,anesthesia time,infusion volume,urine volume,bleeding volume between the two groups(P>0.05).4.Compared with To,PaO2 was higher in both groups at T2-T4;compared with group M,PaO2 were higher in group P at T2-T5(P<0.05).5.Compared with group M,OI was higher in group P at T2-T4(P<0.05).6.Compared with T1,Ppeak and Pplat were higher at T2 and T3 in both groups(P<0.05);compared with group M,Ppeak and Pplat were lower in group P at T2 and T3(P<0.05).7.Compared with T1,Cdyn in both groups was lower at T2-T4(P<0.05);compared with group M,Cdyn in group P was higher at T2-T4(P<0.05).8.Compared with group M,the extubation time was lower in group P(P=0.002),the rate of hypoxemia after extubation was lower in group P(P=0.031);there was no significant difference in the rate of pulmonary complications and hospital stays after surgery between the two groups(P>0.05).Conclusion:Compared to manual lung recruitment maneuver,the lung recruitment maneuver of pressure-controlled ventilation could increase the patients’ pulmonary oxygenation and compliance,but decrease the extubation time and the rate of hypoxemia after extubation,who undergoing laparoscopic radical resection of cervical cancer.